Encyclopaedia of Biological Disaster Management: vol. 3. Biological Disaster Management and Information Technology

Biological Disaster Management

Vol. 3

Biological Disaster Management

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Contents Preface

1. Biological Warfare

1

2. Chemical Warfare

32

3. Agricultural Disaster Management System

57

4. Government Initiative

62

5. Disaster Management Cycle

175

6. United Nations Framework Convention on Climate Change History of Formation

184

7. Disaster Management Information System

228

8. Terrorist Chemical and Biological Attack

233

9. Improving Disaster Management: The Role of Information Technology

240

10. The Potential to Enhance Disaster Management

272

Bibliography

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Index

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Biological Warfare

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1 Biological Warfare Biological weapons include any organism (such as bacteria, viruses, or fungi) or toxin found in nature that can be used to kill or injure people. The act of bioterrorism can range from a simple hoax to the actual use of these biological weapons, also referred to as agents. A number of nations have or are seeking to acquire biological warfare agents, and there are concerns that terrorist groups or individuals may acquire the technologies and expertise to use these destructive agents. Biological agents may be used for an isolated assassination, as well as to cause incapacitation or death to thousands. If the environment is contaminated, a long-term threat to the population could be created. HISTORY The use of biological agents is not a new concept, and history is filled with examples of their use. Attempts to use biological warfare agents date back to antiquity. Scythian archers infected their arrows by dipping them in decomposing bodies or in blood mixed with manure as far back as 400 BC. Persian, Greek, and Roman literature from 300 BC quotes examples of dead animals used to contaminate wells and other sources of water. In the Battle of Eurymedon in 190 BC, Hannibal won a naval victory over King Eumenes II of Pergamon by firing earthen vessels full of venomous snakes into the enemy ships. During the battle of Tortona in the 12th century AD, Barbarossa used the bodies of dead and decomposing soldiers to poison wells. During the siege of Kaffa in the 14th century AD, the

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attacking Tatar forces hurled plague-infected corpses into the city in an attempt to cause an epidemic within enemy forces. This was repeated in 1710, when the Russians besieging Swedish forces at Reval in Estonia catapulted bodies of people who had died from plague. During the French and Indian War in the 18th century AD, British forces under the direction of Sir Jeffrey Amherst gave blankets that had been used by smallpox victims to the Native Americans in a plan to spread the disease. Allegations were made during the American Civil War by both sides, but especially against the Confederate Army, of the attempted use of smallpox to cause disease among enemy forces. MODERN TIMES Biological warfare reached sophistication during the 1900s. During World War I, the German Army developed anthrax, glanders, cholera, and a wheat fungus specifically for use as biological weapons. They allegedly spread plague in St. Petersburg, Russia, infected mules with glanders in Mesopotamia, and attempted to do the same with the horses of the French Cavalry. The Geneva Protocol of 1925 was signed by 108 nations. This was the first multilateral agreement that extended prohibition of chemical agents to biological agents. Unfortunately, no method for verification of compliance was addressed. During World War II, Japanese forces operated a secret biological warfare research facility (Unit 731) in Manchuria that carried out human experiments on prisoners. They exposed more than 3000 victims to plague, anthrax, syphilis, and other agents in an attempt to develop and observe the disease. Some victims were executed or died from their infections. Autopsies were also performed for greater understanding of the effects on the human body. In 1942, the United States formed the War Research Service. Anthrax and botulinum toxin initially were investigated for use as weapons. Sufficient quantities of botulinum toxin and anthrax were stockpiled by June 1944 to allow unlimited retaliation if the German forces first used biological agents. The British also tested anthrax bombs on Gruinard Island off the northwest coast of

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Scotland in 1942 and 1943 and then prepared and stockpiled anthrax-laced cattle cakes for the same reason. The United States continued research on various offensive biological weapons during the 1950s and 1960s. From 1951-1954, harmless organisms were released off both coasts of the United States to demonstrate the vulnerability of American cities to biological attacks. This weakness was tested again in 1966 when a test substance was released in the New York City subway system. During the Vietnam War, Viet Cong guerrillas used needlesharp punji sticks dipped in feces to cause severe infections after an enemy soldier had been stabbed. In 1979, an accidental release of anthrax from a weapons facility in Sverdlovsk, USSR, killed at least 66 people. The Russian government claimed these deaths were due to infected meat, and maintained this position until 1992, when Russian President Boris Yeltsin finally admitted to the accident. BIOTERRORISM AND BIOWARFARE TODAY A number of countries have continued offensive biological weapons research and use. Additionally, since the 1980s, terrorist organizations have become users of biological agents. Usually, these cases amount only to hoaxes. However, the following exceptions have been noted: In 1985, Iraq began an offensive biological weapons program producing anthrax, botulinum toxin, and aflatoxin. During Operation Desert Storm, the coalition of allied forces faced the threat of chemical and biological agents. Following the Persian Gulf War, Iraq disclosed that it had bombs, Scud missiles, 122mm rockets, and artillery shells armed with botulinum toxin, anthrax, and aflatoxin. They also had spray tanks fitted to aircraft that could distribute agents over a specific target. In September and October of 1984, 751 people were intentionally infected with Salmonella, an agent that causes food poisoning, when followers of the Bhagwan Shree Rajneesh contaminated restaurant salad bars in Oregon. In 1994, a Japanese sect of the Aum Shinrikyo cult attempted an aerosolized (sprayed into the air) release of anthrax from the

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tops of buildings in Tokyo. In 1995, 2 members of a Minnesota militia group were convicted of possession of ricin, which they had produced themselves for use in retaliation against local government officials. In 1996, an Ohio man attempted to obtain bubonic plague cultures through the mail. In 2001, anthrax was delivered by mail to US media and government offices. There were 4 deaths. In December 2002, 6 terrorist suspects were arrested in Manchester, England; their apartment was serving as a “ricin laboratory.” Among them was a 27-year-old chemist who was producing the toxin. Later, on January 5, 2003, British police raided 2 residences around London and found traces of ricin, which led to an investigation of a possible Chechen separatist plan to attack the Russian embassy with the toxin; several arrests were made. On February 3, 2004, 3 US Senate office buildings were closed after the toxin ricin was found in mailroom that serves Senate Majority Leader Bill Frist’s office.

HOW BIOLOGICAL AGENTS ARE DELIVERED AND DETECTED Although there are more than 1200 biological agents that could be used to cause illness or death, relatively few possess the necessary characteristics to make them ideal candidates for biological warfare or terrorism agents. The ideal biological agents are relatively easy to acquire, process, and use. Only small amounts (on the order of pounds and often less) would be needed to kill or incapacitate hundreds of thousands of people in a metropolitan area. Biological warfare agents are easy to hide and difficult to detect or protect against. They are invisible, odorless, tasteless, and can be spread silently. DELIVERY Biological warfare agents can be disseminated in various ways. Through the air by aerosol sprays: To be an effective biological weapon, airborne germs must be dispersed as fine particles. To be infected, a person must breathe a sufficient quantity of particles into the lungs to cause illness.

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Used in explosives (artillery, missiles, detonated bombs): The use of an explosive device to deliver and spread biological agents is not as effective as the delivery by aerosol. This is because agents tend to be destroyed by the blast, typically leaving less than 5% of the agent capable of causing disease. Put into food or water: Contamination of a city’s water supplies requires an unrealistically large amount of an agent as well as introduction into the water after it passes through a regional treatment facility. Absorbed through or injected into the skin. This method might be ideal for assassination, but is not likely to be used to cause mass casualties.

DETECTION Biological agents could either be found in the environment using advanced detection devices or after specific testing or by a doctor reporting a medical diagnosis of an illness caused by an agent. Animals may also be early victims and shouldn’t be overlooked. Early detection of a biological agent in the environment allows for early and specific treatment and time enough to treat others who were exposed with protective medications. Currently, the US Department of Defense is evaluating devices to detect clouds of biological warfare agents in the air. Doctors must be able to identify early victims and recognize patterns of disease. If unusual symptoms, a large numbers of people with symptoms, dead animals, or other inconsistent medical findings are noted, a biological warfare attack should be suspected. Doctors report these patterns to public health officials. PROTECTIVE MEASURES Protective measures can be taken against biological warfare agents. These should be started early (if enough warning is received) but definitely once it is suspected that a biological agent has been used. To read more about protective clothing, see Personal Protective Equipment. Masks: Currently, available masks such as the military gas mask or high-efficiency particulate air (HEPA) filter masks used

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for tuberculosis exposure filter out most biological warfare particles delivered through the air. However, the face seals on ill-fitting masks often leak. For a mask to fit properly, it must be fitted to a person’s face. Clothing: Most biological agents in the air do not penetrate unbroken skin, and few organisms stick to skin or clothing. After an aerosol attack, the simple removal of clothing eliminates a great majority of surface contamination. Thorough showering with soap and water removes 99.99% of the few organisms that may be left on the victim’s skin. Medical protection: Health care providers treating victims of biological warfare may not need special suits but should use latex gloves and take other precautions such as wearing gowns and masks with protective eye shields. Victims would be isolated in private rooms while receiving treatment. Antibiotics: Victims of biological warfare might be given antibiotics orally (pills) or through an IV, even before the specific agent is identified. Vaccinations: Currently, protective vaccines (given as shots) are available for anthrax, botulinum toxin, tularemia, plague, Q fever, and smallpox. The widespread immunization of nonmilitary personnel has not been recommended by any governmental agency so far. Immune protection against ricin and staphylococcal toxins may also be possible in the near future. ANTHRAX Anthrax bacteria occur worldwide. The organisms known as Bacillus anthracis may ordinarily produce disease in domesticated as well as wild animals such as goats, sheep, cattle, horses, and swine. Humans become infected by contact with infected animals or contaminated animal products. Infection occurs mainly through the skin and rarely by breathing spores or swallowing them. Spores exist in the soil and become active when the organisms in the carcass are exposed to air. Apart from biological warfare, anthrax in humans is rare. In the United States, only 127 cases of anthrax appeared in the early years of the 20th century and dropped to about 1 per year during the 1990s.

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Signs and Symptoms Skin anthrax (cutaneous): Infection begins when the spores enter the skin through small cuts or abrasions. Spores then become active in the host (human or animal) and produce poisonous toxins. Swelling, bleeding, and tissue death may occur at the site of infection. More than 95% of the cases of anthrax involve the skin. After a person is exposed, the disease first appears in 1-5 days as a small pimple-looking sore that progresses over the next 1-2 days to contain fluid filled with many organisms. The sore is usually painless and it may have swelling around it. Sometimes the swelling affects a person’s entire face or limb. Victims may have fever, feel tired, and have a headache. Once the sore opens, it forms a black area of tissue. The black appearance of the tissue injury gives anthrax its name from the Greek word anthrakos meaning coal. After a period of 2-3 weeks, the black tissue separates, often leaving a scar. With adequate treatment, less than 1% of people infected with skin anthrax die. Inhalation anthrax: In inhalation anthrax, the spores are inhaled into the lungs where they become active and multiply. There they produce massive bleeding and swelling inside the chest cavity. The germs then can spread to the blood, leading to shock and blood poisoning, which may lead to death. Historically known as woolsorter’s disease (because it affected people who work around sheep), inhalation anthrax can appear anywhere within 1-6 days, or as long as 60 days after exposure. Initial symptoms are general and can include headache, tiredness, body aches, and fever. The victim may have a nonproductive cough and mild chest pain. These symptoms usually last for 23 days. Some people show a short period of improvement. This is followed by the sudden onset of increased trouble breathing, shortness of breath, bluish skin color, increased chest pain, and sweating. Swelling of the chest and neck may also occur. Shock and death may follow within 24-36 hours in most people with this type of infection. Anthrax is not spread from person to person. Inhalation anthrax is the most likely form of disease to follow a military or

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terrorist attack. Such an attack likely will involve the aerosolized delivery of anthrax spores. Mouth, throat, GI tract (oropharyngeal and gastrointestinal): These cases result when someone eats infected meat that has not been cooked sufficiently. After an incubation period of 2-5 days, victims with oropharyngeal disease develop a severe sore throat or sores in the mouth or on a tonsil. Fever and neck swelling may occur. The victim may have trouble breathing. GI anthrax begins with nonspecific symptoms of nausea, vomiting, and fever. These are followed in most victims by severe abdominal pain. The victim may also vomit blood and have diarrhea.

Diagnosis Doctors will perform various tests, especially if anthrax is suspected. With skin anthrax, a biopsy is taken of the sore (lesion), and lab tests are performed to look at the organism under a microscope and confirm the diagnosis of anthrax. The diagnosis of inhalation anthrax is difficult to make. A chest x-ray may show certain signs in the chest cavity. Cultures (growing the bacteria in a lab and then examining them under a microscope) are minimally helpful in making the diagnosis. Blood tests may also be performed. GI anthrax also is difficult to diagnose because the disease is rare and symptoms are not always obvious. Diagnosis usually is confirmed only if the victim has a history of eating contaminated meat in the setting of an outbreak. Once again, cultures generally are not helpful in making the diagnosis. Meningitis (brain swelling) from anthrax is difficult to distinguish from meningitis due to other causes. A spinal tap may be performed to look at the person’s spinal fluid in identifying the organism. The most useful microbiologic test is the standard blood culture, which is almost always positive in victims with anthrax throughout their bodies. Blood cultures should show growth in 6-24 hours and if the laboratory has been alerted to the possibility of anthrax, biochemical testing should provide a preliminary diagnosis 12-24 hours later. However, if the laboratory has not

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been alerted to the possibility of anthrax, there is the chance that the organism may not be identified correctly. Rapid diagnostic tests for anthrax and its proteins include polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and direct fluorescent antibody (DFA) testing. Currently, these tests are only available at national reference laboratories.

Treatment Inhalation anthrax: As previously stated because inhalation anthrax moves quickly throughout the body, doctors will begin antibiotic treatment right away even before a firm diagnosis is made through lab testing. Ciprofloxacin (Cipro), doxycycline (Vibramycin), and penicillin are FDA-approved antibiotics for treatment of anthrax. Experts currently recommend ciprofloxacin or other drugs in the same class for adults who are assumed to have inhalation anthrax infection. Penicillin and doxycycline may be used once organism culture sensitivities are known. Traditionally, ciprofloxacin and other antibiotics in that class are not recommended for use in children younger than 16-18 years because of a weak theoretical link to permanent joint disorders. Balancing these small risks against the risk of death and the possibility of infection with a resistant strain of anthrax, experts recommend that ciprofloxacin nonetheless be given to children in appropriate doses. Because there is a risk the infection will recur, victims are treated with antibiotics for at least 60 days. Skin anthrax: Treatment of skin anthrax with antibiotics generally prevents the disease from progressing to the entire body although the black tissue and scar continue to form. Although previous guidelines have suggested treating skin anthrax with 710 days of therapy, recent recommendations suggest treatment for 60 days in the setting of bioterrorism, thus assuming the person may also have been exposed to inhalational anthrax. In pregnant women, experts recommend that ciprofloxacin be given after exposure as a preventive medication following exposure to an anthrax attack.

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Prevention After exposure, the antibiotics ciprofloxacin, or doxycycline may be prescribed by a doctor and the medications are usually taken for 60 days. A vaccination series to protect against anthrax consists of 6 injections given over a period of 18 months, followed by booster shots every year. If a biological warfare attack is expected or may have occurred, people who have not had the vaccine may be given ciprofloxacin or doxycycline for at least 4 weeks. PLAGUE Plague is another infection that can strike humans and animals. It is caused by the bacteria Yersinia pestis, which has been the cause of 3 great human pandemics in the 6th, 14th, and 20th centuries. Throughout history, the oriental rat flea has been largely responsible for spreading bubonic plague. After the flea bites an infected animal, the organisms can multiply inside the flea. When an infected flea attempts to bite again, it vomits clotted blood and bacteria into the victim’s bloodstream and passes the infection on to the next victim, whether small mammal (usually rodent) or human. Although the largest outbreaks of plague have been associated with the rat flea, all fleas should be considered dangerous in areas where plague may be found. The most important vector (a vector is an animal that can transmit the disease) in the United States is the most prevalent flea of rock squirrels and California ground squirrels. The black rat has been most responsible worldwide for the continuing spread of plague in urban epidemics.

Signs and Symptoms People infected with plague may suddenly develop high a fever, painful lymph nodes, and have bacteria in their blood. Some victims with the bubonic form of the disease may develop secondary pneumonic plague (a disease similar to pneumonia). Plague is contagious and when the victim coughs, plague can spread. Pneumonic plague is the most severe form of the disease and if untreated, most people die. As few as 1-10 organisms are enough to infect humans or other animals including rodents.

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During the early phase, the germs usually spread to lymph nodes near the bite, where swelling occurs. The infection then spreads to other organs such as the spleen, liver, lungs, skin, mucous membranes, and later, the brain. In the United States, most victims with human plague have the bubonic form. If the organisms were used as a biological warfare agent, it most likely would be spread through the air and inhaled by victims. The result would be primary pneumonic plague (epidemic pneumonia). If fleas were used as carriers of disease, bubonic or septicemic (blood infection) plague would result. Bubonic plague: Swollen lymph nodes (called buboes) develop 1-8 days after exposure. Their appearance is associated with the onset of sudden fever, chills, and headache, which often are followed by nausea and vomiting several hours later. The buboes become visible within 24 hours and cause severe pain. Untreated, septicemia (blood poisoning) develops in 2-6 days. Up to 15% of bubonic plague victims develop secondary pneumonic plague and thus can spread illness from person to person by coughing. Septicemia plague: Septicemia plague may occur with bubonic plague. The signs and symptoms of primary septicemic plague include fever, chills, nausea, vomiting, and diarrhea. Later, bleeding in the skin may develop, hands and feet may lose circulation, and tissue may die. Pneumonic plague: Pneumonic plague may occur primarily from inhaling organisms in the air or from exposure to infected blood. Victims typically have a productive cough with bloodtinged sputum within 24 hours of symptom onset.

Diagnosis The diagnosis of bubonic plague may be made if the victim has painful lymph glands and other common symptoms, especially if the victim has been exposed to rodents or fleas. But if the victim is not in an area where plague is present and symptoms are typical of other illnesses, the diagnosis may be difficult. The doctor may view under a microscope a sample of sputum from a productive cough or the fluid from a swollen lymph gland. Samples may grow in the laboratory and indicate plague within 48 hours and blood tests may also be performed.

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Treatment Victims of suspected plague will be isolated for the first 48 hours after treatment begins. If pneumonic plague is present, isolation may last for 4 more days. Since 1948, streptomycin has been the treatment of choice for plague but other antibiotics may be given. If treated with antibiotics, buboes typically become smaller in 10-14 days and do not require drainage. Victims are unlikely to survive primary pneumonic plague if antibiotic therapy is not begun within 18 hours of the beginning of symptoms. Without treatment, 60% of people with bubonic plague die, and 100% with pneumonic and septicemic forms die.

Prevention Fleas always must be targeted for destruction before the rodents, because killing rodents may release into the environment massive amounts of infected fleas, which will be hungry for a blood meal and, in the absence of rodents, the fleas will seek out any warm-blooded animal including humans and infect them. Pesticides have been successful in getting rid of rats and other animal hosts. Public education about how plague spreads is an important part of prevention. People who have been exposed to pneumonic plague and those who have been exposed to organisms in the air may be treated with antibiotics such as tetracycline or doxycycline for 6 days. Contacts with victims who have bubonic plague do not need preventive medication. But people who were in the same environment as those who are infected may need preventive antibiotics. A previously FDA-approved plague vaccine is no longer manufactured. It was useful against the bubonic form of plague but not the more serious pneumonic (lung) form of plague, which is the kind most often expected in a terrorist incident. A new vaccine effective against all varieties of plague is under development. Only those at high risk for plague should be given the vaccine. This might include military troops and personnel working in

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areas where plague exists and lab personnel working with the organism. The current vaccine against bubonic plague by flea bite does not have the same effectiveness against the organisms released in the air. CHOLERA Cholera is an acute and potentially severe gastrointestinal disease (stomach and intestines) caused by the bacteria Vibrio cholerae. This agent has been investigated in the past as a biological weapon. Cholera does not spread easily from human to human, so it appears that major drinking water supplies would have to be profusely contaminated for this agent to be effective as a biological weapon. Cholera normally can infect water or food that becomes contaminated by human bowel waste. The organism can survive for up to 24 hours in sewage and as long as 6 weeks in certain types of relatively impure water containing organic matter. It can withstand freezing for 3-4 days, but it is killed readily by dry heat, steam, boiling, short-term exposure to ordinary disinfectants, and chlorination of water. The toxin causes a person’s intestines to create massive amounts of fluid that then produces thin, grayish brown diarrhea.

Signs and Symptoms Depending on how many organisms a person drinks or eats, the illness could begin within 12-72 hours. The symptoms start suddenly with intestinal cramps and painless (rice-water appearing) diarrhea. Vomiting, feeling ill, and headache often accompany the diarrhea, especially early in the illness. Fever is rare. If untreated, the disease generally lasts 1-7 days. During the illness, the body loses great amounts of fluid, so it is important during recovery to replace fluids and balance electrolytes (such as sodium and potassium). Children may experience seizures and cardiovascular imbalances severe enough to cause heart problems. The rapid loss of body fluids often leads to more severe illness. If not treated, up to half of children with cholera may die.

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Diagnosis The doctor may examine a sample of the stool under a microscope to confirm the diagnosis. Symptoms alone are usually enough to identify cholera.

Treatment Fluids and electrolytes need to be replaced because the body has lost large amounts of fluids through the vomiting and diarrhea. Doctors may encourage the person to drink, but if someone continues to vomit or has frequent stools, an IV may be used to replace the fluid lost. Antibiotics such as tetracycline or doxycycline shorten the duration of diarrhea and reduce fluid losses. The antibiotics ciprofloxacin or erythromycin also may be used for a few days.

Prevention A live vaccine is available for use in those considered to be at risk for exposure. The vaccine is protective for only about half of those immunized, and protection lasts for no more than 6 months. The vaccination schedule is an initial dose followed by another dose 4 weeks later, with booster doses every 6 months. An inactivated oral vaccine is safe and provides rapid shortterm protection. It requires 2 doses and has about 85% efficacy lasting 2-3 years for 2 different types of cholera. TULAREMIA Tularemia is an infection that can strike humans and animals. It is caused by the bacterium Francisella tularensis. The disease causes fever, localized skin or mucous membrane ulcerations, regional swelling of lymph glands, and occasionally pneumonia. G.W. McCay discovered the disease in Tulare County, California, in 1911. The first confirmed case of human disease was reported in 1914. Edward Francis, who described transmission by deer flies via infected blood, coined the term tularemia in 1921. It has been considered an important biological warfare agent because it can infect many people if dispersed by the aerosol route. Rabbits and ticks most commonly spread tularemia in North America. In other areas of the world, tularemia is transmitted by

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water rats and other aquatic animals. The bacteria are usually introduced into the victim through breaks in the skin or through the mucous membranes of the eye, respiratory tract, or GI tract. Ten virulent organisms injected under the skin from a bite or 1050 organisms breathed into the lungs can cause infection in humans. Hunters may contract this disease by trapping and skinning rabbits in some parts of the country.

Signs and Symptoms Tularemia can be divided into 2 forms: the ulceroglandular (75% of cases) and typhoidal (25% of cases). Victims with the ulceroglandular type have sores on the skin or mucous membranes, large lymph nodes, or both. Those with typhoidal tularemia have smaller lymph nodes and no skin sores. After 3-6 days, people with the ulceroglandular form of the disease develop a group of symptoms: fever, chills, headache, cough, and muscle aches. They may also have chest pain, vomiting, joint pain, sore throat, abdominal pain, diarrhea, shortness of breath, back pain, or neck stiffness. A sore up to an inch across may appear on the skin in about 60% of people and is the most common sign of tularemia. If the bite associated with infection was from an animal carrying the disease, the sore is usually on the upper part of a person’s body, such as on the arm. If the infection came from an insect bite, the sore might appear on the lower part of the body, such as on the leg. Enlarged lymph nodes are seen in about 85% of victims and may be the initial or the only sign of infection. Although enlarged lymph nodes usually occur as single lesions, they may appear in groups. Enlarged lymph nodes may come and go and last for as long as 3 years. When swollen, they may be confused with buboes of bubonic plague. Sore throat and other complications may occur in up to 25% of people with tularemia. People with either type of tularemia may develop pneumonia. They may have a productive or nonproductive cough and possibly chest pain, shortness of breath, and vomit blood.

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Diagnosis Tularemia can be diagnosed by growing the bacteria in the laboratory from samples taken of blood, ulcers, sputum, and other body fluids. Blood tests may not be helpful.

Treatment Victims with tularemia who do not receive appropriate antibiotics may have a prolonged illness with weakness and weight loss. Treated properly, very few people with tularemia die. A 14day course of streptomycin is effective treatment for tularemia. Gentamicin is also effective. Although tetracycline and chloramphenicol have also been found effective, they are associated with significant relapse rates. Although laboratory-related infections with this organism are common, human-to-human spread is unusual. Victims do not need to be isolated from others.

Prevention An antibiotic given after exposure to tularemia is difficult, because the ideal drug, streptomycin, must be given by injection. Tetracycline is effective after exposure to an aerosol of tularemia if given within 24 hours of the exposure and taken for 14 days. A vaccine has been developed and used in humans since 1940. In the 1960s, a more purified vaccine was developed. Extensive studies have demonstrated that the vaccine protects humans against the organism released into the air. Immunization with the vaccine prevents the typhoidal type and lessens the effects of the ulceroglandular form of tularemia. BRUCELLOSIS Brucellosis is an infection of domesticated and wild animals that can be transmitted to humans. It is caused by an organism of the genus Brucella. The organism infects mainly cattle, sheep, goats, and other similar animals causing death of developing fetuses and genital infection. Humans, who usually are infected incidentally by contact with infected animals, may develop numerous symptoms in addition to the usual ones of fever, general illness, and muscle pain.

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The disease often becomes long-term and may return, even with appropriate treatment. The ease of transmission through the air suggests that these organisms may be useful in biological warfare. Each of 6 different species may tend to infect certain animal species. Four are known to cause illness in humans. Animals may transmit organisms during a miscarriage, at the time of slaughter, and in their milk. Brucellosis is rarely, if ever, transmitted from human to human. Certain species can enter animal hosts through skin abrasions or cuts, the eye membranes, the respiratory tract, and the GI tract. Organisms grow rapidly and eventually go to the lymph nodes, liver, spleen, joints, kidneys, and bone marrow.

Signs and Symptoms Victims may have a fever or a long-term infection or just a local inflammation. The disease may appear suddenly or develop slowly anywhere from 3 days to several weeks after exposure. Symptoms include fever, sweats, fatigue, loss of appetite, and muscle or joint aches. Depression, headache, and irritability occur frequently. In addition, infection of bones, joints, or the genitourinary tract may cause pain. Cough and chest pain also may be noted. Symptoms often last 3-6 months and occasionally for longer than a year. Different species of the organism can cause different symptoms from skin sores to low back pain to liver disease.

Diagnosis The doctor will want to know about any exposure to animals, animal products, or environmental exposures in making the diagnosis. Military troops exposed to a biological attack and who have fever are likely candidates for this illness. Environmental samples may show the presence of this organism in the attack area. Laboratory tests and cultures of blood or body fluid samples including bone marrow may be performed.

Treatment Therapy with a single drug has resulted in a high relapse rate, so a combination of antibiotics should be prescribed. A 6-week course of doxycycline along with streptomycin for the first 2 weeks is effective in most adults with most forms of brucellosis.

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Prevention Animal handlers should wear appropriate protective clothing when working with infected animals. Meat should be well cooked, and milk should be pasteurized. Laboratory workers need to take appropriate cautions in handling the organism. In the event of a biological attack, the standard gas mask should protect adequately from airborne species. No commercially available vaccine exists for humans. Q FEVER Q fever is a disease that also affects animals and humans. It is caused by the bacteria Coxiella burnetii. A sporelike form of the organism is extremely resistant to heat, pressure, and many cleaning solutions. This allows the germs to live in the environment for long periods under harsh conditions. In contrast, the disease it causes in humans is usually not harmful, although it can be temporarily disabling. Even without treatment, most people recover. The organism is extremely infectious. The potential of the organism as a biological warfare agent is related directly to its ability to infect people easily. A single organism is capable of producing infection and disease in humans. Different strains have been identified worldwide. Humans have been infected most commonly by contact with domestic livestock, particularly goats, cattle, and sheep. The risk of infection is increased greatly if humans are exposed while these animals are giving birth to young. Large numbers of the germs may be released into the air as an animal gives birth. Survival of the organism on surfaces, such as straw, hay, or clothing, allows for transmission to other people who are not in direct contact with infected animals. People can become infected by breathing the organisms.

Signs and Symptoms Humans are the only hosts that commonly develop an illness as a result of the infection. The illness may begin within 10-40 days. There is no typical pattern of symptoms, and some people show none at all. Most people appear mildly to moderately ill.

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Fever (can go up and down and last less than 13 days), chills, and headache are the most common signs and symptoms. Sweating, aches, fatigue, and loss of appetite are also common. Cough often occurs later in the illness. Chest pain occurs in a few people. Sometimes there is a rash. Other symptoms such as headache, facial pain, and hallucinations have been reported. Sometimes problems in the lungs are seen on chest x-rays. And some people may seem to have acute hepatitis because of their liver involvement. Others may develop a heart condition called endocarditis.

Diagnosis Blood tests may help in making the diagnosis of Q fever.

Treatment Tetracycline has been the main drug used since the 1950s. When initiated within the first few days of the illness, treatment significantly shortens its course. Other antibiotics, such as erythromycin and azithromycin, are also effective. People with chronic Q fever who develop endocarditis may die, even with appropriate treatment.

Prevention Although an effective vaccine (Q-Vax) is licensed in Australia, all Q fever vaccines used in the United States are under study. Q fever can be prevented by immunization. SMALLPOX Variola (the virus that causes smallpox) is the most notorious of the poxviruses. Smallpox was an important cause of illness and death in the developing world until recent times. In 1980, the World Health Organization (WHO) declared that smallpox had been completely wiped out. The last case was noted in Somalia in 1977. Variola represents a significant threat as a biological warfare agent. Variola is highly infectious and is associated with a high death rate and secondary spread. Currently, the majority of the US population has no immunity, vaccine is in short supply, and

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no effective treatment exists for the disease. Two WHO-approved and inspected repositories remain: One is at the Centers for Disease Control and Prevention in the United States; the other at Vector Laboratories in Russia. It is widely believed that clandestine stockpiles exist in other countries such as Iraq and North Korea. Variola virus is highly infectious when released into the air. It is environmentally stable and can retain its ability to infect people for long periods. Infection through contaminated objects such as clothing is infrequent. After a person is exposed to aerosolized virus, the virus multiplies in the person’s respiratory tract. After a period of 7-17 days, variola is spread through the bloodstream to lymph nodes where it continues to multiply. Variola then moves into smaller blood vessels near the surface of the skin where the inflammatory changes occur. The classic smallpox rash then begins. Two types of smallpox generally are recognized. Variola major, the most severe form, may cause death in up to 30% of unvaccinated people who develop it. (3% of people vaccinated people may also develop variola major). Variola minor, a milder form of smallpox, produces death in 1% of unvaccinated people.

Signs and Symptoms The symptoms of variola major occur after a 7- to 17-day incubation period. They begin acutely with high fever, headache, chills, aches, vomiting, abdominal and back pain. During the initial phase, 15% of people develop delirium (hallucinations), and 10% of light-skinned people may develop a fleeting rash. After 2-3 days, the rash develops on the face, hands, and forearms and extends gradually to the trunk and lower part of the body. The sores progress all at once into fluid-filled sacs. The distribution of the rash is important in making the diagnosis of smallpox. A greater number of lesions will appear on the face arms and legs compared to the trunk. People with smallpox are most infectious on days 3-6 after the fever begins. Virus is spread to others through coughing and sneezing or by direct contact.

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With the milder form of smallpox, variola minor, the skin sores are similar but smaller and fewer in number. People are not as ill as those who have variola major.

Diagnosis Most doctors have never seen a case of smallpox and may have difficulty diagnosing it. Other viral illnesses with rash, such as chickenpox or allergic contact dermatitis, can look similar. Smallpox is different from chickenpox because of the distribution of the lesions and because they are all at the same stage of development everywhere on the body. With chickenpox, sores may be forming while others are scabbing over. The failure to recognize mild cases of smallpox in people with partial immunity permits rapid person-to-person transmission. Exposed people may shed virus through coughing without ever showing the signs and symptoms of the disease. The doctor may look at scrapings of tissue under a microscope but will be unable to tell the difference between smallpox and monkeypox or cowpox. Advanced PCR techniques have been developed and may provide for more accurate diagnosis in the near future.

Treatment People with smallpox are usually isolated from people without smallpox for 17 days. Anyone exposed to either weaponized variola or people infected with smallpox must be vaccinated immediately; this may lessen or prevent the illness if done within 4 or 5 days of infection. Treatment of smallpox is mainly to help relieve symptoms. The antiviral agent, cidofovir, may be effective in treating symptoms.

Prevention Smallpox vaccine is used to prevent people from getting smallpox. The vaccine is given as a type of shot, but a 2-pronged needle is used to place the medication into the skin. This leaves a permanent scar, which many adults may still have from smallpox inoculations given to them when they were babies.

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Once the shot is given, a small fluid-filled pimple usually appears 5-7 days later. A scab forms over the site during the next 1-2 weeks. Common side effects include low-grade fever and swollen lymph glands. People with weakened immune systems should not have the smallpox vaccination. This includes people with HIV, anyone with a history of eczema, and pregnant women. MONKEYPOX The monkeypox virus is a naturally occurring relative of variola, which is found in Africa. The first case of human monkeypox was identified in 1970, but fewer than 400 cases have been diagnosed since. Some concern exists that monkeypox may be weaponized, however, human monkeypox is not as potent as smallpox. Pneumonia due to monkeypox may cause death in about half of people who develop it. VIRAL ENCEPHALITIDES The viral encephalitides, Venezuelan equine encephalitis (VEE) virus, western equine encephalitis (WEE) virus, and eastern equine encephalitis (EEE) virus, are members of the Alphavirus genus and are regularly associated with encephalitis. These viruses were recovered from horses during the 1930s. VEE was isolated in the Guajira peninsula of Venezuela in 1930, WEE in the San Joaquin Valley of California in 1930, and EEE in Virginia and New Jersey in 1933. Although natural infections with these viruses occur following bites from mosquitos, the viruses are also highly infectious when spread through the air. If intentionally released as a small particle aerosol, this virus may be expected to infect a high percentage of people exposed within a few miles. VEE virus has the capacity to produce epidemics. Outcomes are significantly worse for the very young and the very old. Up to 35% of people infected may die. WEE and EEE typically produce less severe and widespread disease but are associated with death rates as high as 50-75% in those with severe illness.

Signs and Symptoms VEE: After an incubation period of 2-6 days, people with VEE develop fevers, chills, headache, aches, sore throat, and sensitivity

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to light (eyes). They may become mildly confused, have seizures or paralysis, or go into a coma. For those who survive, their nervous system functions usually recover completely. EEE: The incubation period for EEE varies from 5-15 days. Adults may have certain early symptoms up to 11 days before the onset of nervous system problems such as mild confusion, seizures, and paralysis. Signs and symptoms include fever, chills, vomiting, muscle rigidity, lethargy, slight paralysis, excess salivation, and difficulty breathing. Children frequently develop swelling on their face and near their eyes. Up to 30% of survivors of severe disease have permanent nervous system problems such as seizures and various degrees of confusion (dementia). WEE: The incubation period is 5-10 days. Most people have no symptoms, or they might develop a fever. Other symptoms include nausea, vomiting, headache, a stiff neck, and drowsiness. Up to 90% of victims younger than 1 year have seizures. Typically, adults recover completely. Children, especially newborns, may have lasting nervous system problems.

Diagnosis Laboratory tests, including nasal swab samples, may show any of the 3 viruses.

Treatment No specific treatment is available. Doctors will help control symptoms. For some people that may include medications to control fever and seizures or help breathing.

Prevention A vaccine for VEE can be given as an injection for those at high risk, such as laboratory field personnel. About 20% of those who receive the vaccine fail to respond to it, meaning they would not be protected by the vaccine. An additional 25% of those vaccinated develop high fever, chills, and feel sick enough to be in bed. A different vaccine was developed for those who did not develop protection from the initial activated vaccine. It is an inactivated vaccine, which produces only mild tenderness at the

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injection site. Shots are given at 2- and 4-week intervals until the person responds and develops antibodies as protection. The EEE vaccine is inactivated and given as an injection (1 to start and another 28 days later). There are no serious side effects or long-term problems with this vaccine. Boosters are required. VIRAL HEMORRHAGIC FEVERS Viral hemorrhagic fevers are caused by 4 families of viruses. Arenaviridae (Lassa, Argentine, Bolivian, Brazilian, Venezuelan hemorrhagic fevers) Bunyaviridae (Rift Valley, Crimean-Congo, Hantaan) Filoviridae (Marburg, Ebola) Flaviviridae (Yellow, Dengue, Kyasanur Forest, Omsk HFs) The best known of the viral hemorrhagic fevers is Ebola virus. First recognized in Zaire in 1976, the virus has been linked to 3 outbreaks in Africa. Up to 92% of people who contract Ebola will die. A related virus was discovered in Reston, Virginia, in 1989 in association with an outbreak of illness among monkeys imported from the Philippines. No human cases occurred with this outbreak. These viruses are each characterized by an acute generalized illness that includes feeling quite ill (flulike illness) with profound exhaustion and often associated internal bleeding. All agents are highly infectious via the aerosol route, and most are stable as respiratory aerosols. Thus, they possess characteristics that may make them attractive for use by terrorists. The agents that produce viral hemorrhagic fever are all simple RNA viruses. They are able to survive in blood for long periods, which means they can infect people who are around animals slaughtered domestically. These viruses are linked to the rodent or insect that helps to spread them, which helps in searching for a diagnosis. The specific viral hemorrhagic fever that develops depends on many factors such as the strength of the virus, its strain, and the route of exposure.

Signs and Symptoms All viral hemorrhagic fevers primarily target blood vessels. They damage the blood vessels and produce internal bleeding.

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Victims may have fever, aches, exhaustion, infected eyes, low blood pressure to severe shock, and bleeding in tiny blood vessels such as in the eye. More severe cases will have serious problems with the nervous system, liver, and lungs. Depending on the type of virus, symptoms can include deafness, severe internal bleeding, kidney failure, rash, black (bloody) vomit, and other life-threatening symptoms.

Diagnosis It is important for the doctor to know a person’s travel history in making a diagnosis of viral hemorrhagic fever. These agents are linked tightly with their natural geographic area and the ecology of the species and vectors found in that specific locale. Victims often recall exposures to rodents (Arenavirus, Hantavirus), mosquitoes (Rift Valley fever virus, yellow and dengue fever viruses), or even slaughtered horses (Rift Valley fever virus, Crimean-Congo virus). Laboratory tests may be helpful. Testing can be conducted at the CDC in Atlanta or the US Army Medical Research Institute of Infectious Disease (USAMRIID) at Fort Detrick in Frederick, Maryland.

Treatment Treatment for viral hemorrhagic fevers is largely directed at easing the discomfort of the symptoms. Victims benefit from being placed in a hospital setting immediately. Air transport is not advised. Sedative and pain-relieving medications are helpful, but aspirin and similar drugs should not be given because of their tendency to make bleeding worse. Doctors will also not usually use IV lines or catheters because of bleeding problems. The treatment for bleeding is controversial. Generally, mild bleeding is not usually treated, but severe bleeding requires appropriate replacement therapy (blood through an IV line). Specific treatment with ribavirin has been used and is currently under investigation as a therapy for Lassa fever, Hantavirus, Crimean-Congo, and Rift Valley Fever. Treatment is most effective if begun within 7 days. Ribavirin has poor activity against the filoviruses and flaviviruses.

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Prevention The only established and licensed virus-specific vaccine against any of these viruses is the yellow fever vaccine. It is mandatory for those traveling into areas of Africa and South America where the disease is commonly found. Current trials are underway for further vaccines and antibody therapies. TOXINS

STAPHYLOCOCCAL ENTEROTOXIN B Staphylococcal enterotoxin B (SEB) is one of the best-studied and, therefore, best-understood toxins. Staphylococcal enterotoxin is one of the most common causes of food poisoning. Nausea, vomiting, and diarrhea normally occur after someone eats or drinks contaminated food. The toxin creates different symptoms when exposure is through the air in a biological warfare situation. Only a small, inhaled dose is necessary to harm people within 24 hours of inhalation.

Signs and Symptoms After exposure, signs and symptoms begin in 2-12 hours. Mild-to-moderate exposure to SEB produces fever, chills, headache, nausea, vomiting, shortness of breath, chest pain, body aches, and a nonproductive cough. Severe exposures can lead to a toxic shock -type picture and even death. Depending on the severity of exposure, the illness may last 3-10 days.

Diagnosis Diagnosis of SEB can be difficult. Laboratory tests and a chest x-ray may be performed. Nasal swabs may show the toxin for 1224 hours after exposure.

Treatment Doctors provide care to relieve symptoms. Close attention to oxygenation and hydration are important. People with severe SEB may need help breathing with a ventilator. Most victims are expected to do well after the initial phase, but the time to full recovery may be long.

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Prevention No approved human vaccine exists for SEB, although human trials are ongoing. Passive immunotherapy agents have demonstrated some promise when given within 4 hours of exposure, but such therapy is still being tested. RICIN Ricin, a plant protein toxin derived from the beans of the castor plant, is one of the most toxic and easily produced of the plant toxins. Although the lethal toxicity of ricin is about 1000fold less than botulinum toxin, the worldwide ready availability of castor beans and the ease with which the toxin can be produced give it significant potential as a biological weapon. Since ancient times, more than 750 cases of ricin intoxication have been described. Ricin may have been used in the highly published killing of Bulgarian exile Georgi Markov in London in 1978. He was attacked with a device in an umbrella that implanted a ricin-containing pellet into his thigh.

Signs and Symptoms The toxicity of ricin varies greatly with the way it is given. Ricin is extremely toxic to cells and acts by inhibiting protein synthesis. Inhalation exposure causes primarily breathing and lung problems. If eaten, ricin causes symptoms in the GI tract. If injected, the reaction takes place in that area. Following inhalation exposure of ricin, toxicity is characterized by the sudden onset of nasal and throat congestion, nausea and vomiting, itching of the eyes, itching, and tightness in the chest. If exposure is significant, after 12-24 hours severe breathing problems may set in. In animal studies, death occurs 36-48 hours after severe exposure. Ingestion of ricin is generally less toxic because it is not absorbed well and may degrade in the digestive tract. Out of 751 ingestions recorded, only 14 resulted in a death. At low doses, injection exposures produce flulike symptoms, body aches, nausea, vomiting, and localized pain and swelling at the injection site. Severe exposure results in tissue death and GI bleeding, as well as widespread liver, spleen, and kidney problems.

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Diagnosis The diagnosis of ricin poisoning is made on the basis of symptoms and whether exposure was possible. In biological warfare, exposure is likely to occur by inhalation of a toxin aerosol. Victims may have certain signs on a chest x-ray. The diagnosis can be confirmed by lab tests on samples from a nasal swab. Ricin can be identified for up to 24 hours after exposure.

Treatment Treatment is mainly to relieve symptoms. If exposure was by inhalation, the person may need help breathing. Those who ingested the poison may need to have their stomachs pumped (gastric lavage), or they might be given activated charcoal to soak up the material.

Prevention Currently, no vaccine is available for ricin exposure. Test vaccines have proven effective in animals. Other drugs are being studied as well. BOTULINUM TOXIN Botulinum toxins are the most deadly toxins known. Because botulinum toxin is so lethal and easy to manufacture and weaponize, it represents a credible threat as a biological warfare agent. When used in this manner, exposure is likely to occur following inhalation of aerosolized toxin or ingestion of food contaminated with the toxin or its microbial spores. Iraq admitted to active research on the offensive use of botulinum toxins and to weaponizing and deploying more than 100 munitions with botulinum toxin in 1995. All 7 subtypes (A-G) of botulinum toxin act in similar ways. The toxin produces similar effects whether ingested, inhaled, or via a wound. The time course and severity of illness vary with route of exposure and dose received. Symptom onset is slower after inhalation exposure.

Signs and Symptoms Symptoms may occur hours to several days after exposure.

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Initial signs and symptoms include blurred vision, dilated pupils, difficulty swallowing, difficulty speaking, an altered voice, and muscle weakness. After 24-48 hours, muscle weakness and paralysis may cause the person to be unable to breathe. Varying degrees of muscular weakness may occur.

Diagnosis Paralysis may indicate the presence of this exposure. Laboratory tests generally are not helpful. Infection by inhalation can be diagnosed from nasal swabs up to 24 hours after exposure.

Treatment The most serious complication is respiratory failure. With attention to symptoms and help breathing, sometimes with a ventilator, death occurs in fewer than 5% of cases. For confirmed exposures, an antitoxin is available from the CDC. This antitoxin has all of the disadvantages of horse serum products, including the risks for shock and serum sickness. Skin testing is performed first by injecting a small amount of the antitoxin into the skin and then monitoring the person for 20 minutes.

Prevention A toxoid (inactivated toxin that produces immunity) has been used in volunteers and occupationally at-risk workers. It is available through the CDC. It was used to immunize US military troops during the Persian Gulf War. The current schedule for immunization is at 0, 2, and 12 weeks with an annual booster. MYCOTOXINS The trichothecene mycotoxins are highly toxic compounds produced by certain species of fungi. Because these mycotoxins can cause massive organ damage, and because they are fairly easy to produce and can be dispersed by various methods (dusts, droplets, aerosols, smoke, rockets, artillery mines, portable sprays), mycotoxins have an excellent potential for weaponization. Strong evidence suggests that trichothecenes (“yellow rain”) have been used as a biological warfare agent in Southwest Asia and Afghanistan. From 1974-1981, numerous attacks resulted in

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a minimum of 6310 deaths in Laos, 981 deaths in Cambodia, and 3042 deaths in Afghanistan. When taken from fungal cultures, the mycotoxins yield a yellow-brown liquid that evaporates into a yellow crystalline product (thus, the “yellow rain” appearance). These toxins require certain solutions and high heat to be completely inactivated.

Signs and Symptoms After exposure to the mycotoxins, early symptoms begin within 5 minutes. Full effects take 60 minutes. If skin exposure occurs, the skin burns, becomes tender, swollen, and blisters. In lethal cases, large areas of skin die and slough (fall off). Respiratory exposure results in nasal itching, pain, sneezing, a bloody nose, shortness of breath, wheezing, cough, and bloodtinged saliva and sputum. If ingested, the person feels nausea and vomits, loses appetite, feels abdominal cramping, and has watery and/or bloody diarrhea. Following entry into the eyes, pain, tearing, redness, and blurred vision occur. Systemic toxicity may occur and includes weakness, exhaustion, dizziness, inability to coordinate muscles, heart problems, low or high temperature, diffuse bleeding, and low blood pressure. Death may occur within minutes to days depending on the dose and route of exposure.

Diagnosis Diagnosis of an attack of trichothecene mycotoxin depends on the symptoms and identifying the toxin from biological and environmental samples. Many people with these symptoms may report being in a yellow rain or smoke attack. Initial laboratory tests are not always helpful. Currently, a rapid identification kit for any of the trichothecene mycotoxins does not exist. Gas-liquid chromatography has been used in the past with great success. However, chromatographic methods lack great sensitivity, and presently alternative methods of detection are under investigation.

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Treatment Treatment is mainly to help with symptoms. The immediate use of protective clothing and mask during a mycotoxin aerosol attack should prevent illness. If a soldier is unprotected during an attack, the outer clothing should be removed within 4-6 hours and decontaminated with 5% sodium hydroxide for 6-10 hours. The skin should be washed with copious amounts of soap and uncontaminated water. The eyes, if exposed, should be washed out with large amounts of normal saline or sterile water. US military personnel can use a skin decontamination kit effectively against most chemical warfare agents, including the mycotoxins. No specific therapy exists for a trichothecene exposure. After appropriate skin decontamination, victims of inhalation and oral exposures may be given superactivated charcoal orally. Activated charcoal removes mycotoxins from the GI tract. Some victims may need help breathing with a ventilator. Early use of steroids increases survival time by decreasing the primary injury and shock-like state that follows significant poisoning.

Prevention No vaccine exists for trichothecene mycotoxin exposure. Currently, 2 topical skin protectants as well as vaccines are in advanced development but have not been approved yet for use in humans.

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2 Chemical Warfare RISK OF EXPOSURE Injury from chemical weapon agents, known as CWAs, may result from industrial accidents, military stockpiling, war, or a terrorist attack. Industrial accidents are a significant potential source of exposure to chemical agents. Chemicals such as phosgene, cyanide, anhydrous ammonia, and chlorine are used widely. These chemicals are frequently transported by industry. The accidental release of a methylisocyanate cloud (composed of phosgene and isocyanate) was implicated in the Bhopal, India, disaster in 1984. Chemical weapons first were used in 1915, when the German military released 168 tons of chlorine gas at Ypres, Belgium, killing an estimated 5,000 Allied troops. Two years later, the same battlefields saw the first deployment of sulfur mustard. Sulfur mustard was the major cause of chemical casualties in World War I. CWAs have been used in at least 12 conflicts since, including the first Persian Gulf War (Iraq-Iran War). The Iraqi military also used chemical weapons against the Iraqi Kurds during the second Persian Gulf War. Civilians also have been exposed inadvertently to chemical weapons many years after weapon deployment during war. Some 50,000 tons of mustard shells were disposed of in the Baltic Sea following World War I. Since then, numerous fishermen have been burned accidentally while hauling leaking shells aboard boats. Leaking mustard shells also have injured collectors of military memorabilia and children playing on old battlefields.

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Although a number of international treaties have banned the development, production, and stockpiling of chemical weapons, these agents reportedly are still being produced or stockpiled in several countries. Within the last decade, terrorists deployed chemical weapons against civilian populations for the first time in history. The release of sarin in Matsumoto, Japan, in June 1994 by the extremist Aum Shinrikyo cult left 7 dead and 280 injured. The following year, the Aum Shinrikyo cult released sarin vapor in the Tokyo subway system during morning rush hour, leaving 12 dead and sending more than 5,000 casualties to local hospitals. Several characteristics of chemical weapon agents lend themselves to terrorist use. • Chemicals used in CWAs are widely available, and recipes for CWA production may be found on the Internet. • CWAs are transported easily and may be delivered by a variety of routes. • Chemical agents often are difficult to protect against and quickly incapacitate the intended targets. • Most civilian medical communities are inadequately prepared to deal with a chemical terrorist attack. • Types of Chemical Weapon Agents • Chemical weapon agents are hazardous substances. Major categories of CWAs include the following: • Nerve agents (such as sarin, soman, cyclohexylsarin, tabun, VX) • Vesicating or blistering agents (such as mustards, lewisite) • Choking agents or lung toxicants (such as chlorine, phosgene, diphosgene)

CYANIDES Incapacitating agents (such as anticholinergic compounds) Lacrimating or riot control agents (such as pepper gas, chloroacetophenone, CS) Vomiting agents (such as adamsite) Physical properties: CWAs generally are stored and transported as liquids and deployed as either liquid aerosols or

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vapors. Victims usually are exposed to agents via 1 or more of 3 routes: skin (liquid and high vapor concentrations), eyes (liquid or vapor), and respiratory tract (vapor inhalation). In general, some liquids may be harmful whether inhaled into the lungs or absorbed into the skin. Vapors can be affected by winds. Even a slight breeze can blow a nerve agent vapor away from its intended target. The effects of vapor are enhanced when used within an enclosed space. Clinical effects: Depending on the agent and the type and amount (concentration) of exposure, CWA effects may be immediate or delayed. Large inhalation exposures to nerve agents or mustards are likely to kill people immediately. Small exposures on the skin to nerve agents and mustards are more dangerous than they seem at first. People exposed to such agents need to be carefully observed for slowly developing or delayed effects. A chart of signs and symptoms is available from the North Carolina Statewide Program for Infection Control and Epidemiology. Medical management: Ideally, emergency personnel will wear personal protective equipment, decontaminate the victims immediately, provide medical support to the victims and provide specific antidotes to counteract the harmful effects. Personal protective equipment: First responders to a chemical attack are at serious risk themselves from the chemically contaminated environment (known as the hot zone). They can come in direct contact with the CWA or inhale the vapor. They are also at risk if they handle skin and clothing of victims if a liquid chemical agent was used. Vapors pose little added risk for anyone outside the hot zone. Decontamination: Decontamination is the physical process of removing the remaining chemicals from people, equipment, and the environment. Residual hazardous chemicals on those who have been exposed directly are a source of ongoing exposure to others and pose a risk of secondary exposure to first responders and emergency care personnel. Immediate decontamination is a major treatment priority for those with CWA exposure. Initial decontamination involves removing all contaminated clothes and jewelry from the affected person and then washing the body thoroughly with warm water and soap.

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Hot water and vigorous scrubbing may actually worsen the effects by increasing chemical absorption into the skin. Vapor exposure alone may not require decontamination. But if it is not known whether the exposure was to a vapor or liquid, or if exposed people have symptoms, they should undergo decontamination. Ideally, decontamination will take place as close as possible to the site of exposure to minimize duration of exposure and prevent further spread. Hospitals receiving contaminated people may establish an area outside the Emergency Department in which to perform initial decontamination before people and equipment are allowed entry. Portable decontamination equipment with showers and run-off water collection systems are commercially available. All hospitals should have the capacity to safely decontaminate at least 1 person. Supportive and specific therapy: Doctors will first make sure exposed victims are able to breathe. For many chemical warfare agents, doctors can only treat the symptoms they produce. But specific, well-established antidotes are available for nerve agent and cyanide exposures. Lab tests are not widely available in hospitals to rapidly confirm exposure to chemical agents.

NERVE AGENTS The 5 nerve agents, tabun (GA), sarin (GB), soman (GD), cyclohexylsarin (GF), and VX, have chemical structures similar to the common organophosphate pesticide Malathion. These agents initially stimulate and then paralyze certain nerve transmissions throughout the body and cause other toxic effects such as seizures. Physical properties: Under temperate conditions, all nerve agents are volatile liquids, which means they can evaporate quickly. The most volatile agent, sarin, evaporates at about the same rate as water. The least volatile agent, VX, has the consistency of motor oil, which makes it 100-150 times more toxic than sarin when victims are exposed on their skin. A 10 mg dose applied to the skin may cause death in up to half of unprotected people. All nerve agents rapidly penetrate skin and clothing. Nerve agent vapors are heavier than air and tend to sink into low places (for example, trenches or basements).

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Signs and symptoms: Nerve agents produce various signs and symptoms depending on the agent someone might be exposed to, its concentration, and length of exposure. Liquid exposure: Liquid agents easily penetrate skin and clothing. Symptoms may begin anywhere from 30 minutes to 18 hours after skin exposure. A small droplet on the skin, for example, may cause local sweating and muscle twitching, followed by nausea, vomiting, diarrhea, and generalized weakness. Even with decontamination, signs and symptoms may last for hours. In contrast, people with severe liquid exposures may show no symptoms (for 1-30 minutes) but rapidly may suffer abrupt loss of consciousness, convulsions, generalized muscular twitching, paralysis, secretions (from the nose, mouth, lungs), difficulty breathing, and death. Vapor exposure: Vapor inhalation produces poisonous symptoms within seconds to several minutes. Effects may be local or throughout the body. Exposure to even a small amount of vapor usually results in at least one of the following categories of symptoms: (1) in the eyes, blurred vision, eye pain, red eyes; (2) runny nose; or (3) difficulty breathing, shortness of breath, excessive productive coughing. Respiratory tract: Nerve agents act on the upper respiratory tract to produce runny nose, drooling, and weakness of the tongue and throat muscles. High-pitched, distressed breathing can occur. A great deal of phlegm production and narrowing of the airways can occur. If untreated, the combination of symptoms rapidly progresses to respiratory failure and death. Cardiovascular system: Nerve agents also act on the heart and may produce abnormal heartbeats, more likely to be too fast rather than slow. Central nervous system: Nerve agents produce a variety of signs and symptoms throughout the central nervous system. People may lose consciousness (sometimes within seconds of exposure) and have seizures. Symptoms such as headache, dizziness,

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numbness or tingling, anxiety, insomnia, depression, and emotional instability also have been reported. Musculoskeletal system: Nerve agents initially stimulate and then paralyze muscles. With minimal exposure, exposed people may complain of vague weakness or difficulty walking. Eyes: Nerve agent liquid or vapor readily penetrates the eye tissues and may cause the pupils to contract, blurred and dim vision, headache, redness, tears, pain, nausea, and vomiting. Although contraction of the pupils is the most consistent clinical finding after vapor exposure to nerve agents (this occurred in 99% of people exposed in the Tokyo sarin attack), it may not occur or occur later if the exposure is on the skin. In severe cases, the pupils of the eye may remain narrowed up to 45 days. Diagnosis: Routine testing is not reliable in identifying nerve agents in blood or urine. So doctors will make their treatment decisions based on the signs and symptoms a person shows and on information about the type of chemical exposure, if known. Treatment: Treatment of victims exposed to nerve gas is similar to the treatment of those poisoned by organophosphate insecticides. Atropine sulfate: Victims with symptoms require immediate treatment with atropine. Atropine helps people breathe by drying secretions and opening their airways to allow them to breathe more freely. Atropine also blocks other effects of poisoning, such as nausea, vomiting, abdominal cramping, low heart rate, and sweating. Atropine, however, does not prevent or reverse paralysis. Adults and children will be given appropriate doses of atropine by IV or injection. Another medication, pralidoxime chloride, may also be given. With adequate decontamination and appropriate initial therapy, serious signs and symptoms of nerve agent toxicity rarely last more than a couple of hours. Mark I kit: The Mark I kit was designed for military selfadministration in the field. It consists of 2 spring-loaded devices to inject yourself, containing atropine and pralidoxime, respectively. These antidote kits are not yet available for civilian use. Prognosis: Peak toxic effects occur within minutes to hours and go away within 1 day. People who were exposed but show

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no symptoms are usually observed for at least 18 hours because some signs and symptoms can show up later.

MUSTARDS Sulfur mustard has been used as a chemical weapon since World War I. Nitrogen mustard, a derivative of sulfur mustard, was one of the first chemotherapy agents but never has been used in warfare. These agents cause blistering of exposed surfaces. Both mustard agents rapidly penetrate cells and generate a highly toxic reaction that disrupts cell function and causes cell death. The chemical reaction is both temperature dependent and aided by the presence of water, which explains why warm, moist tissues are affected more severely. Actively reproducing cells, such as skin and blood cells, are most at risk. Physical properties: Mustards are oily liquids with odors of mustard, onion, garlic, or horseradish. Highly soluble in oils, fats, and organic solvents, mustards quickly penetrate skin and most materials, including rubber and most textiles. Sulfur mustard is considered a persistent agent with low volatility at cool temperatures but becomes a major vapor hazard at high temperatures. Exposure to mustard vapor, not mustard liquid, is the primary medical concern. More than 80% of mustard casualties in World War I were caused by exposure to mustard vapor. Mustard vapor is 3 times more toxic than a similar concentration of cyanide gas; however, mustard liquid is also quite toxic. Skin exposure to as little as 1-1.5 teaspoons of liquid (7 g) is lethal to half of those exposed. Signs and symptoms: Mustards injure the skin, eyes, respiratory tract, GI tissues, and blood system. The pattern of toxicity depends partly on whether the person is exposed to liquid or vapor. Liquid exposure primarily damages the skin, producing an initial rash followed by blistering similar to a partial-thickness burn. Vapor exposure damages the upper respiratory tract (skin usually is not affected). Mustards penetrate cells in less than 2 minutes, yet signs and symptoms usually are delayed 4-6 hours (the range can be from 1-24 hours). The time it takes to show symptoms is shorter with high-concentration exposures, such as those occurring at increased room temperature and humidity.

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Skin: Chemical burns caused by mustard often appear deceptively superficial at first. Earliest symptoms are itching, burning, and stinging pain over exposed areas. Moist, thinner skin is affected more severely. Affected areas appear red and swollen. If contamination is more extensive, superficial blisters occur within 24 hours of exposure. Most burns are partial thickness, but full-thickness burns with deep blisters may result from exposure to higher concentrations. Blister fluid does not contain active mustard and is not toxic. Eyes: Eyes are especially sensitive to the effects of mustard. Symptoms begin 4-8 hours after exposure. Earliest symptoms include burning pain, a feeling that something is in the eye, sensitivity to light, tearing, and blurred vision. Permanent corneal scarring and blindness may occur with severe exposures, but is rare. Respiratory tract: Mustards primarily damage tissues in the upper airway through a direct inflammatory effect. Following a period of 2-24 hours after exposure, symptoms may appear. Early symptoms include sinus congestion, a sore throat, and hoarseness. Later, cough, shortness of breath, and trouble breathing may develop. People with severe and extensive contact with mustard gas may develop respiratory complications up to several days after exposure. Gastrointestinal tract: Rarely, mustard damages rapidly growing cells of the intestinal tract. GI involvement results in abdominal pain, nausea, vomiting, diarrhea, and weight loss. Blood system: Rarely, mustards cause unpredictable loss in the production of bone narrow. Certain specialized cells begin dying 3-5 days after exposure reaching its worst point in 3-14 days, depending on the severity of exposure. Diagnosis: Diagnosis of mustard exposure is based on what the doctor observes from the person’s signs and symptoms. No laboratory tests are useful. Personal protective equipment: Liquid mustard contamination poses a risk for emergency care personnel. Ideally, they will be wearing appropriate personal protective gear. Decontamination: Immediate decontamination within 2

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minutes of exposure is the most important intervention for people who have skin exposure to mustard, because it rapidly becomes fixed to tissues, and its effects are irreversible. Even if an exposure takes place and a person shows no obvious sign and symptoms, decontamination is still urgent. Remove clothing immediately and wash the skin with soap and water. Eye exposure requires immediate washing out with a large amount of saline or water. Decontamination after the first few minutes of exposure does not prevent further damage later but at least prevents spread of the chemical to other parts of the body and protects emergency care personnel from further contact exposure. Treatment: Treatment of mustard exposure is based on symptoms. Because the effects of mustards typically are delayed, people with complaints immediately after exposure may have an additional injury. For those with signs of upper airway obstruction, doctors may treat by using a tube in the person’s throat or perform surgery to open the airway. Mustard-induced burns are especially painful. Doctors will use strong pain relievers. Adequate burn care is essential, because skin lesions heal slowly and are prone to infection. Severe burns may require removal of dead tissue, irrigation, and placement of antibiotics, such as silver sulfadiazine, directly on the burned area. The victim may need a tetanus shot. Severe eye burns may be treated with daily irrigation, topical antibiotic solutions, topical corticosteroids, and drugs that dilate the pupil. Petroleum jelly may be applied to prevent eyelids from sticking together. More severe corneal injuries may take as long as 2-3 months to heal. Permanent visual problems are rare. Although no antidotes currently are available to treat mustard toxicity, several agents are under investigation. Victims with bone marrow suppression following mustard exposure may be treated with medication to stimulate the bone marrow, such as granulocyte colony-stimulating factor.

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Prognosis: Victims with significant respiratory tract burns usually require admission to the hospital’s intensive care unit. Also, victims with several skin burns will be admitted to the burn unit for burn care, pain relief, and supportive care. Blood cell counts will be monitored for 2 weeks following significant exposures. Most people recover completely. Only a small fraction have long-term eye or lung damage. About 2% of those exposed to sulfur mustard in World War I died, mostly due to burns, respiratory tract damage, and bone marrow suppression. Sulfur mustard is known to cause cancer, yet a single exposure causes only a small risk. DEFINITION OF CHEMICAL TERRORISM Chemical terrorism: Terrorism using chemical agents. These chemical agents are poisonous gases, liquids or solids that have toxic effects on people, animals or plants. Most chemical agents are capable of causing serious injuries or death. The severity of injuries depends on the type and amount of the chemical agent used, and the duration of exposure. Chemical agents that might be used for terrorism have been divided by the US Centers for Disease Control and Prevention (the CDC) as follows: Blistering (Vesicant) Chemicals • Distilled Mustard (HD) • Lewisite (L) • Mustard Gas (H) • Nitrogen Mustard (HN-2) • Phosgene Oxime (CX) • Ethyldichloroarsine (ED) • Lewisite 1 (L-1) • Lewisite 1 (L-2) • Lewisite 1 (L-3) • Methyldichloroarsine (MD) • Mustard/Lewisite (HL) • Mustard/T • Nitrogen Mustard (HN-1)

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Biological Disaster Management • Nitrogen Mustard (HN-3) • Phenodichloroarsine (PD) • Sesqui Mustard Blood Chemicals (chemicals acting on the blood) • Arsine (SA) • Cyanogen Chloride (CK) • Hydrogen Chloride • Hydrogen Cyanide (AC) Choking/Lung/Pulmonary Damaging Chemicals • Chlorine (CL) • Diphosgene (DP) • Nitrogen Oxide (NO) • Perflurorisobutylene (PHIB) • Phosgene (CG) • Red Phosphorous (RP) • Sulfur Trioxide-Chlorosulfonic Acid (FS) • Teflon and Perflurorisobutylene (PHIB) • Titanium Tetrachloride (FM) • Zinc Oxide (HC) Incapacitating Chemicals • Agent 15 • BZ • Canniboids • Fentanyls • LSD • Phenothiazines • Nerve Chemicals • Cyclohexyl Sarin (GF) • GE • Sarin (GB) • Soman (GD) • Tabun (GA) • VE

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VG V-Gas VM VX

Riot Control/Tear Chemicals • Bromobenzylcyanide (CA) • Chloroacetophenone (CN) • Chloropicrin (PS) • CNB - (CN in Benzene and Carbon Tetrachloride) • CNC - (CN in Chloroform) • CNS - (CN and Chloropicrin in Chloroform) • CR • CS Vomiting (Emetic) Chemicals • Adamsite (DM) • Diphenylchloroarsine (DA) • Diphenylcyanoarsine (DC) • Other Industrial Chemicals EMERGENCY ROOM PROCEDURES IN CHEMICAL HAZARD EMERGENCIES A JOB AID

PREPARATIONS 1. Try to determine agent identity. 2. Break out personal protection equipment, decon supplies, antidotes, etc. 3. Is chemical hazard certain or very likely? YES: o Don personal protective equipment. o Set up hot line. 4. Clear and secure all areas which could become contaminated. 5. Prepare to or secure hospital entrances and grounds. 6. Notify local emergency management authorities if needed.

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Biological Disaster Management 7. If chemical is a military agent and Army has not been informed. call them. 8. If an organophosphate is involved, notify hospital pharmacy that large amounts of atropine and 2-PAM may be needed. When victim arrives (Note: A contaminated patient may present at an emergency room without prior warning.) 9. Does chemical hazard exist? Known release/exposure (including late notification) Liquid on victim's skin or clothing Symptoms in victim, EMTs, others Odor (H, L, phosgene, chlorine) M-8 paper, if appropriate YES: Go to 10. NO: Handle victim routinely. 10. Hold victim outside until preparations are completed (don personal protective equipment to assist EMT's as necessary). 11. If patient is grossly contaminated (liquid on skin, positive M-8 paper) OR if there is any suspicion of contamination, decontaminate patient before entry into building.

Initial Treatment and Identification of the Chemical Agent 1. Establish airway if necessary. 2. Give artificial respiration if not breathing. 3. Control bleeding if hemorrhaging. 4. Symptoms of cholinesterase poisoning? • Pinpoint pupils • Difficulty breathing (wheezing, gasping, etc) • Local or generalized sweating • Fasciculations • Copious secretions • Nausea, vomiting, diarrhea • Convulsions

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• Coma • YES: Go to NERVE AGENT PROTOCOL 5. History of chlorine poisoning? YES: Go to CHLORINE PROTOCOL. 6. Burns that began within minutes of poisoning? YES: Go to 7. NO: Go to 8. 7. Thermal burn? YES: Go to 9. NO: Go to LEWISITE PROTOCOL 8. Burns or eye irritation beginning 2-12 hours after exposure? YES: Go to MUSTARD PROTOCOL. NO: Go to 9. 9. Is phosgene exposure possible? • Known exposure to phosgene • Known exposure to hot chlorinated hydrocarbons • Respiratory discomfort beginning a few hours after exposure YES: Go to PHOSGENE PROTOCOL. 10. • • • •

Check other possible chemical exposures: Known exposure Decreased level of consciousness without head trauma. Odor on clothes or breath Specific signs or symptoms

RICIN A maximum credible event is one that could cause a large loss of life in addition to disruption, panic, and overwhelming use of civilian health care resources. This possibility brings about an attempt to evaluate and discuss substances that could be used as agents of biological warfare or as weapons of mass destruction (WMD). An agent considered capable of causing a maximum credible event is highly lethal, inexpensively and easily produced in large

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quantities, stable in aerosol form, and can be dispersed. The ideal agent is also communicable from person to person and has no treatment or vaccine. Ricin is a potent toxin that could be used as an agent of biological warfare or as a WMD. Derived from the beans of the castor plant (Ricinus communis), Ricin is native to Africa and common in warm climates worldwide. More than 1 million tons of castor beans are processed every year worldwide. It is easily and inexpensively produced, is highly toxic, and is stable in aerosolized form. Ricin has no treatment or vaccine, but it is not communicable from person to person. Although a large amount of ricin would be necessary to produce many casualties, it would be highly effective within a closed environment. Ricin can be disseminated as an aerosol, by injection, or as a food and water contaminant. Its use as a food and water contaminant is a major concern. If ricin were used in that fashion, resultant deaths could overwhelm local health care resources. Even use without casualties can be disruptive. Three US Senate office buildings closed on February 3, 2004, after ricin was found in the mailroom that serves Senate Majority Leader Bill Frist’s office. No injuries were reported. On February 4, 2004, as part of the ongoing investigation as to the source of this most recent ricin attack, the Secret Service acknowledged that ricin had also been found at a White House mail-processing center in early November 2003. A vial containing ricin was also found at a post office in Greenville, South Carolina, in October 2003. The envelope, addressed to the US Department of Transportation, was labeled “caution RICIN POISON.” The letter, protesting a proposed federal limit on the number of truckers’ hours behind the wheel to go into effect in January 2004, was signed “Fallen Angel.” Officials suspect that the attacks in October 2003 and November 2003 are related because both letters were signed “Fallen Angel” and contained ricin of poor quality. The FBI is currently investigating whether these two earlier attacks are at all related to the ricin found in the Senate mailroom.

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From 1991-1997, 3 cases involving ricin were reported in the United States. In Minnesota, 4 members of the Patriots Council, an extremist group that held antigovernment and antitax ideals and advocated the overthrow of the US government, were arrested in 1991 for plotting to kill a US marshal with ricin. The ricin was produced in a home laboratory. They planned to mix the ricin with the solvent dimethyl sulfoxide (DMSO) and then smear it on the door handles of the marshal’s vehicle. The plan was discovered, and the men were convicted. In 1995, a man entered Canada from Alaska on his way to North Carolina. Canadian custom officials stopped the man and found him in possession of several guns, $98,000, and a container of white powder, which was identified as ricin. In 1997, a man shot his stepson in the face. Investigators discovered a makeshift laboratory in his basement and found agents such as ricin and nicotine sulfate. The use of ricin is not limited to the United States. In December 2002, 6 terrorist suspects were arrested in Manchester, England. Their apartment was serving as a “ricin laboratory.” Among them was a 27-year-old chemist who was producing the toxin. On January 5, 2003, British police raided 2 residences around London and found traces of ricin, which led to an investigation of a possible Chechen separatist plan to attack the Russian embassy with the toxin. Several arrests were made. RICIN CAUSES Ricin is a protein derived from the beans of the castor plant (R communis). Castor beans are used in the production of castor oil, a brake and hydraulic fluid constituent. Ricin makes up 3-5% of the “waste mash” that is produced during this process. Separating out this protein is not difficult; it only requires chromatography, a common undergraduate chemistry skill. RICIN SYMPTOMS Symptoms from exposure to ricin depend on the route of

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exposure and the amount of absorption. Routes of exposure are respiratory (inhaled aerosol), gastrointestinal (GI [ingested]), and percutaneous (injected). If exposed to ricin through inhaled aerosol, it will most likely affect numerous individuals simultaneously. In this case, a cluster of people would develop similar symptoms over a brief period, typically within 8 hours following inhalation. Such an occurrence would point to the possibility of an intentional act. People exposed to the ricin may experience symptoms such as fever, nausea and vomiting, a progressively severe cough, and congestion in the nose and the throat. Other symptoms associated with inhalation of ricin include difficulty breathing and tightness in the chest. With significant exposure to ricin, breathing difficulties occur within 12-24 hours. A chest x-ray may reveal excess fluid in the lungs. If exposed to ricin by ingesting contaminated foods or beverages, symptoms may initially mimic food poisoning, usually within 6 hours after ingestion. People who ingested ricin may feel abdominal pain, often accompanied by vomiting and diarrhea. Because of this, they may also become dehydrated. Although ingesting ricin is usually less toxic than exposure through inhalation, with significant amounts of the poison, resulting symptoms may become more severe and possibly result in death. People injected with ricin, either in pellet form or with it dissolved in a liquid, may experience pain and swelling at the injection site. They may experience other flulike symptoms as well, such as nausea, vomiting, and body aches. More severe symptoms will occur later and a critical life-threatening syndrome will develop. WHEN TO SEEK MEDICAL CARE A person exposed to ricin should seek medical attention as soon as possible. If in an area where ricin has been released and people may have been exposed to it, they must immediately leave that area and move to an area with fresh air. If near an area where ricin has been released, people must wait for emergency personnel to

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advise them regarding appropriate evacuation procedures. In an aerosol attack, people should use protective masks that are effective in preventing toxicity. To avoid possible contamination, people exposed to ricin must remove and dispose of any clothing and thoroughly wash their skin with copious amounts of soap and water. If their eyes are irritated, people must wash them out with water.

EXAMS AND TESTS Diagnosing an aerosolized attack or a food and water contaminant with ricin primarily depends on symptoms and the likelihood of such an exposure. In cases of an isolated ricin injection, diagnosis is extremely difficult. In addition, diagnostic testing is of limited value, because no test is currently available to confirm exposure to ricin definitively. Nonetheless, in the case of possible exposure to ricin, a person would most likely undergo a complete physical examination by a doctor. Sophisticated diagnostic tests (not widely available) can identify ricin in the body up to 24 hours after exposure. If exposure is from an inhaled aerosol, the presentation is similar to a sudden, rapidly worsening lung injury. The most common findings include labored breathing or difficulty in breathing, tightness in the chest, and rapid heart rate. A chest xray film shows excess fluid in the lungs. If exposure is through ingestion, the physical findings are usually confined to the GI tract. Symptoms include abdominal pain, vomiting, and diarrhea. Dehydration is common. If the dose was sufficient and the disease has progressed, vomiting blood or passing bloody diarrhea or dark-colored tarry stools may occur. If exposure is from an injection, the skin at the injection site is examined for swelling and redness. The affected area may feel painful. The skin is also examined for the possibility of a retained foreign object. The physical findings on the skin from injected ricin may occur prior to or at the time of other flulike symptoms. MEDICAL TREATMENT No antidote or vaccine is available for ricin. Regardless of the route of exposure, treatment remains mainly supportive.

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If exposure is from inhaled aerosol, the person may need assistance with breathing. If particularly severe, the person who was exposed may require intubation and use of a ventilator. If ricin was ingested, the stomach may need to be pumped (called gastric decontamination). Superactivated charcoal may also be given to help soak up the poison. To treat dehydration, intravenous fluids may be given.

MEDICATIONS Antibiotics serve no role in the treatment of ricin poisoning. Medications may be given to treat seizures and low blood pressure that are sometimes associated with exposure to ricin. In the case of ricin exposure by injection, antibiotics may serve to prevent infection. A tetanus immunization may also be given as a precautionary measure. SURGERY Surgical care is not necessary for exposure to ricin, unless the ricin was injected. In this instance, the injection site should be treated to assess whether a foreign object is present. If so, the object should be surgically removed. NEXT STEPS

Follow-up Depending on the severity of the symptoms, a person exposed to ricin may be admitted to the hospital for monitoring.

Prevention The only effective prevention against a biological attack with ricin is avoidance; unfortunately, no antidote or vaccine exists. Currently, investigations are ongoing for possible vaccines and ricin inhibitors. Protective masks have been shown to be effective in preventing toxicity during an aerosol attack. Although ricin is not the ideal biological warfare agent, it remains a threat, primarily as a food and water contaminant. Ricin is widely available and easily produced. With the increasing number of biological threats, hoaxes, and “how to” Internet

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resources available, this threat has the potential to become reality. Therefore, being familiar with ricin’s characteristics is important.

Outlook Depending on the dose and the route, death can occur within 36-72 hours following the time of exposure. If death has not occurred within 3-5 days from the time of exposure, recovery is likely.

SUPPORT GROUPS AND COUNSELING Local or regional poison control centers may be able to provide more information about ricin. The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) are additional resources for informational material about ricin and its toxic effects. (See For More Information.) GENITAL WARTS Genital warts, sometimes referred to as condyloma acuminata, are flesh-colored or gray growths found in the genital area and anal region of both men and women. They represent the most common sexually-transmitted disease caused by a virus. The warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be obvious. Genital warts affect both men and women and can occur at any age. Most patients with genital warts are between the ages of 1733 years. Genital warts are highly contagious. There is a 60% risk of getting the infection from a single sexual contact with someone who has genital warts. In children younger than three years, genital warts are thought to be transmitted by nonsexual methods such as direct manual contact. Nevertheless, the presence of genital warts in children should raise the suspicion for sexual abuse. GENITAL WARTS CAUSES (HPV) Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these

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types have the potential to infect the genital area. About 90% of genital warts are caused by two specific types of the virus (HPV6 and -11), and these HPV types are considered “low risk,” having a low cancer-causing potential. Other HPV types have been strongly associated with premalignant changes and cervical cancers in women. HPV-16 is responsible for about 50% of cervical cancers, and types 16, 18, 31, and 45 together account for 80% of cancers. Common warts are not the same as genital warts and are caused by different HPV types that infect the skin. The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur. Generally, two-thirds of people who have sexual contact with a partner who has genital warts develop them within three months. Genital warts are indirectly associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age. GENITAL WARTS SYMPTOMS (HPV) Although genital warts are painless, they may be bothersome because of their location, size, or due to itching. The size may range from less than one millimeter across to several square centimeters when many warts join together. Men and women with genital warts will often complain of painless bumps, itching, and discharge. Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.) Warts in more than one area are common. There may be a history of previous or concurrent sexually transmitted diseases (STDs).

SPECIFIC DESCRIPTIONS In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with

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many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Infection with HPV may be dormant or undetectable, with some lesions hidden by hair or in the inner aspect of the uncircumcised foreskin in males. In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.

WHEN TO SEEK MEDICAL CARE If you have genital warts, see your doctor and discuss treatment options. Bleeding warts that cannot be controlled with direct pressure should be seen by a doctor. Warts that obstruct the urethral opening and don’t allow you to urinate are an emergency and should be treated as soon as possible. EXAMS AND TESTS Diagnosis is often based on findings from the history and appearance of the genital warts. Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the area of suspicion for about 5-10 minutes. Infected areas will turn white. Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females, a colposcope may be used to look for lesions in the vaginal canal and on the cervix. A routine Pap smear should always be done in order to look for evidence of HPV infection and abnormal cells on the cervix. A biopsy can be performed if the lesion appears unusual or recurs after treatment. Special laboratory tests can also be used to confirm the presence of HPV infection.

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SELF-CARE

AT

HOME

Because genital warts essentially have no symptoms other than their appearance, there is little need for home treatment. It is important, however, to recognize that the warts exist. Take the necessary precautions to prevent trauma to the area, which can result in bleeding. Be careful to prevent transmission to a sexual partner. Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.

MEDICAL TREATMENT No single treatment is effective in eliminating warts and preventing them from coming back. Genital warts may go away on their own in about 10%-20% of people over a period of three to four months. Cryotherapy: This technique freezes the wart using liquid nitrogen or a “cryoprobe.” It is an excellent first-line treatment because response rates are high with few side effects. Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume. Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. Of note, the resulting smoke plume may be infectious.

MEDICATIONS Several medications exist for treating genital warts and can be used as an alternative to other treatments. • podophyllum resin (Pod-Ben-25, Podofin) – Topically applied by a doctor • podofilox (Condylox) - Can be topically applied at home, higher cure rates than Podophyllum resin, useful for prevention

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• trichloroacetic acid – Topically applied, response is often incomplete and recurrence is higher, may cause pain and burning • 5-Fluorouracil (Efudex) – Applied as a cream, long treatment time, can cause burning and irritation, many side effects Interferon alpha-n3 (Alferon N) – Used as an injection for warts that do not respond to other therapies, many side effects imiquimod (Aldara) – New treatment, applied as a cream, local skin irritation is a common side effect

SURGERY Cutting the warts away can be done as an office procedure with local anesthesia. It is usually done when the warts are small in size and number. Of all the treatment techniques, it has the highest success rate and lowest recurrence rate. Initial cure rates are 63%-91%.

NEXT STEPS

Follow-up Complete the necessary treatment as outlined by your doctor. Women with genital warts should see their doctor for a routine Pap smear and investigation for HPV infection of the vaginal canal and cervix. If the genital warts are not successfully treated with the initial therapy, follow-up with your doctor or a dermatologist to discuss options for alternative treatment.

Prevention In 2006, an HPV vaccine (Gardasil) was approved by the FDA for use in girls and women aged 9-26. This vaccine has been shown to be safe and 100% effective in preventing infection with the four most common HPV types (6, 11, 16, and 18) in women who have had no previous exposure to the virus. However, it is less effective in women who have already been infected with HPV, and it does not protect against all types of HPV infection. Studies are underway to determine whether the vaccine is safe and effective in older women and in males.

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Because no treatment is 100% effective, it is important to prevent the spread of HPV, which causes genital warts and some cancers whenever possible. Transmission of genital warts can be decreased if you use condoms and refrain from sexual activity until therapy is completed.

Outlook In many cases, genital warts fail to respond to treatment or come back even after an initial good response. Reappearance of abnormal cells on the cervix of women is not altered by treatment of their sexual partners. Recurrence rates of genital warts are greater than 50% after one year and have been attributed to the following factors: Recurrent infection from a sexual partner Potentially long incubation time of HPV Persistence of the virus in the surrounding skin, in the hair follicle, or in sites that are missed by the treatment used Deep lesions or lesions that cannot be detected Genital warts often appear or increase in number during pregnancy. Dormant infections may also become activated. The presence of genital warts may make vaginal delivery difficult if they are in the cervix or vagina and warts in these locations tend to bleed easily. The warts often disappear on their own after pregnancy. The real danger, however, is that newborns may become infected during passage through an infected birth canal. HPV can cause a very serious condition in children called recurrent respiratory papillomatosis (RRP). This is a life-threatening disease of the respiratory tract. The papillomas or warts appear and spread quickly, sometimes dangerously blocking the child’s airway.

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3 Agricultural Disaster Management System INTRODUCTION In recent years, Agricultural Disaster Management System (ADMS) has been being widely researched and fast developed, in which it not only is playing a more important role, but also has become a very important tool in modern agricultural production. However, how to reasonably apply various existent information processing techniques for designing and implementing excellent performance ADMS has been a very important and interesting problem in field of agricultural production management. Unfortunately, ADMS design and implementation is also a very complex and difficult problem for most of agricultural applications. Major reason resulting in the situation is that ADMS must process a lot of information relevant to agricultural disasters (especially including some random or undetermined information) and provide precise decision information for ADMS users. Otherwise, another reason includes that the work to build one good model for implementing satisfactory ADMS is also very difficult. Thus, the number of existent ADMS’not only is much limited, but those ADMS function, quality and performance are usually unsatisfactory in many practical applications. However, our research shown that a new effective method can solve above problems or overcome relevant difficulties. Further, the new method provides really an approach to building one good ADMS model. Then, the model supports fast and reasonable implementation of excellent performance ADMS.

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In this paper, we present this new method. This method applies three key information processing techniques such as geographic information system (GIS), simulation and expert system (ES) for building ADMS model or ADMS. Really, they are also the most important techniques for implementing excellent performance ADMS. The ADMS based on this method not only makes use of advantages of those techniques as more as possible, but also has much better performance and more users than existent ADMS. ADMS ARCHITECTURE MODEL One of the most important tasks to design ADMS is carefully to determine its various function parts and to build the logical relationship between those parts, so that those parts and relationship are used to construct ADMS architecture model. However, in practical applications, ADMS involves decisionmaking based on complex interactions between people, pests, lands, crops, natural disasters, and other natural resources relevant to agricultural disasters. Modeling these interactions and representing them in ADMS for supporting decision have presented difficulties in its design and implementation when traditional design methods were used. Thus, during ADMS design, a layered architecture model that includes both seven layers and relevant functions is used to guide the ADMS design and implementation. The model is in practice a widely accepted structuring technique. The functions of ADMS are partitioned into a vertical set of layers. Each layer performs a related subset of the functions required to exchange information with another similar system which has the architecture. On the other hand, the ability to exchange information can flexibly support the large size of distributed or web ADMS design and implementation on a network or internet environment. A layer relies on the next lower layer to perform more primitive functions and to conceal details of those functions. It provides services to the next higher layer. Ideally, the layers should be defined so that changes in one layer do not require changes in the other layers. Thus, we have decomposed one complex problem about how to construct ADMS into a number

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of more manageable small problems. The task of our research team was to define a set of layers and the services performed by each layer in order to make the design and implementation of ADMS become more simple and easy. Further, the partitioning should group functions logically, should have enough layers to make each layer manageably small, but should not have so many layers that the processing overhead imposed by the collection of layer burden some. Thus, we define carefully all functions of ADMS according to the practical application requirements. ADMS ARCHITECTURE MODEL The environmental disaster layer (first layer) provides the mechanism for managing the environmental data about various disaster, which include mainly a number of natural disasters about flood, land, pollution and other natural factors about geographic environment. The second layer (weather disaster layer) attempts to make use of the services from the first layer and provides the means to mange the data about various weather disasters. The basic service of the biological disaster layer (the third layer) is to provide the management for data of biological disasters. The purpose of layer 4 (decision data layer) is to provide a mechanism to generate various data to support the decision and management about agricultural disasters. The layer complexity depends on the type of service it can get from layer 3. The decision layer provides a mechanism for making various decisions for agricultural disaster management with the help of a number of decision and management models. The management layer is concerned with the integrated management decisions for a number of special groups of agricultural disasters. Its purpose is mainly to define various standard application-oriented management decisions. Finally, the application layer related to ADMS application provides a means for various users or application processes to access ADMS. This layer contains management functions about the applications and some useful mechanisms to support local and remote applications. According to the description of various layers of the architecture model, ADMS architecture model implementation can be divided into three subsystems.

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The subsystem is primarily intended to provide the “raw”management service of agricultural disasters which is directly used by an end user and does not support further decisions based on raw management. Two main components such as GIS and Data base management system support its operations. The second is advanced management subsystem, which performs an analysis of basic management data from the first subsystem and recommends the best basic management decisions or strategies for disaster management application subsystem. The decision and management models, expert system (Davis, 1989), and simulation models are used support its operation. The simulation models (Law, 1991) generate a complete input data for each basic management decision of the expert system. In general, the expert system is capable of integrating the knowledge of several disciplines about ADMS management into a single knowledge base system to support making-decisions about the management (Coulson, 1987). The properly developed expert system (Edwards, 1991) is a powerful tool for providing managers or users of ADMS with the event-to-event decision support. The management models in the subsystem are object-oriented programs (Booch, 1991) designed to analyze alternatives over both numeric and non-numeric management criteria. According to various different application requirement, those programs form final recommendation for the best disaster management decision with an user’s preferences and perceptions about the set of management decisions. The third is disaster management application subsystem, which provides a means for application processes or users to access ADMS. It is composed of three classes of models: local application models to handle various services for local users, remote application models to provide various services for remote users, and models for testing system functions, which provide for testing ADMS component operation state and assisting in fault isolation and identification. GIS INTEGRATION The above subsystems can be regarded as collections of tools or methods that serve a special role in ADMS. Thus, we can use

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a real world model based on GIS (ESRI, 1989, 1990) as the joining tool for ADMS integration. In fact, ESRI ARCVIEW 3.1 (ESRI, 2000a) provides a good GIS framework for the integration. The OO design does not allow subsystems to communicate directly (Folse, 1990). All communication is governed by the real world model or ARCVIEW 3.1 kernel. The advantage to this approach was that ADMS would not be committed to or built around any specific type of subsystem, making ADMS compatible with more application environments (Henderson, 1990). In practical ADMS implementation, the Microsoft’s VISUAL BASIC 6.00 and VISUAL C++ 6.00 as well as ESRI’s AVENUE(ESRI, 2000b) were used to implement the object-orient implementation model in ARCVIEW environment. Especially, a number of scripts were developed by AVENUE as a tool to complete complex integration, which makes the design and implementation of some complex user interfaces become very simple. A typical ADMS application is to evaluate the influence of disaster weather on cotton growth, so as to apply suitable means to improve cotton management to reduce disaster loss. The system operation result shown that the ADMS reduces largely cotton loss due to some disaster weather, which is equal to increase cotton yield. Further, the management results from ADMS are used to make or design various effective control strategies to maintain a very good quality of cotton distributed over a very large geographic area with the help of the remote models of ADMS. For arriving at the objective, ADMS used 10 years of weather data to evaluate various possible influence of current disaster weather on cotton growth and provided satisfactory management services for a number of cotton farmers.

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4 Government Initiative MIDTERM PLAN ASSESSMENT This chapter presents an assessment of the region’s accomplishments in terms of achieving the 10-Point Agenda (summarized in Table 1) and the macroeconomic targets as laid down in the Medium-Term Regional Development Plan (MTRDP) 2004-2010. A discussion on the regional development challenges and opportunities is also provided, based on the following assessment and other sectoral accomplishments that are discussed in individual chapters of this document.

MACROECONOMIC ASSESSMENT

Population and Demography Bicol’s population is projected to grow by 1.92 percent, or from 4,674,855 in 2000 to 5,711,798 in 2010. This projection, which is higher than the 2000 population census growth rate of 1.68 percent is also higher than the MTRDP target of 1.5 percent. Although estimates of crude birth and total fertility rates decreased, the region’s population is still expected to double in 41 years. Average household size of 5.24 is higher than the national average of 5.0. Population density of 265 persons/sq.km. is also higher than the national average of 255 persons/sq.km., making Bicol one of the more densely populated regions aside from the National Capital Region. About 72 percent of the population is in the rural areas.

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Table 1: Bicol Region’s Contribution to the 10-Point Agenda, 2004-2006 Na t ion a l Agen da

1. Cr ea t e 6-10 m illion jobs.

2. E du ca t ion for a ll ch ildr en in com pu t er equ ipped sch ools.

3. Ach ieve a ba la n ced bu dget by 2009.

4. Lin k t h e cou n t r y t h r ou gh a n et wor k of t r a n spor t a n d digit a l in fr a st r u ct u r e

Bicol Region 's Ta r get s

Bicol Region 's Cu m u la t ive Accom plish m en t s (20042006) Cr ea t e 100,000 jobs per Aver a ge in cr ea se in yea r . em ployed per son s by 72,000 in 2004 a n d 55,000 in 2005; a ver a ge decr ea se in em ployed per son s by 30,000 in 2006 Con st r u ct sch ools in As of 2005, t h e n u m ber of sch ool-less ba r a n ga ys. ba r a n ga ys wit h ou t elem en t a r y sch ools wa s r edu ced fr om 173 t o 38; t h e n u m ber of in com plet e elem en t a r y sch ools decr ea sed fr om 380 t o 261 a s of 2006 Con st r u ct 451 elem en t a r y Con st r u ct ed 2,696 a n d secon da r y cla ssr oom s elem en t a r y a n d secon da r y cla ssr oom s fr om 2004 t o 2006 E xpa n d college/S&T/ 49,279 qu a lified poor t ech /voc sch ola r sh ip t o st u den t s pr ovided va r iou s qu a lified poor fa m ilies sch ola r sh ips fr om 2004 t o 2005 P r ovide com pu t er s in 1,776 com pu t er s pr ovided ever y sch ool t o elem en t a r y a n d secon da r y sch ools fr om 2004 t o 2005 In cr ea se r even u e BIR collect ion s: 2004collect ion h igh er t h a n t h e pr eviou s yea r a n d 96% of t a r get ; 2005 & 2006 - h igh er t h a n t h e pr eviou s yea r s a n d 103% of t a r get s D e v e lo p th e fo llo w in g m a jo r ro a d lin k s : Libon -Ma r ocm oc-P a n t a o P r ocu r em en t of civil wor ks con t r a ct on -goin g a s of Ma r ch 31, 2007. Liga o-P iodu r a m 4.68% com plet ed a s of Sept . 25, 2006. Ca t a n du a n es P a ck a ge I is 91.4% Cir cu m fer en t ia l Roa d com plet ed a s of Ma r ch 25, 2007. La gon oy-P r esen t a cion Ma a n ga s Br idge is 92% Ca r a m oa n -Ga r ch it or en a com plet ed a s of Sept . 25, Gu ija lo 2006. F ive r oa d pr oject s a r e on goin g a lon g t h e en t ir e r oa d sect ion a s of Decem ber 2006. Ma sba t e-Mila gr os Com plet ed a sph a lt over la y.

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5. P r ovide elect r icit y a n d wa t er t o ever y ba r a n ga y.

P r ovide wa t er syst em s t o t h e followin g t a r get h ou seh olds:

Level I – 121,000 Level II – 91,000 Level III – 91,000 E n er gize t h e r em a in in g 288 u n ser ved bgys. 6. J u st con clu sion t o t h e pea ce pr ocess a n d a n en d t o a r m ed in su r gen cies.

Adopt /Im plem en t t h e Na t ion a l In t er n a l Secu r it y P la n wit h a h olist ic a ppr oa ch .

On ly da t a on t h e pr opor t ion of h ou seh olds wit h sa fe dr in k in g wa t er a r e a va ila ble, i.e., fr om 82.7 per cen t in 2004 t o 82 per cen t in 2006. Th e decr ea se wa s du e t o t h e con t a m in a t ion of som e wa t er sou r ces especia lly Levels I a n d II.

81 ba r a n ga ys wer e en er gized r epr esen t in g 28% of t h e t a r get .Q Con du ct ed “pu lon gpu lon gs”, m edica l/den t a l m ission s, blood don a t ion a n d in for m a t ion ca m pa ign in t h r ea t en ed ba r a n ga ys; det ect ed, iden t ified, m on it or ed, a n d n eu t r a lized com m u n ist t er r or ist s; a wa r ded ou t st a n din g lu pon g t a ga pa m a ya pa ; im plem en t ed P r oject Tin a m po, P a t r ol 117; est a blish ed com m u n it y police a ssist a n ce cen t er s.

* The remaining four of the 10-Point Agenda are not within the purview of the region.

Around 46 percent of Bicolanos are within the dependent age brackets of 0-14 and above 65 years. This results to a ratio of 85 dependents for every 100 persons in the working age bracket of 15-64 years. The high dependency ratio implies a greater burden on the working-age population to satisfy the population’s basic needs, thereby negating the capability for savings and investment. This also means that the bulk of public expenditures need to be focused on the delivery of basic social services.

Human Development Index The human development index (HDI) provides a comparison of provinces in terms of component indices on health, education, and income. In the Bicol Region, Camarines Sur ranked highest at 34th place among the 77 provinces in the country. Albay, Catanduanes, Sorsogon, and Camarines Norte have relatively the same HDIs, ranking 44th, 48th, 49th, and 50th, respectively.

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Masbate ranked near the bottom at 73rd place, only higher than Basilan, Tawi-tawi, Maguindanao, and Sulu. Except for Masbate, Bicol provinces have medium HDIs. Masbate has a low HDI due to a low education index, which is attributed further to a very low percentage of high school graduates. All the six provinces have medium health indices and low income indices. Low levels of per capita income despite medium health and education levels indicate one or a combination of the following: • Low quality of basic education • Inability to pursue higher education beyond secondary level • Low level of skills acquired in tertiary education • Inadequate employment opportunities • Mismatch between the skills acquired by the labor force and the skills required by the labor market • Low productivity

Poverty Situation The percentage of poor individuals in the region decreased from 52.6 percent in 2000 to 48.5 percent in 2003, but is a long way from the MTRDP target of 26-27 percent by 2010. A total of 2,332,719 individuals still live below the poverty threshold, with only 207,941 individuals graduating out of poverty from 2000 to 2003. In terms of poverty incidence of families and population, Bicol is the poorest region in Luzon and the fourth poorest in the country, next to Region 9, ARMM, and CARAGA. Camarines Norte slid from being the 10th poorest province in the country to 11th, with a 6.5 percentage point decrease in poverty incidence of families from 2000 to 2003. Masbate has consistently been in the ten poorest, although poverty incidence in the province has been on a downhill since 1997. In the region, Catanduanes recorded the highest reduction in poverty incidence of families and population from 2000 to 2003. On the other hand, Camarines Sur only managed a slight decrease

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of 0.7 and 0.1 percentage points in poverty incidence of families and population, respectively. A Bicolano needs at least P14,908 a year so as not to be considered poor, based on the 2007 preliminary poverty threshold estimates for the region. With this annual per capita poverty threshold, a family of five in the Bicol Region needs at least P74,540 a year or P6,211.67 a month or P207.06 a day to be able to meet its food and other basic needs. In urban areas, a family of five needs a daily income of P250. In rural areas, the same family needs at least P192 a day. Therefore, a sole breadwinner of a family of five earning a daily minimum wage between P168-P220 (as per Wage Order No. RB 05-11 issued on July 17, 2006) will find it difficult to stay above poverty line. These poverty thresholds should be taken into consideration during the succeeding round of regional wage deliberations. Satisfying life’s basic necessities in urban areas is higher by an average of 29.7 percent. The disparity in poverty thresholds between urban and rural areas is highest in Catanduanes where living in urban areas is 65.5 percent higher than in rural areas. The successive typhoons (Milenyo, Reming, and Seniang) in 2006 that claimed lives, property and livelihood particularly in Albay, are expected to aggravate the poverty situation. Rehabilitation programs and projects in the economic, social, and infrastructure sectors should be continued and pursued for the rest of the plan period. Likewise, disaster management activities should be initiated and institutionalized.

Economic Growth The total value of goods and services produced by the regional economy, as measured by the Gross Regional Domestic Product (GRDP), reached P147.8 billion in 2006 prices or P35.4 billion in 1985 constant prices. Table 2 summarizes the target and actual growth rates in GRDP and Gross Value Added (GVA) in agriculture, fishery and forestry, industry and services. It also highlights the major economic activities and events in the region that contributed to the increase/ decrease in the growth rates of GRDP and GVA.

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Table 2: Target and Actual GRDP/GVA Growth Rates Bicol Region, 2003-2006. Ye a rs

GR D P

20032004

Gr owt h Ta r get (%) Act u a l Gr owt h (%) Rea son s for Devia t ion s

20042005

Gr owt h Ta r get (%) Act u a l Gr owt h (%) Rea son s for Devia t ion s

20052006

Gr owt h Ta r get (%) Act u a l Gr owt h (%) Rea son s for Devia t ion s

Gro s s Va lu e Ad d e d (GVA) Ag ric u ltu re , In d u s try S e rv i c e s F is h e ry a n d F o re s try 5.6 5.1 6.8 5.4 5.7 3.9 10.5 4.7 Robu st in du st r y ou t pu t , pa r t icu la r ly fr om m a n u fa ct u r in g a n d elect r icit y/ga s/wa t er (E GW) m a de u p for t h e deceler a t ed gr owt h s in a gr icu lt u r e a n d ser vices; t yph oon s U n din g a n d Yoyon g in ea r ly pa r t of t h e yea r a ffect ed a gr icu lt u r e a n d fish er y pr odu ct ion ; con t in u ou s oper a t ion of t h e r egion ’s m a jor power gen er a t in g pla n t s a n d en er giza t ion of 62 a ddit ion a l ba r a n ga ys boost ed E GW ou t pu t ; t h e h igh dem a n d of m et a ls fr om t h e wor ld m a r ket a lso boost ed m a n u fa ct u r in g ou t pu t ; t r a de a n d dwellin gs/r ea l est a t e slowed down du e t o wea ken in g of t h e peso; gover n m en t ser vices ba r ely gr ew du e t o t h e t igh t fisca l sit u a t ion . 5.8 5.1 6.9 5.8 5.0 8.1 3.4 3.5 Im pr oved fa r m pr odu ct ivit y a n d fa vor a ble wea t h er con dit ion t h r ou gh ou t t h e yea r boost ed a gr icu lt u r e a n d fish er y ou t pu t ; sh u t down of Ba cm a n II power gen er a t in g m odu le a n d r eh a bilit a t ion of Tiwi geot h er m a l power pla n t u n it s r esu lt ed t o a st eep deceler a t ion of E GW ou t pu t ; vola t ile oil a n d pet r oleu m pr ices slowed down m a n u fa ct u r in g, t r a n spor t , t r a de, a n d pr iva t e ser vices; con st r u ct ion con t r a ct ed du e t o u n st a ble wor ld cr u de oil pr ices a m id fea r s of a polit ica l cr isis br ou gh t a bou t by t h e im pea ch m en t ca se a ga in st t h e P r esiden t . 5.8 4.6 7.2 6.0 2.6 0.7 4.6 3.1 Typh oon s Ca loy, Milen yo, a n d Rem in g in Ma y, Sept em ber , a n d Novem ber , r espect ively ca u sed m a ssive dest r u ct ion of a gr icu lt u r a l la n ds, pr iva t e a n d com m er cia l pr oper t ies, a n d in fr a st r u ct u r e fa cilit ies.

The agriculture and fishery subsector remains the largest contributor to GRDP at an average of 33.5 percent from 2004 to 2006. Another large source of growth for the regional economy is electricity, gas, and water (EGW) under the industry sector, which expanded and contributed an average of 6.6 percent and 10.5 percent, respectively, during the same period. Major contributors to this subsector’s performance are the region’s

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geothermal power plants in Tiwi, Bacon, and Manito. Despite operating below optimum capacity because of continued rehabilitation, these power plants remain a potent source of growth for the EGW subsector. The lifting of the suspension order against the Lafayette mining operations in Rapu-Rapu, Albay is seen as a step towards the full recovery of this subsector, which grew at an average of 15.2 percent and contributed 5.3 percent to GRDP. The other industry subsectors (manufacturing and construction) exhibited erratic growths and altogether contributed a meager 6.9 percent to GRDP. Despite a continued slowdown, the services sector contributed an average of 43.9 percent to the regional economy. Time series data proves the resilience of this sector amid negative growths in the agriculture and industry sectors. Wholesale and retail trade, which expanded and contributed an average of 3.9 percent and 12.2 percent, respectively, is a steady source of growth. The same is true with transport and communication, which grew at an average of 6.0 percent and contributed 6.3 percent to GRDP. Private services, which include tourism-related services, expanded by an average of 4.6 percent and contributed an average of 8.8percent to GRDP. The recent alignment of Bicol Region to the Central Philippines super region as the country’s prime tourist destination is expected to boost the region’s economy and generate employment. To maximize this opportunity, priority should be given to tourism development and promotion programs, including infrastructure projects in support of tourism. Bicol’s contribution to the country’s Gross Domestic Product (GDP) remains at about 2.8 percent, ranking 10th among the regions. Per capita GRDP of P6,632 in 2005, growing by only 2.9 percent from the previous year, has been the second lowest in the country since 1993. On the expenditure side, the main growth driver was personal consumption spending, which grew by 8.5 percent and 6.3 percent in 2004 and 2005, respectively. Investments in capital formation shrank by 8.2 percent in 2005, a reversal from a 3.4 percent growth in 2004. The drop in capital formation was attributed to a sustained slump in construction (public and private) and a decline in durable equipment investments. Personal expenditures constitute more

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than 70 percent of Gross Regional Domestic Expenditures (GRDE), whose share has been increasing from 2003 to 2005. Less than 30 percent comprise both capital formation and government expenditures, whose respective shares have been decreasing. An economy that is driven primarily by consumer spending, coupled with a decreasing ratio of investments to GRDE, prove to be unsustainable in the long run. Efforts, therefore, to promote and generate more investments in the region need to be aggressively pursued. Government should also implement priority infrastructure projects in order to stimulate construction-related spending and attract similar investments from the private sector.

LABOR AND EMPLOYMENT Bicol’s labor force participation rate has been decreasing from 69.6 percent in 2004 to 65.6 percent in 2006. This means that the number of persons who choose to work and/or look for work has not been increasing in proportion to the increase in the workingage population 15 years old and above. Representing about 43 percent of total population, the labor force provides for the food and other basic needs of more than half of Bicol’s population. Average employment rate increased from 91.4 percent in 2004 to 94.1percent in 2005 corresponding to an average increase of 55,000 workers, which was below the MTRDP target of 100,000 jobs every year. The increase was not even sustained in 2006, as average employment dropped by 30,000 workers from the agriculture, manufacturing, and construction subsectors, barely increasing the average employment rate to 94.4 percent. Underemployment rate also increased from 34.9 percent in 2005 to 38.1 percent in 2006. About 73 percent of the labor force is located in the rural areas. The agriculture and services sectors remain to be the major employers in the region, accounting for 46 percent and 42 percent, respectively, of the total number of employed persons. The industry sector absorbs 12 percent of the total employed persons. For every 100 employed persons, 41 are earning wages and salaries, 43 are self-employed, and 16 are unpaid family workers. The concentration of the population, the poor, and the labor force in the rural areas necessitates the prioritization of these areas

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in the delivery of basic social services, employment generation, and provision of support facilities.

ECONOMIC GROWTH, EMPLOYMENT, AND LABOR PRODUCTIVITY The growth in regional economy did not create enough jobs for the labor force. In 2005, a 5 percent GRDP growth was able to generate only a 3.0 percent increase in employed persons, resulting to a meager 2.0 percent increase in labor productivity. Labor productivity, or the ratio of GRDP to average number of employed persons, was estimated to be P17,366 in 2005 at constant 1985 prices. Compared to the national labor productivity of P37,430, the region’s labor productivity was the lowest in Luzon and the fourth lowest in the country, next to Region 8, CARAGA, and ARMM. Gross Value Added (GVA) in agriculture, fishery, and forestry (AFF) grew by 7.7 percent, generating a 3.1 percent increase in employment and a 4.4 percent increase in labor productivity. On the other hand, a 4.4 percent GVA growth in the industry sector that generated a 4.3 percent increase in workers resulted to a meager 0.2 percent increase in labor productivity. Similarly, a 3.2 percent GVA growth in the services sector generated a 2.2 percent increase in employment and a 0.9 percent increase in labor productivity. Low levels of labor productivity require more effective productivity improvement strategies in all sectors. In order to create the needed jobs for the labor force, public and private investments should be promoted, particularly in high growth sectors where the bulk of workers are and where more jobs can be generated, to wit: agribusiness, tourism, trade, transport and communication, real estate, and construction. PRICE LEVELS From 2004 to 2006, monthly inflation rates stayed within the MTRDP target of single-digit levels. From an average of 6.7 percent in 2004, inflation rates went on a downtrend, finally settling at an average of 2.7 percent in the third quarter of 2007. The supply of food and other basic commodities was not severely affected in the aftermath of the successive typhoons in

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2006, due to the immediate restoration of vital transport links. Aside from overall price stability, easing global oil prices and foreign exchange rates also contributed to the inflation downtrend. Maintaining inflation rates at single-digit levels for the rest of the plan period necessitates ensuring adequate and continuous supply of food and other basic commodities and services.

REGIONAL DEVELOPMENT CHALLENGES AND OPPORTUNITIES Based on the foregoing assessment and other sectoral assessments provided in the pertinent chapters, the following are the region’s development challenges and opportunities for the remaining plan period: • Reduce poverty incidence of population to 26-27 percent as part of the region’s commitment to the attainment of the Millennium Development Goals (MDGs). • Recover from the devastation caused by the strong typhoons in 2006 by fasttracking rehabilitation programs/ projects in the social, economic and infrastructure sectors. • Institutionalize disaster risk management initiatives and capacitate institutions at the local levels to avert further losses in social, environment and economic assets. • Accelerate and sustain economic growth over a long-term period. • Scale up public and private investments, particularly in high growth sectors where the bulk of workers are and where more jobs can be generated, to wit: agribusiness, tourism, trade, transport and communication, real estate and construction. • Prioritize tourism development and promotion programs, including infrastructure projects in support of tourism, to capitalize on the recent alignment of Bicol Region to the Central Philippines super region as the country’s prime tourist destination. • Intensify investments promotion in the region by providing modern and adequate infrastructure, communication and transport facilities, and reducing power rates. • Implement priority infrastructure projects in order to

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DEVELOPMENT FRAMEWORK This chapter presents the development framework of the updated plan, outlining the priority development objectives and strategies that shall be pursued by the region for the remaining plan period. It also provides a set of revised targets for 2008 to 2010 and identifies the top ten priority programs and projects for implementation.

Figure: Regional Development Framework Consistent with national thrusts and priorities, the Updated Development Plan’s primary objective is poverty reduction. This can be achieved through the delivery of basic social services, promotion of economic growth, and provision of infrastructure support facilities.

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Providing the engine for economic growth are the region’s production sectors that include agriculture, fishery, forestry, mining and quarrying, trade and industry, and tourism. Basic social services include health, nutrition, population management, education, skills development, housing and community development, welfare, and labor services that are biased towards the poor and marginalized groups. The provision of infrastructure support facilities shall serve as the vehicle to prop up the engines for economic growth, as well as the delivery of basic social services. These three major strategies shall be accelerated through the aggressive promotion of investments, productivity improvement in all sectors, and knowledge transfer through science and technology. In order to overcome obstacles in propelling the region forward, good governance and disaster management initiatives shall be institutionalized, and peace and order throughout the region shall be maintained. There will be more conscious efforts for disaster risk management among stakeholders during this three-year plan period. All these strategies shall adhere to the underlying principles of sustainable development and gender and development. The mechanisms for plan implementation, financing, monitoring, and evaluation shall ensure that all programs, projects, and activities are carried out. These mechanisms shall guarantee the participation of all stakeholders in the development process, i.e., the public and private sectors, as well as the civil society. Core values formation shall be the foundation of all development efforts. In this context, core values are salient cultural values that promote and enhance the development process. The successful implementation of all programs and projects depends not only on the undertakings of concerned agencies but on the participation, cooperation, and appropriate response of the society. Hence, this framework identifies positive values that must be developed or strengthened among project implementers and beneficiaries. Such core values may be broadly categorized as individual values and corporate values. Generally, all Bicolanos must be encouraged to form and strengthen the values of integrity, hard work, self-determination

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and self-reliance, nationalism and cooperation (bayanihan), discipline, punctuality, vigilance, as well as adaptability and creativity. These values are expected to promote productivity, innovation, entrepreneurship, equanimity and survival among Bicolanos, thus enabling them to participate in and contribute to poverty alleviation, economic recovery, and disaster risk management. The public sector and other institutional stakeholders must adopt corporate values such as transparency and accountability, credibility, social justice, efficiency, effectiveness and sustainability. These values are expected to result in just and equitable distribution of goods and services among the populace. Integrating core values in all phases of plan implementation calls for an in-depth adoption of such values on the part of both the implementers and the beneficiaries.

MACROECONOMIC TARGETS • Reduce poverty incidence of population to 26-27 percent by 2015. • Reduce population growth rate to 1.5 percent. • Accelerate and sustain economic growth to 5-6.3 percent per year. • Create 100,000 jobs per year. • Maintain inflation rates at single-digit levels. * Other sectoral targets are presented in the individual chapters. Table: Gross Regional Domestic Product (GRDP) and Gross Value Added (GVA) Targets, by Sector, Bicol Region, 20082010 GRDP/Sector 2007-2008 GRDP Agriculture Industry Services

Growth Targets* (%) 2008-2009 5.0 4.6 6.5 4.6

2009-2010 6.0 5.7 6.5 5.9

6.3 6.4 6.6 6.1

* Based on the harmonized GRDP Growth Targets approved by the Dept. of Budget Coordinating Committee (DBCC).

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Table: Top Ten Priority Programs and Projects, Bicol Region, 2008-2010 Title /Lo c a tio n 1. RORO P or t s Alon g t h e Cen t r a l a n d E a st er n Na u t ica l H igh wa ys Loca t ion : Ca m a r in es Su r , Alba y, Ma sba t e, Ca t a n du a n es

2. Bicol River Ba sin a n d Wa t er sh ed Ma n a gem en t P r oject Loca t ion : Ca m a r in es Su r , Alba y a n d Ca m a r in es N or t e

3. Bicol In t er n a t ion a l Air por t (New Lega zpi Air por t ) Loca t ion : Da r a ga , Alba y 4. Bicol Ma in lin e Sou t h Ra ilwa y P r oject Loca t ion : La gu n a , Qu ezon Ca m a r in es Su r , Alba y, Sor sogon

5. Sa n F er n a n do-Oa s Bypa ss Roa d (GMA H igh wa y) Loca t ion : Ca m a r in es Su r & Alba y

D e s c riptio n P r ovision of RORO r a m p fa cilit ies for t h e exist in g a n d pr oposed por t s in t h e followin g a r ea s: Pa sa ca o, Sa n P a scu a l, Cla ver ia , Boca E n ga n o (Cla ver ia ), P a n t a o, P iodu r a n , Ar or oy, P ila r (Sa n An t on io), E sper a n za , Ca wa ya n , Codon , Sa n ga y, a n d Sa n Vicen t e. Th e pr oject will pilot a com pr eh en sive developm en t pr ogr a m on n a t u r a l r esou r ces m a n a gem en t a n d wa t er r esou r ces pr oject s wit h in t h e con t ext of a r iver ba sin pla n n in g m a n a gem en t . It h a s 4 m a jor com pon en t s: (1) In st it u t ion a l Developm en t ; (2) Wa t er sh ed Ma n a gem en t a n d Developm en t ; (3) F lood a n d H a za r d Mit iga t ion ; a n d (4) Ir r iga t ion Moder n iza t ion . Con st r u ct ion of a n ew Lega zpi Air por t of in t er n a t ion a l st a n da r ds a t Ba r a n ga y Alobo, Da r a ga , Alba y. Th e en t ir e pr oject is pr oposed t o be im plem en t ed in t h r ee ph a ses: (1) P h a se 1- Reh a bilit a t ion of exist in g r a ilwa y lin e fr om Ca la m ba t o Lu cen a Cit y (77 km s.); (2) P h a se 2Reh a bilit a t ion of exist in g r a ilwa y lin e fr om Lu cen a Cit y t o Lega zpi Cit y (345 km s.); a n d (3) P h a se 3Con st r u ct ion of n ew r a ilwa y ext en sion lin e fr om Com u n , Ca m a lig, Alba y t o Ma t n og, Sor sogon (135 km s.). Th e pr oject a lso in clu des t h e su pply a n d in st a lla t ion of sign a lin g a n d com m u n ica t ion syst em s, a n d t h e a cqu isit ion of a dequ a t e n u m ber of r ollin g st ock s. Th e r eh a bilit a t ed lin e will a llow t r a in speed u p t o 120 kph in som e sect ion s, t h u s pr ovidin g fa st er , sa fer a n d econ om ica l pa ssen ger t r a in s ser vices t o t h e Bicol Region . Th e pr oject is a 61.9 km . diver sion r oa d a lon g t h e Ma h a r lika H igh wa y fr om t h e m u n icipa lit ies of Sa n F er n a n do, Ca m a r in es Su r t o Oa s, Alba y.

76 6. Ca t a n du a n es Cir cu m fer en t ia l Roa d Im pr ovem en t P r oject Loca t ion : Ca t a n du a n es 7. Reh a bilit a t ion of Qu ir in o H igh wa y Loca t ion : Qu ezon and Ca m a r in es Su r 8. Bicol H ea lt h Ser vice Deliver y E n h a n cem en t P r ogr a m Loca t ion : Region wide 9. Geoh a za r d Su r vey a n d Assessm en t Loca t ion : Ma sba t e, Ca t a n du a n es a n d 7 Cit ies 10.Com pr eh en sive Disa st er P r even t ion Ar ou n d Ma yon Volca n o Loca t ion : Alba y

Biological Disaster Management Th e pr oject in volves t h e im pr ovem en t a n d con cr et in g of a t ot a l of 200.184 km s. of n a t ion a l r oa d. P h a se I, cover in g 79.818 km s. is on -goin g, wh ile t h e r em a in in g 120.366 km s. will be im plem en t ed u n der t h e P h a se II com pon en t .

Re-blockin g a n d a sph a lt over la yin g of t h e en t ir e st r et ch of Qu ir in o H igh wa y (92 km s.) st a r t in g fr om t h e ju n ct ion a t Ca la u a g, Qu ezon t o Sipocot , Ca m a r in es Su r .

In volves t h e u pgr a din g a n d equ ippin g of t h e r egion a l devolved h ea lt h fa cilit ies.

A pr oject of t h e Min es a n d Geoscien ces Bu r ea u a im ed a t a ssessin g t h e vu ln er a bilit y of com m u n it ies t o geoh a za r ds. Th is in clu des su r vey a n d pr odu ct ion of geoh a zar d m a ps in 1:50,000 sca le.

Ma st er pla n a n d fea sibilit y st u dy pr epa r a t ion a n d pr oject im plem en t a t ion ; P r ovision of st r u ct u r a l a n d n on -st r u ct u r a l m ea su r es.

PHYSICAL FRAMEWORK The Bicol Regional Physical Framework Plan (RPFP) provides the framework and defines the scope of development planning for the whole region. The RPFP serves as guide to decisions on how land and natural resources may be put to the most beneficial use for the people. It indicates how resources may be managed and conserved for the benefit of present and future generations. It is designed to show the desired direction and amount of growth of the region as a whole and its sub-regional areas over a plan period of 30 years. It deems to promote the direction and amount of growth that represents a balance between the need of the region

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to fulfill its functional role in the national economy and the need to ensure sustainable utilization of physical resources. Thus, it takes into account and seeks to contribute to the attainment of national development goals and targets. The RPFP guides public and private investment to achieve an efficient settlement pattern providing better access by the region’s population to basic services. It provides a rational mix of land uses that promotes both productivity and environmental integrity. It should be noted that the RPFP is indicative in nature and does not intend to usurp the zoning powers of local government units. The RDC approved and adopted the RPFP during its meeting on April 25, 2006. Thus, the various policies and strategies of the different plan components are reflected in this chapter. It will guide the formulation of the next Medium-Term Bicol Regional Development Plan (MTRDP).

VISION, GOAL AND ROLES Vision. Bicol Region is envisioned to be a region achieving accelerated economic growth and equitable social development and rational distribution of population among sub-regional areas through sound management of natural resources. To help achieve the vision, land use and physical planning shall focus on rational use and allocation of land and physical resources. This goal can be achieved if production lands are used according to the land use suitability. It will also mean keeping protection lands in their right state to be able to provide an effective life support system to Bicolanos. Infrastructure support facilities will be placed in strategic areas that will promote economic and social development while not compromising environmental health. Corollary to the above goal, the following objectives shall be pursued: • To attain environmental stability and ecological integrity. • To attain sustainable use of protected agricultural areas. • To provide efficient and effective infrastructure facilities and utilities for economic integration and for an equitable access and delivery of services.

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Roles of Bicol Region. Bicol region shall have the following roles: (a) geothermal energy producer; (b) agri-industrial center; (c) food basket of Luzon; (d) mineral-based production center; (e) ecotourism destination; and (f) south Luzon’s gateway to the Visayas and the Pacific. Geothermal Energy Producer. The Bicol Region, having geothermal power generating plants with aggregate generating capacity of 512.574 MW, shall continue providing ample amount of electricity to the Luzon Grid for distribution to the island group. Other potential sources of geothermal energy shall be explored. Agri-Industrial Center. The agriculture resource-base of the Bicol Region shall be utilized for the development of agri-based industries. Non-traditional products from traditional commodities, i.e. coconut, abaca and pili shall be developed through science and technology. Likewise, non-traditional crops of high commercial value will be developed into agri-industries. Food Basket of Luzon. With the improved climatic condition in the Region coupled with large areas for agricultural expansion, production of food crops will be intensified to get a larger market share of the needs in Luzon regions. Food commodities include rice, vegetables, rootcrops, fruits especially queen pineapple, fishery products, pork, chicken and beef. Mineral-Based Production Center. Mineral-based activities in Bicol shall cover exploration, extraction and value adding activities that will lead to the development of vertically and horizontally integrated mineral-based industries. Ecotourism Destination. The presence of unique and diverse flora and fauna in Bicol makes it a primary destination for domestic and foreign tourists. South Luzon’s Gateway to the Visayas and the Pacific. Bicol’s strategic location at the southern tip of Luzon makes it south Luzon’s gateway to the Visayas. The presence of Legazpi and Tabaco Ports, both catering to international vessels, bring Luzon close to having trade and tourism relations with other countries in the Pacific.

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SPATIAL DEVELOPMENT STRATEGIES Planning Units. There will be a network of sub-regional planning and programming units dividing the region into smaller and more manageable units. At the sub-regional level, a province is an integrated area development (IAD) unit. Each IAD has subintegrated area development (SIAD) units that are clusters of municipalities grouped according to homogeneity of physical resources, economic activities, proximity and accessibility to each other and concentration of services and facilities. Network of Settlements. A network of settlements shall be developed with Metro Naga and Metro Legazpi as the primary growth areas; the capital towns as secondary growth centers; and SIAD centers as tertiary growth centers. The various services required of an expanding population in the less urbanized and rural municipalities will be catered by the more urbanized and identified secondary centers and/or tertiary centers backed up, if necessary, by the primary industrial/service centers of Metro Legazpi and Metro Naga. The two island provinces and the two sub-islands of Masbate will continue to strive to be self-sufficient in basic social services due to its increasing population while maximizing the use of their agriculture, mineral and tourism resource bases. The respective secondary and tertiary growth centers shall be developed to serve as an efficient market and/or marketing intermediary. Development Drivers. The region’s development drivers are related to the roles of Bicol, namely: geothermal power generation; intensified agricultural production, especially for food and raw materials for industry; mineral extraction and processing; and ecotourism. Trade shall also be a development driver as profitability that will redound to greater family income shall be determined by the marketing system. Production activities shall be pursued in agriculture-rich areas, mineral-rich areas, identified tourism areas and industrial areas, while taking consideration of their sustainability of land use and their effect on ecological balance. The way we manage ecological balance and biodiversity shall have a great impact on the state of the life support system of the

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Bicolanos as well as the state of ecotourism in the Region. Transportation and digital communication infrastructure shall play a major role in making these effective development drivers that will ultimately lead to poverty reduction. Physical and digital infrastructure support shall be strategically located to effect: • Economic integration of production (agriculture, mineral and industrial areas) with consumption areas; • Greater access to basic social services especially by rural areas, the island provinces and the islands of Masbate, and of other municipalities with island barangays; • Greater accessibility of ecotourism destinations; and • Integration of Bicol Region with the rest of the country through intermodal transportation. • Greater accessibility of ecotourism destinations; and • Integration of Bicol Region with the rest of the country through intermodal transportation. Intra-regional Economic Integration. Intra-regional economic integration shall be achieved through the improvement in physical access and access to information in all areas. Physical access shall be improved through an intermodal transport network among cities and municipalities that will: • Reduce cash and non-cash hauling/transport cost of farmers/fisherfolks in bringing their products to trading centers; • Reduce cash and non-cash hauling/transport cost of middlemen in the performance of their assembling function; • Facilitate access of rural population to basic social services, i.e. schools and hospitals. Information related to marketing, basic social services, employment, government services and requirements and the like shall be made available by allowing digital infrastructure to cover the whole region. Partnership with the private sector, especially the telecommunication service providers need to be forged in establishing landline telecommunication lines in the rural areas. Interregional Economic Integration. The Bicol Region shall have interregional economic relations with most of the regions in Luzon

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and some regions in Visayas and Mindanao. Major areas of interregional relations are agriculture, agri-industry, trade and tourism. Transportation and information infrastructure shall play a critical role in making effective and efficient interregional linkages in these areas. Intermodal transportation shall be improved. Regular routes along the Philippine nautical highway shall include the Bicol Region. The following shall be the major transport strategies: • Provision of roll-on roll-off facilities in ports in strategic locations to transport a greater amount of goods in and out of these areas; • Improvement of land transport infrastructure which connect production areas to these ports; • Upgrading of the rail transport system that will extend to Matnog, Sorsogon. Feasibility of extending it to other parts of mainland Bicol, i.e., Camarines Norte, shall be studied; • Construction and upgrading of airports and work for increased air traffic to and from Bicol airports. Industrial activities must be banned in SAFDZs, NIPAS areas, and other similarly protected areas, and hazard-prone areas that have been identified to be too risky for industrial activities to take place (e.g. fault lines, erosion-prone areas, permanent volcanic eruption danger zones). Urban centers whose growth must be restrained/discouraged for disaster risk reduction include: • All settlements within the proclaimed reservations areas. Affected settlements of Tiwi, Malinao, and Manito, all of Albay and part of Sorsogon City (areas covered by thenBacon) in Sorsogon province will be allowed expansion outside the peripheries of the reservation areas suitable for settlement purposes; • All settlements within the danger zones of Mayon Volcano, Mts. Bulusan and Iriga which are all active volcanoes; and those lying along active fault lines. Consonant to these, frontline agencies especially those in the services and infrastructure sectors shall be prohibited from

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HEALTH Health is a basic human right and is an influential factor in attaining an ideal level of development. A healthy population brings out a socially and economically productive population with longer life expectancy, low infant and maternal mortality, less disability, with adequate shelter, education and means of livelihood. Thus, investing in health by the government and other sectors has to be pursued to deliver an effective and efficient health care system in the region.

DEVELOPMENT CHALLENGES In 2004-2006, the health sector had both gains and pitfalls. The gains include better health outcomes such as longer life expectancies for both males and females, reduction in live births, maternal deaths, and Total Fertility Rate, and decrease in the prevalence of malnourished preschoolers. There were also modest achievements in the implementation of public health programs. These are attributed to a more improved and focused health care delivery system. However, these still need to be sustained and be made consistent with the community’s political and cultural traditions. The pitfalls include: (a) increase in the number of cases of morbidity and mortality including infants; (b) reduction in the number of households and families who had access to both potable water and sanitary facilities; (c) decrease in the number of individuals and families covered by health insurance benefit packages; and (d) reduction in the number of clientele provided with micronutrient supplements for improved nutrition of the

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vulnerable groups and antigens for immunizable diseases in infants and pregnant mothers. These outcomes are attributed to inadequate health service packages, poor health-seeking behavior of the public, inability to afford costs of health services, inaccessibility and/or nonavailability of the essential health goods and services and lack of logistic support for medicines, food supplements and medical supplies, and monetary counterpart of sponsoring LGUs and other entities for PhilHealth benefits.

VITAL INDICATORS The 2000 population census estimates life expectancy at birth for both male and female have improved. Male life expectancy for the period 2005-2010 is 66.11 years, an increase over the 64.11 years posted for the period 2000-2005. The female population still outlive the males with their life expectancy estimated to be 71.09 years for 2005-2010, also indicating an increase from 69.09 years in 2000-2005. Crude birth rate (CBR) was reduced from 29.1 births per 1,000 population in 2004 to 28.1 births per 1,000 population in 2006. Crude Death Rate (CDR) of 4.84 deaths per 1,000 population in 2006 increased by 0.54 percentage points from 4.3 deaths per 1,000 population in 2006. Infant Mortality Rate (IMR) also increased from 9.33 infant deaths per 1.000 livebirths to 10.59 deaths. The leading causes were respiratory diseases, septicemia, prematurity, congenital anomalies and diarrhea. Aside from deaths, there was also an increase on morbidity cases caused by acute respiratory infections, bronchitis, diarrhea, hypertension, pneumonia, bronchial asthma and congenital anomalies. At the end of 2006, epidemics reported include food and waterborne diseases such as cholera, diarrhea, hepatitis A and typhoid fever. Other epidemics reported were leptospirosis, tetanus, meningococcemia, food poisoning and rabies. Maternal Mortality Rate (MMR) slightly increased from 1.16 deaths in 2004 to 1.19 deaths per 1,000 livebirths in 2006 with the following leading causes — hemorrhages related to pregnancy, eclampsia, puerperal infection and ectopic pregnancy. This maybe attributed to inadequate knowledge and fertility management,

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poor nutrition practices and poor access and delivery of maternal care services. Of particular significance is the result of the 2005 Family Planning Survey (FPS) which reveals that 45 percent of all deliveries were attended to by health professionals. The majority (54.1 percent) are still attended by hilots, friends and relatives, particularly those residing in rural areas where hilots are more accessible, less expensive, and tend to share in taking care of the family. Expansion of coverage of the maternal care service delivery –pre-natal, natal and post-natal services, training of midwives and barangay health workers on maternal care and education is therefore warranted by maximizing the capabilities of birth attendants and health educators in information dissemination on childbirth care. The percentage of households with potable water slightly decreased from 82.7 percent in 2004 to 82 percent in 2006. This is probably due to changes in the non- potability of water as a result of contamination of water sources. Households with sanitation facilities decreased from 67.85 percent in 2004 to 64 percent in 2006. This is attributed to the lack of support for the construction of toilets in the local government units.

HEALTH CARE FINANCING The National Health Insurance Program (NHIP) aims to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for the whole population. For the plan period, the program targeted to conduct information dissemination campaigns, encourage local chief executives to support the Indigency Program and accredit more health facilities. In 2004-2006, it has expanded insurance coverage across sectors, except for the indigents. More health packages were available, such as tuberculosis directly observed treatment short course (TB-DOTS), malaria and maternity packages. The number of government employees covered by the program increased from 92.001 in 2004 to 102,443 in 2006. Private employee coverage also increased from 73.470 in 2004 to 114.199 in 2006 while individually paying members reached 86,198 in 2006 from 50,126 in 2004. The

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increase in the number of beneficiaries for the employed, individually-paying and overseas workers is attributed to the aggressive information dissemination campaign of the PhilHealth staff to encourage the individually-paying members for continued membership. Media activities were done through monthly spots in radio stations for updates on the health program. The number of indigent household members decreased from 566,375 in 2004 to 344,622 in 2006. This is due to the discontinued subsidies coming from private individuals and LGUs whose support to the program declined from 120 in 2004 to 84 in 2006. To expand coverage for the indigent families, there is a need for advocacy and information of the LGUs to support the program. The number of accredited facilities increased from 155 in 2004 to 84 in 2006 due to the inclusion of one freestanding dialysis clinic, five maternity care clinics and five TB-DOTS facilities. Accredited professionals also increased from 544 in 2004 to 613 in 2006.

HEALTH REGULATION Licensing of Botika sa Barangay (BnBs) was a priority activity to improve access to affordable drugs and medicines. By the end of 2006, 427 BnBs were licensed. Generic prescribing was given emphasis. Monitoring results revealed that correct prescriptions increased from 90 percent to 96 percent. Warning letters to violators followed. The proliferation of counterfeit drugs in the region was also addressed. Violative products were confiscated and condemned and information dissemination on unlicensed drug distributors was also undertaken. Given these developments, the consumers should become more vigilant in reporting offices, persons or entities involved in illegal sale of drugs to the Department of HealthCenter for Health Development (DOH-CHD) or the nearest DOHProvincial Health Team (PHT). HEALTH SERVICE DELIVERY Increased access to health care services were strongly advocated to local government implementers. Such services include preventive and promotive care utilizing the primary health care

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approach. Despite funding and logistical constraints, public health programs were implemented at the local level. These programs focused on four priorities, namely: (a) safe motherhood and family planning; (b) child and maternal health care; (c) communicable disease control program; and (d) non-communicable disease control program. On Child and Maternal Health Care. The immunization program coverage of children and pregnant mothers decreased. Fully immunized children covered remained at 82 percent. This is below the target of 95 percent coverage. Causes for the decreased coverage were lack of syringes for the vaccines, decrease of outreach activities for follow-up of defaulters, rapid turnover of trained health workers, deterioration of the cold chain system, poor stocks management and inadequate of monitoring and supervision. Although the Reach Every Barangay (REB) strategy which validate data and mentor health workers has been implemented, it is still inadequate to cover all barangays with high un-immunized children. On Communicable Disease Conrol Program. Relative to TB Control, the TB detection rate improved from 79 percent in 2004 to 99 percent in 2006 due largely to treatment administered by trained health personnel. This is due to intensified quality assurance (QA) in four provincial QA laboratories an establishment of three public and one Private Mix DOTS facilities. At the regional level, the Regional TB Reference Laboratory has also started its operations. TB cure rate was 84.3 percent in 2005. For dengue prevention and control, there was intensified campaign on source reduction and environmental sanitation (Operation Kiti-Kiti and the 4 o’clock Habit). Provision of logistics and training for early case detection was also implemented. In the case of Malaria Control Program, Masbate and Sorsogon have been declared as malaria free by the World Health Organization (WHO). Albay is in the process of being declared as malaria-free. There is still continued diagnostic and management capability trainings being undertaken particularly on malaria surveillance and vector control (MASSUVECO), basic malariology and malaria smear microscopy.

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On filariasis control, efforts were focused on morbidity control and mass drug treatment (MDT). For 2006, MDT accomplishment was 63 percent. Early diagnosis and treatment was given emphasis for leprosy control while the Schistosomiasis Control Program focused on malacological surveys in preparation for it being being eliminated as a public health problem. On Non-Communicable Disease Conrol Program. Under the Rabies Control Program, the curriculum integration project was expanded to 8 elementary schools in Cabusao, Camarines Sur. There was also pre-exposure anti-rabies vaccination given to schoolchildren. Intensified dog vaccination dubbed as “askal” elimination was also conducted in the region. For epidemiology and surveillance, surveillance activities were undertaken for cases of cholera, diarrhea, typhoid fever and dengue. In response to epidemic occurrences, and other health-related emergencies, disaster Response Teams were organized. Expansion of the Healthy Lifestyle Program focused not only on target risk factors and risky behavior (smoking, road safety, dangerous drug use, etc) but covered other aspects such as limiting the ill-effects of environmental risks and hazards such as garbage, flooding, pollution (air and water), emergency management, traditional medicine and voluntary blood donation. There is also increased emphasis on diabetes, renal diseases, cancer, heart disease and other degenerative diseases. HEALTH SYSTEMS DEVELOPMENT For effective and efficient health care delivery, inter-local health zones were strengthened, municipalities/cities were assisted to facilitate Sentrong Sigla certifications and additional Botika sa Barangay were established and provided with drugs and medicines. Despite the improvements in the health sector, problems still persist. Preventable communicable diseases like diarrhea, pneumonia and bronchitis still remain as the leading cause of illnesses. The prevalence of tuberculosis and lifestyle diseases such as diseases of the heart and the vascular system prevail as

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the leading causes of death. With these trends, hospitals are expected to acquire modern and diagnostic and therapeutic technology for secondary and tertiary care. Access to health care and health-seeking behavior remain poor due to geographical inaccessibility of facilities, low income of families, high cost of medicines and hospital care and lack of knowledge on proper health care. Health facilities still lack physical and human resources. There is still lack of LGU support for program implementation particularly those related to health service delivery. DEVELOPMENT OBJECTIVES AND TARGETS The objectives and the corresponding targets for each objective are: 1. To minimize health problems and improve health outcomes by year 2010. a. Decrease in IMR. MMR, CMR from 2005 levels by 510 percent in 2010. b. Decelerate incidence of communicable diseases by an increment of 1-2 percent per year until 2010. c. Decrease in mortality cases for lifestyle-related diseases by an increment of 3-5 percent per year until 2010. d. Increase in the number of health facilities equipped with modern diagnostic and therapeutic technology by 50 percent in 2010. e. Reduce the prevalence of water-borne diseases by at least 10 percent per year until 2010. 2. To assure access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor. a. Increase access to health services with improvements in bed-population ratio, manpower-population ratio. b. Reduce of cost of medicines commonly bought by the poor to half of its 2005 price and made available in all DOH-retained and district hospitals. 3. To improve the accessibility and availability of basic and essential health care for all, particularly the poor.

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a. Increase the number of households with access to potable water and sanitation facilities by 80 percent and 86 percent, respectively, until 2010. b. Increase enrolment of individually-paying and indigent/ sponsored members to the NHIP by about 5 percent annually until 2010. c. Increase health insurance coverage of PhilHealth members and their beneficiaries by 5 percent annually until 2010. 4. To improve health systems performance at the local levels. a. Establish seven inter-local health zones (ILHZs) by 2010.

STRATEGIES The strategies that will promote improvement in the nutritional status of Bicolanos are: 1. Promote the health well-being of the vulnerable groups, i.e., infants and children, young and adolescents, women, people with disabilities and the elderly. 2. Put emphasis on preventive and promotive health services in health care facilities. 3. Promote integrated programs for the prevention and control of communicable and non-communicable diseases and other emerging illnesses. 4. Assure the availability of low-priced quality essential medicines commonly used by the poor. 5. Intensify advocacy efforts to expand the NHIP among the LGUs and employers and develop innovative strategies, i.e. LGU voucher system for health services. 6. Develop collaborative schemes involving private health insurance and health maintenance organizations. 7. Enhance capability of local government units to manage and administer devolved health functions. 8. Develop modern health and rehabilitation facilities — hospitals, clinics, city/municipal health centers and barangay health stations, laboratories and other entities — where health and rehabilitation services are provided.

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Biological Disaster Management Major Programs and Projects Title Ma t er n a l H ea lt h a n d Nu t r it ion a . Sa fe Mot h er h ood P r ogr a m b. F em a le F u n ct ion a l Lit er a cy

Ch ild H ea lt h a n d N u t r it ion (DOH CH D P r ogr a m s) a . E xpa n ded Im m u n iza t ion P r ogr a m b. E n h a n ced Ch ild Gr owt h P r oject c. Nu t r it ion P r ogr a m d. In t egr a t ed Ma n a gem en t of Ch ildh ood Illn esses

2n d Wom en 's H ea lt h a n d Sa fe Mot h er h ood Pr oject

Low-P r iced Medicin e P r ogr a m a . GMA50 Medicin es for Devolved H ospit a ls b. Con sign m en t of Dr u gs c. Bot ika n g Ba r a n ga y/Bot ika sa Ma sa Bicol H ea lt h Ser vice Deliver y E n h a n cem en t P r ogr a m P r even t ion a n d Con t r ol of Wa t er a n d F ood Bor n e Disea ses TB-DOTS Cer t ifica t ion

Avia n In flu en za P r even t ion a n d Con t r ol of H u m a n Ra bies

P r im a r y H ea lt h Ca r e Pr ogr a m a . Ma t er n a l a n d Ch ild H ea lt h b. Wom en 's/Ma t er n a l H ea lt h Sa fe Mot h er h ood &F a m ily P la n n in g c. H ea lt h y Lifest yle a n d N u t r it ion

D e s c rip ti o n Gea r ed t owa r ds t h e im pr ovem en t of t h e well-bein g of m ot h er s t h r ou gh a com pr eh en sive a ppr oa ch of pr ovidin g pr even t ive, pr om ot ive a n d cu r a t ive h ea lt h ca r e a n d en su r e t h e bir t h of h ea lt h y in fa n t s. In volves im m u n iza t ion fr om com m on ch ildh ood disea ses. P r om ot ion of ch ild gr owt h a n d developm en t in clu din g psych osocia l st im u la t ion for a ll ch ildr en . P r even t ion of n u t r it ion a l a n d m icr on u t r ien t deficien cies t h r ou gh st r a t egies on food secu r it y a n d r ein for cem en t a n d expa n sion of food for t ifica t ion a n d m icr on u t r ien t su pplem en t a t ion . P r om ot ion of disea se m a n a gem en t of ch ildr en ; in clu des t r a in in g of fir st level h ea lt h wor ker s. A 5-yea r DOH -LGU pa r t n er sh ip t h a t will a ssist disa dva n t a ged wom en of r epr odu ct ive a ge t o ga in su st a in ed a ccess t o h igh qu a lit y a n d cost -effect ive r epr oduct ive h ea lt h ser vices. E st a blish m en t a n d licen sin g of Bot ika n g Ba r a n ga ys (Bn Bs).

In volves t h e u pgr a din g a n d equ ippin g of t h e r egion a l devolved h ea lt h fa cilit ies. In clu des t h e clin ica l m a n a gem en t of wa t er a n d food bor n e disea ses a n d wa t er a n a lysis. In clu des det ect ion /con fir m a t ion of TB ca ses a n d pr ocu r em ent of la bor a t or y r ea gen t s. In clu des t h e pr e/post exposu r e im m u n iza t ion of h ea lt h wor ker s in volved a n d clin ica l m a n a gem en t of dog bit es a n d h u m a n r a bies.

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NUTRITION Good nutrition is a basic human right. It is a central element of survival and a critical factor in an individual’s optimum growth and development. A well-nourished population therefore is economically and socially active and can contribute more meaningfully and be able to reap the benefits of development . It is within this context that the government aims to achieve goals for nutrition improvement to ensure nutritional adequacy for all Filipinos.

DEVELOPMENT CHALLENGES The region is faced with problems on continued occurrence of underweight preschoolers and schoolchildren and the prevalence of micro nutrient deficiencies – anemia across all population groups, especially among infants and pregnant and lactating women, iodine deficiency and vitamin A deficiency. There is a need to focus nutrition services to groups and areas with high malnutrition prevalence. The prevalence of below normal and very low below normal preschoolers decreased from 22.6 percent in 2004 to 20.23 percent in 2006. The targeted percentage decrease of 2 percent per year has been surpassed with a 10 percent decrease. This is a result of nutrition interventions for the vulnerable groups such as the infants, preschoolers, schoolchildren and pregnant and lactating mother. As of 2006, malnutrition was highest in Camarines Sur (25.16 percent) among the provinces and Legazpi (12.20 percent) among the cities. It was lowest in Sorsogon (16.47 percent) and Naga City (4.22 percent). Naga City posted the highest percentage reduction at 24 percent from 2004-2006. On the other hand, the proportion of malnourished schoolchildren increased from 27.8 percent in SY 2004-2005 to 28.10 percent in SY 2005-2006. Contributory factors to the increase include occurrence of health illnesses, nonaffordability of poor households to food commodities, inadequate knowledge of parents and caregivers on proper health and nutrition care and improper diet and nutrition habits and practices. The regional agencies implemented programs in accordance with the Philippine Plan of Action for Nutrition (PPAN) consisting of: (a) home, school and community food production; (b) food

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fortification; (c )micronutrient supplementation (distribution of Vit. A, iron and iodine supplements); (d) nutrition information; (e), communication and education; (f) food assistance; (g) livelihood assistance; and (h) integration of nutrition in essential maternal and child health services. Specific programs include the following: 1. Bright Child Program – a package of interventions on food, nutrition, health, early education and psycho-social programs for children 0-17 years; implemented in 4 provinces – Albay (Malilipot, Pio Duran, Manito, Oas); Camarines Norte (J. Panganiban, Labo);’ Masbate (Claveria, Monreal); Camarines Sur ( Minalabac, San Jose, Tigaon, Calabanga, Pasacao, Bula, Baao, Pamplona and Libmanan). 2. Supplemental Feeding Program under Ahon Bayan Projectaims to generate resources for the delivery of day care services and in the conduct of supplemental feeding program covering priority barangays with high incidence of malnutrition; covered the provinces of Albay (Bgys. Bagatangki and Quinarabasahan), and Camarines Sur( Barangay Pararao and Siramag). 3. Food For Work Program – addresses the basic food and the socio-economic needs of the poor through employment and livelihood opportunities for a sustained family income; pilot in 11 municipalities in Camarines Sur covering 335 barangays 4. Pabasa sa Nutrisyon Project – a strategy and tool for nutrition workers in communicating proper nutrition among families to effectively improve and control malnutrition; implemented in the provinces of Albay and Catanduanes with 1,080 parents/mothers as beneficiaries. 5. National Expanded Pre-school Program – aims to eradicate the incidence of hunger and malnutrition in the region especially the undernourished day care children; piloted in Albay (Malinao, Pio Duran, Jovellar), Camarines Norte (Basud, Capalonga and Mercedes), and Masbate (Uson, Placer and Balud). 6. Early Childhood Care and Development Program – refers to child and family-oriented services designed to build

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and improve the existing health, nutrition and early education services for disadvantaged children. 7. School Feeding Program – includes Fortified Biscuits and Milk Feeding, FreshMilk Feeding, Breakfast Feeding, Food for School Program (Bigas Para sa Mag-aaral at Pamilya), Teacher-Child-Parent Approach and Inter-Vida School Feeding. 8. Micronutrient Supplementation, Promotion of Breastfeeding, Food Fortification, Iodized Salt Utilization, Patak Asin.

DEVELOPMENT OBJECTIVES AND TARGETS The objectives and the corresponding targets for each objective are: 1. To reduce hunger incidence and promote good nutrition in food-poor areas. • Reduction of prevalence rate of malnourished preschoolers from the 2005 level of 21.83 percent to 18.3 percent by 2010. 2. To mitigate protein-energy malnutrition, micronutrient deficiencies, and overnutrition. • Reduction in malnutrition cases due to micronutrient deficiencies by 15-20 percent by 2010. 3. To contribute to the reduction in the incidence of low birth weight. 4. To contribute to the reduction by 30% in the prevalence rate of lifestyle-related non-communicable diseases by 2010. STRATEGIES 1. Integrate nutrition activities in sectoral plans particularly on food production, health, early education and psychosocial programs with nutritionally-at-risk families and children and pregnant and lactating mothers as priority. 2. Expand existing programs on maternal and child health and nutrition welfare.

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Biological Disaster Management 3. Fast-track the implementation of impact programs on nutrition such as the Accelerated Hunger Mitigation Program for the LGUs to invest on infant and young child feeding, breastfeeding, enforcement of Milk Code, Food Fortification Act and the ASIN Law and provision of logistic support for capability-building, information education campaign and advocacy efforts. Major Programs and Projects

Title H om e, Sch ool a n d Com m u n it y Food P r odu ct ion

F ood F or t ifica t ion

Micr on u t r ien t Su pplem en t a t ion Nu t r it ion In for m a t ion , Com m u n ica t ion a n d E du ca t ion

F ood Assist a n ce

Livelih ood Assist a n ce

Nu t r it ion in E ssen t ia l Ma t er n a l a n d Ch ild H ea lt h Ser vices

B rie f D e s c rip ti o n In clu des est a blish m en t of kit ch en ga r den s in t h e h om e, sch ool a n d in com m u n it ies, est a blish m en t of dem on st r a t ion cen t er s a n d n u r ser ies a n d dist r ibu t ion of pla n t in g m a t er ia ls, sm a ll a n im a ls a n d fin ger lin gs a n d pr ovision of t ech n ica l a ssist a n ce. In clu des t h e a ddit ion of n u t r ien t s t o pr even t or cor r ect m icr on u t r ien t deficien cies; m a n da t or y for t ifica t ion of m icr on u t r ien t s a n d m in er a ls t o food veh icles. Dist r ibu t ion of vit a m in A, ir on a n d iodin e su pplem en t s t o t a r get ed popu la t ion gr ou ps. In clu des t h e pr om ot ion of n u t r it ion a l gu idelin es a n d ot h er n u t r it ion r ela t ed m essa ges, con du ct of n u t r it ion - r ela t ed r esea r ch es a n d dissem in a t ion of t h e sa m e t o loca l com m it t ees. Con sist s of cen t er -ba sed su pplem en t a r y feedin g, sch ool feedin g, growt h m on it or in g a n d pr om ot ion ; pr ice discou n t on ba sic food com m odit ies t h r ou gh pr ogr a m s a s F ood for Wor k, F ood for Sch ool a n d GMA r ollin g st or es. In clu des pr ovision of cr edit a n d livelih ood oppor t u n it ies t o poor a n d m a ln ou r ish ed h ou seh olds a n d com plem en t a t ion wit h ot h er in t er ven t ion s su ch a s fu n ct ion a l lit er a cy, en t er pr ise edu ca t ion a n d h ea lt h a n d n u t r it ion edu ca t ion , in clu din g va lu es for m a t ion . In volves deliver y of essen t ia l m a t er n a l a n d ch ild h ea lt h a n d n u t r it ion pa cka ge of ser vices t h a t will en su r e t h e r igh t of t h e ch ild t o su r viva l, developm en t , pr ot ect ion a n d pa r t icipa t ion .

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4. Review of the effectiveness of nutrition programs such as the Food for School Program. 5. Promote healthy diet and intensification of efforts to prevent, diagnose and treat nutritional diseases and related conditions. FAMILY PLANNING Demographic effects on growth demonstrate that excess population may have some effect on the rate of productivity gains. The faster the growth of population of working ages, for example leads to a much larger labor force. It may also have some adverse impact on child health, nutrition and educational performance. These in turn have a future impact on the quality of human resources. Rapid population growth also implies the need to produce more goods and services to accommodate the larger population. It may constrain resources and may lead to the overuse of natural resources. In terms of its effect on the ability of the economy to save and invest, more income is spent on personal consumption, especially in terms of providing basic needs. This means lesser savings, capital accumulation and physical infrastructure. The government has recognized the implications of rapid population growth and while fertility decisions are made by couples, the government must ensure that people have access to family planning information and services. It must still provide the direction in determining the population level that is consistent with sustained development.

DEVELOPMENT CHALLENGES The Family Planning Program has played a vital role in the advancement of the health and socio-economic status of the Bicolanas. The region has actually achieved a modest decline in fertility from 4.13 in 2004 to an estimated 3.9 in 2006. But this is still one child more than the wanted fertility rate of 3.2 children. The unmet need for family planning or the proportion of currently married women who are not using any method of family planning but do not want any more children or prefer to space birth declined

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from 33 percent in 1993 to 24 percent in 2003. The decline maybe attributed to the strength of fertility preferences, perceived risk of conceiving, husband’s fertility preferences and acceptance of family planning methods. The region’s contraceptive prevalence rate (CPR) increased from in 42.9 in 2003 (NDHS Survey) to 43.2 in 2005 (FP Survey) and estimated to be 43.4 in 2006. However, those not using any method (56.8 percent) still outweigh both those using modern methods (43.2 percent) and the traditional methods (20.1 percent). The reasons for non-use of contraception are: (1) fertility-related such as wanting to have as many children as possible; (2) the women are already in menopausal stage; (3) fear of side effects on women’s health; and (4) opposition to use. The use of modern methods is below 50. In terms of new acceptors and current users, family planning performance has not exhibited a sustained growth. This could be attributed to: (1) inadequate knowledge on population and family planning; (2) lack of family planning service centers and service providers; and (3) IEC materials and commodity support. Political will and LGU participation is important for family planning services to be sustained at the local level. These are important especially that foreign donors will no longer supply contraceptives. Information on other methods, natural family planning included, will have to be provided to married couples of reproductive age, especially in rural areas.

DEVELOPMENT OBJECTIVES AND TARGETS 1. To improve access to family planning services: a. Close the gap between the desired number of children (3.2 children) and actual family size (4.13 children). b. Increase Contraceptive Prevalence Rate from 43.2 in 2005 to 44 by 2010. c. Reduce the unmet need for family planning (proportion of currently married women who are not using any method of family planning but do not want any more children or prefer to space birth) from 29.3 percent in 2003 to 19 percent by 2010.

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d. Increase the number of FP modern method users by encouraging the FP traditional method users to shift to modern methods. e. Advocate to LGUs to provide logistic support to FP services, facilities and supplies. 2. To disseminate responsible parenting concepts including basic responsibilities of parents. 3. To contribute to the reduction of maternal, infant and early child mortality. 4. To address the issues on reproductive health in men and women and youth and adolescents.

STRATEGIES The Responsible Parenting Movement sets the new direction for family planning in the country and the region as well. The program gives emphasis on the Natural Family Planning Program alongside traditional methods in the promotion of family planning services. Along this line, the grassroots level shall be mobilized to become active advocates of responsible parenthood. Classes on responsible parenting shall be conducted in the barangays. One class shall be composed of 10 married couples of child-bearing age who want to practice birth spacing through NFP. Attention will be focused on Maternal Health Care not only to cover pregnancy-related concerns but also on other reproductive health problems such as reproductive tract infections, malignancies and infertility. The government shall provide acceptable, accessible, affordable, culturally sensitive and gender-sensitive health services and facilities for married couples of reproductive age to improve access to family planning services. MAJOR PROGRAMS AND PROJECTS 1. Reinforced Planned Parenthood Program - provision of services that will decrease the number of unplanned pregnancies when effective methods of contraception are available. Includes universal coverage of pre-marriage counselling and the provision of modern method as well as permanent methods.

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Biological Disaster Management 2. Contraceptive Self-Reliance - encourage self-sufficiency and eliminate dependence on foreign donors for FP services and commodities. 3. Natural Family Planning- promotion of alternative methods of contraception for those who cannot use or are not suitable for the modern methods of contraception. 4. Women’s Health and Development Program 5. Family Welfare Program in the Workplace 6. Parent Effectiveness Program 7. UNFPA 6th Country Program – covers the municipalities of Palanas, Placer, Dimasalang in Masbate Province.

BASIC AND TERTIARY EDUCATION In a world where knowledge has become a crucial element for nations to prosper and compete, primacy is placed on quality and accessible education, from early childhood development to primary, secondary and tertiary learning. The vision set out in the World Declaration on Education for All prescribes that every child, youth and adult has the human right to benefit from education that will meet their basic learning needs including the full development of human personality. Today we regard an educated Filipino as someone who is functionally literate. This means one has the complete range of skills and competencies – cognitive, affective and behavioral— that enables individuals to live and work as human persons; develop their potentials; make critical and informed decisions; and function effectively in a society. This is within the context of their environment and that of the wider community for the improvement of their quality of life and of the society. Investing in education is important. One, it supports economic growth over the long term. Two, it helps break the transmission of poverty from one generation to another. Education is an important means for families to emerge from poverty. It provides people, particularly the youth, with more opportunities. However, a high percentage of individuals give lack of money as the reason for not attending schools. As a result, there are families who do not have access to the benefits of education. The

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government has an important role to play in education. The government has the responsibility to provide equal opportunities for everyone to develop their human capacities and ensure that every child complete basic schooling, and that a significant number are enrolled in tertiary education. This Plan gives full and adequate attention on basic education as an essential human right and fundamental obligation of the state. It underscores the relevance of education as a basis for life long learning of every Bicolano. EARLY CHILDHOOD DEVELOPMENT

Development Challenges Children who have the benefit of adequate Early Childhood Care and Development (ECCD) experience tend to be better prepared for formal education. Overall pre-school enrolment in 2006 showed an increase of 8.5 percent in the number of 3-5 years old enrolled in the formal pre-schools with the private pre-schools posting a 44.92 percent growth and surpassing the plan target. However this represents only about 36.7 percent of the total preschool population. Moreover there was a noted decline of 21.53 percent in the public formal pre-school enrolment. There is still a considerable number of children that are not provided with pre-school education. Only 59.83 percent of grade 1enrollees have ECCD experience. The number of day care centers (DCCs) increased from 3,949 in 2005 to 3,997 in 2006, but there are still 359 barangays (10 percent) without day care centers. Each barangay is supposed to have a day care center. The number of children served in DCCs increased by 5.12 percent in 2006. In order to achieve a more focused implementation of the ECCD program, the following strategic interventions were undertaken: (a) modified 6-8 weeks pre-school curriculum for grade 1 to offset the absence of ECCD experience of grade 1 enrollees; and (b) the pre-school service contracting scheme where the national government pays the private schools who are the service providers. The other challenges that face early education are: (a) improving the quality of day care centers through the DCC

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accreditation system including adequate provision of learning materials; (b) improving the quality of day care workers through continuous capability building and standardizing the salaries of day care workers; (c) improving parental education, skills and awareness; (d) strengthening program support for information dissemination and education; and (e) widening the coverage of programs and services.

Objectives The following are the objectives for early childhood care and development: 1. Universal coverage of 3-5 years old in quality assured preschool and early childhood care and development programs. 2. To ensure that young children are adequately prepared for formal learning system and that both public and private schools are responsive to the development needs of the children. 3. Facilitate a smooth transition from care and education provided at home to community or school-based setting and to primary school.

Strategies The following are the strategies for ECCD: 1. Make expansion of ECCD coverage yield more EFA benefits by: • identifying and encouraging the most cost-effective and quality assured ECCD programs; • making sure that the most disadvantaged children get into these programs; • developing ECCD investment and financial plans at all levels for purposes of cost sharing arrangements as provided in Section 9 of R.A. 8980 of the ECCD Act; • evaluating and implementing cost effective ECCD programs; • expanding access to quality ECCD programs; and • undertaking pro-active advocacy and social marketing

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3. 4.

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to increase awareness and demand for quality ECCD services. Develop and update quality assurance standards, i.e., ECCD curriculum, ECCD checklist and school readiness tool to assess the child’s over-all development. The ECCD curriculum shall focus on the child’s total development and promote the delivery of complementary and integrative services for health care, nutrition, early childhood education, psycho-social, cultural and value formation activities. Enhance, support and educate the parents in their roles as primary caregivers and educators of their children. Harness involvement and mobilization of communities by: • expanding parent participation in existing center-based and home-based programs; and • promoting knowledge and practices and disseminating relevant information on health, early education, psycho-social development, values and spirituality and other services among parents and community. Develop and implement a human resource development program for ECCD volunteers, service providers, supervisors and program managers to upgrade their competencies. The program shall define core competency standards, training framework, strategies and mechanisms for continuing education of various ECCD service providers and volunteers. Institutionalize a recruitment, registration and credential system for ECCD service providers and foster continuing education program through formal education and other complementary alternative forms of training. Create an ECCD network of community-based groups to develop and implement ECCD action plans in partnership with local governments units. Improve the quality of day care centers through the DCC accreditation system including the provision of adequate learning materials.

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Biological Disaster Management 9. Monitor ECCD progress towards attainment of goals and document/ disseminate, replicate and institutionalize good models and practices on ECCD.

TARGETS 1. Day care center established in all barangays. 2. Accreditation of 80 percent of day care centers. 3. One hundred (100) percent of grade I enrollees with ECCD experience. MAJOR PROGRAMS AND PROJECTS 1. Early Childhood Care and Development Program includes the provision of technical, financial and material support to local government units to improve program implementation on health, nutrition and early education services. 2. Parent Education - The parent effectiveness service is designed for parents to improve quality of care and teaching that children receive at home as well as improved family life. 3. Supervised Neighborhood Play - is a neighborhood-based early childhood program for 3-5 year old children who are unable to participate in ECCD classes. 4. Supplemental feeding for underweight pre-school children. 5. Capacity building of key stakeholders and performance monitoring programs. 6. Advocacy, Communication and Social Marketing. Advocacy campaigns to encourage parents to enroll their children in pre-schools as preparation for basic education and for LGUs to establish day care centers in barangays without day care centers and to provide support to the ECCD program. BASIC EDUCATION

Development Challenges In view of the high fertility in the region, the educational system has to cope reasonably with the rapid increase in school

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age children which has led to lack of classrooms and inadequate teaching materials including books. In SY 2005-2006, basic education enrolment increased by 6.4 percent and surpassed the plan target. It was noted that there has been an increase in enrolment in public schools, which is due to the transfer of students from private to public as a result of the increase in tuition fees. This will put more pressure on the public education system and the government will have to increase budget allocation to teachers, textbooks and expansion of school facilities. Access to basic education has been expanded through the twin strategies of establishing schools in school-less barangays and completing incomplete schools through multi-grade classes. In 2005, the number of barangays without elementary schools was reduced from 173 to 38 barangays. The number of incomplete elementary schools decreased from 380 to 261 in 2006. Likewise, the Government Assistance to Students and Teachers for Private Education (GASTPE) provided financial subsidy to students who could not be absorbed by the public schools. A total of 25,524 students benefited from the Education Service Contracting Scheme participated in by 112 schools, while the Education Vouchers Scheme issued 3,306 vouchers with 81 schools participating. Although access to education has been significantly addressed, there is much to be done in improving the quality of education. This includes improving the quality of instruction and upgrading school facilities. While most children have access to school, only about 71 percent for elementary and 54 percent for secondary complete the education. For those who complete school, little learning takes place as evidenced by the low mean achievement of about 55 percent for elementary and 42 percent for secondary. This is much lower than the expected 75 percent level of mastery. The participation rates in both the elementary and secondary levels have remained stable at 91.59 and 55.49 percent respectively but still fell short of the plan targets. The challenge is sustaining the initiatives relative to improving access and affordability and how to address the needs of the remaining number of children particularly in the secondary level who are not in school or who have not availed of any form of schooling.

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The elementary drop out rate, although increasing, is within the plan target but secondary level drop out rate and the cohort survival rates for both elementary and secondary levels are below the plan targets. The increasing number of dropouts could indicate a tighter economic condition for the Bicolano family forcing the children to stop schooling because of lack of funds. The frequent occurrence of typhoons could contribute to increased drop out rates due to the adverse impact of typhoons to family income and condition of school infrastructure and facilities. Schools are usually transformed into evacuation centers and facilities of these schools are insufficient to meet the demands of the evacuees. The transformation of schools into evacuation centers disrupts the education of students. The persistent issue that needs to be addressed is raising the level of performance along the key development indicators such as cohort survival rate, completion rate, academic performance and high drop out rate. In view of the high drop out rates, there is a recognized need to reduce the incidence of dropouts and to supplement formal schooling with programs to reach those unable to continue formal school. Other concerns that need to be addressed are the backlog of teachers in elementary and secondary schools, shortage of classrooms and inadequate instructional materials and facilities including audio visual materials. The government’s response to the challenges in its basic education system is embodied in the Philippine Education for All (EFA) 2015 Plan. This Plan is a vision and a holistic program of reforms aimed at improving the quality of education. This serves as the blueprint for basic education.

OBJECTIVES The objectives for development in basic education are: 1. To increase access to, affordability and quality of basic education. 2. To ensure that all children, youth and adults complete a good quality basic education with emphasis on disadvantaged children, including the poorest working children and children with special needs.

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3. Universal school participation and completion of the full cycle of basic education schooling (10 yrs) with satisfactory achievement levels by all at every grade and year level. 4. Total community commitment to attainment of basic education competencies for all. 5. To close the gaps in the existing educational inputs particularly those of classrooms.

STRATEGIES The strategies for basic education are: In view of the high fertility in the region, the educational system has to cope reasonably with the rapid increase in school age children which has led to lack of classrooms and inadequate teaching materials including books. In SY 2005-2006, basic education enrolment increased by 6.4 percent and surpassed the plan target. It was noted that there has been an increase in enrolment in public schools, which is due to the transfer of students from private to public as a result of the increase in tuition fees. This will put more pressure on the public education system and the government will have to increase budget allocation to teachers, textbooks and expansion of school facilities. Access to basic education has been expanded through the twin strategies of establishing schools in school-less barangays and completing incomplete schools through multi-grade classes. In 2005, the number of barangays without elementary schools was reduced from 173 to 38 barangays. The number of incomplete elementary schools decreased from 380 to 261 in 2006. Likewise, the Government Assistance to Students and Teachers for Private Education (GASTPE) provided financial subsidy to students who could not be absorbed by the public schools. A total of 25,524 students benefited from the Education Service Contracting Scheme participated in by 112 schools, while the Education Vouchers Scheme issued 3,306 vouchers with 81 schools participating. Although access to education has been significantly addressed, there is much to be done in improving the quality of education. This includes improving the quality of instruction and upgrading school facilities. While most children have access to school, only about 71 percent for elementary and 54 percent for secondary

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complete the education. For those who complete school, little learning takes place as evidenced by the low mean achievement of about 55 percent for elementary and 42 percent for secondary. This is much lower than the expected 75 percent level of mastery. The participation rates in both the elementary and secondary levels have remained stable at 91.59 and 55.49 percent respectively but still fell short of the plan targets. The challenge is sustaining the initiatives relative to improving access and affordability and how to address the needs of the remaining number of children particularly in the secondary level who are not in school or who have not availed of any form of schooling. The elementary drop out rate, although increasing, is within the plan target but secondary level drop out rate and the cohort survival rates for both elementary and secondary levels are below the plan targets. The increasing number of dropouts could indicate a tighter economic condition for the Bicolano family forcing the children to stop schooling because of lack of funds. The frequent occurrence of typhoons could contribute to increased drop out rates due to the adverse impact of typhoons to family income and condition of school infrastructure and facilities. Schools are usually transformed into evacuation centers and facilities of these schools are insufficient to meet the demands of the evacuees. The transformation of schools into evacuation centers disrupts the education of students. The persistent issue that needs to be addressed is raising the level of performance along the key development indicators such as cohort survival rate, completion rate, academic performance and high drop out rate. In view of the high drop out rates, there is a recognized need to reduce the incidence of dropouts and to supplement formal schooling with programs to reach those unable to continue formal school. Other concerns that need to be addressed are the backlog of teachers in elementary and secondary schools, shortage of classrooms and inadequate instructional materials and facilities including audio visual materials. The government’s response to the challenges in its basic education system is embodied in the Philippine Education for All

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(EFA) 2015 Plan. This Plan is a vision and a holistic program of reforms aimed at improving the quality of education. This serves as the blueprint for basic education.

TARGETS By 2010, the following operational targets shall have been achieved: 1. Improvement of key indicators to —a. 87.94 percent elementary cohort survival rate; b. 75.00 percent secondary cohort survival rate c. 70.00 percent elementary completion rate d. 58.00 percent secondary completion rate e. 98.00 percent elementary graduation rate f. 95.00 percent secondary graduation rate g. 1.14 percent elementary drop-out rate h. 5.00 percent secondary drop-out rate i. 1:30 Teacher/pupil/student ratio 2. Attainment of more than 75 percent mean performance level in achievement tests. 3. All public high schools will have a computer laboratory. MAJOR 1. 2. 3.

PROGRAMS AND PROJECTS Third Elementary Education Project (TEEP) Brigada Eskwela Every Child A Reader Program - an intensive reading skills development program to address the very low reading performance among pupils. 4. Secondary Education Development and Improvement Project (SEDIP) – provision of facilities and equipment and the training of teachers in underserved, depressed, disadvantaged schools division. It aims to increase access to quality secondary education and improve student achievement. 5. Educational Subcontracting Program - provision of funds to secondary private schools to absorb the excess enrolment in public high schools.

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Biological Disaster Management 6. Adopt-A-School Program – involves partnership with private sector in the provision of educational inputs. 7. In-Service Training Program – enhance teacher’s competencies through teacher training programs in the different learning areas. 8. Government Assistance to Students and Teachers for Private Education (GASTPE) – provides financial subsidy to students who could not be absorbed by the public schools. 9. School Building Program/Computerization Program – construction, repair, rehabilitation and upgrading of school facilities/implementation of the modernization and information technology interventions.

HIGHER EDUCATION Higher Education programs are geared towards the provision of better quality education, the development of higher-level work force and the intensification of research, extension and production services. Higher education development is guided by the policy framework defined in the Long Term Higher Education Development Plan 2001-2010. The plan provided a blueprint for higher education and serves as a guide in initiating and implementing meaningful reforms in higher education to ensure relevance and responsiveness of the system to the changing societal demands. DEVELOPMENT CHALLENGES The higher education sub-sector posted a modest performance in 2005. Enrolment declined by 2.85 percentage points from 106,790 in 2005 to 103,744 in 2006 and is still short of the targeted students. There were more female (56.6 percent) than male students. Public higher education institutions (HEIs) enrolment likewise decreased by 3.74 percent and served approximately 46.72 percent of the total number of higher education students in the region. For a number of years, enrolment has not been effectively directed toward courses necessary for regional development. Enrolment was high in the traditional courses such as commerce, arts and

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sciences, and engineering. There were 25,582 graduates in 2006 registering a 6.41 percent growth. The region has an oversupply of graduates and there is also a mismatch between competency and skills of graduates with the demands of the industry/labor market. Limited funding for scholarship grants/loans resulted to limited educational opportunities. Only about 13,726 scholars were provided assistance and failed to reach the 20,717 target. Overall only about 13 percent of the total student population benefited from the scholarship programs with a funding assistance amounting to P30.7 million. The CHED has likewise expanded access to higher education through the Expanded Tertiary Education and Accreditation Program. However, deputized HEIs declined from 10 to 5 in 2005. The most availed program was Bachelor of Science in Criminology followed by Business Management, Bachelor of Science in Nursing and Bachelor in Elementary Education. Accreditation is another mechanism to ensure quality in higher education. Of the 136 HEIs, 21 (15 percent) have accredited programs. As to the number of accredited programs, the top three were teacher education, commerce/business and accountancy and liberal arts. HEIs have not attained the requirement that faculty should be holders of masters degree or above. About 59 percent of the faculty members of private HEIs and 34 percent of SUCs have not acquired masteral degrees. In the area of instruction, curricular offerings in both private institutions and SUCs were revised/revitalized to conform to policies, standards and guidelines of specific programs. The courses include health-related programs, architecture and engineering, agriculture, business and information technology programs. The research and development centers of the SUCs continued to cater to diverse areas and had completed researches in agriculture and fisheries. But only a few universities conduct extensive research. This has been due to inadequacy of research facilities and qualified faculty to conduct research. On extension services, the HEIs continued to maximize participation in anti-

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poverty programs of the government by addressing the needs of the marginalized sector and establishing partnerships with LGUs, NGOs and communities. The higher education system still continue to face the following issues and concerns: (a) upgrading quality of higher education programs and institutions; (b) ensuring the relevance of higher education programs and services by matching the competency/skills of graduates with the needs of the industry/labor market and reengineering of programs to make our graduates competitive; (c) adapting and utilizing appropriate ICT and other innovations in education; (d) increased levels of research and development and (e) identifying and tapping alternative sources of revenues.

OBJECTIVES The objectives for higher education are: 1. To broaden the access of economically and socially disadvantaged groups to quality higher education. 2. To improve quality and international comparability of higher education programs and institutions. 3. To strengthen complementation and productive partnerships between and among public and private HEIs, between college or university and industry, and educational institutions involved with other sectors. 4. To generate, adapt, and disseminate knowledge that equips graduates with competencies, values and skills vital in a dynamically-changing domestic and international environment. STRATEGIES On access and equity. The coverage of scholarships and students assistance programs shall be expanded and the awards raised in order to increase the number of beneficiaries especially among the disadvantaged sectors. Access to postgraduate

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education can be resolved by an increase in the government budget for scholarship grants to nurture talented individuals who are tapped to take on leadership positions in the future. Firms can opt to invest on higher education as part of their human resource development initiatives. Alternative delivery systems will be strengthened through the accreditation of HEIs offering Distance Education and Open Learning. The Expanded Tertiary Education Equivalency and Accreditation Program will be fully implemented. Competency standards will be upgraded and the quality performance of deputized HEIs will be maintained.

ON QUALITY AND EXCELLENCE The local colleges and universities shall offer quality undergraduate and graduate education programs with standards comparable with those offered by leading HEIs and network with global centers of excellence to help boost the curriculum. Other benefits may include faculty exchange programs or research collaborations both of which will expose faculty and students to new technology, skills and knowledge. Flagship programs will likewise be implemented while developing/strengthening institutions excelling in and focusing on specific disciplines. The HEIs will comply with the regional and international standards in selected programs like engineering, architecture accountancy and nursing education. Entry selection process will be put in place and a selection system/admission system established to ensure student readiness for college studies and improve survival and success at the tertiary level. Relevant faculty development programs will be implemented to enhance the qualification of teachers in higher education. Research and development and extension plans shall be prepared and HEI faculties will be encouraged and supported to undertake research and extension activities in identified priority areas and disseminate their research output. ON RELEVANCE AND RESPONSIVENESS The higher education system must take advantage of the opportunities provided by information and communication technologies (ICT) as a means of improving the opportunities of their students. ICT subjects shall be incorporated in the general curricula. Establish multi-stakeholder linkages to adapt a

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curriculum that will produce graduates according to the industry fit and students to benefit from industry experts through teaching arrangements or internships/apprenticeships programs. Program offerings that are critically required for national and regional development shall be prioritized. Graduates should be highly skilled in the areas of information technology, finance and engineering as well as equipped with proficient language skills for the global market demand and complemented with a strong culture of entrepreneurship and innovation.

ON EFFICIENCY AND EFFECTIVENESS Rationalization of program offerings to define clearly the roles, functions and appropriate program offerings of each type of institution. Specialized programs responsive to the needs of the region will be developed. The allocation of resources in higher education shall also be rationalized. Complementation and networking between and among public and private higher education institutions shall be carried out through the establishment of a local network of data/information exchange; sharing of expertise, facilities and other resources and implementation of collaborative multi-HEI projects and undertakings. Tuition and other school fees in SUCs will also be rationalized TARGETS 1. All SUCs shall be offering flagship programs that are in accordance with their mandates. 2. Five (5) percent of the HEIs will have distinct program specialization. 3. Fifty (50) percent of HEIs will have established networking arrangements by 2010. 4. All HEIs shall have formulated strategic plans. 5. One hundred (100) percent of the higher education sector shall be making use of ICT and the internet. 6. Five (5) percent of the HEIs will be developed into Centers of Excellence/ Centers of Development. 7. The percentage of faculty members with graduate degrees will increase to 50 percent.

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8. More than half of the HEIs will have collaborative projects with industry and placement programs that would ensure employability of graduates. 9. The number of beneficiaries of scholarship and student assistance program will reach more than half by 2010. 10. The number of deputized HEIs will increase to 20 by 2010. 11. The identified priority training needs of all SUCs and 30 percent of HEIs shall have been addressed.

MAJOR PROGRAMS AND PROJECTS 1. Curriculum Reform and Revitalization – the objective is to have a relevant and responsive curriculum based on revised policies and standards both in the undergraduate and graduate level. 2. Scholarship and Financial Assistance Program – includes the expansion of scholarship coverage for a wider access to quality tertiary education of disadvantaged sector. 3. Ladderized Education Program – a mechanism that allows students and workers’ progression between TVET and HEI or college and vice-versa. Specifically, it intends to create seamless and borderless education and training system that will allow mobility in terms of flexible entry and exit into the educational system. 4. Faculty Development Program – includes the provision of scholarship grant that seeks to upgrade the academic qualifications of tertiary faculty to masters and doctorate levels. 5. Expanded Tertiary Education Equivalency and Accreditation Program – a comprehensive assessment program that recognizes knowledge, skills, attitudes and values obtained by an individual from relevant work experiences and higher level non-formal and informal training towards the awarding of as appropriate degree. 6. Institutional Monitoring and Evaluation for Quality Assurances (IQuAME) – monitoring and evaluation of programs and projects of the HEIs in the region. 7. Center of Excellence Project – The centers of excellence

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SKILLS DEVELOPMENT The Macapagal-Arroyo Administration regards education and training as investments for human development that are indispensable in breaking the vicious cycle of poverty. One means to alleviate workers from the claws of poverty is through job generation through skills training. A growing number of people do not have the capacity to acquire formal education that will empower them to get decent jobs and lead a better quality of life. The role therefore of technical vocational education and training is important in addressing the priority agenda of creating jobs. Department of Education Secretary Jesli A. Lapus claimed that tech-voc is the best career option for many graduating high school students. The results of the National Career Achievement Examination (NCAE) revealed a high aptitude of high school students for technical-vocational programs. Reports show that Technical Vocational Education Training (TVET) suffers from a low status and image, since society perceives it as a dead-end and the last option among many parents and students. Students in the region prefer to take bachelors degrees than take TVET courses. There is a perception that technical courses are only for the less academically talented and low salary-blue collar workers. Overcoming the societal bias against TVET requires a proactive approach that will redound to immediate benefits to TVET graduates, like immediate employment in jobs where they are trained.

DEVELOPMENT CHALLENGES Technical Vocational Education Training (TVET) has proven to be a viable but cost effective alternative to higher education as shown by the increasing number of graduates in the various middle level skills development programs. Total TVET graduates are 98,244 representing a seven percent increase from 91,627 graduates in 2005. Majority of the graduates came from community

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based training programs (78 percent) while school-based TVET programs accounted for only five percent. Enterprise-based training programs and center-based training programs accounted for only thirteen percent and four percent, respectively. Compared to the MTRDP plan targets, both enrollment and graduates from TVET far exceeded these targets. The increasing number of graduates suggests an emerging social demand for TVET courses. The assessment and certification of TVET graduates’ performance likewise showed an improvement in the acquired competencies of workers according to quality standards defined by industry but this only constitutes thirty-nine percent of the total TVET graduates and workers assessed in 2006. In terms of student assistance, there is a relatively small percentage of the students receiving financial assistance. Although TVET students who benefited from the scholarship and financial assistance programs through PESFA (1,517) and TESDP (498) increased, this constituted only a small fraction (4 percent) of the plan target. Institutional reforms are being implemented to improve the quality of its outputs to match industry needs. Still TVET should strengthen its social marketing program to promote TVET as a viable occupational option and ensure the sustained engagement of the private sector, particularly in the priority industries in providing TVET services - validation of competency and training standards, curricula assessment and certification and enterprisebased trainings. There has been an increase in the participation of the private and industry sectors in the Technical Vocational Education Training. High out-migration decreased the pool of skilled manpower in the region thus creating the opportunity for TVET to train more. There is still the need to strengthen ladderized interface between TVET and higher education as an education system which will entail lesser cost for TVET graduates and rationalize response of local government units.

OBJECTIVES The following are the objectives for skills development: 1. Promote and enhance capability across sectors for gainful income and productive employment;

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STRATEGIES The interface between TVET and higher education shall be ladderized to provide the avenue for continued improvement without hampering the growth of students. The ladderized tertiary education system will allow certification or recognition of units gained in TESDA-registered technical-vocational programs for equivalent credits under programs recognized by the Commission on Higher Education (CHED). It will entail lesser cost for graduates who want to continue their training in higher education institutions. The participation of industries in training shall be strengthened. This will be through the dual system mode of training and education for workers in all areas while exploring other enterprisebased training systems. Enterprise-based trainings are essentially hands-on trainings that are done inside participating firms and companies to provide skills specific to a particular occupation that may not be fully provided in the classroom setting. The TVET system shall be improved. This will include standards and quality of programs to produce workers who are endowed not only with requisite skills and knowledge to match industry needs, the right attitude and work values but are likewise equipped with the appropriate talents and skills to address the demands for innovations that respond to the growing and ever changing needs of society. This would refer to the whole qualityassured TVET system within which quality systems, procedures and processes are worked out for the adoption of institutions and partners to ensure quality products and service delivery. The system involves the continuous development and review of training, assessment and certification processes to ensure adherence to industry-accepted norms and standards. Technical vocational education training institutions shall continuously be improved with better facilities, training materials and faculty.

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Job-skills matching shall be pursued with the assistance of the private sector. The Seek-Find-Train Framework shall be enhanced for the effective matching of skills provided by the labor market. Scholarship and other financial assistance programs shall be expanded to provide access to training opportunities for more TVET beneficiaries. The implementation of the Private Education Student Fund Assistance (PESFA) with other TVET incentive packages will be put in place to broaden access and equity to opportunities. These scholarship programs are not only for deserving students but also for faculty/trainer development and other deserving partner institutions. The implementation of technical-vocational education in public high schools shall be strengthened to ensure that the students develop the aptitude and skills needed to make them more employable. Social marketing of middle-level skills shall be aggressively promoted through regular career guidance in high school and clientele-specific information education and communication programs that would strengthen labor market information.

TARGETS 1. One hundred percent of local governments units will have at least one Community Based Training for Enterprise Development by 2010. 2. Ten percent of the total assessed workers will have been certified annually. 3. Ten percent annual increase in enrolment/graduates in TVET programs. 4. Two percent annual increase in the numbers of scholarships MAJOR PROGRAMS AND PROJECTS 1. School-Based Technical-Vocational Education Program formal technical-vocational courses from 1-3 year programs offered by schools. 2. Center-based technical-vocational education program provide skills to youth and clients to gain competencies needed by the industry or for self-employment offered by the regional/provincial training centers.

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Biological Disaster Management 3. Community based training program - skills development program implemented in partnership with local government units and other private organizations suited to the needs of the locality. 4. Competency Assessment and Certification program testing and certification system for skilled workers and graduates. 5. Private Education Student Fund Assistance (PESFA) scholarship program - sustained support program that caters to the financial need of TVET beneficiaries. It is designed not only for the qualified poor but for deserving students who are willing to pursue non-degree TVET courses. 6. Kasanayan at Hanapbuhay Program - a training and employment program that provides new entrants to the labor force the opportunity to acquire basic skills and work experience. 7. Registration of Programs/Courses under the UTPRAS compliance with minimum standards provided for in training regulations and anchored on competency-based system. 8. Technical Assistance and Capability Building for TVET Partners - Strengthening of TVET partners through capacity building programs. 9. Village Technology Project/Dangal ng Barangay Products - LGUs take the lead in identifying, developing and promoting specific products or services that have competitive advantage and supported by other government agencies.

HOUSING Housing contributes significantly to economic growth given its importance in generating employment and promoting entrepreneurial activities. It also promotes social and political stability by expanding the class of property owners who have a stake and interest in preserving our society. The impact of a vigorous housing program on the national economy is highly significant with its multiplier effects on other industries, especially

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on manufacturing and construction. It stimulates employment by enlarging the various activities of other service-related groups.

DEVELOPMENT CHALLENGES Housing for all. The sector delivered 9,787 units of housing assistance amounting to P1.240 billion for the period 2004-2006. This figure is lower than the housing output for 2001-2003 by 32 percent but is on track to achieve the housing target by the end of 2010. The housing output represents 51.4 percent of the housing target for the medium term. The focus during the period under review was on implementing Housing for All by providing Bicolanos an opportunity to acquire affordable and decent homes. Access to housing and land particularly for the informal sector was enhanced with the issuance of several presidential proclamations to provide security of tenure. The sector also provided employment through the major programs of the shelter agencies. Housing loans were made more available and affordable. Direct housing provision accounted for majority (76.6 percent) of the total housing output, followed by Community Mortgage Program (12.9 percent) and indirect housing provision (8.13 percent). Direct housing provision includes housing loans programs implemented by Pag-ibig Fund and the community-based housing programs of the National Housing Authority (NHA). The total value of its output for the three-year period is P1.034 billion. The Local Housing Program was the only housing program that achieved its medium-term target as early as 2004 and benefited 2,379 families. Institutional loans will most likely achieve its target (93.5 percent) in the mid-term. The rest of the housing programs will have to double efforts to attain the targets. The Emergency Housing Assistance Program of the NHA did not register any accomplishments because of lack of funds. On the other hand, the Department of Social Welfare and Development (DSWD) constructed 94 units of Core Shelter Housing and provided emergency shelter assistance to 1,184families. Housing loan was made more available and affordable for both the formal and informal sectors with the following measures:

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Biological Disaster Management 1. Adjustment in the ceilings on loan packages, thus: (a) Socialized Housing (P300,000 and below); (b) Low Cost Housing Level I (P300,000–P500,000); (c) Low Cost Housing Level II (P500,000-P1.25 million); (d) Low Cost; Housing Level III (above P1.25 million to P3.0 million); and (e) Open Housing (above P3.0 million). 2. Reduction in interest rates of Pag-ibig housing loans, to wit: (a) up to P300,000 – 6 percent; (b) over P300,000 to P500,000 – 7 percent; (c) over P500,000 to P1.0 million – 10.5 percent; and (d) over P1.0 million to P2.0 million – 11.5 percent. 3. Intensification of collection efforts for Pag-ibig fund members. Higher membership level means more funds available for housing. The sustainability of housing loan programs depends largely on the recovery of loans earlier granted. 4. Moratorium on GSIS housing loan payments for five months and on Pag-ibig housing loans for six months to provide relief for fund borrowers affected by the strong typhoons in 2006. 5. Short-term loan program made more available. Minor house repairs could be made through financing under short-term loans.

From the private sector, Gawad Kalinga (GK) contributed significantly in providing durable homes to the poorest Bicolanos. GK established 78 communities: 11 in Albay; 17 in Camarines Norte; 46 in Camarines Sur; and two each in Masbate and Sorsogon. It also provided other physical structures such as pathwalks and drainage systems, water and toilet facilities, a school, a livelihood center, a multi-purpose hall and a clinic. A Gawad Kalinga community is composed of about 60 – 100 families. Security of land tenure. In support of the Millennium Development Goal target to significantly improve the lives of slum-dwellers by 2020, President Arroyo issued several proclamations to address the tenurial problem of the urban poor and informal settlers in the region. Proclamation 40 involves 139 hectares of unutilized properties

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of the Philippine National Railways (PNR) in Albay and Legazpi City and is expected to benefit 4,800 families. At present, the City Government has purchased a portion of the property located in Looban, Barangay Peñaranda as a pilot area for socialized housing that will benefit 94 families. A Certificate of Entitlement for Lot Award or CELA was awarded to 81 families and 13 families are for validation by the local Awards and Arbitration Committee. Executive Order 90 declared the property of the Department of Public Works and Highways (DPWH) in Bulan, Sorsogon as a socialized housing site that will benefit 716 families. The masterlisting of beneficiaries was completed and CELA were granted to the beneficiaries. The local government conducted subdivision survey of the area and is awaiting approval by the Land Management Bureau of the DENR. Proclamation No. 593 covers two barangays in Pili, Camarines Sur—Caroyroyan and San Jose. The implementing rules and regulations is being finalized and actual survey is being conducted for the proposed delineation of areas and to determine the number and lot allocation for each agency beneficiaries. The property has a total area of 160 hectares and involves the following agencies/ offices: Camarines Sur State Agricultural College (CSSAC), Pili National High School, Provincial Government, Philippine Coconut Authority (PCA) and the Philippine Army (PA). Proclamation No. 653 covers a parcel of land in Barangay 2 - EM’s Barrio South, Legazpi City. The targeted number of beneficiaries is 157 families but this number may be trimmed down due to a Transco line that traversed the area which has a 69-KV right-of-way limit. Provision of essential facilities. The general low level of basic services or facilities available in many barangays and communities is a critical concern. There are still 207 barangays in the region that have no access to electricity in 2006, although this is an improvement over the 288 unserved barangays in 2005. The percentage of households with access to safe drinking water decreased slightly from 82.7 percent in 2004 to 82 percent in 2006 due to contamination of some water sources especially Levels I and II. Two water supply projects with a total cost of P151.445 million that were completed in Masbate in 2004 helped

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in improving the province’ access to safe water. These projects were completed through the Local Water Utilities Administration (LWUA) and generated a total of 3,378 service connections and benefited some 16,890 people being serviced by the MasbateMobo Water District and the Aroroy Water District. The proportion of households with sanitary toilets in the region slightly declined from 67.85 percent in 2004 to 64 percent in 2006 due to the lack of support for the construction of toilets in the local government units. A study of resettlement sites in Albay in 2004, however, showed that access road, potable water, sanitary toilets, drainage system, barangay health station and day care center were generally inadequate to serve the needs of the resettled families. Another concern that hampers the implementation of resettlement projects is the lack of livelihood activities to support the displaced families. Employment generation. The sector generated 78,415 jobs[1] through the implementation of housing programs by key shelter agencies. This represents 51.5 percent accomplishment and is on track to achieve the target for the medium term. Pag-ibig Housing Loan Program is the biggest employer among the housing programs accounting for 26 percent.

DEVELOPMENT OBJECTIVE The objective for housing is to meet the rapidly growing demand for affordable and decent housing from the formal and informal sectors and create employment opportunities through construction activities and ancillary services. STRATEGIES Making loans more available and affordable especially to the low income groups. The sector shall continue to provide more opportunities for Bicolanos to own affordable and decent housing and generate employment through housing construction in 20082010. It shall continue to implement Housing for All by making loans more available and affordable for the formal and informal sectors. The pension fund’s housing programs shall continue to be strengthened to respond to the housing demand of its members. Pag-ibig, GSIS and other government financing institutions/banks

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shall implement lower interest rates for housing loans and liberal restructuring program to enhance collection and create more funds available for housing loans. Establish a comprehensive LGU database for inventory of informal settersand beneficiaries of socialized housing and study possible issuance of identification cards for provision of LGU assistance. Regularize tenure of informal settlers. Present gains shall be sustained and access to housing and land particularly for the informal settlers and vulnerable groups shall be accelerated. The government shall provide priority assistance to those who are in danger areas, in right-of-way of government infrastructure projects and in idle government lands. In support of the MDG target of improving significantly the lives of slum-dwellers, the government shall complete the regularization of tenure of informal settlers covered under the presidential proclamations, provided these are within secure zones. Strictly implement LGU ordinances prohibiting informal settlers in high disaster risk areas and resettle those occupying these areas. To prevent loss of lives and damages to properties, local governments shall enact and strictly implement local laws that prohibit informal settlers in identified danger areas. Efforts shall be focused in the immediate term to help families affected by typhoons to rebuild their homes and communities. Existing resettlement areas shall be expanded and new ones shall be established. Identification of new or potential resettlement areas should be based on disaster risk assessment. Those in moderate risk areas can be regularized and provided with structural and non-structural mitigation measures. Those in low risk areas can also be regularized. Advocate for the creation of local Housing Boards and preparation/ updating of CLUPs. The sector shall continue to advocate to the local government units to assume full responsibility on housing and urban development. Priority areas of concern are the creation of local housing boards and comprehensive land use plans. The local housing boards shall, among others, formulate, develop, implement and monitor policies on the provision of housing, resettlement areas and shall uphold the right of the underprivileged and homeless to a just and human resettlement process.

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Promote greater participation of the private sector in housing delivery. The private sector shall be encouraged to take advantage of the growing demand for housing as the population continues to grow. The government shall make an effort to reduce and simplify further the number of days, processes and requirements for land titles, permits and licenses for housing and land development without compromising safety standards. To ensure quality and affordable housing units, appropriate standards for cost design and materials for housing shall be adopted. Promote development of new housing technologies at lower cost. The promotion and development of new housing technologies that can provide quality houses at the least cost shall be supported and non-traditional building and management technology in housing production shall be encouraged. Strengthen partnership and collaboration with housing stakeholders. The government shall strengthen partnership and collaboration among key shelter agencies, government financing institutions and the private sector. The business community, particularly the private developers, shall continue to be encouraged to invest in the housing market. Regular consultation with stakeholders. The Housing and Urban Development Coordinating Council (HUDCC) shall undertake regular consultations with all stakeholders to strengthen the coordination and supervision of policy on shelter delivery, finance and regulate housing and urban development services.

TARGETS 1. 12,689 units of housing assistance through the major programs of key shelter agencies under the Housing for All Program. 2. Development of 10 new resettlement sites and expansion of five existing ones to benefit 33,748 families and housing materials assistance to 24,000 families who are victims of disasters. 3. Complete the regularization of tenure of families covered by all the presidential proclamations. This will benefit 3,114 families.

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4. Gawad Kalinga shall undertake the establishment of 20 additional GK communities while Habitat for Humanity shall construct 564 housing units and repair/renovate 832 homes destroyed by the recent typhoons. 5. Generate 98,289 jobs.

MAJOR PROGRAMS AND PROJECTS 1. NHA-Administered Resettlement Program (CARE Fund) involves the acquisition and development of raw lands into homelots or core housing units for families displaced from sites earmarked for government infrastructure projects and those occupying high disaster risk areas and for families permanently displaced by natural calamities. 2. Resettlement Assistance Program for LGUs. NHA assists LGUs in the development of their resettlement sites. LGUs’ primary contribution is land while NHA provides funds to cover the cost of land development. 3. Housing Materials Assistance Program(CARE Fund) involves the provision of housing materials for house repair and construction for families affected by natural calamities in all provinces of Bicol Region. 4. Community Mortgage Program assists and enables informal settlers, slum dwellers or residents of blighted areas to purchase the privately-owned lands they occupy or they wish to be relocated to through their registered community associations. Under this program, the residents can purchase the land under the concept of communal ownership. 5. Pag-ibig Housing Loan Program involves financial assistance to member-borrowers for: house construction; purchase of a lot; purchase of a lot and construction of a house; purchase of a residential unit; home improvement;refinancing of an existing loan; or acquisition of Pag-ibig-acquired properties 6. Institutional Loans involves the provision of developmental loans to provide funding sources for the horizontal and vertical developmental projects. It can be availed of directly from Pag-ibig Fund.

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Biological Disaster Management 7. Community Based Housing Program involves the mobilization of community resources in solving land tenure issues and site development through slum upgrading, community mortgage program, community land acquisition support program and land tenure assistance program. 8. Medium Rise Housing is an in-city housing which entails the construction of three-to five-storey buildings. The Medium Rise Public Housing Program is implemented directly by NHA, utilizing the allocation for the Program under RA 7835 and units are made available under lease arrangement. The Medium Rise Private Housing Program, on the other hand, is implemented directly by NHA or in joint venture with other government agencies and/or the private sector. 9. Core Shelter Assistance Program involves the organization of disaster victims and formation of work teams which shall build core shelter units that can withstand 180 kph wind velocity, and earthquake of moderate intensity and other similar natural hazards. 10. Gawad Kalinga Shelter and Site DevelopmentProgram builds colorful, durable and secure homes for the poorest of the poor. It also provides other physical structures such as pathwalks and drainage systems, water and toilet facilities, a school, a livelihood center, a multi-purpose hall and a clinic. 11. Habitat for Humanity House Rebuilding/Renovation Program builds and rehabilitates simple, decent houses with the help of homeowner’s families, volunteer labor, and donations of money and materials. Habitat houses are sold to homepartner families at no profit. Homepartners repay through affordable, zero-interest, inflation-adjusted mortgage loans.

SOCIAL WELFARE Economic development is not merely achieving a high growth rate in gross domestic product, it is also the cultivation of selfreliance and the full development of the potentials of an individual.

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A major task is to ensure that economic growth is shared by all through the distribution of the fruits of development among the citizenry particularly the marginalized sectors of society. Prevailing economic difficulties have rendered more people vulnerable to social dislocation resulting to a growing number of individuals who are unable to provide for their own needs. Diminished real income and increasing unemployment have adversely affected the welfare of the disadvantaged individuals. For the disadvantaged sector, access to components of better living conditions depends to a great extent upon the availability and quality of government social welfare programs. The social welfare program is principally involved in developing attitudes and skills and providing opportunities that will make the disadvantaged sector creative and productive as well as socially responsible and active members of the community.

DEVELOPMENT CHALLENGES Social welfare and development programs in the region are focused on those marginalized by various circumstances due to their disadvantaged position. These include children, streetchildren, youth offenders, women, elderly, persons with disabilities, indigenous people and disaster victims. The past two years saw the intensified implementation of propoor programs in consonance with the MTRDP and the ten-point agenda of the present administration and responding to the challenges brought about by disasters. However, most of the poor are still unable to access or benefit from government programs on health, livelihood, credit and public infrastructure. There is the pressing need to address the issue of inadequate family income, the parents’ lack of effective access to credit and employment opportunities and the dependence of some families on child work to augment their income.

Institutionalizing Empowerment of the Poor The years 2005-2006 saw the expansion of the World Bankassisted project, the Kalahi-CIDSS Kapangyarihan at Kaunlaran sa Barangay (KKB). It was piloted in Batuan, Masbate and reached out to 25 municipalities with 647 barangays and 55,859 households.

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Beneficiaries and local government units contribute about 40 percent of the total costs of the community projects. The project has also mobilized community volunteers who were trained on participatory analysis, project development, financial management and procurement, advocacy and fund sourcing, organizational development and project operations and maintenance. The most common implemented projects are barangay roads, foot bridges, day care centers, water supply systems, barangay health stations, 2-classroom elementary school buildings and livelihood projects. These projects were identified and implemented through a community driven approach with an open menu of subprojects based on the needs and wants of the community. In 2006, a total of 141community projects have been constructed in the region with a total cost of Php 156 million. The success of KALAHI-CIDSS KKB brought about the partnership between DSWD and Agencia Española Cooperacion International (AECI) and implemented the Poder Y Prosperidad De La Communidad project in the municipalities of Manito and Malinao in Albay. A total of 41subprojects were implemented amounting to P126 million with P13 million as grant from AECI. One of the main programs found effective in augmenting income and which contributed to the improvement of the individuals’ and families’ welfare is the self-employment assistance (SEA-K) program. It provided opportunities for clients to engage in income generating projects. In 2006, DSWD was able to provide funding assistance to 70 SEA Kaunlaran Level 1 Associations (SKA) surpassing the plan target of 40 SKAs with a total fund release of Php4.88 million. Five groups composed of 205 family members have availed of the SEA-K level 2 amounting to P3.028 million. There are 658 functional SKAs with 15,018 memberfamilies exceeding the plan targets. However, the implementation of the SEA-K, being the only welfare-oriented government livelihood program, needs to be revisited to prepare beneficiaries to eventually avail of credit from existing micro-finance institutions at market rates. Efforts were made to mainstream micro-finance by providing credit to the poor by granting funds to NGOs engaged in microcredit. Providing credit to the poor through micro-finance

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institutions has been an important component of the government’s poverty alleviation programs. There is however low availment of training programs, livelihood funds and entrepreneurial development.

Improving Access of the Vulnerable Groups to Social Protection A total of 1,834 individual clients were served by DSWD through its retained community-based programs and services and operation of residential and non-residential centers and institutions. There has been a reported increase in the incidence of violence against children. DSWD reported and provided protective and rehabilitative services to 166 children, 47 cases of which are sexual abuse and 49 cases were on children in conflict with the law. For 2006, DSWD in partnership with LGUs and NGOs extended relief and rehabilitation services to a total of 353,613 displaced families who were victims of Mount Mayon and Mt. Bulusan eruptions and three major typhoons that hit the region last year. The total funds released to assist these families amounted to P82.5 million. Food subsidy consisting of one kilo of ironfortified rice was provided for every daily attendance of a child in day care centers. A total of 49,371 children in 1,394 day care centers covering 49 municipalities and one city were served. The project is funded by the DSWD and the President’s Social Fund. The National Commission of Indigenous Peoples (NCIP) provided indigenous peoples greater access to basic services. It implemented services ranging from small-scale infrastructure, health and nutrition services, alternative livelihood, cultural and non-formal education assistance. The elderly and the differently abled persons continue to have poor access to health and social services as well as opportunities for income generation and special education.

OBJECTIVES The objectives for the improvement of social welfare are: 1. To increase access, develop the capability and improve the quality of life of the marginalized sector giving emphasis to those with special needs like the disadvantaged and

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STRATEGIES The strategies to improve social welfare are: 1. Promotion of self-employment programs and assistance to small and micro-enterprises. 2. Expansion of micro-credit services and provision of seed capital and capability building. 3. Enable LGUs to empower communities to address their minimum basic needs through the convergence approach with focus on the poor communities, disadvantaged, and indigenous peoples’ communities. 4. Strengthen linkages and coordinative mechanisms among government agencies, non-government and people’s organizations and civil society to enable them to contribute productively and bring about a more efficient and effective delivery of services. 5. Strengthen the capacity of LGUs and the communities to improve preventive and rehabilitative assistance services to cope with effects of disaster/calamities. 6. Promote among LGUs, government agencies and private institutions the laws covering the rights and welfare of the elderly and persons with disabilities and monitor the implementation of the Senior Citizens Act and Accessibility Law. 7. Develop the database for monitoring the situation of the poor and vulnerable groups at the local level and harmonize them with the monitoring systems for social development interventions at the national and sub-regional levels. MAJOR PROGRAMS AND PROJECTS 1. Self-Employment Assistance Program – community-based credit assistance program utilizing people’s organization,

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the SEA Kaunlaran Associations as credit conduits and includes capability building opportunities. Community-Based Protective Services – protective and rehabilitative services provided to children with special needs, women in specially difficult circumstances, older persons and persons with disabilities. Center-Based Protective Services – provides 24-hour residential care on a temporary basis to individuals whose needs cannot be met by their own families. Shelter Assistance Project - provides shelter assistance to those rendered homeless by natural or man-made disasters. Food for School Program – provision of one kilo iron fortified rice for every daily attendance of the child in the day care center. Tindahan Natin – provides access to basic foods at affordable prices. KALAHI-CIDSS KKB – aims to empower communities, improve local governance and provide economic opportunities. Poder Y Prosperidad del Communidad - a community driven development program being funded by the Spanish government through the Agencia Espanola Cooperacion International (AECI). Disaster Relief and Rehabilitation – provision of relief and rehabilitation services to individuals and families who were victims of man-made and natural calamities.

LABOR WELFARE AND PROTECTION As economic development proceeds, employment becomes the major source of economic support for the majority of workers and their families. Improving operations in the labor market, managing to create jobs for workers and ensuring their social protection are important strategies to reduce poverty, improve human capital and address gender inequalities. The government has an important role to play in protecting workers’ welfare in terms of social assistance and welfare service programs for the vulnerable groups, social safety nets, micro and

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area-based schemes and child protection measures for child workers.

DEVELOPMENT CHALLENGES Employment Generation for Marginalized Groups. At least 2,762 students under the Special Program for the Employment of Students (SPES) were provided with employment in 2004. Clientele coverage increased to 2,720 students in 2006 and forty people with disabilities. To provide employment in the poor communities, new agribusiness lands were developed in 2005 generating 19,922 jobs for agricultural commodity-related activities. Livelihood projects generated jobs and increased income for: (1) 25 rural workers under the Poverty Free Zone Project; (2) 24 families under the Community Livelihood Assistance Project; (3) 80 farmers and fisher folks who were trained in seaweed farming and 464 coconut farmers. The Self-Employment Assistance Kaunlaran (SEA-K) Level 1 associations numbering 607 consisting of 13,991 families were provided with a seed capital of P5.6 million. The SEA-Kabayan provided 491 families with capability and entrepreneurial skills training and a seed capital of P17.7 million for various livelihood projects. Employment Facilitation. To ease the unemployment problem, the government, under the PESO Local Employment Program solicited an increasing number of job vacancies from 14,802 in 2004 to as high as 59,155 in 2006. However, the percentage of registrants and those referred compared to the number of job vacancies available showed a fluctuating trend, reflecting an increase of 5.6 percentage points from 2004 to 2005 and suddenly going down by 17.8 percentage points in 2006. In job fairs, there was also a significant slowing down in terms of those hired from 82.7 percent in 2004 to 8.5 percent in 2007. The low level of employment during job fairs reflects the mismatch of skills of workers and the job opportunities provided, hence the need for continuous skills advancement and training to enhance potentials of the Bicolanos. There is also a need to study and review curricular offerings to meet the demand in labor force.

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Hiring under contracts of services and job orders is being practiced by the government for services related to or incidental to the hiring agency’s functions and operations. These include janitorial, security or consultancy services for a specific period of time not exceeding six months. As a safeguard measure, the agency and the worker enter into a memorandum of agreement which stipulates remuneration not less than the applicable minimum wage rates and conditions for services rendered. In the case of local governments, emergency or casual employees or laborers paid on a daily wage or piecework basis are hired through job orders for local projects. These workers receive at least the applicable minimum wage rates. Employment Preservation. The labor environment in the region was generally peaceful for 2004-2006. Mutual support and social protection were encouraged to improve working conditions through the registration of 68 workers’ associations and 9 unions. Seven collective bargaining agreements were registered. The DOLE conducted labor education seminars for unionized and non-unionized establishments covering 2,384 workers The DOLE conducted labor education seminars for unionized and non-unionized establishments covering 2,384 workers to minimize friction between management and labor. No mediation-arbitration cases were undertaken. The Regional Tripartite Wages and Productivity Board issued Wage Order No. RBO5-11 in August 2006 to rationalize wages. The new minimum wage rates for the cities of Legazpi and Naga range from P185 to P220 per day for the non-agricultural areas and P178–198 per day for agricultural. Wages range from P173213 for the towns of Pili and Daraga and the cities of Iriga and Tabaco, and P168-208 for all other areas. This is an improvement of the daily minimum wage rate in 2005 which were: P169-209 for non-agricultural workers; P177-187 for agri-plantation workers; and P157-166 for non-plantation workers. Wage Order No. RB05 encourages businesses to adopt productivity improvement schemes such as time and motion studies, good housekeeping, quality circles, labor management cooperation and gain-sharing programs. An information drive dubbed as the Pagpapatupad ng Wasto at Itinalagang Sahod

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PAWIS project was conducted to disseminate the new wage order through TV, radio interviews and dialogues. In the agriculture sector, part of social protection services for the labor force is the availability of agricultural insurance for crops in five insurance lines – palay, corn, livestock, high value crops and agri-assets. An increase of 151 percent was noted in the total claims paid for 2,261 farmers compared to 2004. A new product line was introduced consisting of accident and dismemberment security scheme, agriculture producers’ protection scheme and loan repayment protection plan. It intends to expand coverage and address the insurance needs of the target sector. Meantime, while RA 7658 prohibits the employment of children below 15 years of age, child labor still persists in the region. There were cases of child labor in mining and quarrying in Camarines Norte and Masbate, agricultural plantations, fishing, prostitution, and traffic management in road construction sites. The government in collaboration with the International Programme on the Elimination of Child Labor (IPEC) has implemented action programs against child labor to address the problems of child workers exposed to hazardous environment. Activities included awareness raising on the plight of child laborers, employment and income-generating programs for parents and other adults, training, microfinance and other credit schemes and establishment of small industries in the community. Direct assistance to children and their families included provision of financial support to schools through scholarships, non-formal or alternative learning programs and remedial lessons to children. Employment Enhancement. In 2004, a new Labor Standards Enforcement Framework was implemented to promote a culture of safety and health, self-regulation and voluntary compliance to labor standards and productivity. Of the 379 establishments inspected, 60 percent complied with the standards. By 2006, however, only 49 percent complied with the general labor standards. This implies the need to disseminate information and monitor the compliance to the Labor Standards Law. There were 1737 establishments inspected, about 20 percent were found complying with general labor standards and 30 percent complied with technical safety standards.

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Enhanced employment opportunities for groups with specific needs were undertaken during 2004-2006. This consisted of trainings on technical and business skills to undertake entrepreneurial activities. The Work and Technology Improvement in Small Enterprises (WISE) was introduced to assist small and medium scale enterprise workers improve their own working conditions and productivity. A total of 443 participants were trained in 2006. Under the Promotion of Rural Employment and Entreneurship Development (PRESEED), 100 beneficiaries were given trainings while under the Women’s Enterprise Development (WEED), there were 72 participants trained. Under the Sugar Amelioration Program, a total of P2.9 million liens collected benefited 7,473 sugar workers in 2004. In 2005, P2.1 million were distributed to 7,216 sugar workers and by 2006, this reached P2.14 million benefiting 7,554 workers. The Kasanayan at Hanapbuhay Program (KasH) was initiated to afford new graduates and young workers with the opportunity to acquire job-specific trainings from selected industries. There were 39 beneficiaries in 2006. Social protection services for the informal sector workers include coverage by the Social Security System (SSS) for death, retirement and disability. For sickness, injury, disability or death due to work-connected contingencies, a package of benefits were provided by the Employees Compensation Program (ECC) for public and private sector employees and their dependents. These include psychosocial counseling services, medical help and assistance in filing and receipt of claims, provision of vocational skills and entrepreneurial training and other assistance that will allow occupational-disabled workers to find employment/selfemployment or to set up a micro-enterprise or home-based witness. For overseas workers, the government has provided for insurance and health care program services, credit, education and training and on-site services. A total of P680,000 was released for life insurance and burial benefits while P7,500 was for disability claims. Pre-departure orientation seminars were also conducted with 57 participants in attendance. Family welfare, education and livelihood assistance were given to the families of workers.

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There were 21 OFW organizations maintained with 516 members. Nine livelihood projects amounting to P1.45 million were given to 45 beneficiaries. Ten scholars have been maintained under the Education for Development Scholarship Program and 4 scholars under the Congressional Migrant Workers Scholarship. For the plan period, the region is still faced with issues on: (1) unsustained efforts for job generation among special groups; (2) poor absorption of labor force in the labor market; (3) increased underemployment; (4) diminishing job productivity; (5) low quality of employment and (6) decreasing income levels.

OBJECTIVES AND TARGETS The following are the objectives to improve labor welfare and protection: 1. To generate more jobs for the marginalized groups. a. Vulnerable groups shall have been assisted with skills trainings, to increase in coverage by 10 percent annually until 2010. 2. To improve the level of living for the gainfully employed, unemployed and underemployed. a. Technical and vocational training shall have been provided to workers, with a yearly increase of 10 percent coverage. STRATEGIES 1. Strengthening of micro-financing and provision of credit assistance to small and medium scale enterprises and farming communities. 2. Formulation of social insurance, social assistance and welfare services programs to cushion risks associated with unemployment, particularly of the vulnerable groups. 3. Promotion of micro insurance and agricultural insurance schemes to address major community risks such as natural calamities and man-made disasters. 4. Intensification of tie-ups and participation of the LGUs, the private sector and the academe for programs that would impact on employment creation, improvement of worker’s’ welfare and poverty reduction. In particular,

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linkaging with the Export Processing Zone Authority (EDZA) shall be forged by DOLE and TESDA for matching of needed skills in industries. 5. Provision of child protective services to assist families with youth workers.

MAJOR PROGRAMS

AND

PROJECTS

Employment Generation 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Special Program for the Employment of Students (SPES) Work Appreciation Program (WAP) Tulong Alalalay sa Taong May Kapansanan (TULAY) Kasanayan ant Hanapbuhay (KASH) Promotion of Rural Employment thru Self Employment and Entrepreneurship Development (PRESEED) Poverty Free Zone Family Welfare Program Working Youth Center Informal Sector and Workers Microfinance Program National Program Against Child Labor Social Amelioration Program WEED

Employment Facilitation 1. 2. 3. 4. 5. 6. 7. 8.

PESO Local Employment Job Fair PRA/SRA Career Guidance Local Employment Regulations Alien Employment Service Registration of Job Labor Market Information

Employment Preservation 1. Workers’s Organization Tripartism and Empowerment Promotion Services

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Dispute Prevention and Settlement Services Small Money Claims Quick Response Team Conduct of consulations, dialogues and conferences

Employment Enhancement 1. Standard Setting and Enforcement Program 2. Labor Standard Cases

Programs,Benefits and Services for Overseas Workers 1. Insurance and Health Care Benefits 2. Credit Program for OFWs 3. Education and Training Benefits • Skills for Employment Scholarship Program • Education for Development Scholarship Program • Seafarer’s Upgrading Program 4. Social Services and Family Welfare Assistance • Repatriation Program • Reintegration Program 5. Worker’s Assistance and On-Site Services DISASTER RISK MANAGEMENT The starting point in disaster management is to understand what disaster risk is all about. Risk is an effect of the interplay of hazard, vulnerability and capacity. It is important to consider hazards, vulnerabilities and capacities of people and societies in understanding disaster and risk scenarios. Natural phenomena become hazards only when they pose a threat to persons and property. Natural hazards only result in a disaster if they coincide with vulnerable conditions. It is not only hazards which cause disaster but also the political, economic, social, geographical location and environmental context. A disaster happens when a hazard impacts on a vulnerable population and causes damage, casualties and disruption. Researches show that the causes of disasters are closely associated with unsustainable development patterns, which increase the risks faced by large sectors of society.

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Due to the many challenges in addressing disasters, there had been a growing recognition for shifting the paradigm from emergency management to disaster risk management. Successful disaster management is firmly rooted in good governance which supports national and sub-national systems to focus on reducing risk in all sectors and at all levels and disaster management. It is aimed at reducing the negative impact on economic growth and society’s quality of life.

SITUATIONAL ANALYSIS Hazards. The Bicol Region is subject to sudden natural hazards (e.g. floods, landslides, earthquakes), slow-onset hazard (e.g. typhoon, drought,volcanic eruption) and biological hazards (e.g., avian flu, rice black bug, brontispa bug and epidemic). Bicol lies near the center of the Philippine Fault Zone along the China Sea which is a major earthquake generator in the Philippine archipelago. It is about 1,300 kilometers long and has a bundle of parallel to sub parallel active faults. Another major source of earthquake is the Philippine trench. Dangerous effects of earthquake are seismic sea wave or tsunami, landslides, liquefaction, structural failure and fire and explosions. The region experienced two major earthquakes, the Ragay Gulf earthquake (17 March 1973) and the Masbate earthquake (15 February 2003). The Ragay Gulf earthquake greatly affected the Quezon province and wrought damages to roads, railroads and bridges that hampered the travel to and from Bicol. The Masbate earthquake, with a maximum Intensity 8, was generated along the Masbate segment of the Philippine Fault Zone in Central Philippines. The earthquake totally damaged houses and severely damaged roads, school buildings, bridges and river flood control projects in the province. The presence of Mt. Mayon (Albay), Mt. Bulusan (Sorsogon), Mt. Isarog (Cam. Sur) and Mt. Iriga (Iriga City) pose hazards from volcanic quakes, pyroclastic flow, mud & debris flow, ash falls, tephra falls & lava flows. Mt. Mayon and Mt. Bulusan are the most active and their eruptions have caused disturbance in the socioeconomic growth and even the physical landscape of their surrounding areas.

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The region has experienced destructive tropical cyclones/ typhoons. Most of these occurred during the period October to January and have a wind velocity greater than 117 kilometers per hour. The El Niño and La Niña phenomena greatly affect the region’s agricultural productivity, aggravating the poverty situation in the region. Biological hazards such as rice black bug and brontispa bug have adversely affected the region’s rice and coconut crops respectively. Other biological hazards that may affect Bicol are the avian flu and foot and mouth disease. Vulnerability. All provinces are vulnerable to floods, landslides, typhoons, fire, El Niño and La Niña, red tide and epidemic. Vulnerabilities to other hazards are: 1. Volcanic eruptions in Albay and Sorsogon with Mayon and Bulusan volcanoes respectively; 2. Oil spill in Albay with the presence of industries along the coast; 3. Mine tailings in Albay, Camarines Norte and Masbate where mining for metallic minerals occur; 4. Brontispa bug in areas planted to coconut; 5. Rice black bug in areas planted to rice;and 6. Avian flu in areas visited by migratory birds.

CAPACITIES OF PEOPLE AND SOCIETY Government institutions that have been put in place to address disaster management concerns are the disaster coordinating councils from the barangay to the regional levels. The capability of these councils vary according to the nature of its organization, work program and budgetary allocation, extent of experience on disaster management and political will to mainstream disaster risk reduction in local government activities. Most of their activities are on disaster response with very little disaster preparedness and post-disaster activities. Moreover, these councils are not stable as they have to be reorganized every election period and are activated during calamities. Likewise, local government units have offices or committees in charge of disaster management with varying capabilities. Many

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LGUs’ Executive and Legislative Agenda (ELA) do not include disaster management. Among the provinces, only Albay has established a Provincial Disaster Management Office (PDMO). Other provinces have at least one staff assigned to coordinate disaster response activities with other departments. The capabilities of institutions such as Philippine Atmospheric, Geophysical and Astronomical Services Administration (PAGASA), the Philippine Institute of Volcanology and Seismology (PhiVolcs) and other agencies for disaster preparedness are still inadequate to provide accurate forecasts. PAGASA is relatively adequate for wind forecasting but inadequate for rainfall forecasting. Dissemination of information to communities is limited to radio stations. Failure of communication occurs when there is power outage because most receiver radios are ran by electricity. PhiVolcs has mapped the active faults and volcanic hazard maps but these are still macro maps and have to be further scaled up to lot or parcel level to accurately identify population at risk. Front line agencies have the technical capability for disaster response but lacking in equipment on early warning, weather forecasting and earthquake monitoring. The Mines and Geosciences Bureau (MGB) has an ongoing project on hazard assessment. The output of the project is a 1:50,000 scale geohazard (landslide, flood, ground subsidence) maps. It has completed about 60 percent of the municipalities and cities. A separate project covering Camarines Norte conducted by the central office of MGB is complete. The MGB has conducted utilization workshops on the hazard maps in six barangays. On disaster response,concerned institutions performed their mandated functions (e.g., organized task forces for the safety of the affected families). Government agencies and organizations in charge of search and rescue operations are wanting of equipment and gadgets for immediate and more effective operations. On disaster relief operations, there were cases of under and over coverage of beneficiaries due to the lack of coordination among government agencies and non-government organizations. The following are the challenges in disaster management: 1. Economic growth has to be achieved even with the presence of disaster risks.

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Biological Disaster Management 2. The timeframe between the identification of an impending disaster and organizing an appropriate action by the communities should be shortened. 3. Lasting and profound improvements have to be achieved in reducing the level of disaster risk to which the majority of marginalized population groups are exposed. 4. Barangays, being the location of population at risk, have to be involved as active participants in disaster management. 5. The political will must be established to sustain new disaster risk management policies.

DEVELOPMENT OBJECTIVE Disaster risk management in the Bicol development plan aims to improve capacities of institutions involved in disaster risk management in the areas of pre-disaster, disaster response and post-disaster activities. STRATEGIES A. Communities will be educated on disaster mitigation, preparedness, response and recovery. Provinces will conduct hazard assessment and disaster management plan formulation workshops, trainings and information dissemination on disaster preparedness and disaster monitoring and reporting for barangays. Communities shall establish community-based warning systems that shall be known by all households. B. Capabilities of local government units will be enhanced through: 1. Build-up of geographic information systems (GIS) database for comprehensive land use planning with conscious consideration of disaster risk management; 2. Formulation of comprehensive local development plans which are in accordance with the planning guidelines and standards and to include cost effective risk reduction strategies, i.e., establishment of relocation sites with facilities for residents in high disaster risk zones;

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3. Enforcement of land use ordinances and settlements regulations by the LGUs especially those in identified hazard prone areas. a. LGUs shall ensure that applications for building and business permits have complied with the standard requirements of the DPWH, BFP and other agencies concerned. b. Disaster risk zones shall be delineated based on geohazard maps and settlements policies will be enacted: • High risk zones: These will be prohibited from new investments while existing resources will be relocated, including settlements. • Low to moderate risk zones: These will be provided with structural mitigation for maximum protection. • Safe zones: These will be considered as space for new investments both by the government, business and private sector. 4. Institutionalization of a public safety and emergency management office in all provinces, cities and municipalities; 5. Capability building of local disaster coordinating councils; 6. Activation of local price coordinating councils; and 7. Institutionalization of the UN Cluster Approach to disaster risk management. C. PAGASA, PhilVolcs, and other relevant agencies shall improve their technological monitoring and information dissemination system including the integration of such with a regional or worldwide system. Other reliable sources of information in the internet may be culled in cases when official information is not yet available. D. The response of national, local governments and private sector organizations in the event of a disaster, through the disaster coordinating council network, shall be strengthened. The regional/local disaster coordinating

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Biological Disaster Management councils shall take the lead in delineating the roles of and coordination among stakeholders (individuals, communities, local government units, national government agencies and civil society organizations). E. The Department of Education (DepEd), in coordination with LGUs, shall construct multi-purpose evacuation centers in schools safe from hazards. F. The Department of Interior and Local Government (DILG), in coordination with the DBM, shall include management of the calamity fund as one of its topics for advocacy with local government units. G. The Regional Disaster Coordinating Council (RDCC) shall formulate disaster preparedness, response and recovery guidelines for high disaster risk circumstances (i.e., typhoons, floods, lahar flow, volcanic eruption, fire, biological hazards). It shall coordinate a yearly conference of stakeholders in disaster risk reduction in the region.

POLICY RECOMMENDATIONS 1. Strengthen institutional framework by creating a permanent disaster management office in provinces, cities and municipalities as part of the Local Government structure. 2. Line agencies involved in disaster management (e.g., BFP, AFP, etc.) be provided with a regular disaster calamity fund. 3. PAGASA at the regional level shall be strengthened by capacitating it in providing ttimely information on climaterelated hazards. 4. The guidelines for the use of calamity funds be revised to define pre-disaster activities for which the calamity fund may be used and include provisions that will protect the fund from abuse. 5. Institutional strengthening of PAGASA and PhiVolcs especially in their technological capacity to provide early and accurate warning or forecasts. 6. Harmonization of guidelines on pre-, during and postdisaster response.

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7. DRM-enhanced local and regional development and physical plans. 8. Include the development of geohazard tools and geohazard maps and their periodic updating under the strategies. Review policies specific to the development of high, moderate, low, and safe areas. Title 1. Geoh a za r d Su r vey a n d Assessm en t Ma sba t e, Ca t a n du a n es a n d cit ies 2. Geoh a za r d Awa r en ess a n d Disa st er P r epa r edn ess Advoca cy

3. Com m u n it y Ba sed Disa st er Risk Ma n a gem en t P ilot P r ogr a m

4. Reh a bilit a t ion of Typh oon a n d Volca n ic E r u pt ion a ffect ed Ar ea s

D e s c ri ptio n Th is is a pr oject of t h e Min es a n d Geoscien ces Bu r ea u a im ed a t a ssessin g t h e vu ln er a bilit y of com m u n it ies t o geoh a za r ds. Th is in clu des su r vey a n d pr odu ct ion of geoh a za r d m a ps in 1:50,000 sca le.

Th is is a pr oject of t h e Min es a n d Geoscien ces Bu r ea u a im ed a t cr ea t in g a wa r en ess of com m u n it ies on t h eir vu ln er a bilit y t o geoh a za r ds. Th is in clu des dissem in a t ion of h a za r d a dvisor ies t o ba r a n ga ys, ca pa cit y bu ildin g t h r ou gh sem in a r wor ksh ops for ba r a n ga y a n d m u n icipa l officia ls a n d a wa r en ess of geologica l h a za r ds via t r im edia . Th is is a pr oject t o be im plem en t ed by t h e AP SE MO in cooper a t ion wit h t h e Office of Civil Defen se, Asia n P r epa r edn ess Cen t er a n d t h e loca l gover n m en t u n it of Ca m a lig, Alba y. It will in clu de t h e en h a n cem en t wit h disa st er r isk r edu ct ion of t h e Ca m a lig com pr eh en sive la n d u se pla n a n d com pr eh en sive developmen t pla n a n d t h e im plem en t a t ion of a com m u n ica t ion a n d wa r n in g syst em . Th is is a pr oject of t h e Dept . of Agr icu lt u r e RF U 5 for t h e r eh a bilit a t ion of t h e a gr icu lt u r e sect or wh ich in clu de: pr ovision of pla n t in g m a t er ia ls, r eh a bilit a t ion of da m a ged fa cilit ies, a dvoca cy, edu ca t ion a n d t r a in in g a n d m on it or in g a n d coor din a t ion .

SUSTAINABLE DEVELOPMENT Sustainable Development as defined by the World Commission on Environment and Development (WCED), and the Brundtland Commission means “meeting the present needs without limiting the ability of the future generations to meets their own needs”. It ensures that economic development should support the natural systems of the environment for the current and future needs. The Philippine Agenda 21 was formulated in response to the government’s commitment to the earth summit in 1992. Contained in the document is a development strategy to achieve and maintain economic growth without depletion of natural resources and

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degradation of environmental quality. Development is anchored on an area and ecosystem based approach. Since then, policies, regulations and guidelines were provided for the protection, conservation and management of the environment and natural resources geared towards attaining sustainability for economic development. It is in this development framework that the region will pursue to attain a better quality of life for all Bicolanos while ensuring environmental quality in the long run. ANALYSIS Poverty can be associated with the quality of the environment of the people. The quality of life is low when the quality of the environment is low because its natural resources can no longer support the life and livelihood of the people. It is always a pattern that if the resources are already depleted, people will move out to seek better economic opportunities and better environment. Whenever we look at environmental conditions of an area, one cannot depart from taking a glimpse on its economic status. In 2006, Bicol ranked as the fourth poorest region in the country in terms of poverty incidence with 40.6 percent of its families or 48.5 percent of its population considered as poor. The region is thickly populated with population density of 265 persons per sq. kilometer, higher than the national average of 255 persons per sq. kilometer. The average household size of 5.24 is also higher than the national average of 5.0. Population growth based on the 2000 census is 1.68 percent. The per capita GRDP of P6,632 in 2005 is the second lowest in the country. The services sector contributed 44.1 percent, agriculture, fisheries and forestry contributed 33.5 percent, and industry with 22.4 percent. The forestry sector showed a negative average growth of 12.4 percent from 2003 to 2005, therefore, not contributing to the economy of the region. The region’s forest cover is 2.18 percent of the Philippines’ forest cover. Forestland to alienable and disposable land ratio is 69:29, far below the ideal ratio of 60:40. In 2003, the region’s forest cover comprised 32.4 percent old growth, 57 percent residual and 8.2 percent mangrove. With typhoon Reming that devastated the region in November 2006, this forest cover is expected to decrease.

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Forest development, reforestation of degraded areas, support to upland communities through the issuance of community-based tenurial instruments, and strict protection of critical watershed were implemented under the Forestry Code (PD 705). The prohibition of logging and any commercial exploitation of forestry resources in old growth forests, proclaimed watershed and other areas covered by the National Integrated Protected Areas Systems (NIPAS) were pursued. Notwithstanding the implementation of these programs and projects, forest cover decreases at an annual average of 5.16 percent from 1991 to 1997. It is only between 1997 and 2003 that a growth of 46 percent was realized from 41,800 hectares in 1997 to 156,476 hectares in 2003. The brush land area with 46,400 hectares in 1997 was reduced to zero in 2003 and also the sub-marginal areas. A minimal 1.3 percent plantation forest surfaced from the zero data since 1991. Thus, we consider the long gestation effect of the implementation of reforestation, rehabilitation and conservation programs and projects on forestry.. Under NIPAS Act (RA 7586), the region pursued vigorous forest development in watershed areas. A total of 4,775 hectares of forest boundary was completely delineated and 20,128 hectares of forestlands reforested in the Bicol River Basin area. The characterization of 15 critical watershed areas was undertaken in support to the National Irrigation Systems (NIS) program. The characterization includes area elevation, slope, drainage density, rainfall pattern and distribution, land uses and micro level information on social environment. Information generated in these watersheds was used in land use planning. The active participation of the people in the conservation and protection of natural resources was undertaken through the seven active multi forest protection committees (MFPC). The conservation and protection of wildlife species and their habitats to promote ecological balance and enhance biodiversity was provided under the Wild Life Conservation and Protection Act of 2001. This is in response to the international commitment on biodiversity. It prohibits and penalizes unlawful acts which are detrimental to wildlife resources and their habitats such as killing and trading of wildlife, squatting or dumping of wastes in critical

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habitats, mineral exploration and extraction, logging, quarrying and other related acts. Likewise, Republic Act (RA) 9072 or the National Caves and Caves Resources Management and Protection Act provides for the conservation, protection and management of caves and cave resources as part of the country’s natural wealth. The promotion of biodiversity conservation as a way of promoting eco-tourism in the region was undertaken in CY 2005. The assessment of the 17 protected areas as potential sites for ecotourism was completed and updates of the resource inventory in these sites were available. The Bicol region has five endangered biotic areas: (1) Lagonoy Natural Biotic Area (445 has.); (2) Mananap Natural Biotic Area (5,420 has.); (3) Chico Island Wildlife Sanctuary (8 has.); (4) Naro Island Wildlife Sanctuary (110 has.); (5) Malabungot Protected Landscape (121 has.).

COASTAL RESOURCES Deforestation in the upland and mangrove areas affect the coastal fishery. The food chain in coastal areas is dependent on surface runoff, river and discharges from the mangrove forest. Continuous surface runoff washing away of soil particles in valley floors, river beds and ocean floors results to flash floods and excessive flow of water during rainy season and drought during dry season. To protect this soil from possible erosion, vegetative and structural measures were implemented in CYs 2004-2006. Under RA 8550 or the Fisheries Code, the local government was given authority in the establishment, conservation, protection, utilization and disposition of all fish and fishery/aquatic resources within the municipal waters. The LGUs will have to establish fishery refuge and sanctuaries, and be responsible for prohibition and regulation of fisheries within their municipal jurisdiction. This is also in support to RA 8435 or the Agriculture and Fisheries Modernization Act of 1977 which promote sustained increase in agriculture and fisheries production. The law delineates strategic agriculture and fisheries development zones (SAFDZ) and provides the criteria for classifying various types of agricultural land for protection. In line with the conservation of coastal resources, the marine sanctuary in Marilag Prieto Diaz was proclaimed as marine

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protected area. Likewise, 5,483 kilometers of foreshore areas that are degraded and idle were opened for aquaculture/silviculture in partnership with the communities. The Coastal Resource Management Project is being implemented in the provinces of Masbate and Sorsogon to arrest coastal degradation. Mine wastes and tailings contribute significantly to the siltation of rivers and irrigations. The mining industry in the Bicol Region played a vital role in the development of its economy due to the abundant mineral resources present in the region. The present mining activities posed a great environmental impact on the communities. The Philippine Mining Act of 1995 promotes responsible mining in the country; however, it also states that environmental management of mining should be in accordance with the antipollution laws. Under the Small Mining Act, regulatory boards of provinces or cities were created as the regulatory arm of the government for small scale mining.

ECOLOGICAL SOLID WASTE The growing population and emerging industrialization of the region are bringing about problems in solid waste management. In Bicol, the most commonly used method of disposal is open dumping. The passage of the Ecological Solid Waste Management Act of 2000 (RA 9003) provided opportunities to the local government units to adopt a systematic, comprehensive and ecological solid waste management program within their respective areas. The law provides that open dump sites have to be converted into controlled dumps or sanitary land fills. As of end 2006, there are already 42 functional controlled dump sites in the region. For local government units with no dumpsites, the Environment and Management Bureau (EMB 5) extends technical assistance in the assessment of potential sanitary landfill sites. This involves the field validation and assessment of the proposed area using an ideal site criteria. Material Recovery Facilities (MRFs) are encouraged to be set up by local government units in order to lessen the volume of waste that is disposed. At present there are 29 functional MRFs and 81 markets in the region.

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CLEAN WATER The Philippine Clean Water Act of 2004 (RA 9275) provides for a comprehensive water quality management. It adheres to the policy of economic growth in a manner consistent with the protection, preservation and revival of the quality of our fresh, brackish and marine waters. The monitoring of water bodies was undertaken to determines the extent of possible sources of pollution if there are any in order that remedial measures may be acted upon. The indicators being measured are pH, temperature, dissolved oxygen, biochemical oxygen demand, total suspended solids, and oil and grease. As of end 2006, 11 water bodies were monitored by the EMB 5. These consisted of six rivers, three lakes and two bays. Results of the monitoring showed that solid waste, discharge from oil mill, agricultural effluents, small scale mining residues, and oil and grease were the major pollutants of the water bodies. Point sources of pollution were identified and the polluters were admonished to comply with the environmental laws. The participation of local government units was solicited through the enactment of ordinances which will protect the water bodies from further degradation. On safeguarding water quality, the Eco-watch Program for Bathing Beaches and the TAPWATCH which monitors the surface water as source of drinking water in poor communities and barangays were pursued. The primary objective of Eco watch is to safeguard the health of the public bathers through the determination of the possible sources of pollution if there is any. Water samples from bathing beaches are collected and analyzed for fecal coliform counts. Seven coastal municipalities were the recipients of the Eco watch and four barangays each of Legazpi City and Naga City were the recipients of the project TAPWATCH. Drinking water sources were analyzed and assessed as to whether they conform to the Philippine National Standards for drinking water. Results of the analysis showed that the drinking water sources in the eight barangays conform to the national standards.

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CLEAN AIR The Philippine Clean Air Act of 1999 (RA 8749) provides for a comprehensive air pollution control policy. Regular ambient air quality monitoring is conducted in three major cities of the region— Legazpi, Naga, and Iriga. Fixed Air Quality Monitoring Stations were installed in strategic locations in order to monitor the total suspended particulates (TSP) in the urban centers. Interpretation of the data generated for the year 2006 showed that these cities had fair quality air with a concentration level of the suspended particulates between 81ug/NCM to 230ug/NCM. OBJECTIVES The sustainable development objectives are: 1. To protect and conserve the remaining natural resources of the region like forests and watershed, mangroves areas, coral reefs and fishing grounds, and the biological diversity of the region. 2. Rehabilitate and restore the destroyed/degraded ecosystems. 3. To control pollution at a minimum level. 4. To develop public awareness on environmental values of natural resources and its productivity. STRATEGIES Protecting, conserving and restoring the region’s environment require the implementation of critical strategies. Environmental laws and policies are already in place. What is needed is a strong and active monitoring of the provisions of the law including the implementing rules and regulations. Strict implementation of the provisions of the environmental laws shall be implemented in cooperation and collaboration with the local government units. These shall be carried out through intensive information, education and communication activities. 1. Strengthen the Environmental Impact Assessment (EIA). Environmental tools and processes were already in place and integrated in the decision process. The consequence of the impact of the project to the environment is evaluated thru the environmental impact assessment (EIA). However,

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2.

3.

4.

5.

6.

7.

the present practice of project-to-project and ad hoc environmental impact assessment is inadequate in assessing the long-term consequences of environmental degradation. Steps should be taken to strengthen the present EIA system particularly the public review mechanism in evaluating environmental impacts of the project. Mechanisms should be set up to broaden the involvement of public in the planning process. Land Use Planning/Zoning. Land use planning shall be done to determine the optimum land use allocation based on the environmental quality and ensure that environmental considerations are integrated in the decision making of the local government. Zoning and delineation of forest areas must be vigorously pursued to effectively delineate the protection forest from the production forestlands. Strengthening LGUs and Citizens’ Participation. Formation of community organizations, non-government organizations, and civic organizations will be encouraged to assist the government in monitoring and promotion of environmental protection and conservation. Enhance the monitoring capability of the environmental agencies, and strengthen the role of the local government units (LGUs) in the implementation of policies and structures in environmental protection. Imposition of Environmental Fees. Environmental resources which have been degraded will be priced based on the polluters pay principle. The one who caused the damage to the resources will pay based on the cost of replenishing and increasing their supply and providing appropriate substitutes. Conservation of Biodiversity. Preservation and conservation of wildlife for scientific, educational, cultural and historical values will be emphasized. The existing national parks and protected areas will be continuously conserved and protected. Massive reforestation of denuded forestlands, denuded watersheds, rainforest, mangrove replanting, sea grass

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9.

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transplanting will be vigorously undertaken. Plantation of industrial trees and minor forest species in private lands will be encouraged to meet the demand for raw materials for wood and non-wood industries. This will alleviate pressures on protected forestland and watershed areas. The rehabilitation of rivers and waterways will be pursued to reduce pollution and flooding in the community. Implementation of vegetative and structural measures along river banks to reduce soil erosion and flooding in the settlement areas will be fasttracked. Provision of Alternative Livelihood. Alternative sources of livelihood will be implemented to support families while they serve as forest protector. Pollution Control. The implementation of waste management system by the LGUs will be encouraged and a system of reward for the LGUs will be pursued. Solid waste management program will be supported by the local government. Continuous monitoring of the quality of air and water will be conducted to maintain its standard quality. Human Development. The delivery of social services such as education, health and nutrition will be strengthened and the promotion of environmental education will be pursued. Advocacy and IEC. Massive information, education and communication advocacy involving multi sectoral institutions, i.e., government, business, and civil society will be conducted. Sustained awareness program on environmental values of natural resources shall be developed thru massive information drive. Mainstreaming climate change adaptation to local levels through advocacy, political will and budget support.

MAJOR PROGRAMS AND PROJECTS 1. Integrated Coastal Resources Management Program (ICRMP). This is an ongoing project of DENR implemented regionwide. It involves the assessment of coastal municipalities through a participatory coastal resource

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Biological Disaster Management assessment, establishment of marine sanctuary, management and protection of mangrove stands, strengthening coastal law enforcement, coastal biodiversity conservation and policy study on coastal and marine resources management. 2. Biodiversity Conservation Program. This is an ongoing program of the Protected Area, Wildlife and Coastal Zone Management (PACZM) of DENR. It involves the implementation of biodiversity monitoring systems, monitoring of critical wetlands, establishment of wildlife rescue center,establishment of wildlife traffic monitoring units, implementation of nature conservation education program, inventory of existing monitoring facilities, breeding farms to ensure compliance with existing DENR rules and regulations. 3. Implementation of Natural Integrated Protected Area System (NIPAS). This is an ongoing program of DENRPACZM. It involves the protection and patrolling of protected area, operationalization of Protected Area management Boards (PAMB), delineation of management zone in Bulusan Volcano Natural Park, and boundary delineation/demarcation of protected areas.

GENDER AND DEVELOPMENT The Gender and Development (GAD) framework rests on the basic principle that Development is for all: that both women and men equally contribute to and benefit from development. Hence, GAD‘s objective is to promote gender equality or address gender inequalities especially on women as the more disadvantaged group. Pursuing gender equality is crucial to economic development. The presence of gender disparities and discrimination limit productivity and economic growth. Not giving equal opportunities, equal access to health and education especially to women would hinder their great potential in contributing to the economy. Studies showed that investments in promoting women’s welfare resulted to improved productivity, healthier families and decreased levels of poverty.

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The government has been committed to advocate the GAD framework. International commitments to promote gender equality and advance the welfare of women such as the UN-Convention on the Elimination of all Forms of Discrimination Against Women, Beijing Platform of Action of the Fourth World Conference on Women and the Millennium Development Goals were forged. On the national level, laws were enacted to promote gender equality such as: the Women in Development and Nation Building Act or RA 7192, an Act promoting the integration of women as full and equal partners of men in nation building; Section 28 of the General Appropriations Act, an Act directing government agencies to formulate GAD plan and allocate the GAD budget; Executive Order 273, directing government agencies to institutionalize GAD in their planning, programming and budgeting processes; and the Local Budget Memorandum No.28, which directs local government units (LGUs) to mainstream and implement GAD programs using the 5% development fund. Moreover, the Philippine Plan for Gender-Responsive Development (1995-2025) was crafted to guide agencies in responding to GAD issues and concerns and formulate corresponding strategies and programs. With these developments, it is necessary to ask what is happening at the local level. Are there gender inequalities and discrimination present in the region that need to be addressed immediately? What has the region accomplished so far in the implementation of these GAD policies? Are there issues in carrying out gender mainstreaming at the local level?

DEVELOPMENT CHALLENGES

Situation of Women and Men in the Region Over the years, there has been an increase in the Bicolano women’s participation in development. Their contribution to the economy has been recognized. They also have been benefiting from various interventions implemented to improve their health, access to education and access to better opportunities. But there are still issues to solve along violence on women and children and issues on GAD implementation in the region. More women in management level positions. In 2004, women labor participation is still significantly lower than men. However,

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more women in the region are involved in high-level decision making, as about 63 percent of women in the labor force were holding management level positions. For men, more are engaged in skilled labor such as farming, fishing, and construction works. Men still dominate the political arena. In the 2004 elections, there were about 81 percent elected male officials in the region compared to women with only 19 percent. However, there is an increasing number of women being elected, from 175 number of women elected into office in 1998 election to 225 women in 2004. In the recent May 2007 elections, women garnered higher positions. There are now two women governors and two congresswomen elected in the region. More women joining agricultural cooperatives and Agrarian Reform Community organizations. This is a positive development for women in the agriculture sector. Considering that the sector is maledominated, participating in these organizations is a venue where women can collectively voice out their concerns particularly on matters related to limited access to credit, land ownership and low salary. More women pursuing higher education. In general, women dominate men in the aspect of education. There are more literate women with 83.8 percent functional literacy rate in the region than men (76.6 percent). For secondary and tertiary education, women still has the higher number of enrollment and completion. More women are deciding to work abroad. With the great demand for domestic helpers, caregivers and nurses, more women are deciding to work abroad. Majority of them belong to younger age bracket of 20-39 years old. Increasing use of both traditional and modern method of birth control. The percentage of married women using birth control methods have been increasing from 36.3 percent in 1998 to 47.4 percent in 2003. Presence of violence on women and children. In the region, PNP recorded more than 200 rape cases each year from 2004 to 2006 (2004- 276 cases; 2005- 271 cases and 2006- 214 cases). In 2006, DSWD served 166 children in need of special protection including victims of rape/maltreatment, and neglected children. In the same

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year, the agency served 24 cases of women in especially difficult circumstance such as those physically abused, maltreated and battered. It must be noted also that Bicol region is tagged as one of the hotspots for the rising number of women and children being trafficked for work and sexual exploitation.

ON GAD IMPLEMENTATION More programs implemented along improving women’s welfare especially along health aspect. Based on the annual submission of reports of agencies, SUCs and LGUs on their GAD programs, the bulk of women-specific programs and activities were those that catered to the health wellness of women through the provision of medical assistance, programs on nutrition (ex. Women’s Health and Safe Motherhood Program, Nutri-Nanay, Mothers Class) and other health services which were made more available and accessible especially to disadvantaged women. Livelihood assistance was likewise provided through opportunity trade and skills trainings (especially on product development and entrepreneurship) and granting of loans or capital to start up or continue their businesses. Awareness on women’s rights and proper health care were also disseminated through different forms of advocacy activities. Lack of understanding and appreciation of local chief executives and officials on GAD. In the recent series of re-orientation seminars on GAD concepts conducted by DILG Region 5 to its field officers in the region, this concern was highlighted as one major issue in GAD implementation at the municipal level. This lack of understanding and appreciation of GAD may be the reason for the perceived weak mainstreaming of GAD activities in the local development plans and budget. It was also noted that most of the LGUs do not strictly comply to the allotment and utilization of the 5 percent GAD Budget. Lack of sex-disaggregated data at the local level. To be able to appropriately fashion strategies and programs on the needs of women and men, it is imperative to generate sex-disaggregated data. Efforts to generate gender statistics were pursued particularly by the National Statistical Coordination Board (NSCB). NSCB currently publishes data on women and men but it is only at the

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regional level. Sex-disaggregated data most especially at the municipal and barangay level is rarely available.

DEVELOPMENT OBJECTIVES 1. To promote gender equality (or eliminate gender inequalities and discrimination); and 2. To effectively mainstream GAD policies at the local level. STRATEGIES Continue the promotion of women and children’s welfare especially those in difficult circumstances. Concerned agencies to continue and implement new programs and activities on improving women and children’s health and nutrition. Establish more women and children’s desks and crisis intervention centers. Establishment of these centers is also a must abroad to address the concerns of women OFWs. Encourage participation of men and boys in education. Information dissemination and advocacies must be conducted to motivate the male population to pursue higher education. Curriculum should be continuously enhanced to accommodate the changing needs of girls, boys, men and women. DepEd must study the low participation especially drop-out cases among boys and identify strategies and programs to address this. Open more business opportunities and credit access to women. As more and more women are educated, their potentials could be tapped by providing them more opportunities in opening their own businesses and giving them more access to credit. Aggressively promote responsible parenting. The 2006 Presidential Directive on Responsible Parenthood and National Family Planning focuses on the program- responsible parenting, the shared responsibility of the mother and father in responding to the needs and aspirations of their family and children. This program must be promoted to the LGUS especially to the barangay level so that men not only women shall be involved in fertility, child-rearing and household activities. Encourage women to organize or participate more in organization. More women involvement in organizations and movement would translate in women’s empowerment in pushing their agenda.

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Strengthen promotion and advocacy of GAD in the region. Raising awareness and deepening the appreciation of local governments, agencies, and other institutions on GAD would significantly contribute to better planning, increased budget allocation and better delivery of services and interventions especially on women and children. Advocacy activities must not only be the concern of the government but should involve the private sector, nongovernment and people’s organizations. The DILG should also look into strengthening the functionality of GAD focal point mechanisms and GAD councils to effectively mainstream and monitor GAD efforts especially at the LGU level. Generate sex-disaggregated data at the LGU level. It is a primary need to have gender statistics at the municipal and barangay level for better gender-responsive planning and budgeting. LGUs as well as agencies/SUCs should consider setting up of a database or information system. PLAN IMPLEMENTATION The key elements of plan implementation are: investment programming, plan advocacy and program/project implementation. The investment program is a concrete expression of the plan objectives. It is important that the Plan is known and understood by the stakeholders so that they will know their roles and will be able to contribute to the successful implementation of the Plan. This is achieved by plan advocacy activities.

OBJECTIVES The following objectives shall be pursued in plan implementation: • Plan objectives are achieved in consideration of the optimum use of limited resources; and • Public, private sector and civil society are aware of the Plan and are able to participate in plan implementation. STRATEGIES The strategies, programs and projects in the Plan will be implemented in 2008-2010 with the supervision of the concerned agencies and instrumentalities. The RDC shall coordinate the

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overall implementation in providing the direction in coordination with the sectoral, special and affiliate committees. The local government units (LGUs) will have the Bicol Regional Development Plan as a basic input document to local planning and policy making. The private sector shall participate in the prioritization and monitoring of identified programs and projects. The following strategies shall be done to ensure that plan objectives are achieved in consideration of the optimum use of limited resources: • The Comprehensive Investment Programming Guidelines (CIPG) shall be the main mechanism to ensure that programs and projects proposed for national government funding are consistent with the Plan objectives. The RDC sectoral committees play a critical role in this process. The CIPG starts with the submission of project proposals by line agencies, local government units (LGUs), government owned and controlled corporations(GOCCs) and state universities and colleges (SUCs) with the required documents. These documents are: the project feasibility study or comprehensive project profile, concurrence of line agency that will implement that project, concurrence of the local government unit where the project will be located and a resolution of approval from the Board of Regents or Trustees for SUCs. These projects comprise the Project Identification List (PIL). • Prioritization of projects for the medium-term shall be done through a process whose output is the Regional Development Investment Program (RDIP). The RDIP is the basis for identifying projects for inclusion to the agency budget proposals for a fiscal year. A set of core criteria plus the criteria set by the concerned sectoral committee will be used in prioritizing projects to be endorsed by the RDC to agency central offices. • The Regional Development Investment Program (RDIP) shall be regularly updated to closely align to that of the MTRDP updating. The RDIP shall contain programs and projects that will be consistent with the “8 by 08 priorities”. This should focus on the government response on job

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opportunities, improvement in the cost of living, peso appreciation, investment enhancement, pro-poor education program, health, housing and anti-hunger measures, antiterrorism measures implementation and green Philippines to bring out the new and competitive Philippine economy in the face of globalization. • The Bicol Project Development Committee (BPDC) shall provide technical assistance in developing projects to ensure high probability of being funded. • Fund Sourcing: Various programs and projects can be funded out from various sources either through loans, grants, build-operate-transfer (BOT), build-operate-own (BOO), build-operate-lease (BOL) and other schemes for the private sector, funding from the national government appropriations through the General Appropriations Act (GAA), GOCCs, GFIs, local government funds, Priority Development Assistance Fund (PDAF), bond flotation and Official Development Assistance (ODA).

PLAN ADVOCACY Advocacy shall be a part of plan implementation to ensure wide dissemination of the plan. Resources will be committed to build sp; awareness and support for the Plan through capacity building of stakeholders to include trainings, workshops, publication of information materials and other multi-media outlets. The Regional Information and Advocacy Committee (RIAC) shall focus its efforts toward creating awareness and support among plan stakeholders. Networking between and among LGUs, government agencies and the private sector in disseminating the Plan to stakeholders. PROGRAM/PROJECT IMPLEMENTATION The execution of activities/programs/projects shall be the responsibility of the concerned offices, agencies, LGUs or SUCs. The RDC and the sector committees shall take an important role in the project implementation by comparing actual accomplishment versus Plan targets and considering the timetable for implementation.

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There is a need to continue enhancing the capacities of LGUs on development planning, project development, implementation and management. Local Development Councils (LDCs) and special development bodies need to be strengthened to effectively perform their mandated functions. Implementation of Joint Memorandum Circular No. 1 Series of 2007 issued by DILG, NEDA, DBM and DOF entitled “Harmonization of Local Planning, Investment Programming, Revenue Administration, Budgeting and Expenditure Management” must be strictly enforced. LGUs are expected to prepare their Comprehensive and Physical Plans with the Regional Development Plan as guide in the identification of thrusts and priorities for the respective provinces and other local government units. Private sector will be encouraged to participate actively to provide a different perspective in plan implementation. The Private Sector Representatives (PSRs) to the RDC can be of great help in the review/evaluation and monitoring of major projects especially in the geographical area that they represent. Sectoral concerns will likewise be given attention in the course of program/project implementation through consultation with target beneficiaries. The print and broadcast media shall be partners in plan advocacy and serve as “watchdogs” against graft and corruption in project implementation. FINANCING THE PLAN There are several sources of financing the programs and projects in the updated MTRDP to achieve the over-all goals for 2008-2010. These sources are: General Appropriations Act (GAA), Official Development Assistance (ODA), government owned and controlled corporations (GOCCs), government financing institutions (GFIs), 20 percent development fund of local government units, bond flotation and the priority development assistance fund (PDAF). Financing by the private sector may be of various schemes like the build-operate-transfer (BOT), the buildoperate-own (BOO), and build-operate-lease (BOL). A good investment program is important in fund sourcing. The investment program is a source of feasible and implementable projects for the planning period. Projects must be prioritized given

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the limited resources of the government. The massive and increasing public investments for the past years have contributed to the high foreign obligations that is facing our country today. These pressing difficulties posed by this external environment necessitate greater efforts to raise local revenues and fiscal policy in order to finance development programs.

SITUATIONAL ANALYSIS The fiscal position of the Philippine Government depends mostly on the revenue taxes generated by the Bureau of Internal Revenue (BIR) and the Bureau of Customs (BOC). Of the two agencies, the BIR is the biggest revenue earner for the government. For CY 2006, the BIR targetted a collection of at least P765.00 billion. Of this national target, Region 5 (Revenue District 10) was given a collection target of P2.825 billion which is 0.38 percent of the national target. The total collection for 2006 was P2.907 billion, surpassing its target by P81.865 million or 2.90 percent. It is 16 percent higher than the 2005 collection of P2.504 billion. The bulk of investments for the 2004-2007 planning period was borne by the national government with the private sector playing a role in complementing and supporting government initiatives. Investments were channeled towards economic activities that generated employment, promote trade and industries, good governance and capital intensive projects like roads and bridges, irrigation systems and other infrastructurerelated projects. These projects partially achieved economic growth in the region. The government’s allocation of financial resources for 2004-2006 was not sufficient to cope with the development requirements of the region. The region’s three year average share for 2002-2006 in the national budget was only 2.98 percent (Table 1). However, the 2007 share was 3.34 percent, a measly increase of 0.42 percent over the 2006 level. The individual agency proposed budgets did not materialize due to the limited resources. In 2004 and 2006, the budgets were re-enacted (2002 and 2005 levels) which deprived some new projects of funding. RDC resolution numbers 05-19, 05-20 and 05-21, series of 2006, were passed requesting an increase in the budgets of the

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Fiber Industry Development Authority (FIDA), Environment Management Bureau (EMB) and Mines and Geosciences Bureau (MGB) to support their major programs and projects. On decentralization efforts, the budgets of eight state universities and colleges (SUCs) and five agency regional offices were receiving their allotment from the Department of Budget and Management (DBM) Regional Office 5 which led to fast and on-time releases compared to those agencies receiving their allotment from DBM Central Office. The five agency regional offices are: Department of Health (DOH), Department of Education (DepEd), Technical Education and Skills Development Authority (TESDA), Department of Public Works and Highways (DPWH) and Commission on Higher Education (CHED). The eight SUCS are: Bicol University (BU), Catanduanes State College (CSC), Camarines Norte State College (CNSC), Camarines Sur State Agricultural Colleges (CSSAC), Partido State University (PSU), Sorsogon State College (SSC), Don Emilio B. Espinosa Memorial State College of Arts and Trades (DEBESMSCAT) and Camarines Sur Polytechic Colleges (CSPC). One of the initiatives undertaken in the budget review was the conduct of a dialogue between officials of the Regional Development Councils and Agency Central Offices where the latter gave a briefing on agency lump sum funds. In 006, the RDC endorsed the budget proposals for CY 2007 of 28 agencies for incorporation into the agency budget proposal. In this manner, the RDC mandate to push for critical regional projects was exercised. Implementation of programs and projects funded from Local Government Units (LGUs) was sourced from the Internal Revenue Allotment (IRA) including the 20 percent Development Fund of the LGU. Most of the LGUs are highly dependent on the IRA so that there is a need to enhance and strengthen their revenue generating capacities as provided in the 1991 Local Government Code (LGC) to veer away from too much dependency on national aid. In 2005, a reclassification of LGUs was undertaken, which reflected a downgrading of the Cities of Legazpi and Naga from first class to second class cities. This reclassification was based on their income and served as basis for the determination of the

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financial capability of the LGUs to provide in full or in part the funding requirements of developmental projects and other priority needs in their locality. Likewise, the income of the LGU is used as a factor in the allocation of national or other financial grants. For the provinces, only Albay, Camarines Sur and Masbate have been classified as first class provinces; Camarines Norte and Sorsogon are second class and Catanduanes is third class province. Projects funded from Official Development Assistance (ODA) were given priority particularly in allocating the counterpart from the Government of the Philippines (GOP) in the agency budget proposal. Special projects of NEDA like the Country Program for Children (CPC), the United Nations Program in Masbate, and the Second Kennedy Round (KR2) were successfully funded from grants of UNICEF, United Nations Population Fund and Japan. Another special project which took off in 2006 was the Agriculture, Social Support and Environmental Facilities (ASSEF) which is a grant from the Agencia Española Cooperacion de Internacional (AECI) for implementation by 4th, 5th, and 6th class LGUs. Both the KR2 and ASSEF projects required LGU counterpart. Projects funded by locally generated revenues of LGUs were taken from real property taxes and other fees collected from local businesses. In 2006, because of poor revenue generating capacities of LGUs, the dependency on the IRA ranged from 54.34 percent to 92.01 percent. For the cities, Naga City had the least dependency ratio of 54.34 percent in 2006, followed by Legazpi City with 64.06 percent and followed by Masbate City with 86 percent. For the provinces, Catanduanes had the highest dependency ratio of 97.24 percent, followed by Camarines Sur with 92.01 percent. Performance of real property tax collection of the provinces and cities was affected by Typhoons Reming and Milenyo.

OBJECTIVES 1. To be able to finance priority regional programs and projects given the limited resources, strengthening of the local planning, budgeting, resource generation and decentralization of agency budget releases in the next planning period.

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STRATEGIES In support of the overall development objectives, financial policies and strategies will focus on: • Improving the generation of local financial resources of LGUs through a more responsive financial intermediation mechanism and an improved revenue collection system. This will be done through improved tax administration efficiency, tax mapping activities, intensive tax information and collection drives and updating of the local revenue tax code. • Improving and expanding the structure of financial resource allocation through a more responsive regionalized budget system that is directly supportive to the annual budgetary translation of regional programs/projects and priorities that are recommended by the RDC. • Attaining fiscal discipline through prudent and efficient use of financial and fiscal resources, ensuring judicious allocation of resources to priority programs, projects and activities that will attain regional goals and objectives. • Tapping other sources of funds, either local or foreign to provide adequate provision for a continuing support for public services delivery and other activities geared toward the achievement of a better quality of life of the Bicolanos. • Updating of the Regional Development Investment Program (RDIP) to come up with feasible programs and projects for fund sourcing and implementation. • Having viable project proposals for fund sourcing with high impact to the region through the Bicol Project

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Development Committee (BPDC) and facilitate ODA funding for private sector projects. • RDC to work out the creation of a lump sum fund for the region similar to that of the Regional Budget Allocation Scheme (RBAS). • Oversight agencies to meet all newly-elected officials on the reforms in the preparation of plans and budgeting.

FUNDING SOURCES FOR 2008-2010 Fund sources for 2008-2010 shall be from the General Appropriations Act (GAA), Official Development Assistance (ODA), Regular Calamity Funds, Local Government Units (LGUs) and the Private Sector through its BOT, BOO, BOL schemes. Economic sector projects will be sourced out from the regular appropriations of the Department of Agriculture (DA), the Department of Environment and Natural Resources (DENR), the Department of Agrarian Reform (DAR), the Department of Tourism (DOT), the Department of Trade and Industry (DTI), the Environment Management Bureau (EMB) and Mines and Geosciences Bureau ( MGB) as major agencies in the areas of agriculture, fisheries, mines and geo-sciences, agrarian reform, forestry, trade, tourism and environment. Earmarked for ODA are the River Basin Watershed Management Program (RBWMP) with the following sub-projects:flood control, watershed management and irrigation modernization. Likewise, the Agrarian Reform Communities Development Program (ARCDP) will cater to agrarian reform communities. LGU counterpart will be needed for the critical foreign-assisted projects. Calamity funds will be used to fund the rehabilitation of damaged crops and facilities including infrastructure, health and school buildings destroyed by Typhoons Reming and Milenyo. Social services projects are likely to be financed from the regular budgets of the social agencies like Department of Health (DOH), Department of Education (DepEd), state universities and colleges (SUCs), Technical Education and Skills Development Authority (TESDA), Department of Social Welfare and Development (DSWD), Department of Labor and Employment (DOLE) and other major implementing agencies. Projects under

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the infrastructure sector will be financed from a combination of ODA and regular budgets of the Department of Public Works and Highways (DPWH), Department of Transportation and Communications (DOTC), National Irrigation Administration (NIA), Philippine Ports Authority (PPA), the LGUs and the Priority Development Assistance Fund (PDAF). Table. Comparative Statement of Regional and National Budgets in Million Pesos, 2004-2007 Year 2004** 2005 2006*** 2007

Budget National*

Regional

575,123.728 597,663.400 597,663.400 635,041.878

17,880.241 17,492.287 17,492.287 21,221.355

Region 5 Percent Share (%) 3.11 2.92 2.92 3.34

Source: GAA 2002, 2005, 2007 * Excludes appropriations for debt servicing ** Re-enacted budget 2002 level ***Re-enacted budget 2005 level Excludes lump sum funds of agencies Table. Classification of LGUs Based on Income, Bicol Region, 2005 In c o m e Cla s s F ir st Secon d Th ir d F ou r t h

F ift h Sixt h Tot a l

P ro v in c e s

Citie s

Ca m a r in es Su r , Alba y, Ma sba t e Ca m a r in es Nor t e, Sor sogon Ca t a n du a n es n on e

n on e

9

Na ga , Lega zpi

17

n on e Liga o, Ta ba co, Ir iga , Ma sba t e, Sor sogon n on e n on e 7

21 35*

n on e n on e 6

Mu n ic i p a litie s

23** n on e 105

Source: DOF * Caramoan (Camarines Sur) classification is as of November 2001. ** Presentacion (Camarines Sur), Baras (Catanduanes) and Batuan (Masbate) classification as of November 2001. San Fernando (Camarines Sur) has no classification (not included in the summary).

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Table. IRA Dependency Rate of LGUs*, by Province/City Bicol Region, 2004-2006 (in thousand pesos) Particulars Albay Total Income Total IRA % IRA to Total Income Camarines Norte Total Income Total IRA % IRA to Total Income Camarines Sur Total Income Total IRA % IRA to Total Income Catanduanes Total Income Total IRA % IRA to Total Income Masbate Total Income Total IRA % IRA to Total Income Sorsogon Total Income Total IRA % IRA to Total Income Ligao City Total Income Total IRA % IRA to Total Income Tabaco City Total Income Total IRA % IRA to Total Income Legazpi City Total Income

2004

2005

2006

542,605 472,232 87.03

585,236 508,800 86.94

764,137.000 615,004.230 80.48

380,156.23 299,331.26 78.74

360,084.07 321,721.29 89.35

486,090.80 387,997.25 79.82

667,516.95 625,522.4 93.71

741,966.54 674,514.93 90.91

862,636.006 793,692.342 92.01

242,763.361 234,730.30 96.69

259,765.011 249,920.10 96.21

303,817.481 295,434.42 97.24

417,752.13 411,891.30 98.60

449,646.84 442,961.78 98.51

491,290.02 456,357.07 92.89

375,597.000 354,622.000 94.42

411,037.000 380,812.29 92.64

560,056.184 441,166.000 78.77

203,295.16 185,083.82 91.04

220,585.90 196,500.04 89.08

252,295.60 223,710.60 88.67

183,979.05 164,385.48 89.35

194,825.15 173,952.71 89.28

196,015.073 173,953.00 88.74

299,687.00

336,135.00

403,039.785

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Total IRA % IRA to Total Masbate City Total Income Total IRA % IRA to Total Iriga City Total Income Total IRA % IRA to Total Sorsogon City Total Income Total IRA % IRA to Total Naga City Total Income Total IRA % IRA to Total

Income

202,641.00 67.62

214,441.00 63.80

258,176.464 64.06

Income

181,044.22 162,593.63 89.81

188,795.30 168,708.73 89.36

228,149.71 196,208.75 86.00

Income

181,005.84 157,588.22 87.06

195,257.07 166,951.50 85.50

229,147.252 201,285.507 87.84

Income

252,537.65 221,343.01 86.62

263,887.603 234,678.58 88.93

269,824.590 233,969.124 86.71

Income

311,238.913 177,899.371 57.16

347,717.138 187,831.144 54.02

379,632.151 206,296.238 54.34

Source: LGUs

*For validation by LGUs

Table. Real Property Tax Collection, By Province Bicol Region, 2004-2005 (In Thousand Pesos)* Province/City Albay Camarines Norte Camarines Sur Catanduanes Masbate Sorsogon Legazpi City Ligao City Tabaco City Iriga City Naga City Sorsogon City Masbate City *For validation by LGUs

2004

2005

2006

9,105.598 5,412.20 22,591.52 1,938.375 29,900.28 24,223.681 26,680.00 4,021.747 2,718.89 2,056.75 nda 2,445.909 13,627.27

8,718.863 5,747.98 28,567.26 1,258.036 23,245.69 35,392.099 29,220.00 3,764.251 3,060.38 3,378.49 nda 5,292.554 14,658.93

8,169.325 6,353.15 29,192.504 1,586.399 17,775.66 22,475.382 28,321.60 4,202.856 3,191.258 3,089.66 nda 6,066.466 2,027,141.79*

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MONITORING AND EVALUATION 1. Ensure that the Plan objectives and strategies are being achieved; 2. Provide information to all stakeholders on the progress of the MTRDP implementation and performance; and 3. Assist in the mobilization of appropriate interventions. The monitoring and evaluation of the MTRDP implementation will be based on manageable processes and on measurable and verifiable indicators. It will conform to basic rules of simplicity, timeliness and cost effectiveness.

MONITORING Monitoring will be conducted as a continuous implementation review function to provide the RDC and the main stakeholders with early indications of the MTRDP’s progress or delay in the achievement of objectives and outputs. The RDC will enjoin all regional line agencies (RLAs), government-owned and controlled corporations (GOCCs), state universities and colleges (SUCs), the local government units (LGUs), the private sector, and all other concerned stakeholders to carry out the monitoring function in accordance with their respective functions, level and responsibilities. This function will be coordinated by the RDC Secretariat. Monitoring will be supported by an implementation framework as outlined in the Plan, funding strategies, work plans and programs, progress reports and any other tools which may be developed during the implementation of the Plan. At the highest level, the RDC will exercise continuous oversight of the implementation of the MTRDP to ensure consistency of outputs against the mission, vision and strategies and the achievement of set targets. The RDC may direct a change of focus and/or strategies based on current achievements, challenges, and priorities. It may also initiate a review of specific policies for improved implementation of the Plan. At the operational and technical levels, the Secretariat and the different Sectoral/Sub-Sectoral Committees will be responsible for ensuring that progress on the MTRDP is monitored on a

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regular basis. An integrated monitoring system for the MTRDP will be developed by the Secretariat and the Sectoral/Sub-Sectoral Committees to provide an early warning mechanism and to maintain a good grasp on the development and implementation of the Plan. Other than the formulated strategies, interventions and outputs, various other intervening concerns that may emerge from the implementation of the MTRDP will also be monitored and evaluated in terms of their contribution to the on-going implementation of the Plan. The Secretariat will ensure that the monitoring system provides for aggregate indicators to monitor the overall development of the region by tracking developments in all areas of integration. The Secretariat will also play the role of advisor and facilitator in ensuring that appropriate interventions are implemented, and supplementary programs are developed to ensure that set targets are met and that emerging developments are being addressed. The RDC Secretariat will produce an annual Regional Development Report (RDR) on the overall implementation of the Plan. The report will be presented to the various development sectors/sub-sectors and to the RDC. On a quarterly basis, the RDC Secretariat will issue a regional economic situationer, which will report on the status of regional economic performance. The Regional Project Monitoring Committee (RPMC) will likewise issue reports on the highlights of its quarterly monitoring through the Bicol Development Updates, a publication of the RDC 5 and its periodic monitoring reports as submitted by LGUs and RLAs.

EVALUATION Evaluation of the MTRDP will provide analytical and objective feedbacks on the Plan based on the systematic and objective assessment of sectoral/subsectoral implementation results. Its aim is to determine the efficiency, effectiveness, relevance and sustainability towards the fulfillment of the overall objective of poverty reduction. The two main types of evaluation will be selfevaluation and independent in-depth evaluation. Self-evaluation, to be conducted at the sectoral/subsectoral levels through the coordination of the RDC secretariat, will be the main tool for reviewing in a systematic and regular manner

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progress on the Plan’s implementation. It will be a process of continuous improvement and will take place during program implementation and completion. Independent in-depth evaluation will be the main tool for assessing in an analytical and objective manner the MTRDP performance comparing achievements against objectives. Independent evaluators who will not be associated with the implementation of the Plan will carry it out. Independent evaluators shall be encouraged from among the non-governmental organizations (NGOs) through the leadership of the private sector representatives to the RDC. A feedback mechanism to that effect shall be coordinated through the RDC5 Secretariat. This evaluation will take place either during the Plan implementation (mid-term evaluation), at the end of the Plan implementation (terminal evaluation) or after completion of the Plan implementation considering a time period sufficient to observe developmental impact (ex-post evaluation). Mid-term evaluation will focus on possible modifications to the planned implementation of the Plan through successive medium-term programs while terminal evaluation will focus on the desirability and feasibility of future activities. The objectives of the evaluation will include but not be limited to: 1. Assessment of the impact of the MTRDP on the overall objective of poverty reduction; 2. Tracking and highlighting of the achievements and delays as they relate to priority intervention areas of the MTRDP; 3. Appraisal of the adequacy of policies, capacities and resources needed by the development process; 4. Detailing the constraints, best practices and lessons learned and providing action-oriented recommendations; 5. Reviewing the roles played by the various entities and those accountable for various responsibilities in the implementation of the plan; 6. Review of the MTRDP Vision and Mission in the light of prevailing priorities of the region; 7. Review of strategies and targets against outcomes, explaining the variances;

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Biological Disaster Management 8. Evaluation of the entire MTRDP in relation to the current priorities of the region.

SUMMARY OF ROLES 1. The RDC will exercise continuous oversight using progress reports from the Secretariat. 2. The RDC Secretariat will coordinate and monitor at the regional level through an integrated monitoring and evaluation system. 3. Sectoral/Sub-Sectoral Committees will coordinate and monitor at the regional level with regular feedback to the Secretariat. 4. Stakeholders will conduct fora to review and provide input to monitoring progress reports and evaluation reports. The fora will include members from the private sector and PSOs. 5. External evaluators will produce reports, which assess the implementation process, the outputs as against the set targets and the overall impact of the MTRDP.

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5 Disaster Management Cycle Lets discuss about the definition: “Collection actions/measures taken before, during and after any situation to predict, prevent, reduce or cope with its impact. These measures may be taken at community or household levels.”

DISASTER RESPONSE Activities that take place when a disaster strikes to reduce loss of life and to deliver relief as quickly as possible to the affected people. The following are the examples: — 1. Search and Rescue 2. Need for assessment. 3. Provide the victims Psychological support. 4. Emergency food, water, medicines are required 5. There should a provison for temporary shelters and other relief activities. 6. There should also be a scope for restoring the family links. RECOVERY (REHABILITATION) After a disaster, there are scenes, which are very heart-rending. The people needs psychological support. Measures taken after a disaster, to bring back the condition within the community to normal even better than before are given below:

a. Psychological Rehabiltation: The affected people needs counseling. Their primary needs have to be met. They will be best, when they are in surroundings

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of their relatives. The affected have to be slowly involved in matters which will help them to see Life in a new way. The best thing is proper follow up of the matter.

b. Financial Rehabilitation: The most important thing is that if the disaster is big, then the affected victims loses all there finances and this result in more tension. Plans should be made in advance for ‘DISASTER INSURANCE’ in areas, where natural disasters are very common. It will help. The distribution of livelihood kits should be distributed.

c. Social Rehabilitation: Places such as Welfare Centers should be established. More emphasis shoould be given to self help groups. Places like ‘HOMES’ should be built, so that the affected people can get traumatic councelling and make a new living.

RISK REDUCTION (MITIGATION) Its actually a long term measure to reduce the risk of a disaster. This means; Strengthening of existing buildings and infrastructures. Raised earth platform in flood prone areas. Taking out insurance policies. Plantation of drought resistant crops. Building of cyclone shelters, reinforcement of river banks in flood prone areas. Public awareness programs should be run. That is the most important part of risk reduction activities. There should be also community based health care/health promotion. DISASTER PREPAREDNESS Its the effort to enable a community to cope with and respond quickly and effectively to any further disaster. These can be done by the following: a. By Vulnerability and Capacity Assessment (VCA) of the community through mapping exercise. b. Deveopment of Early Warning Systems. These can be done with the help of satellite data, through Geographic Information System and Remote Sensing. c. Formation of community disaster preparedness and response committee and plan.

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d. Emphasis also should be given to community based first aid, disaster preparedness and response commitee and plan. e. Increasing community disaster awareness. f. Improve the basic training skills. g. Understanding information flow channels and develop information and reporting system. INTRODUCTION When one thinks of Disasters, it naturally crosses one’s mind that; if only it had been averted. Disasters are by their very nature unpredictable and happen inspite of the best efforts. It appears to be so sudden and powerful that one attributes it to ones fate. This is what make each of the disasters remarkable and larger than life. Even though all precautions are taken, yet they happen and the sheer ferocity of their occurence brings terror to one’s heart. It is hard to believe that except for a chance event of the affected people being part of the disaster, they might very well be alive. The scene of the disaster is heart-rending and what comes to mind is the horror of what happened and one is compelled to feel sorrow for the victims of the disasters. Whether it is the Hurricane Katrina, Wilma, Recent Earthquake in India, Tsunamis, Chernobyl Nuclear Tragedy, Bhopal Gas Tragedy (India), Hurricane Andrew 1992, cyclone at Darwin Australia (1974) etc; each of the disaster has a unique story to tell: if only it could have been avoided and here lies the imporatnce of pre-disaster management policy. Some times our stereotypial attitudes and lack of proper policy implementation often leads to failure to recognize THAT RELIEF AND DEVELOPMENT are inextricably linked and part of the sae on-going process. It is now being acknowledged that disasters an wipe out years of development and can dramatically increase vulnerability An increasing number of Governments and International Organizations are promoting risk reduction as the only sustainable solution for reducing the Social, Economical and Environmental impacts of disasters. Risk Redution strategies includes vulnerability mapping identification of areas that are safe for settlement and development adoption of building codes

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based on disaster resilient engineering and on local hazard risk assessments and enforcing these plans and codes by economic and other incentives. We want to stress on the points of local capacities and predisaster management to safeguard the precious lives of our brothers and sisters of my planet. One of the most important of these concerns is to build local capacities. The rationale here is based on recognition that local communities have developed their own, indiginous, preparedness and mitigation activities based on their extensive experiences of living with disasters. (All too often in the past, these have been overlooked or undervalued by Disaster Management Specialists from Outside) Let me give some examples: In India, one tribal group living in the Andaman and Nicobar Islands understood the coming of the arrival of the slayer Tsunami and fled to a safer place long before the killer waves would have engulfed them. An art of their own, passed from generations to generations. In Africa, there are a lot of food shortages due to drought; but they are able to prevent full blown famine by employing a variety of ‘coping’ mechanisms that allow them to ride out the hungry season until the next harvset. Also I believe that successful disaster prevention depends partly upon being able to predict these crisis before they happen. Though Disasters happen with great regularity, I believe that we should do research as how to stop these natural calamities rather than forecasting it’s arrival. To that effect, we should stress the need for natural barriers for cyclones and hurricanes, rainwater harvesting methods for continuous suuply of water even in the driest seasons, concepts on recharging of groundwater in the driest part of the world. Stressing the need to use methods for liberatiuon of energy from the faults in the earth-strata, so that the release of the enormous energy from the bottom of the earth will stop earthquakes happening! Also we should stress on the afforestation intiatives in catchment areas basins. We believe this basic research can enable us to undersatnd the water-soil-climate system better. This can lead to new thinking

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and new avenues of action, which can yield larger stable production within the existing constraints. The effort spent in basic research and the policies obtained from those pays for it many times over, though not necessarily immediately.

Development at Risk Expensive long-term development projects are put at greater risk, if they do not take natural hazards into account. An earthquake can shatter a housing project; a farming scheme, ruined by a hurricane or flood. Disaster statistics are hard to calculate with any accuracy or consisting. Nonetheless, all the evidence points to a steep and continuing rise in deaths and injuries from disasters since the 1960’s and there is a general consensus among researches and insurers that the number of disasters is increasing. This rise can not be explained by a parallel rise in the number of erthquakes, cyclones and the like. What we are seeing is an increase in the effects of disasters on people or in other words, people vulnerability to disasters. It is the social, cultural, economic and political environment that makes people vulnerable. This is most apparent; as eonomic pressures, force many of the poor to live in cheap but dangerous locations such as the flood plains and unstable hillslides. There are also many less visible underlying factors — social, political as well as economic that effect people’s ability to protect themselves against ethnicity, gender, disability and age. In most cases, the rich are affected much less due to better constructed houses and safer locations. Disasters caused by natural hazards such as earthquakes, floods, storms, volcanoes and droughts are major global problems. Between 1971 and 1995, they caused each year on average more than 1,28,000 deaths and affected the lives of 136 million people. Every country is affected by natural hazards to some extent. However, most disasters occur in the poorer countries of the third world; some 97% of deaths and 99% of people affected between 1971 and 1995 were in developing countries and the economic consequences of disasters there were massive. To some extent: This is an accident of geography; that many third world countries are in the regions prone to the most severe

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hazards such as earthquakes, droughts, volcanoes, floods, landslides and cyclones.

Some facts about Disasters Until the 1970’s, the International community considered disasters as exceptional circumstances, when local coping capacities were exhausted and external emergency relief was required. The term Disaster Managment was generally equivalent to disaster response and tended to be within the exclusive competence of organisations such as the Red Cross and Red Cresent Socities or National Civil Defence Institutions. In 1971, the United Nations Disaster Relief Office, now the United Nations Office for the Co-ordination of Humanitarian Affairs ( UNOCHA ), was established to mobilize and co-ordinate relief activities from all sources in times of disaster. The concept of disaster pre-paredness was developed during 1970’s and 1980’s and included training and some cross-sectional activities to increase capacity for rescue, relief and rehabilitation during and after a disaster. But even the most pessinmistic forecasts could not have forseen the upward spiral in negative socioeconomic consequences of natural disasters in the closing decades of the 20th Century. The 1990s was declared the International Decade for Natural Disaster Reduction (IDNDR), one of the principal goals of which was to inculcate a culture of disaster prevention; through the wider application of known scientific and technological mechanisms by a better informed population. In the words of United Nations Secretary General Kofi Annan, “We must, above all, shift from a culture of reaction to a culture of prevention. The humanitarian community does a remarkable job in responding to disasters. But the most important task in the medium and long term is to strengthen and broaden programmes which reduce the number and cost of disasters in the first place. PREVENTION IS NOT ONLY MORE HUMAN THAN CURE, IT IS ALSO MUCH CHEAPER” (IDNDR 199b) The IDNDR successfully placed risk reduction higher on the political agenda, as well as setting out a number of priorities to be undertaken by countries and regions in the 21st Century.

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FLOOD MANAGEMENT It is necessary to review the strategies of flood management under which most of the efforts have been confined to structural measures of flood control. As the major component of flood damage is due to unregulated rapid encraochment of flood plains, which in turn is due to population pressure and development activities, there is a need to adopt a judicious mix of structural and nonstructural measures with a view to ‘manage the floods’ rather than to control them. It is also essential to encourage the ‘ concept of living with floods ‘, particularly in areas, which are strategies need to be carefully extended. For those areas, it will be necessary to evolve suitable varities of flood - resisitant or short duration crops supplemented by income generating like animal husbandry, fisheries and fish farming.

Recommendations for Flood Management 1. Deforestation / Clear falling of trees should be stopped and afforestation intitiatives to be taken. 2. State-wise area - specific mitigation plans should be prepared of chronic flood - prone areas and clear deadlines have to be made, to put those plans into reality. 3. Flood shelters have to be made and flood should be stored there in advance under cold storage. 4. Proper riverbank protection has to be made by making proper embankments and suing anti-erosion measures. There should not be any encroachments or embankments. 5. Proper drainage is the only solution in case of floods affecting an area. It is through this undergroung drains, that the flood waters could recede easilty and thus minimize the period of losses. 6. State-wise area specific mitigation plans should be prepared of chronic flood prone areas. 7. Environmental awareness is required for flood management.

DROUGHT MANAGEMENT 1. An area-specific watershed model development plan should be prepared for arid and sub-humid regions of the country.

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Biological Disaster Management 2. In rain fed agricultural zones ( having less rainfall and frequent droughts ), considerable stress should be placed on the rain water harvesting methods. It’s through this that water can be stored for months and slso the ground water can be recharged. It’s one of the greatest solutions to the problem drought. 3. Development programmes such as National Water-shed Development Program for rain fed areas, drought prone areas programme. Desert Development programme, National Rural Employment Alleviation Programme should be integrated to form a comprehensive drought mitigation programmes. 4. Drought -prone areas incorporate short-term and longterm development projects, Which will be of great benefit to the residing community. 5. Increase awareness for public participation for the drought mitigation projects.

EARTHQUAKE MANAGEMENT 1. Public buildings like police stations, fire stations, hospital and school play a vital role during an earthquake and it should be made earthquake resistant by using the code of Bureau of Indian Standards (BIS) for earthquake resistant designs and the design given by the National Disaster Management Authority. 2. One of the most important aspect of earthquake disaster management is to make flammable oils i.e gasoline, petrol, diesel oils and gas storehouses earthquake resistant. To add to that I feel that large water-pool and tanks filled with water should be placed in the vicinity. 3. In order to make crowded cities safe from damaging earthquakes, systemic town planning is necessary. Two aspect may be included a) Long term construction of a disaster - proof city b) Comparatively short - term renewal of the existing city areas, which may be undertaken if necessary. 4. Highly motivated and committed resource persons/ agencies specialized in public education about earthquakes,

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hazard awareness and mitigation should be identified periodically and encouraged to undertake specific and timely research and development and Training activities on both preparedness and relief operations. 5. Controlling earthquakes could be through the construction of large dams inseismicaly active place, which may release energy periodically through smaller earthquakes therby possibly preventing large earthquakes.

CYCLONE DISASTER PREPAREDNESS PROGRAMME 1. Construction of cyclone shelter, adequate in number along the cyclone- prone coastal belts. 2. Afforestation programme to be followed more near the coastal belts prone to cyclone. 3. Constructions of satellite communication systems near the coastal belts; so that in the fall out of a cyclone disaster, there would remain a good communication network. 4. Appointment of good experienced officers to look after the total project. 5. An educational programme related to nature of cyclones, warning system and preparedness activities for the Government officials connected to disaster mitigation measures as well as to public. 6. There should be a regulation mechanism for the industrial activities in the cyclone prone belt. Also industries set-up in those areas should have special designed buildings, so that it can withstand a cyclone of category four. 7. Educating the masses about the importance of natural barriers, as it turns out to be the protector against cyclones.

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6 United Nations Framework Convention on Climate Change History of Formation Climate Change is a burning issue these days. In October 1985, at an International meeting in Villach, Austria convened by United Nations agencies, a group of Scientists decided it was time for the World to take action. The meeting concluded that there was a need to combat the perceived danger of global warming that would result from increasing concentrations of so-called green house gases in the atmosphere. This green house gas concentrations, particularly those of carbon dioxide ( a product of burning coal, oil and other fossil fuels ) are increasing as a direct consequence of a range of human activities. The Villach Statement and its threat of global warming became an international forum for actions to curb emissions of green house gases to the atmosphere. Around the World a diverse range of interest groups, especially across the environment movement, co-operated to raise public awareness of the greenhouse climate change threat. Later a series of Government and National and International conferences of invited experts were widely reported in the media and ensured a raised public recognition of the issue. So, successful was the awareness- raising campaign that within 3 years the United Nations, through its agencies UNEP (United Nations Environment Programme) and WMO (The World Meteorological Organization), had established an Intergovernmental Panel on Climate Change, which we know as IPCC. This organization was empowered with:

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a) “Assessing the scientific informaton that is related to the various components of the climate change issue, such as emissions of major green house gases and modification of the earth’s radiation balance resulting therefrom, and that needed to enable the environmental and socioeconomic consequences of climate change to be evaluated. b) Formulating realistic response strategies for the management of the climate change issue. 3 working groups were established to address the IPCC objectives. The tasks of Working Groups I, II and III were respectively to: i) Assess available scientific information on climate change. ii) Assess environmental and socio-economic impacts of climate change. iii) Formulate response strategies. The working group did confirm the Villach conclusions and found a serious anthropogenic threat to the Global Climate. After a period of less than 18 months, in July 1990, the IPCC WG1 published their findings following an assessment of the available scientific literature. The principal findings of the report were: i) There is a greenhouse effect because a range of gases occurring naturally in the atmosphere, such carbon dioxide, keep the earth’s surface warmer than it would otherwise be. ii) The concentrations in the atmosphere of a range of greenhouse gases, including carbon dioxide, are increasing because of human activities. iii) The increasing concentrations of certain greenhouse gases in the atmosphere, such as carbon dioxide will lead to global warming but neither its magnitude, timing nor regional characteristics could be determined. Later the United Nations General Assembly took up the challenge presented by the IPCC scientific assessment and the Statement of the second World Climate conference. An Intergovernmental Negotiating Committee was convened to develop a Framework Convention on Climate Change in time for the June 1992, Earth Summit at Rio de Janeiro. The committee,

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open to all member countries of the United Nations, met six occasions between 1991 and May 1992 before finally a reaching agreement. At the Earth Summit, representatives of more than 150 countries signed the United Nations Framework Convention on Cimate Change (UNFCCC) that result from negotiations. More countries signed subsequently. The Convention requires countries to take actions necessary for “Stabilisation of green house gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system.” Despite the perceived threat posed by anthropogenic global warming, the short period available for negotiations meant that agreement could not be reached on binding mechanisms for reducing greenhouse gas emissions and commitments that individual countries should make. Counter balancing the global warming threat were the immediate economic and social costs that would be experienced by many countries if they took action to reduce greenhouse gas emissions. The IPCC continued its work and issued its Second Assessment Report in 1995. Contemporary experiments using computer models of the climate system and various natural and anthropogenic forcing functions pointed to anthropogenic signals that could be detected in the observed Global Warming Pattern. The IPCC in its Second Assessment Report, concluded that the balance of evidence suggested that a discernible human influence on global climate could be detected. The public interest in the anthropogenic global warming issue and the perceived need for action did not abate. More than 10,000 people, made up mostly of non-government lobby groups and representatives of the World media, converged on Kyoto, Japan in December 1997 for the third meeting of the Conference of the Parties to the UNFCCC. They were there to witness Government delegates negotiate a Protocol to stem the unconstrained emission of green house gases into the atmosphere. The Protocol was expected to give teeth to the Convention.

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But the rush to judgement met stiff resistance at Kyoto. The negotiations were tense and the final text of the Protocol was agreed to by a number of developed countries with reservation. Still now, Kyoto, the Protocol could not come into force. Notwithstanding the stalled action on the political front, the scientific work has continued. The IPCC issued its Third Assessment Report in 2001, claiming that most of the warming of the previous 50 years has been caused by human activities. IPCC moved forward with its mission of the SAVE THE PLANET with its new reports. Its a great news to all that this year’s (2007) NOBLE PEACE PRIZE went to Mr. Al Gore, former US VICEPRESIDENT and Mr. R K Pachauri, Chairman IPCC. EARTHQUAKE What is an earthquake and what causes them to happen? An earthquake is caused by a sudden slip on a fault. Stresses in the earth’s outer layer push the sides of the fault together. Stress builds up and the rocks slips suddenly, releasing energy in waves that travel through the earth’s crust and cause the shaking that we feel during an earthquake. An EQ occurs when plates grind and scrape against each other. In California there are two plates the Pacific Plate and the North American Plate. The Pacific Plate consists of most of the Pacific Ocean floor and the California Coast line. The North American Plate comprises most the North American Continent and parts of the Atlantic Ocean floor. These primary boundary between these two plates is the San Andreas Fault. The San Andreas Fault is more than 650 miles long and extends to depths of at least 10 miles. Many other smaller faults like the Hayward (Northern California) and the San Jacinto (Southern California) branch from and join the San Andreas Fault Zone. The Pacific Plate grinds northwestward past the North American Plate at a rate of about two inches per year. Parts of the San Andreas Fault system adapt to this movement by constant “creep” resulting in many tiny shocks and a few moderate earth tremors. In other areas where creep is NOT constant, strain can build up for hundreds of years, producing great EQs when it finally releases.

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EARTHQUAKE FACTS & STATISTICS Fact Sheet 01: Frequency of Occurrence of Earthquakes Descriptor

Magnitude

Average Annually

Great

8 and higher

1¹

Major

7 - 7.9

17 ²

Strong

6 - 6.9

134 ²

Moderate

5 - 5.9

1319 ²

Light

4 - 4.9

13,000 (estimated)

Minor

3 - 3.9

130,000 (estimated)

Very Minor

2 - 2.9

1,300,000 (estimated)

¹ Based on observations since 1900. ² Based on observations since 1990. [* Internal error: Invalid file format. | In-line.WMF *]

Fact Sheet 02: Year-wise description of Earth Quakes N u m be r o f Ea rth qu a k e s Wo rld w id e fo r 2000 - 2005. Lo c a te d by th e U S Ge o lo g ic a l S u rv e y N a tio n a l Ea rth qu a k e In fo rm a tio n Ce n te r Ma g n itu d e 2000 2001 2002 2003 2004 2005 8.0 t o 9.9 1 1 0 1 2 1 7.0 t o 7.9 14 15 13 14 14 9 6.0 t o 6.9 158 126 130 140 140 116 5.0 t o 5.9 1345 1243 1218 1203 1509 1307 4.0 t o 4.9 8045 8084 8584 8462 10894 10264 3.0 t o 3.9 4784 6151 7005 7624 7937 5782 2.0 t o 2.9 3758 4162 6419 7727 6317 3249 1.0 t o 1.9 1026 944 1137 2506 1344 20 0.1 t o 0.9 5 1 10 134 103 0 No 3120 2938 2937 3608 2939 642 Ma gn it u de To ta l

22256

23534

27454

31419

* 31199

* 21390

Es tim a te d D e a th s

231

21357

1685

33819

284010

1957

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Fact Sheet 03: Largest Earthquakes in the World Since 1900 Lo c a tio n 1. 2. 3.

4. 5. 6. 7. 8. 9. 10. 11. 12.

D a te U TC Ch ile

Ma g n itu d e 1960 05 22

P r in ce Willia m Sou n d, Ala ska Off t h e West Coa st of N or t h er n Su m a t r a Ka m ch a t k a Off t h e Coa st of E cu a dor Nor t h er n Su m a t r a , In don esia Ra t Isla n ds, Ala ska An dr ea n of Isla n ds, Ala ska Assa m - Tibet Ku r il Isla n ds Ba n da Sea , In don esia Ch ile-Ar gen t in a Bor der

1964 03 28

Co o rd in a te s 9.5 38.24 9.2 61.02

Re fe re n c e -73.05 -147.65

2004 12 26

9.0

3.30

95.78

1952 11 04 1906 01 31

9.0 8.8

52.76 1.0

160.06 -81.5

2005 03 28

8.7

2.08

97.01

1965 02 04 1957 03 09

8.7 8.6

51.21 51.56

178.50 -175.39

1950 08 15 1963 10 13 1938 02 01

8.6 8.5 8.5

28.5 44.9 -5.05

96.5 149.6 131.62

1922 11 11

8.5

28.55

-70.50

Fact Sheet 05: List of Some Significant Earthquakes in India Date

Epicenter

Location

Magnitude

Lat

Long

(Deg N)

(Deg E)

1819 Jun 16

23.6

68.6

1869 Jan 10

25

93

1885 May 30

34.1

74.6

1897 Jun 12

26

91

1905 Apr 04

32.3

76.3

Kangra, H.P

8.0

1918 Jul 08

24.5

91.0

Srimangal, Assam

7.6 7.1

Kutch,Gujarat

8.0

Near Cachar, Assam

7.5

Sopor, J&K

7.0

Shillongplateau

8.7

1930 Jul 02

25.8

90.2

Dhubri, Assam

1934jan 15

26.6

86.8

Bihar-Nepalborder

8.3

1941 Jun 26

12.4

92.5

Andaman Islands

8.1

1943 Oct 23

26.8

94.0

Assam

7.2

1950 Aug 15

28.5

96.7

Arunachal Pradesh-China Border

8.5

1956 Jul 21

23.3

7.0

Anjar, Gujarat

7.0

1967 Dec 10

17.37

73.75

Koyna, Maharashtra

6.5

1975 Jan 19

32.38

78.49

Kinnaur, Hp

6.2

1988 Aug 06

25.13

95.15

Manipur-Myanmar Border

6.6

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1988 Aug 21

26.72

86.63

Bihar-Nepal Border

1991 Oct 20

30.75

78.86

Uttarkashi, Up Hills

6.4 6.6

1993 Sep 30

18.07

76.62

Latur - Osmanabad, Maharashtra

6.3

1997 May 22

23.08

80.06

Jabalpur, MP

6.0

1999 Mar 29

30.41

79.42

Champoli, UP

6.8

2001 Jan 26

23.40

70.28

Bhuj, Gujarat

6.9

Fact Sheet 04: Largest and Deadliest Earthquakes by Year 1990 - 2005 La rg e s t Ea rth qu a k e s Ma g n it F a ta litie Re g io n ude s 8.7 1,313 Nor t h er n Su m a t r a , In don esia 9.0 283,106 Off West Coa st of Nor t h er n Su m a t r a 8.3 0 H okka ido, J a pa n Region 7.9 0 Cen t ra l Ala ska

Ye a r

Date

2005

03/28

2004

12/26

2003

09/25

2002

11/03

2001

06/23

8.4

138

2000

11/16

8.0

2

1999 1998

09/20 03/25

7.7 8.1

2,297 0

1997

10/14

7.8

0

12/05

7.8

0

1996

02/17

8.2

166

1995

07/30

8.0

3

10/09

8.0

49

1994

10/04

8.3

11

1993

08/08

7.8

0

1992

12/12

7.8

2,519

1991

04/22 12/22

7.6 7.6

75 0

1990

07/16

7.7

1,621

Nea r Coa st of P eru New Irela n d Region , P .N.G. Ta iwa n Ba llen y Isla n ds Region Sou t h of Fiji Isla n ds Nea r E a st Coa st of Ka m ch a t ka Iria n J a ya Region In don esia Nea r Coa st of Nor t h er n Ch ile Nea r Coa st of J a lisco Mexico Ku ril Isla n ds Sou t h of Ma r ia n a Isla n ds F lores Region , In don esia Cost a Rica Ku ril Isla n ds Lu zon , P h ilippin e Isla n ds

Date 03/28

12/26

D e a d li e s t Ea rth qu a k e Ma g n i F a ta li ti Re g i o n tu d e es 8.7 1,313 Nort h er n Su m a t ra , In don esia 9.0 283,106 Off West Coa st of Nort h er n Su m a t ra

12/26

6.6

31,000

Sou t h ea st ern Ir a n

03/25

6.1

1,000

01/26

7.7

20,023

H in du Ku sh Region , Afgh a n ist a n In dia

06/04

7.9

103

08/17 05/30

7.6 6.6

17,118 4,000

05/10

7.3

1,572

Sou t h ern Su m a t era , In don esia Tu r key Afgh a n ist a n Ta jikist a n Bor der Region Nor t h er n Ir a n

02/03

6.6

322

Yu n n a n , Ch in a

01/16

6.9

5,530

Kobe, J a pa n

06/20

6.8

795

Colom bia

09129

6.2

9,748

In dia

12/12

7.8

2,519

F lor es Region , In don esia

10/19

6.8

2,000

Nort h er n In dia

06/20

7.4

50,000

Ir a n

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Seismic Zonation map of a country is a guide to the seismic status of a region and its susceptibility to earthquakes. India has been divided into five zones with respect to severity of earthquakes. Of these, zone v is seismically the most active where earthquakes of magnitude 8 or more could occur recent strong motion observations around the world have revolutionized thinking on the design of engineering structures, placing emphasis also on the characteristics of the structures themselves it should be realized that in the case of shield type earthquakes, historic data are insufficient to define zones because recurrence intervals are much longer than the recorded human history this may often give a false sense of security. Occurrence of the damaging earthquake at Latur, falling in zone I is a typical example of this situation. DENGUE Dengue is caused by a virus spread by Aedes (Stegomyia) mosquitoes. Over the past two decades there has been a dramatic global increase in the frequency of dengue fever (DF) dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) and their epidemics, with a concomitant increase in disease incidence. The World Health Report 1996 stated, that the “reemergence of infectious diseases is a warning that progress achieved so far towards global security in health and prosperity may be wasted.” The report further indicated that “infectious diseases range from those occurring in tropical areas (such as malaria and DHF which are most common in developing countries) to diseases found worldwide (such as hepatitis and sexually transmitted diseases, including HIV/AIDS) and food-borne illnesses that affect large numbers of people in both the richer and poorer nations.” Dengue epidemics are known to have occurred over the last three centuries in tropical, subtropical and temperate areas of the world. The first epidemic of dengue was recorded in 1635 in the French West Indies, although a disease compatible with dengue had been reported in China as early as 992 AD. During the 18th, 19th and early 20th centuries, epidemics of dengue-like diseases were described globally in the tropics as well as in some temperate regions. Rush was probably describing dengue when he wrote of

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“break-bone fever” occurring in Philadelphia in 1780. Most of these epidemics were clinical dengue fever, although some were associated with the severe haemorrhagic form of the disease. Efforts to control Aedes aegypti and economic development have markedly reduced the threat of epidemic dengue in temperate countries during the past 50 years. The first recorded outbreak of a dengue disease compatible with DHF occurred in Australia in 1897. A similar haemorrhagic disease was recorded in 1928 during an epidemic in Greece and again in Taiwan in 1931. The first confirmed epidemic of DHF was recorded in the Philippines in 1953-1954. Since then, major outbreaks of DHF with significant mortality have occurred in most countries of the South-East Asia Region, including India, Indonesia, Maldives, Myanmar, Sri Lanka, and Thailand, as well as in Singapore, Cambodia, China, Laos, Malaysia, New Caledonia, Palau, Philippines, Tahiti and Vietnam in the Western Pacific Region. Over the past 20 years, there has been a dramatic increase in the incidence and geographical distribution of DHF, and epidemics now occur each year in some South-East Asian countries. CLINICAL PERSPECTIVE

THE VIRUS The dengue viruses are members of the genus Flavivirus and family flaviviridae. These small (50 nm.) viruses contain singlestrand RNA. The virion consists of a nucleocapsid with cubic symmetry enclosed in a lipoprotein envelope. The dengue virus genome is approximately 11,000 base pairs in length, and is composed of three structural protein genes encoding the nucleocaprid or core protein (C), a membrane-associated protein (M), an envelope protein (E), and seven nonstructural protein (NS) genes. The envelope glycoprotein is associated with viral haemagglutination and neutralization activity. The dengue viruses form a distinct complex within the genus flavivirusbased on antigenic and biological characteristics. There are four virus serotypes which are designated as DEN-1, DEN2, DEN-3 and DEN-4. Infection with any one serotype confers lifelong immunity to that virus serotype. Although all four serotypes are antigenically similar, they are different enough to

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elicit cross-protection for only a few months after infection by any one of them. Dengue viruses of all four serotypes have been associated with epidemics of dengue fever in which there was little or no evidence of DHF. All four virus serotypes have also caused DHF epidemics associated with severe and fatal disease.

THE VECTOR Dengue viruses are transmitted from person to person by Aedes (Ae.) mosquitoes of the subgenus Stegomyia. Ae. aegypti is the most important epidemic vector, but other species such as Ae. albopictus, Ae. polynesiensis, members of Ae. scutellaris complex, and Ae. (Finlaya) niveus have also been incriminated as secondary vectors. All except Ae. aegypti have their own restricted geographical distribution and, although they may be excellent hosts for dengue viruses, they are generally less efficient epidemic vectors than Ae. aegypti. THE HOST Dengue viruses infect humans and several species of lower primates. Humans are the main urban reservoir of the viruses. Studies in Malaysia and Africa have shown that monkeys are infected and are the likely reservoir hosts, although the epidemiological significance of this observation remains to be established. Dengue virus strains grow well in insect tissue cultures and on mammalian cell cultures after adaptation. TRANSMISSION CYCLE The female Aedes (Stegomyia) mosquito usually becomes infected with dengue virus when she takes blood from a person during the acute febrile (viraemic) phase of illness. After an extrinsic incubation period of 8 to 10 days, the salivary glands of the mosquito become infected and the virus is transmitted when the infective mosquito bites and injects the salivary fluid into the wound of another person. Following an incubation period in humans of 3-14 days (4-6 days average), there is often a sudden onset of the disease, with fever, headache, myalgias, loss of appetite, and a variety of nonspecific signs and symptoms, including nausea, vomiting and rash.

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Viraemia is usually present at the time of or just before the onset of symptoms and lasts an average of five days after the onset of illness. This is the crucial period when the patient is most infective for the vector mosquito and contributes to maintaining the transmission cycle if the patient is not protected against vector mosquito bites. There is evidence that the vertical transmission of dengue virus from infected female mosquitoes to the next generation occurs in several species including Ae. aegypti and Ae. albopictus. This may be an important mechanism for virus maintenance, but does not appear to be important in epidemics. CLINICAL MANIFESTATION Dengue virus infection may be asymptomatic or may cause undifferentiated febrile illness (viral syndrome), dengue fever (DF), or dengue haemorrhagic fever (DHF) including dengue shock syndrome (DSS). Infection with one dengue serotype gives lifelong immunity to that particular serotype, but there is no crossprotection for the other serotypes. The clinical presentation depends on age, immune status of the host, and the virus strain. 1. Undifferentiated fever: Infants, children and some adults who have been infected with dengue virus for the first time (i.e. primary dengue infection) will develop a simple fever indistinguishable from other viral infections. Maculopapular rashes may accompany the fever or may appear during defervescence. 2. Dengue fever: Dengue fever is most common in older children and adults. It is generally an acute biphasic fever with headache, myalgias, arthralgias, rashes and leucopenia. Although DF is commonly benign, it may be an incapacitating disease with severe muscle and joint pain (break-bone fever), particularly in adults, and occasionally with unusual haemorrhage. In dengue endemic areas, DF seldom occurs among indigenous people. 3. Dengue haemorrhagic fever: Dengue haemorrhagic fever is most common in children less than 15 years of age, but it also occurs in adults. DHF is characterized by the acute

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onset of fever and associated non-specific constitutional signs and symptoms. There is a haemorrhagic diathesis and a tendency to develop fatal shock (dengue shock syndrome). Abnormal haemostasis and plasma leakage are the main patho-physiological changes, with thrombocytopenia and haemoconcentration presenting as constant findings. Although DHF occurs most commonly in children who have experienced secondary dengue infection, it has also been documented in primary infections.

CLINICAL SYMPTOMS After an average incubation period of 4-6 days (range 3-14 days), various non-specific, undifferentiated prodomes, such as headache, backache and general malaise may develop. Typically, the onset of DF in adults is sudden, with a sharp rise in temperature occasionally accompanied by chillis, and is invariably associated with severe headache and flushed face(12). Within 24 hours there may be retro-orbital pain, particularly on eye movement or eye pressure, photophobia, backache and pain in the muscles and joints/bones of the extremities. The other common symptoms include anorexia and altered taste sensation, constipation, colicky pain and abdominal tenderness, dragging pains in the inguinal region, sore throat, and general depression. These symptoms vary in severity and usually persist for several days. 1. Fever: The body temperature is usually between 39oC and 40oC, and the fever may be biphasic, lasting 5-7 days. 2. Rash: Diffuse flushing or fleeting pinpoint eruptions may be observed on the face, neck and chest during the first half of the febrile period, and a conspicuous rash that may be maculopapular or scarlatiniform appears on approximately the third or fourth day. Towards the end of the febrile period or immediately after defervescence, the generalized rash fades and localized clusters of petechiae may appear over the dorsum of the feet, on the legs, and on the hands andarms. This confluent petechial rash is characterized by scattered, pale, round areas of normal skin. Occasionally the rash is accompanied by itching.

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DENGUE HAEMORRHAGIC FEVER AND DENGUE SHOCK SYNDROME Typical cases of DHF are characterized by high fever, haemorrhagic phenomena, hepatomegaly, and often circulatory failure. Moderate to marked thrombocytopenia with concurrent haemoconcentration are distinctive clinical laboratory findings. The major pathophysiologic changes that determine the severity of the disease in DHF and differentiate it from DF are abnormal haemostasis and leakage of plasma as manifested by thrombocytopenia and rising haematocrit. DHF commonly begins with a sudden rise in temperature which is accompanied by facial flush and other non-specific constitutional symptoms resembling dengue fever, such as anorexia, vomiting, headache, and muscle or joint pains. Some DHF patients complain of sore throat, and an injected pharynx may be found on examination. Epigastric discomfort, tenderness at the right costal margin, and generalized abdominal pain are common. The temperature is typically high and in most cases continues for two to seven days, then falls to a normal or subnormal level. Occasionally the temperature may be as high as 40oC, and febrile convulsions may occur. The most common haemorrhagic phenomenon is a positive tourniquet test. Easy bruising and bleeding at venipuncture sites

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are present in most cases. Fine petechiae scattered on the extremities, axillae, face and soft palate may be seen during the early febrile phase. A confluent petechial rash with characteristic small, round areas of normal skin is sometimes seen in convalescence after the temperature has returned to normal. A maculopapular or rubella-type rash may be observed early or late in the disease. Epistaxis and gum bleeding are less common. Mild gastrointestinal haemorrhage is occasionally observed. Haematuria is rarely observed.

COMPLICATIONS AND UNUSUAL MANIFESTATIONS OF DF / DHF IN CHILDHOOD Encephalitic signs such as convulsion and coma are rare in DHF. They may, however, occur as a complication in cases of prolonged shock with severe bleeding in various organs including the brain. Water intoxication, as a result of inappropriate use of hypotonic solution to treat DHF patients with hyponatraemia, is a relatively common iatrogenic complication that leads to encephalopathy. A subtle form of seizure is occasionally observed in infants under one year of age during the febrile phase and, in some cases, is considered to be febrile convulsions since the cerebrospinal fluid is normal. Subdural effusions have been observed in some cases. In recent years there has been an increasing number of reports of DF or DHF with unusual manifestations. Unusual central nervous system manifestations, including convulsions, spasticity, change in consciousness and transient paresis, have been observed. Some of these cases may have encephalopathy as a complication of DHF with severe disseminated intravascular coagulation that may lead to focal occlusion or haemorrhage. Fatal cases with encephalitic manifes-tations have been reported in Indonesia, Malaysia, Myanmar, India and Puerto Rico. However, in most cases there have been no autopsies to rule out bleeding or occlusion of the blood vessels. Although limited, there is some evidence that, on rare occasions, dengue viruses may cross the blood-brain barrier and infect the CNS. Further studies are needed to identify the factors contributing to these unusual manifestations. Attention should be given to the study of

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underlying host factors such as convulsive disorders and concurrent diseases. Encephalopathy associated with acute liver failure is commonly observed and renal failure usually occurs at the terminal stage. Liver enzymes are markedly elevated in these cases, with serum aspartate aminotransferase about 2-3 times higher than serum alanine aminotransferase. Other rarely observed, unusual manifes-tations of DF/DHF include acute renal failure and haemolytic uraemic syndrome. Some of these cases have been observed in patients with underlying host factors (e.g. G6P deficiency and haemoglobinopathy) that lead to intravascular haemolysis. Dual infections with other endemic diseases, such as leptospirosis, viral hepatitis B, and melioidosis, have been reported in cases with unusual manifestations.

PREVENTION AND CONTROL MEASURES No vaccine is available yet for the prevention of dengue infection and there are no specific drugs for its treatment. Hence DF/DHF control is primarily dependent on the control of Ae. aegypti. Dengue control programmes in the Region have in general not been very successful, primarily because they have relied almost exclusively on space spraying of insecticides for adult mosquito control. However, space spraying requires specific operations which were often not adhered to, and most countries found it cost prohibitive. In order to achieve sustainability of a successful DF/ DHF vector control programme, it is essential to focus on larval source reduction and to have complete cooperation with nonhealth sectors, such as nongovernmental organizations, civic organizations and community groups, to ensure community understanding and involvement in implementation. There is, therefore, a need to adopt an integrated approach to mosquito control by including all appropriate methods (environ-mental, biological and chemical) which are safe, cost-effective and environmentally acceptable. A successful, sustainable Ae. aegypti control programme must involve a partnership between government control agencies and the community. The approaches

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described below are considered necessary to achieve long-term, sustainable control of Ae. aegypti. 1. Environmental management: Environmental management involves any change that prevents or minimizes vector breeding and hence reduces human-vector contact. The control of Ae. aegypti in Cuba and Panama in the early part of this century was based mainly on environmental management. Such measures remain applicable wherever dengue is endemic. The World Health Organization (1982) has defined three kinds of environmental management viz. Environmental modification, which involves longlasting physical transformation of vector habitats, environmental manipulation, which includes temporary changes to vector habitats that involve the management of “essential” and “nonessential” containers; and management or removal of “natural” breeding sites and changes to human habitation or behaviour.

Environmental Modification o Improved water supply: Whenever piped water supply is inadequate and available only at restricted hours or at low pressure, the storage of water in varied types of containers is encouraged, thus leading to increased Aedes breeding. The majority of such containers are large and heavy (e.g storage jars) and can neither be easily disposed of nor cleaned. In rural areas, unpolluted, disused wells become breeding grounds for Ae. aegypti. It is essential that potable water supplies be delivered in sufficient quantity, quality and consistency to reduce the necessity and use of water storage containers that serve as the most productive larval habitats. o Mosquito-proofing of overhead tanks/cisterns or underground reservoirs: Where Ae. aegypti larval habitats include overhead tanks/cisterns and masonry chambers of piped waterlines, these structures should be mosquito-proofed. Similarly, mosquito-proofing of domestic wells and underground water storage tanks should be undertaken. Masonry chambers of sluice

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Environmental Manipulation including Change in Human Habitat o Draining of water supply installations: Water collection/ leakages in masonry chambers, distribution pipes, valves, sluice valves, surface boxes for fire hydrants, water meters, etc. collect water and serve as important Ae.aegypti larval habitats in the absence of preventive maintenance. o Domestic storage: The major sources of Ae. aegypti breeding in most urban areas of South-East Asia are containers storing water for household use including clay, ceramic and cement water jars of 200 litre size, 210 litre (50 gallon) metal drums, and smaller containers storing fresh water or rain water. Water storage containers should be covered with tight-fitting lids or screens; care being taken to replace them after water is used. An example of the efficacy of this approach has recently been demonstrated in Thailand. Flower pots/vases and ant traps: Flower pots, flower vases and ant traps are common sources of Ae. aegypti breeding. They should be punctured to produce a drain hole. Alternatively, live flowers can be placed in a mixture of sand and water. Flowers should be removed and discarded weekly and vases scrubbed and cleaned before reuse. Brass flower pots, which make poor larval habitats, can be used in cemeteries in place of traditional glass containers. Ant traps to protect food storage cabinets can be treated with common salt or oil. Aedes breeding in incidental water collections: Desert (evaporation) water coolers, condensation collection pans under refrigerators, and air conditioners should be regularly inspected, drained and cleaned. Desert water coolers generally employed in arid/semiarid regions(44) of South-East Asia to cool houses during summer contain two manufacturing defects. These are as follows: o The exit pipe at the bottom of the water-holding tray is generally fixed a few centimetres above the bottom. This exit pipe should be fitted at such a level that while emptying the tray, all the water should get drained off without any retention at the bottom.

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o Desert coolers are normally fitted to windows with the exit pipe located on the exterior portion of the tray. These sites are usually difficult to access, and, therefore, there is a need to change the design so that both the filling and emptying of the water-holding trays can be manipulated from the room, thus eliminating the need of climbing to approach the exit pipe at the exterior of the building. Building exteriors: The design of buildings is important to prevent Aedes breeding. Drainage pipes of rooftops sunshades/ porticos often get blocked and become breeding sites for Aedes mosquitoes. There is a need for periodic inspection of buildings during the rainy season to locate potential breeding sites. Mandatory water storage for fire fighting: Fire prevention regulations may require mandatory water storage. Such storage tanks need to be kept mosquito-proofed. In some municipalities in India(45), timber merchants are required to maintain two metal drums (50 gallons) full of water for fire fighting. These drums should be kept covered with tight lids. Also, metal drums used for water storage at construction sites should be mosquito-proofed. Solid waste disposal: Solid wastes, namely tins, bottles, buckets or any other waste material scattered around houses, should be removed and buried in land fills. Scrap material in factories and warehouses should be stored appropriately until disposal. Household and garden utensils (buckets, bowls and watering devices) should be turned upside down to prevent the accumulation of rain water. Similarly, canoes and small boats should be emptied of water and turned upside down when not in use. Plant waste (coconut shells, cocoa husks) should be disposed of properly and without delay. Tyre management: Used automobile tyres are of major importance as breeding sites for urban Aedes, and are therefore a significant public health problem. Imported used tyres are believed responsible for the introduction of Ae. albopictus into the United States, Europe and Africa. Tyre depots should always be kept under cover to prevent the collection of rain water. New technologies for tyre recycling and disposal are continually coming into use, but most of them have proved to be of limited application or cost-effectiveness. Used tyres can be filled with earth or concrete

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and used for planters or traffic/crash barriers. They may also be used as soil erosion barriers, or used to create artificial reefs and reduce beach erosion by wave action. Tyres can also be recycled for sandals, floor mats, industrial washers, gaskets, buckets, garbage pails and carpet backing, while truck tyres have been made into durable, low-cost refuse containers. Filling of cavities of fences: Fences and fence posts made from hollow trees such as bamboo should be cut down to the node, and concrete blocks should be filled with packed sand, crushed glass, or concrete to eliminate potential Aedes larval habitats. Glass bottles and cans: Glass bottles, cans and other small containers should be buried in land fills or crushed and recycled for industrial use. PERSONAL PROTECTION Protective clothing: Clothing reduces the risk of mosquito biting if the cloth is sufficiently thick or loosely fitting. Long sleeves and trousers with stockings may protect the arms and legs, the preferred sites for mosquito bites. Schoolchildren should adhere to these practices whenever possible. Impregnating clothing with chemicals such as permethrin can be especially effective in preventing mosquito bites. Mats, coils and aerosols: Household insecticidal products, namely mosquito coils, pyrethrum space spray and aerosols have been used extensively for personal protection against mosquitoes. Electric vaporizer mats and liquid vaporizers are more recent additions which are marketed in practically all urban areas. Repellents: Repellents are a common means of personal protection against mosquitoes and other biting insects. These are broadly classified into two categories, natural repellents and chemical repellents. Essential oils from plant extracts are the main natural repellent ingredients, i.e. citronella oil, lemongrass oil and neem oil. Chemical repellents such as DEET (N, N-Diethyl-mToluamide) can provide protection against Ae. albopictus, Ae. aegypti and anopheline species for several hours. Permethrin is an effective repellant when impregnated in cloth. Insecticide-treated mosquito nets and curtains: Insecticide-treated mosquito nets (ITMN) have limited utility in dengue control

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programmes, since the vector species bites during the day. However, treated nets can be effectively utilized to protect infants and night workers who sleep by day. They can also be effective for people who generally have an afternoon sleep. “Olyset net”, a wide mesh net woven from polyethylene thread containing 2% permethrin, is yet another improvement in ITMN technology. This net has two advantages over traditional nets in that the wide mesh permits better ventilation and light, and the treated thread enables a slow release of permethrin to the fibre surface, ensuring a long residual effect (over a year). In studies carried out in Malaysia, four washings with soap and water did not diminish the efficacy and the mortality of Ae. aegypti was 86.7%. For control of DF/DHF in Vietnam, Olyset net curtains were hung on the inside against doors/windows; Ae. aegypti was adversely affected and dengue virus transmission was interrupted. Further studies on impregnated fabrics appear warranted. BIOLOGICAL CONTROL The application of biological control agents which are directed against the larval stages of dengue vectors in South-East Asia has been somewhat restricted to small-scale field operations. Fish: Larvivorus fish (Gambusia affinis and Poecilia reticulata) have been extensively used for the control of An. stephensi and/ or Ae. aegypti in large water bodies or large water containers in many countries in South-East Asia. The applicability and efficiency of this control measure depend on the type of containers. Bacteria: Two species of endotoxin-producing bacteria, Bacillus thuringiensis serotype H-14 (Bt.H-14) and Bacillus sphaericus (Bs) are effective mosquito control agents. They do not affect nontarget species. Bt.H-14 has been found to be most effective against An. stephensi and Ae. aegypti, while Bs is the most effective against Culex quinquefasciatus which breeds in polluted waters. There is a whole range of formulated Bti products produced by several major companies for control of vector mosquitoes. Such products include wettable powders and various slow-release formulations including briquettes, tablets and pellets. Further developments are expected in slow-release formulations. Bt.H-14 has an extremely low-level mammalian toxicity and has been

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accepted for the control of mosquitoes in containers storing water for household use. Cyclopoids: The predatory role of copepod crustaceans was documented between 1930-50, but scientific evaluation was taken up only in 1980 in Tahiti, French Polynesia, where it was found that Mesocyclops aspericornis could effect a 99.3% mortality rate among Aedes (Stegomyia) larvae and 9.7% and 1.9%, respectively among Cx. quinquefasciatus and Toxorhynchities amboinensis larvae. Trials in crab burrows against Ae. polynesiensis and in water tanks, drums, and covered wells met with mixed results. In Queensland, Australia, out of seven species evaluated in the laboratory, all but M. notius were found to be effective predators of both Ae. aegypti and An. farauti but not against Cx. quinquifasciatus. Field releases in both northern and southern Queensland, however, showed mixed results. In Thailand, results were also mixed, but in Vietnam, results were more successful, contributing to the eradication of Ae. aegypti from one village. Although the lack of nutrients and frequent cleaning of some containers can prevent the sustainability of copepods, they could be suitable for large containers which cannot be cleaned regularly (wells, concrete tanks and tyres). They can also be used in conjunction with Bt.H-14. Copepods have a role in dengue vector control, but more research is required on the feasibility of operational use. Autocidal ovitraps: Autocidal ovitraps were successfully used in Singapore as a control device in the eradication of Ae. aegypti from the Changgi international airport. In Thailand, this autocidal trap was further modified as an auto-larval trap using plastic material available locally. Unfortunately, under the local conditions of water storage practices in Thailand, the technique was not very efficient in reducing natural populations of Ae. aegypti. Better results can be expected if the number of existing potential larval habitats is reduced, or more autocidal traps are placed in the area under control, or both activities are carried out simultaneously. It is believed that, under certain conditions, this technique could be an economical and rapid means of reducing the natural density of adult females as well as serve as a device for monitoring infestations in areas where some reduction in population densities

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of the vector have already taken place. However, the successful application of autocidal ovitraps/larval traps depends on the number placed, the location of placement, and their attractiveness as Ae. aegypti female oviposition sites. CHEMICAL CONTROL Chemicals have been used to control Ae. aegypti since the turn of the century. In the first campaigns against the yellow fever vector in Cuba and Panama, in conjunction with widespread clean-up campaigns, Aedes larval habitats were treated with oil and houses were fumigated with pyrethrins. When the insecticidal properties of DDT were discovered in the 1940s, this compound became a principal method of Ae. aegypti eradication programmes in the Americas. When resistance to DDT emerged in the early 1960s, organophosphate insecticides, including fenthion, malathion and fenitrothion were used for Ae. aegypti adult control and temephos as a larvicide. Current methods for applying insecticides include larvicide application and space spraying. Chemical Larviciding: Larviciding or “focal” control of Ae. aegypti is usually limited to domestic-use containers that cannot be destroyed, eliminated, or otherwise managed. It is difficult and expensive to apply chemical larvicides on a long-term basis. Therefore chemical larvicides are best used in situations where the disease and vector surveillance indicate the existence of certain periods of high risk and in localities where outbreaks might occur. Establishing the precise timing and location are essential for maximum effectiveness. Control personnel distributing the larvicide should always encourage house occupants to control larvae by environmental sanitation. There are three insecticides that can be used for treating containers that hold drinking water. Temephos 1% sand granules: One per cent temephos sand granules are applied to containers using a calibrated plastic spoon to administer a dosage of 1 ppm. This dosage has been found to be effective for 8-12 weeks, especially in porous earthen jars, under normal water use patterns. Although resistance to temephos in Ae. aegypti and Ae. albopictus populations has not been reported from the South-East Asia Region, the susceptibility level of Aedes

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mosquitoes should be monitored regularly in order to ensure the effective use of the insecticide. Insect growth regulators: Insect growth regulators (IGRs) interfere with the development of the immature stages of the mosquito by interference of chitin synthesis during the molting process in larvae or disruption of pupal and adult transformation processes. Most IGRs have extremely low mammalian toxicity (LD50 value of acute oral toxicity for methoprene (Altosid) is 34 600 mg/kg). In general, IGRs may provide long-term residual effects (three to six months) at relatively low dosages when used in porous earthen jars. Because IGRs do not cause immediate mortality of the immature mosquitoes, countries with legislation stipulating that the breeding of Aedes larvae is an offense, will require some alteration of the law, so as not to penalize home owners who use these compounds. Space sprays: Space spraying involves the application of small droplets of insecticide into the air in an attempt to kill adult mosquitoes. It has been the principal method of DF/DHF control used by most countries in the Region for 25 years. Unfortunately, it has not been effective, as illustrated by the dramatic increase in DHF incidence in these countries during the same period of time. Recent studies have demonstrated that the method has little effect on the mosquito population, and thus on dengue transmission. Moreover, when space spraying is conducted in a community, it creates a false sense of security among residents, which has a detrimental effect on community-based source reduction programmes. From a political point of view, however, it is a desirable approach because it is highly visible and conveys the message that the government is doing something about the disease. This, however, is poor justification for using space sprays. The current recommendations are that space spraying of insecticides (fogging) should not be used except in the most extreme conditions during a major DHF epidemic. However, the operations should be carried out at the right time, at the right place, and according to the prescribed instructions with maximum coverage, so that the fog penetration effect is complete enough to achieve the desired results.

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When space sprays are employed, it is important to follow the instructions on both the application equipment and the insecticide label and to make sure the application equipment is well maintained and properly calibrated. Droplets that are too small tend to drift beyond the target area, while large droplets fall out rapidly. Nozzles for ultra-low volume ground equipment should be capable of producing droplets in the 5 to 27 micron range and the mass median diameter should not exceed the droplet size recommended by the manufacturer. Desirable spray characteristics include a sufficient period of suspension in the air with suitable drift and penetration into target areas with the ultimate aim of impacting adult mosquitoes. Generally, there are two forms of space-spray that have been used for Ae. aegypti control, namely “thermal fogs” and “cold fogs”. Both can be dispensed by vehiclemounted or hand-operated machines. Thermal fogs: Thermal fogs containing insecticides are normally produced when a suitable formulation condenses after being vaporized at a high temperature. Generally, a thermal fogging machine employs the resonant pulse principle to generate hot gas (over 200oC) at high velocity. These gases atomize the insecticide formulation instantly so that it is vaporized and condensed rapidly with only negligible formulation breakdown. Thermal fogging formulations can be oil-based or water-based. The oil(diesel)based formulations produce dense clouds of white smoke, whereas water-based formulations produce a colorless fine mist. The droplet (particle) size of a thermal fog is usually less than 15 microns in diameter. The exact droplet size depends on the type of machine and operational conditions. However, uniform droplet size is difficult to achieve in normal fogging operations. Ultra-low volume (ULV), aerosols (cold fogs) and mists: ULV involves the application of a small quantity of concentrated liquid insecticides. The use of less than 4.6 litres/ha of an insecticide concentrate is usually considered as an ULV application. ULV is directly related to the application volume and not to the droplet size. Nevertheless, droplet size is important and the equipment used should be capable of producing droplets in the 10 to 15 micron range, although the effectiveness changes little when the droplet size range is extended to 5-25 microns. The droplet size

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should be monitored by exposure on teflon or silocone-coated slides and examined under a microscope. Aerosols, mists and fogs may be applied by portable machines, vehicle-mounted generators or aircraft equipment. House-to-house application using portable equipment: Portable spray units can be used when the area to be treated is not very large or in areas where vehicle-mounted equipment cannot be used effectively. This equipment is meant for restricted outdoor use and for enclosed spaces (buildings) of not less than 14m3.Portable application can be made in congested low-income housing areas, multistoried buildings, godowns and warehouses, covered drains, sewer tanks and residential or commercial premises. Operators can treat an average of 80 houses per day, but the weight of the machine and the vibrations caused by the engine make it necessary to allow the operators to rest, so that two or three operators are required per machine. Vehicle-mounted fogging: Vehicle-mounted aerosol generators can be used in urban or suburban areas with a good road system. One machine can cover up to 1500-2000 houses (or approximately 80 ha) per day. It is necessary to calibrate the equipment, vehicle speed, and swath width (60-90m) to determine the coverage obtained by a single pass. A good map of the area showing all roads is of great help in undertaking the application. An educational effort may be required to persuade the residents to cooperate by opening doors and windows. The speed of the vehicle and the time of day of application are important factors to consider when insecticides are applied by ground vehicles. The vehicle should not travel faster than 16 kph (10 mph). When the wind speed is greater than 16 kph or when the ambient air temperature is greater than 28oC (82oF), the insecticide should not be applied(25). The best time for application is in the early morning (approximately 0600-0830 hours) or late afternoon (approximately 1700-1930 hours). Insecticide formulations for space sprays: Organophosphate insecticides, such as malathion, fenitrothion and pirimiphos methyl have been used for the control of adult Aedes vectors. Undiluted technical grade malathion (active ingredient 95%+) or one part technical grade diluted with 24 parts of diesel have been used for

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ULV spraying and thermal fogging respectively. For undiluted technical grade ULV malathion applications from vehicles, the dosage on an area basis is 0.5 liters per hectare. Apart from the above-mentioned formulations, a number of companies produce pyrethroid formulations containing either permethrin, deltamethrin, lambda-cyhalothin or other compounds which can be used for space spray applications. It is important not to under-dose during operational conditions. Low dosages of pyrethroid insecticides are usually more effective indoors than outdoors. Integrated Control Approach: The use of insecticides for the prevention and control of dengue vectors should be integrated into environmental methods wherever possible. During periods of little or no dengue virus activity, the routine source reduction measures described earlier can be integrated into larvicide application in containers that cannot be eliminated, covered, filled or otherwise managed. For emergency control to suppress a dengue virus epidemic or to prevent an imminent outbreak, a programme of rapid and massive destruction of the Ae. aegypti population should be undertaken with both insecticides and source reduction, using the techniques described in these guidelines in an integrated manner. Insecticide susceptibility monitoring: During the past 40 years, chemicals have been widely used to control mosquitoes and other insects from spreading diseases of public health importance. As a result, Ae. aegypti and other dengue vectors in several countries have developed resistance to commonly-used insecticides, including temephos, malathion, fenthion, permethrin, propoxur and fenitrothion. It is therefore advisable to obtain baseline data on insecticide susceptibility before insecticidal control operations are started, and to continue monitoring susceptibility levels periodically. WHO kits are available for testing the susceptibility of adult and larval mosquitoes and other arthropod vectors to commonlyused insecticides. These can be obtained from the Communicable Diseases Cluster, World Health Organization, 1211 Geneva 27, Switzerland, or through WHO Regional Offices or WHO Representatives in the countries.

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LONG TERM PREVENTION STRATEGY

COMMUNITY PARTICIPATION Community participation (CP) has been defined “as a process whereby individuals, families and communities are involved in the planning and conduct of local vector control activities so as to ensure that the programme meets the local needs and priorities of the people who live in the community, and promotes community’s self-reliance in respect to development.” In short, CP entails the creation of opportunities that enable all members of the community and extended society to actively contribute to, influence the development of, and share equitably in the fruits of accrued benefits. Objectives of community participation in dengue prevention and control: o To extend the coverage of the programme to the whole community by creating community awareness. This however often requires intensive inputs. o To make the programme more efficient and cost-effective, with greater coordination of resources, activities and efforts pooled by the community. o To make the programme more effective through joint community efforts to set goals, objectives and strategies for action. o To promote equity through sharing of responsibility, and through solidarity in serving those in greatest need and at greatest risk. o To promote self-reliance among community members and increase their sense of control over their own health and destiny.

How to Invoke Community Participation o By showing concern: Community and government organizers should reflect the true concern for human suffering, i.e. morbidity and mortality due to dengue in the country, economic losses to the families and the country, and how the benefits of the programme fit into the people’s needs and expectations. o Initiating dialogue: Community organizers and opinion

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leaders or other key personnel in the power structure of the community, namely women’s groups, youth groups and civic organizations, should be identified. Dialogue should be undertaken through personal contacts, group discussions and film shows. Interaction should generate mutual understanding, trust and confidence, enthusiasm and motivation. The interaction should not be a one-time affair, but should be a continuing dialogue to achieve sustainability. o Creating community ownership: Organizers should use community ideas and participation to initiate the programme, community leaders to assist the programme, and community resources to fund the programme. Mosquito control, abatement agency and community partnerships should be strong, but limited to providing technical guidance and expertise. o Health education (HE): Health education should not be based on telling people the do’s and don’ts through a vertical, top-down communication process. Instead, health education should be based on formative research to identify what is important to the community and should be implemented at three levels, i.e. the community level, systems level and political level. Community level: People should not only be provided with knowledge and skills on vector control, but education materials should empower them with the knowledge that allows them to make positive health choices and gives them the ability to act individually and collectively. Systems level: To enable people to mobilize local actions and societal forces beyond a single community, i.e. health, development and social services. Political level: Mechanisms must be made available to allow people to articulate their health priorities to political authorities. This will facilitate placing vector control high on the priority agenda and effectively lobby for policies and actions. Defining community actions: For sustaining DF/DHF prevention and control programmes, the following community actions are essential:

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community and consequently greater participation in neighborhood campaigns. o Arrange novel incentives for those who participate in community programmes for dengue control. For example, a nationwide competition can be promoted to identify the cleanest communities or those with the lowest larval indices within an urban area.

INTERSECTORAL COORDINATION Developing economies in countries of the South-East Asia Region have recognized many social, economic and environmental problems which promote mosquito breeding. The dengue problem thus exceeds the capabilities of ministries of health. The prevention and control of dengue requires close collaboration and partnerships between the health and non-health sectors (both government and private), nongovernmental organizations (NGOs) and local communities. During epidemics such cooperation becomes even more critical, since it requires pooling of resources from all groups to check the spread of the disease. Intersectoral cooperation involves at least two components: o Resource-sharing o Policy adjustments among the various ministries and nongovernmental sectors.

Resource Sharing Resource sharing should be sought wherever the dengue control coordinator can make use of underutilized human resources, e.g. for local manufacture of needed tools, seasonal government labourers for water supply improvement activities, or community and youth groups to clean up discarded tyres and containers in neighbourhoods. The dengue control programme should seek the accommodation or adjustment of existing policies and practices of other ministries, sectors, and municipal governments to include public health as a central focus for their goals. For instance, the public works sector could be encouraged to adjust its policies to give first priority to water supply improvements for communities at highest risk of dengue. In return, the Ministry of Health could authorize the use of some of its field

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staff to assist the ministry responsible for public works to repair water supply and sewerage systems in other urban areas. The following examples show how several government ministries may contribute to dengue vector control efforts. Role of the ministry responsible for public works: The ministry responsible for public works and its municipal counterparts should play a key role in dengue control. They can contribute to source reduction by providing a safe, dependable water supply, adequate sanitation, and effective solid waste management. In addition, through the adoption and enforcement of housing and building codes, a municipality may mandate the provision of utilities such as individual household piped water supplies or sewerage connections, and rainwater (storm water) run-off control for new housing developments, or forbid open surface wells. Role of the Ministry of Education: The Ministry of Health should work closely with the Ministry of Education to develop a health education (health communication) component targeted at school children, and devise and communicate appropriate health messages. Health education models can be jointly developed, tested, implemented and evaluated for various age groups. Research programmes in universities and colleges can be encouraged to include components that produce information of direct importance (e.g. vector biology and control, case management) or indirect importance (e.g. improved water supply, educational inter-ventions to promote community sanitation, waste characterization studies) to dengue control programmes. Role of the ministry responsible for the environment: The Ministry of Environment can help the Ministry of Health collect data and information on ecosystems and habitats in or around cities at high risk of dengue. Data and information on local geology and climate, land usages, forest cover, surface waters, and human populations are useful in planning control measures for specific ecosystems and habitats. The Ministry of Environment may also be helpful in determining the beneficial and adverse impacts of various Ae. aegypti control tactics (chemical, environmental and biological). Role of the ministry responsible for information, communication and the mass media: Information directed at the community at large is best achieved through the mass media, such

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as television, radio and newspapers. Therefore, the ministry responsible for information, communication and the mass media should be approached to coordinate the release of messages on the prevention and control of dengue developed by public health specialists. Role of Nongovernmental organization (NGOs): NGOs can play an important role in promoting community participation and implementing environmental management for dengue vector control. This will most often involve health education, source reduction, and housing improvement related to vector control. Community NGOs may be informal neighbourhood groups or formal private voluntary organizations, service clubs, churches or other religious groups, or environmental and social action groups. After proper training by the Ministry of Health staff in source reduction methods, NGOs can collect discarded containers (tyres, bottles, tins, etc.), clean drains and culverts, fill depressions, remove abandoned cars and roadside junk, and distribute sand or cement to fill tree holes. NGOs may also play a key role in the development of recycling activities to remove discarded containers from yards and streets. Such activities must be coordinated with the environmental sanitation service. NGOs may also be able to play a specific, but as yet unexplored, role in environmental management during epidemic control. Under guidance from the Ministry of Health, NGOs could concentrate on the physical control of locally identified, key breeding sites such as water drums, waste tyre piles, and cemetery flower vases. Service clubs such as Rotary International have supported DF/DHF prevention and control programmes in the American Region for over 15 years. In Asia and the Pacific, programmes have been initiated in Sri Lanka, Philippines, Indonesia and Australia to provide economic and political support for successful community-based campaigns. A new grant from the Rotary Foundation of Rotary International \as been awarded to study the possibility of up scaling this project to a global programme. Women’s clubs have contributed to Ae. aegypti control by conducting household inspections for foci and carrying out source reduction. There are many opportunities, mostly untapped, for environmental organizations and religious service groups to play

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similar roles in each Ae. aegypti-infested community. Model Development: Model development for dengue control through a community participation approach should be initiated in order to define potential prime movers in the communities and to study ways to persuade them to participate in vector control activities. Social, economic and cultural factors that promote or discourage the participation of these groups should be intensively studied in order to gain more participation from the community. Model development focusing on school children has been studied in several countries and this strategy should be modified and introduced into each country. Social Mobilization: Advocacy meetings should be conducted for policy makers to attain political commitment for mass cleanup campaigns and environmental sanitation. Intersectoral coordination meetings should be conducted to explore possible donors for m\ass antilarval control campaigns and measures and to help finance the programme. Reorientation training of health workers should be conducted to improve their technical capability and ability to supervise prevention and control activities. A “DHF month” should be identified twice a year, during the pretransmission season and during the peak transmission period. Health Education: Health education is very important in achieving community participation. It is a long-term process to achieve human behavioural change, and thus should be carried out on a continuous basis. Even though countries may have limited resources, health education should be given priority in endemic areas and in areas at high risk for DHF. Health education is conducted through the different channels of personal communication, group educational activities, and mass media. Health education can be implemented by women’s groups, school teachers, formal and informal community leaders, and health workers. Health education efforts should be intensified before the period of dengue transmission as one of the components of social mobilization. The main target groups are school children and women. Legislative support: Legislative support is essential for the success of dengue control programmes. All countries of the Region have legislation addressing control of epidemic diseases which

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authorize health officers to take necessary action within the community for the control of epidemics. On a continuous and sustainable basis, various municipalities have adapted legislation for the prevention of “nuisance mosquitoes”, however they lack specific provision related to dengue and/or Ae. aegypti control. At the national level, all countries are signatories to the International Health Regulations which have a specific provision for the control of Ae. aegypti and other disease vectors around international sea/airports. The formulation of legislate/on on dengue/Ae.aegypti control should, therefore, take into consideration the following points: • Legislation should be a necessary component of all dengue/ Ae.aegypti prevention and control programmes. • All existing decrees and resolutions on dengue/Ae.aegypti prevention and control must be reviewed, and their effectiveness evaluated in terms of structural, institutional and administrative changes. It is also important to add dengue to the list of diseases that require mandatory notification in each country. • Regulations should be formulated on the basis of existing sanitary codes, a strategy that is most needed in those countries which lack legislation on the subject. In countries where sanitary regulations are primarily the responsibility of agencies other than the Ministry of Health (e.g. municipal governments), a coordinated and cooperative line of action with the ministry should be developed. • Legislation should incorporate municipal authorities from affected regions as the central element for implementation and enforcement. Where national legislation is weak or absent, municipal governments may consider the adoption of local ordinances for Ae. aegypti control. • Legislation should contemplate intersectoral coordination among the ministries involved in national development in order to prevent isolated implementation of individual programmes and harmful environmental changes that could create potentially hazardous public health conditions. Ministries should be advised on the best ways to encourage disease prevention.

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Biological Disaster Management • Legislation should cover all aspects of environmental sanitation in order to effectively contribute to the prevention of all transmissible diseases.aimed at developing human resources within the institutional framework. • In developing legislation, the social component must be considered. Legislation should seek support based on justice and justification: individuals and the community must be persuaded that the law is good and that it is intended to protect them and their families, and that compliance with it is one of the most important components for dengue control. • Laws should contemplate the existing judicial administrative framework in the context of national public administration. Importance should also be placed on norms.

FREQUENTLY ASKED QUESTIONS 1. What is Dengue fever (DF)? Dengue infection is caused by a virus. It occurs commonly as dengue fever. Occasionally the patient suffering from dengue may develop bleeding. Common sites for bleeding are nose, gums or skin. Sometimes, the patient may have coffee ground vomiting or black stools. This indicates bleeding in gastro intestinal tracts and it is serious. The patient with dengue who has bleeding has dengue haemorrhagic fever (DHF). Rarely the patient suffering from dengue may develop shock, then it is called dengue shock syndrome (DSS). 2. What is Dengue fever (DF)? Dengue infection is caused by a virus. It occurs commonly as dengue fever. Occasionally the patient suffering from dengue may develop bleeding. Common sites for bleeding are nose, gums or skin. Sometimes, the patient may have coffee ground vomiting or black stools. This indicates bleeding in gastro intestinal tracts and it is serious. The patient with dengue who has bleeding has dengue haemorrhagic fever (DHF). Rarely the patient suffering from dengue may develop shock, then it is called dengue shock syndrome (DSS).

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3. When should I suspect Dengue? Dengue should be suspected when you have sudden onset of fever. The fever is high 103-105 degrees F or 39-40 degrees C. It is accompanied with severe headache (mostly in the forehead), pain behind the eyes, body aches and pains, rash on the skin and nausea or vomiting. The fever lasts for 5-7 days. In some patients, fever comes down on 3rd or 4th day but comes back. All the above symptoms and signs may not be present in the patient. The patient feels much discomfort after the illness. 4. There are several types of fever, when should dengue be suspected? The characteristics of dengue that make it different from other causes of fever are the pain behind the eyes, severe pains in the muscles, severe joint pains, and skin rashes. These features make the diagnosis of suspected Dengue likely. The severe joint pains caused by DF is the reason why DF is also called break-bone fever. 5. What is the difference between suspected and probable case of dengue? If a patient suspected to be having dengue has reduced platelets or an increase in blood haematocrit, then the patient has probable dengue. These additional findings make dengue more likely. Patients with dengue may not have a high haematocrit if the person was anaemic to start with. 6. Can you get dengue again after suffering from it once? It is possible to get dengue more than once. Dengue can occur because of 4 different but related strains of dengue virus. If a person has suffered from one virus, there can be a repeat occurrence of dengue if a different strain is involved subsequently. Being affected by one strain offers no protection against the others. A person could suffer from dengue more than once in her/his lifetime. 7. Can the diagnosis of dengue be confirmed? There are laboratory tests that provide direct or indirect evidence for dengue fever. These tests provide evidence for the occurrence of dengue infection. There are some additional tests that can help to identify the type of dengue infection. The tests for confirmation of Dengue should be done in reliable laboratories.

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Dengue fever occurs following the bite of an infected mosquito Aedes aegypti.This type of mosquito has a peculiar white spotted body and legs and is easy to recognize even by laymen. It breeds in clean water (see Question 20) and has a flight range of only 100 - 200 metres. The mosquito gets the Dengue virus after biting a human being infected with dengue virus. 9. When does dengue develop after getting the infection? After the entry of the virus in the person, it multiplies in the lymph glands in the body. The symptoms develop when the virus has multiplied in sufficient numbers to cause the symptoms. This happens generally about 4-6 days (average) after getting infected with the virus. 10. Can people suffer from dengue and not appear ill? Yes, There are many people who are infected with the virus and do not suffer from any signs or symptoms of the disease. For every patient with symptoms and signs there may be 4-5 persons with no symptoms or with very mild symptoms. 11. Can dengue fever be treated at home? Most patients with dengue fever can be treated at home. They should take rest, drink plenty of fluids that are available at home and eat nutritious diet. Whenever available, Oral Rehydration Salt/ORS (commoin treating diarrhoea) is preferable. Sufficient fluid intake is very important and becomes more important in case DF progresses into DHF or DSS where loss of body fluid / blood is the most salient feature. It is important to look for danger signs and contact the doctor as soon as any one or more of these are found. 12. What is the treatment? Is it curable? Like most viral diseases there is no specific cure for dengue fever. Antibiotics do not help. Paracetamol (can be purchased without prescription) is the drug of choice to bring down fever and joint pain. Other medicines such as Aspirin and Brufen should be avoided since they can increase the risk of bleeding. Doctors should be very careful when prescribing medicines. Any medicines that decrease platelets should be avoided.

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13. Can dengue fever become dangerous? The infection can become dangerous since it may cause damage to the blood vessels. The damage may range from increased permeability of the blood vessels, causing leakage of blood fluid/ plasma into various organs to completely broken blood vessels that causes bleeding. The symptoms and signs of dengue hemorrhagic fever and dengue shock syndrome are related to damage to the blood vessels and derangement in functioning in components of blood that help it to clot. 14. Can people die from dengue fever? People who suffer from dengue fever have no risk of death but some of them develop Dengue Hemorrhagic Fever or Dengue Shock Syndrome. In some of these cases death can occur. With proper treatment, the patients with Dengue hemorrhagic fever and dengue shock syndrome can recover fully. Good treatment provided in time can save most lives. 15. When should a patient suffering from Dengue go to the hospital or consult a doctor? Generally the progress towards dengue hemorrhagic fever or dengue shock syndrome occur after 3-5 days of fever. At this time, fever has often come down. This may mislead many of us to believe that the patient is heading towards recovery. In fact, this is the most dangerous period that requires high vigilance from care-givers. The signs and symptoms that should be looked for are severe pain in the abdomen, persistent vomiting, bleeding from any site like, bleeding in the skin appearing as small red or purplish spots, nose bleed, bleeding from gums, passage of black stools like coal tar. Bring the patient to the hospital whenever the first two signs, namely, severe pain in the abdomen and persistent vomiting are detected. Usually it is too late if we wait until bleeding has occurred. The most dangerous type of dengue is the dengue shock syndrome. It is recognized by signs like excessive thirst, pale and cold skin (due to very low blood pressure), restlessness and a feeling of weakness. 16. Is there a vaccine to prevent dengue fever? A vaccine has been developed to prevent dengue fever but it is still under trial. It is not yet available in the market. Scientific

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progress is likely to help in prevention of dengue fever by vaccination in the years to come. 17. Are there any long term ill effects of dengue fever? Most people who suffer from dengue fever recover in 1-2 weeks time. Some may feel tired for several weeks. However, if symptoms persist after this period, consult a doctor. 18. Where does the mosquito that spreads dengue live? The highly domestic mosquito Aedes aegypti rests indoors, in closets and other dark places. Outside it rests where it is cool and shaded. The female mosquito lays her eggs in water containers in and around the homes, and other dwellings. These eggs will develop, become larvae, and further develop into adults in about 10 days. 19. How can the multiplication of mosquitoes be reduced? Dengue mosquitoes breed in stored, exposed water collections. Favoured places for breeding are barrels, drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles, tins, tyres, water coolers etc. To prevent the mosquitoes from multiplying, drain out the water from desert coolers/window air coolers (when not in use), tanks, barrels, drums, buckets etc. Remove all objects containing water (e.g. plant saucers etc.) from the house. Collect and destroy discarded containers in which water collects e.g. bottles, plastic bags, tins, used tyres etc. In case it is not possible to drain out various water collections or to fully cover them, use TEMEPHOS, an insecticide, ( brand name Abate1 part per million according to the local guidelines to prevent larvae from developing into adults. 20. How can I prevent mosquito bites to prevent dengue? There is no way to tell if a mosquito is carrying the dengue virus. Therefore, people must protect themselves from all mosquito bites. Dengue mosquitoes bite during the day time throughout the day. Highest biting intensity is about 2 hours after sunrise and before sunset.Wear full sleeves clothes and long dresses to cover as much of your body as possible. Use repellents- be careful in using them in young children and old people. Use mosquito coils and electric vapour mats during the daytime also to prevent dengue.Use mosquito nets to protect children, old people and

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others who may rest during the day. The effectiveness of these nets can be improved by treating them with permethrin (pyrethroid insecticide). This bed-net is called Insecticide Treated Nets and are widely used in the prevention of malaria. 21. Is there any advice for the patient with dengue fever to prevent the spread of the disease to others? The spread of dengue from a patient to others is possible. The patient should be protected from contact with the mosquito. This can be achieved by ensuring that the patient sleeps under a bednet. Effective mosquito repellents are used where the patient is being provided care. This will prevent the mosquito from biting the patient and from getting infected and spreading it to others. 22. What is your advice on travel if there is an outbreak of dengue? There is no travel restriction. However, you should be aware of what to do if you are traveling an area where dengue has been reported. This includes observing prevention measures described in these frequently asked questions and answers and reporting to the doctor if you have fever and are worried that it might be dengue fever. 23. What should the doctors treating dengue do ? Patients suspected to be suffering from dengue haemorrhagic fever or dengue shock syndrome should be admitted to a hospital without delay.The progress of these patients should be monitored regularly at 1-2 hours interval.Platelet counts and haematocrits should be monitored repeatedly to review the progress of patients.If the haematocrit levels fall dangerously then a blood transfusion should be considered. A fall of more than 20 % as compared to previous levels may be an indication for transfusion. If the haematocrit values rise the patient should be given fluids intravenously and the fluids carefully monitored to ensure that the patient does not get excess fluids. A rise of more than 20 % as compared to previous levels may be an indication for IV fluids. The doctor should decide based on best judgement of patient’s condition. 24. What should the doctors treating dengue avoid? Do not prescribe aspirin and brufen or any other medicine

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that reduces the platelets or increases the tendency to bleed.Avoid giving IV fluids unless the patient is bleeding or the haematocrit level is rising progressively.Avoid rushing into giving blood transfusion unless the haematocrit is falling dangerously. Do not give platelet transfusion unless the platelet count is very low or unless there is bleeding. 25. What is your advice regarding reporting of dengue? All suspected or probable dengue cases should be reported to the health authorities. Further confirmation of the cases is done by the health authorities. Seek their guidance on blood collection and transportation of samples from suspected/probable cases of dengue. 26. What can the community do to prevent dengue? In fact, the community is the key to dengue prevention. As elaborated above, prevention of dengue relies heavily on preventing the mosquito (Aedes aegypti) that transmits dengue from breeding inside and in the vicinity of homes. Every household can undertake the very simple measures to prevent existing water collections from becoming places for breeding of A.aegypti by draining out water from various containers, by regular changing of water plus cleaning flower vases and other items or, in the case of unused items, by discarding/destroying them.Since the mosquito does not travel far, “house cleaning” by all members of a community will ensure that no breeding places exist, preventing dengue from occurring.The main strategy in the prevention and control of dengue is “source reduction”, or prevention of breeding places, mentioned above. 27. In the case of a dengue outbreak or epidemic what are our strategies? Prevention of mosquito breeding places remains our mainstay. However to stop or to slow down the transmission it may be supplemented by “thermal fogging”, using fogging machines. In fogging,we use an insecticide that has an immediate knock-down effect on adult mosquitos. When fogging is undertaken after an epidemic occurs, it is unfortunately too late. Fogging, to be effective, should be done at about 3-4 days interval. It is expensive and time consuming. Therefore, measures undertaken by the community,

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for the community, to prevent the breeding of mosquitoes is far more cost-effective than containment measures once an outbreak occurs. FACT SHEETS ON DENGUE

GENERAL Dengue is an acute fever caused by a virus. It occurs in two forms: 1. Dengue Fever. 2. Dengue Haemorrhagic Fever. Dengue fever is marked by the onset of sudden high fever, severe headache and pain behind the eyes, muscles and joints. Dengue Haemorrhagic fever (DHF) is a more severe form, in which bleeding and sometimes shock occurs - leading to death. It is most serious in children. Symptoms of bleeding usually occur after 3-5 days of fever. The high fever continues for five to six days (103 - 105 OF or 39- 40 OC). It comes down on the third or the fourth day but rises again. The patient feels much discomfort and is very weak after the illness. Dengue spreads rapidly and may affect large number of people during an epidemic resulting in reduced work productivity, but most importantly causing the loss of lives. RECOGNITION OF DENGUE FEVER • Sudden onset of high fever • Severe headache (mostly in the forehead) • Pain behind the eyes which worsens with eye movement • Body aches and joint pains • Nausea or vomiting RECOGNITION OF DENGUE HEMORRHAGIC FEVER AND SHOCK Symptoms similar to dengue fever plus, any one of the following: 1. Severe and continuous pain in abdomen; 2. Bleeding from the nose, mouth and gums or skin bruising;

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Frequent vomiting with or without blood; Black stools, like coal tar; Excessive thirst (dry mouth); Pale, cold skin; Restlessness, or sleepiness;

TREATMENT There is no specific medicine for the treatment of the disease. However proper and early treatment can relieve the symptoms and prevent complications and death. Aspirin and Brufen should be avoided in dengue fever, as it is known to increase the bleeding tendency and also it increases the stomach pain. Paracetamol can be given on medical advice. If one or more signs of Dengue Haemorrhagic fever are seen, take the patient to the hospital immediately. Give fluids to drink while transferring the patient to the hospital. BASIC FACTS ON DENGUE • How dengue spreads? Dengue is spread by the bite of an infected mosquito Aedes aegypti. The mosquito gets the virus by biting the infected persons. The first symptoms of the disease occur about 5-7 days after an infected bite. There is no way to tell if a mosquito is carrying the dengue virus. Therefore, people must protect themselves from all mosquito bites. • Where does the mosquito live? The mosquito rests indoors, in closets and other dark places. Outside, they rest where it is cool and shaded. The female mosquito lays her eggs in water containers in and around homes, schools and other areas in towns or villages. These eggs become adult in about 10 days. • Where does the mosquito breed? Dengue mosquitoes breed in stored exposed water collections. Favoured breeding places are: Barrels, drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles, tins, tyres, water cooler, etc. and a lot more places where rain-water collects or is stored.

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PREVENTION OF DENGUE All efforts of control should be directed against the mosquitoes. It is important to take control measures to eliminate the mosquitoes and their breeding places. However, the efforts should be intensified before the transmission season (during and after the rainy season) and at the time of the epidemic. Prevent Mosquito Bites: Dengue mosquitoes bite during the daytime. Protect yourself from the bite: 1. Wear full sleeve clothes and long dresses to cover the limbs; 2. Repellent - care should be taken in using repellents on small children and the elderly; 3. Use mosquito coils and electric vapour mats during the daytime to prevent Dengue; 4. Use mosquito nets - to protect babies, old people and others, who may rest during the day. The effectiveness of such nets can be improved by treating them with permethrin (pyrethroid insecticide). Curtains (cloth or bamboo) can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes. 5. Protection of people sick with dengue - Mosquitoes become infected when they bite people who are sick with dengue. Mosquito nets and mosquito nets and mosquito coils will effectively prevent mosquitoes from biting sick people and help stop the spread of dengue. Prevention Multiplication of Mosquitoes: Mosquitoes which spread dengue live and breed in and around houses. • Drain water from coolers, tanks, barrels, drums and buckets, etc.; • There should be no water in coolers when not in use; • Remove from the house all objects, e.g. plant saucers, etc. which have water collected in them; • Remove water from refrigerator drip pans every other day; • All stored water containers should be kept covered all the time; • Discard solid waste and objects where water collects, e.g. bottles, tins, tyres, etc.

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7 Disaster Management Information System WHAT IS DMIS? Natural disasters impart lessons at a very high cost of life and property. But if those lessons do not lead to learning and knowledge generation then it is a very heavy cost to bear. This lack of learning from the past hurts most at the recurrence of disasters. The earthquake in Gujarat (26th January 2001, an earthquake of 7.9 magnitude on Richter scale struck Gujarat, India, with its epicentre in Kutch, causing destruction of three towns and death of more than 20,000 people) and the subsequent chaos was an indicator of how crucial disaster planning is to manage relief and rehabilitation during disasters. SRISTI participated in the relief and rehabilitation work in Kutch. But the relief work suffered immensely due to lack of information and proper planning. When we tried to get answers to important questions that were cropping up – for instance, whether there exists a database on the distribution of available resources and expertise with individuals, institutions and corporations – all we got in response was a blank. This pointed to the urgent necessity of building a system for disaster mitigation and for documenting experiences of individuals and organisations, which might act as a knowledge resource and help in better coordination in case of future disasters. The Disaster Management Information System: Thus, SRISTI initiated an effort to build a “Disaster Management Information

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System”. Through this initiative we are trying to develop a database-driven information system for Disaster Management Authorities (DMA) in various states, NGOs and other organisations. We appealed to NGOs, relief workers, DMAs and individuals to share their experiences and volunteer services and resources to the online database maintained at our website. The database currently contains more than a thousand volunteers who have offered to volunteer their services and resources in time of emergency. About 700 organisations and institutions are also listed on the site, besides other resources and web links. The DMIS is a wholly voluntary activity run with contributions in terms of time and services by SRISTI volunteers, NGOs and above all civil society institutions across the world. All the information shared with us is accessible to all, except where the volunteer has chosen to limit accessibility only to the relevant authorities. A GUIDELINE FOR DISASTER PREPAREDNESS I am focusing on preparing a template for disaster management including following seven issues: a) Database: on various resources, skills, and services required for relief at short notice. It will have information on safety equipments, oxygen cylinders and various other equipments, skills and other information required to deal with emergency. b) Logistics: One of the most difficult problems to be handled is the organization of supply chain for relief. Several colleagues at IIMA also developed logistics system for Collectorate at Bhuj. This system could not be integrated with the GIS system so that supplies could be tracked right upto the village. This needs to be done. Likewise, other elements of logistics need to be put in place. c) Technological Needs: Whole range of technical questions regarding buildings, cutting concrete slabs, rescue and relief emerged which needed to be solved on the spot. The best practices have to be put in use. d) Self Reliance: The community self-reliance, lot of aid led to excessive inventory at the household level leading to

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DISASTER PLANNING & MANAGEMENT Suggestive Strategies, Recommendations and Action Plan for Disaster Mitigation, Prevention and Preparedness:

ISSUES ADDRESSED The Expert Group appointed by the Govt. of India examined the current status of work being carried out in these areas: Monitoring of Hazards Vulnerability Assessment Prediction and Forecasting Retrofitting of Existing Unsafe Structures and Buildings Hazard Mapping Disaster Risk Assessment and Mapping Preparation of Building Guidelines Assessing Gaps in the Above. Filling them as much as possible The Report has covered the following issues:

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• • • •

Identification of various hazard prone areas. Vulnerability and Risk Assessment ofBuildings Disaster damage scenarios, Technical Guidelines for Hazard ResistantConstruction of Buildings. • Upgrading of Hazard Resistance of Existing Housing Stock by Retrofitting, and • Techno-Legal Regime to be adopted Based on the findings as above, the Group has recommended strategies to be adopted and Action Plan for consideration of the Government. The Group feels strongly that these need to be urgently considered for evolving a national policy keeping in view of the Govt. of India’s commitment to the Yokohama Strategy for Natural Disaster Reduction. 1. The first and the foremost is to restructure the National Policy on disaster management reflecting the holistic approach involving prevention, mitigation and preparedness in pre-disaster phase with appropriate additional funding, along with the so far existent policy of the post-disaster relief and rehabilitation under crisis management. 2. Creation of awareness for disaster reduction is urgently needed amongst policy makers, decision makers, administrators, professionals (architects, engineers and others at various levels) financial institutions (banks, insurance, house financing institutions) and NGOs and voluntary organizations. 3. Creating awareness for improving preparedness amongst the communities, using media, school education, and the network of the building centre. 4. Appropriate amendments in the legislative and regulatory instruments (state laws, master plans, development area plan rules, building regulations and bye-laws of local bodies) along with strengthening of the enforcement mechanisms at different levels. 5. Capacity building at local and regional levels for undertaking rapid-assessment surveys and investigations

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6.

7.

8.

9.

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of the nature and extent of damage in post disaster situations. Conducting micro-zonation surveys of large urban areas falling in the disaster prone regions and preparing appropriate preparedness and mitigation plans on an urgent basis. To ensure use of disaster resistant construction techniques in all housing and other buildings to be undertaken under the Central and State schemes. Making mandatory, the use of disaster resistant codes and guidelines related to disaster resistant construction in the houses and buildings in all sectors of the society by law and through incentives and disincentives. To create a suitable institutional mechanism at national/ state level to advise and help the existing disaster relief set up in formulation and updating of short and long range action plans for the preparedness, mitigation and prevention of natural disasters. (the mechanisms suggested are establishment of a National Scientific and Technical Committee at Central level and Natural Disaster Mitigation Centres at State levels). To promote the study of natural disaster prevention, mitigation and preparedness as subjects in architecture and engineering curricula. To create detailed database on hazard occurrences, damage caused to buildings and infrastructure and the economic losses suffered and ensure its accessibility to interested researchers for effective analysis of costs of disasters and benefits of mitigative actions. To devise appropriate policy instrument and funding support for urgent disaster preparedness and prevention actions in high risk areas including upgrading the resistance of existing housing and related structures and systems. To include R&D work in disaster preparedness, mitigation and prevention as a thrust area so that adequate funds are earmarked for the schemes of R&D organizations as well as the concerned Central Ministries and State Governments.

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8 Terrorist Chemical and Biological Attack CIVIL CHEMICAL AND BIOLOGICAL WARFARE ATTACK: THE MYTH AND REALITY Following the attacks in New York in September 2001, the spectre of urban attack by terrorists using chemical and biological warfare (CBW) agents again raised its head and led to a wave of speculation and near panic on both sides of the Atlantic Ocean. Newspaper articles about ‘weapons of mass destruction’ abounded, and emergency and hospital medical services made provisions for the management of large numbers of casualties. In the United States, mass ingestion of prophylactic antibiotics began and gas masks were purchased in large numbers. Television pictures of emergency personnel clad in protective suits (many of them totally inappropriate for the real degree of risk) were widely transmitted and for several weeks the public awaited a world-wide chemical/ biological Armageddon. In the event, the reality was confined to the distribution of anthrax spores through the US postal system, which fortunately claimed only a few lives. Nevertheless this attack, coming after the use of a military organophosphate nerve agent by terrorists in Japan in 1995, demonstrated that urban chemical and biological attack was possible and posed a problem for emergency and hospital medical services around the world. The risk of deliberate urban release of chemical and biological agents persists and is not new. From the point of view of casualty management, it is

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important that the momentum generated by the events of last autumn should be sustained. The appearance in this issue of a review concerning the implications of chemical and biological agents for anaesthesia and intensive care is therefore very appropriate. Many clinical specialities may be involved in the management of CBW casualties, but that of anaesthesia and intensive care has a critical role to play since the speciality, more than most others, has the academic background in physiology, applied pharmacology and pathophysiology, and is able to understand the injuries provoked by CBW agents. More importantly, it is able to respond with immediate and continuing life support. It is therefore essential that anaesthetists should be closely involved in the management of CBW casualties and should be properly informed about the risks and the special handling procedures required. Most busy anaesthetists do not have ready access to information about CBW agents. White has produced a useful, comprehensive document detailing a wide range of chemicals, toxins and organisms that have been proven or suspected to be agents of warfare, and more recently of urban terrorist attack. Two points about the extensive range of hazards presented in the review are particularly important. First, despite widespread public and political belief, biological and chemical agents are not strictly weapons of mass destruction but weapons of mass injury, a point recognized by a number of clinical experts including an ex-Soviet source. In this respect, they may lead to mass fatalities where medical resources are limited or non-existent, but with properly organized and equipped medical services the picture may be quite different. Unlike nuclear weapons, biological and chemical agents do not cause mass destruction of material and physical trauma. Biological and chemical agents should therefore be viewed in their own pathophysiological context. The persistence of the Nuclear, Biological and Chemical (NBC) classification owes more to diplomatic manipulation and the balance of military power than medical reality. White has appropriately classified CBW agents as weapons of mass injury rather than destruction, which is a more realistic term for anaesthetists used to the business of supporting life in difficult

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circumstances. This does not alter the fact that, untreated, CBW agents may lead to substantial loss of life. However, advanced life support and guidelines for longer term treatment do exist, and can radically alter the clinical picture. Secondly, it is important to realize that not all the hazards listed in the review are equally likely to be used by terrorists. A few have been identified and used, such as sarin and anthrax. Most, however, are still confined to the area of speculation (sometimes backed by intelligence information). The existence of a hazard does not necessarily imply a threat, a term which implies a means of delivery and intention on the part of the assailant, apart from possession of a hazard. In terms of planning and training, it is more realistic and less nihilistic to build from experience of chemical hazards that have or could be used by terrorists, backed by experience gained from industrial toxic release. Knowledge of the management of naturally occurring epidemics is equally valuable for the management of a deliberately induced epidemic (a biological weapon attack). For those clinicians who feel they have a lack of experience in such cases, it is worth noting that considerable clinical analogous experience exists, which can be used in the management of unfamiliar pathology. For anaesthetists in particular, the essential life support procedures involved are very familiar from more conventional areas of practice. CBW ATTACK AS A SPECIAL CASE OF GENERAL HAZARDOUS MATERIAL RELEASE In civil life, populations are at constant risk from accidental exposure to toxic substances, as they are from naturally occurring epidemics. These are the natural equivalents of the intentional toxic release and epidemics that constitute CBW. Accidental civil toxic releases are managed according to the United Nationscontrolled, hazardous materials control system (HAZMAT), which provides detailed information to emergency services about the properties and management of toxic substances at their place of use or while they are in transit. HAZMAT databases provide information for protection and decontamination, and clinical management protocols. The system is designed to manage accidental releases but provides a valuable framework for the

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management of casualties from deliberate releases. The difference between accidental and deliberate (terrorist) releases is that the identity of the toxic agent may not be known with certainty in the case of the latter, and so measures must be put into place that cover the worst case scenario of the agent being highly toxic, persistent and transmissible. Most HAZMAT incidents involve small numbers of casualties with varying degrees of exposure. Some of these may have the effects of both toxic and conventional trauma, for example after an explosion, such as that which occurred at a chemical factory in Toulouse, France in September 2001. The notion of mass casualties may not always therefore be appropriate, although both chemical and biological accidental releases have occurred in the past, giving rise to large numbers of injured and dead. Much information exists about the management of HAZMAT incidents and the author has made good use of the internet sources that are now available. HAZMAT is a valuable model and all anaesthetists involved in disaster management should be aware of the stages in the overall management of a HAZMAT incident, and of the risks related to the toxicity, latency of action, persistency and transmissibility of the agents involved. These four characteristics are common to both chemical and biological agents, and determine the degree of risk as well as the appropriate reponse. Toxicity is a familiar concept in anaesthesia, and toxic effects appear with a specific latency, which is important for the use of agents in deliberate release. In general, chemical agents and toxins have short periods of latency before specific signs and symptoms appear. In contrast, classical biological warfare agents have extended latency periods (usually familiar as incubation periods) before the effects of the induced disease begin to appear. Persistency relates to the ability of a toxic agent to remain in the environment into which it had been released and is a function of the physicochemical properties of the agent. For chemical agents, the persistency may be variable but for most biological warfare agents, with the exception of spore-forming agents such as anthrax, persistency is usually very short. However, transmissibility may take place as a result of the physical contamination of the victim due to a persistent chemical agent or as a result of infection in the

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case of an airborne agent. Transmissibility is therefore a potential menace in the case of biological warfare agents because of infection down the casualty management line.

WHAT ARE THE HAZARDS LIKELY TO BE FACED? Many known chemical agents (e.g. chlorine, phosgene and hydrogen cyanide) are readily available industrially and their properties are listed in standard sources and databases, which are cited in the review in this issue. Others, such as organophosphates, are familiar as pesticides but are also used by the military as nerve agents that may be synthesized in improvised laboratories. Certain biological warfare agents are recognized as being a more likely threat than others, given the difficulty of delivery and the sensitivity of the agents to meteorological conditions. Thus, anthrax is now an established threat that is more important than the rare viral haemorrhagic fevers, which are the domain of specialist physicians. It is important that biological attack should be viewed as a special case of an epidemic. MEDICAL MANAGEMENT OF CASUALTIES FROM CBW ATTACK: POINTS OF INVOLVEMENT OF ANAESTHETISTS Following CBW attack, anaesthetists may be involved at several points,18 and are thus in danger of primary and secondary exposure. In some countries, anaesthetists form part of the primary emergency response and are familiar with the dangers of toxic exposure and the need for protection and decontamination. Anaesthetists may also be involved in management in the emergency room, operating theatre management and the intensive care unit. In France, special plans were put in place for the management of terrorist toxic release following the Japanese sarin attacks in 1995, which have been recently modified as Plan Biotox. The plans provide special mobile medical response teams (with training and protective suits) as well as protected medical teams to receive casualties who escape the HAZMAT cordon. Anaesthetists are involved at both these points and must have a good understanding of the importance of casualty decontamination. In the hospital, anaesthetists must be aware of the effects of certain toxic agents

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on the conduct of general anaesthesia for the management of accompanying physical trauma. There are effects on the status of the patient before an operation and on the anaesthetic agents themselves. A good example is the effects of exposure to organophosphate anticholinesterases on the action of neuromuscular blocking agents, which is covered by White. Many toxic hazards have long latency effects, which lead to the necessary management of patients in the ICU. Long-term ventilation may be required for neuromuscular problems, toxic pulmonary oedema and associated adult respiratory distress syndrome. Mass toxic casualties will place a heavy burden upon emergency and intensive care services as a result of the short and longer term actions of toxic agents. Attacks using bacterial and viral biological agents essentially pose the problem of epidemic infection, although intensivists are required for the management of the resulting complications, including multiple organ failure. There is a long latency in most cases, but there may be ultra-short and intermediate latency effects if a bacterial toxin is used as a toxic agent. MANAGEMENT OF SPECIFIC PATHOPHYSIOLOGY Toxic agents may attack all somatic systems, but the respiratory system is the most vulnerable in the short and intermediate term, leading to fatality in some cases if resuscitation is not started early and continued. There are many pathophysiological processes leading to respiratory failure after toxic injury, affecting both the airway, and the control and mechanics of breathing. There may be, as in the case of organophosphates, failure of the respiratory centres and paralysis of the muscles of breathing through neuromuscular blockade. The review covers this in some detail.5 The more water-soluble toxic agents, such as chlorine, cause irritation and the production of secretions in the nasopharynx with laryngeal spasm. There may be blockage of the main airways with bronchial and bronchiolar constriction. Finally, many toxic substances act at the level of the alveoli causing toxic pulmonary oedema. Both the central and peripheral nervous systems may be affected as in the case of sarin poisoning, where the respiratory centres are depressed and there is a depolarizing neuromuscular

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block. The airways may be affected at both the upper and lower levels with cough and laryngeal spasm, production of secretions and vomitus, bronchospasm, bronchiolitis and toxic pulmonary oedema. Many substances produce ciliary paralysis, which compounds the bronchial problem. Clinically, the combined effects are to produce increased airway resistance and reduced compliance. This leads to a failure of alveolar ventilation, a rise in end-tidal carbon dioxide, hypoxia and cardiac arrest.

ANAESTHETISTS—A VOICE TO BE HEARD Anaesthetists clearly have a vital role to play in the management of CBW casualties, but in many countries their involvement with planning and provision of care has been relatively limited, particularly in the prehospital and emergency room areas. Many of the special government CBW advisers are from the public health, toxicology and pathology specialities. They do not have first hand experience of the emergency and intensive care life support measures required to break the link between mass injury and mass loss of life. It is important for anaesthetic professional bodies to take an interest in the subject and explain the role anaesthetists have to play in the management of chemical agent injury. For the general public, most of whom are still unaware that anaesthetists are medical practitioners, this may be something of a revelation. Training and close integration of anaesthetists into toxic emergency response teams is essential, but training by exercise is notoriously difficult for busy clinicians who have more than enough real problems to deal with. Nevertheless, it is vital that anaesthetists understand the real risks from CBW and the HAZMAT procedures to avoid becoming the next casualty. Above all, the speciality must give out a clear and positive message about the real dangers of CBW, and the appropriate planning and life support procedures that should form the medical response. This will not only serve to provide some comfort to a frightened general public, but will provide much needed focus for the rational management of casualties from a CBW attack.

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9 Improving Disaster Management: The Role of Information Technology Section 214 of the E-Government Act of 2002 called on the Office of Management and Budget, in consultation with the Federal Emergency Management Agency (FEMA), to “ensure that a study is conducted on using information technology to enhance crisis preparedness, response, and consequence management of natural and manmade disasters.” This, the final report from the National Research Council’s Committee on Using Information Technology to Enhance Disaster Management, addresses the issues listed in Section 214 and provides recommendations for enhancing disaster management through the use of IT. In this study, disasters are defined as natural, technological, and human-initiated events that disrupt the normal functioning of the economy and society on a large scale; information technology (IT) is broadly defined as including computing and communications technology; and disaster management is defined as encompassing mitigation, preparedness, response, and recovery efforts undertaken to reduce the impact of disasters. The purpose of this report is to inform federal, state, and local policy makers and public safety and emergency management professionals about future opportunities for the application of IT to disaster management. Many of the report’s recommendations are aimed at the diverse set of federal, state, and local agencies and other organizations

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(referred to here as disaster management organizations) with responsibility for disaster management activities. Several recommendations indicate what might be done at the federal level to foster IT innovation that would enhance disaster management efforts, but it was beyond the scope of this study to recommend exactly where responsibility for implementing these recommendations should be placed within the federal government. This report is not intended as a comprehensive look at the complex, highly multidisciplinary topic of disaster management, nor does it explicitly address tradeoffs between investments in IT and other capabilities for disaster management or make recommendations about levels of funding for IT (or indeed other) disaster management activities. USING INFORMATION TECHNOLOGY AS A POINT OF LEVERAGE TO ENHANCE DISASTER MANAGEMENT The challenge of disaster management is reducing the harm disasters cause to society, the economy, and the lives of individuals and communities. That task requires disaster managers to reduce uncertainty, to calculate and compare costs and benefits, and to manage resources, often on a much larger scale and at a much faster pace than are supported by methods and means for solving ordinary problems. IT provides capabilities that can help people grasp the dynamic realities of a disaster more clearly and help them formulate better decisions more quickly. And IT can help keep better track of the myriad details involved in all phases of disaster management. The committee concluded that IT has as-yet-unrealized potential to improve how communities, the nation, and the global community handle disasters. Briefings to the committee suggested that some progress is being made in using IT to enhance disaster management. Presentations made at its June 2005 workshop, additional briefings to the committee, and reports on responses to recent disasters indicated, however, that disaster management organizations have not fully exploited many of today’s technology opportunities. This situation stands in contrast to the considerable success enjoyed by some sectors such as financial services and transportation in adopting new IT technologies routinely and

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aggressively. This report describes both short- and long-term opportunities to enhance responsiveness and increase resilience by applying IT to disaster management. As in other sectors, successful use of IT involves multiple factors—making smarter use of existing technologies, creating opportunities to develop and adopt new technologies, and evolving organizational practices to best employ those technologies. Accordingly, this report also examines mechanisms to facilitate the development and effective use of IT.

SHORT-TERM OPPORTUNITIES TO USE IT Although the committee believes that investment in IT research and development (R&D) for disaster management should be guided in the long run by a comprehensive, stakeholder-driven roadmap, it also sees opportunities for short-term investment in a number of specific areas that would yield significant benefits. The committee heard of many instances in which responders were able to make use of readily available technology—either provided by their organizations or acquired personally—that proved valuable during a disaster. The network effects associated with many of these technologies can create a critical mass of users that provides a potential point of interoperability and cooperation across agencies. For example, ad hoc use of 802.11x wireless capabilities in laptops carried by some first responders, peer-to-peer use of Land Mobile Radio System (LMRS) radios, and use of Family Radio Service/General Mobile Radio Service “walkie-talkies” all can help to provide communications even when the communications infrastructure is damaged. Such technology options may already be in the hands of users but may not be deployed in disasters because policies and procedures for their use are not in place. Other examples of “low-hanging fruit” include the following: Use of sensors, wikis (editable Web sites), blogs, and data-mining tools to capture, analyze, and share lessons learned from operational experiences; Use of database, Web, and call center technologies to establish a service to provide information about available equipment, materiel, volunteers, and volunteer organizations; Use of planning, scheduling, task allocation, and resource management tools to help in formulating disaster management plans and

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tracking execution of the plans and to ensure timely recognition of problems and associated follow-up decision making; and Use of deployable cell phone technology to rapidly establish standalone communications capabilities for use in disasters where local infrastructure is damaged. To exploit such short-term opportunities involves identifying them, establishing policies and procedures for their use, and providing training to users. Recommendation 1: Disaster management organizations should take advantage of opportunities for adoption of existing technology or adjustment of policies and procedures that would allow significant short-term enhancement of disaster management. Key IT-Enabled Capabilities and R&D to Achieve Them Making good decisions and taking appropriate action during extreme events require having access to communications, data, and computational resources that can be used to effectively coordinate a large number of geographically dispersed participants and assets, to exchange a wide variety of types of information, and to evaluate many scenarios and responses—all of which are changing dynamically. The committee identified six key areas of IT-enabled capability in which shorter-term development and longer-term research offer the potential for significant benefits: More robust, interoperable, and priority-sensitive communications; Better situational awareness and a common operating picture; Improved decision support and resource tracking and allocation; Greater organizational agility for disaster management; Better engagement of the public; and Enhanced infrastructure survivability and continuity of societal functions. Some of these capabilities address rather specialized problems that do not have a large commercial market, although commercial technologies will provide many of the building blocks needed to realize the capabilities. Disasters are low-frequency events outside the normal planning horizons of most organizations, whose structure, operations, and IT systems are designed to ensure dayto-day efficiency rather than the resilience and scalability that disasters demand. As a result, current research and development efforts may not necessarily focus on developing IT capabilities in a manner optimized for disaster management. IT R&D needs and opportunities are evident across a spectrum from adoption (off-

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the-shelf technology is available today) to adaptation (the technology is on the horizon and ready for transfer to disaster management) to development (the technology is on the horizon and requires development for use in disaster management) to applied research (disaster-management-specific research is required) to basic research (fundamental research is needed to develop new capabilities). In government mission areas such as defense and energy, a research infrastructure has been built over decades to ensure long-term, mission-driven scientific and engineering advances— an effort that has included a long history of investments in IT. The Department of Defense, for example, funds a mix of shorter- and longer-term R&D carried out through the Defense Advanced Research Projects Agency (DARPA) and the service laboratories as in-house, university-based, and contract research. These investments are aimed at building a variety of capabilities, such as the military’s transition to a capability for network-centric warfare, that are also relevant to disaster management. To make the sort of IT-enabled progress in disaster management that is envisioned in this report, the disaster management community should also devote significant attention and investment to a longterm research program. A number of agencies could play a role in developing and implementing such a program. The directly relevant mission of the Department of Homeland Security’s (DHS’s) Science and Technology Directorate is “to protect the homeland by providing Federal and local officials with state-of-the-art technology and other resources.” Other agencies have relevant capabilities in terms of IT and disaster-related research programs, modalities, constituencies, and existing connections with particular research communities, including the National Science Foundation (NSF), the National Institute of Standards and Technology (NIST), DARPA, the National Oceanic and Atmospheric Administration (NOAA), and the research laboratories of the armed services. In a number of federal programs, multiple agencies work jointly to tackle broad problems. One possible model for such an interagency program is the Earthquake Hazard Reduction Program, in which NIST has a lead role and the U.S. Geological Survey (USGS), FEMA, and NSF are participants. Similarly, for

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disaster management, a lead agency (logically DHS) could provide a clear single point of responsibility, coordinate activities, report on progress, and so forth; the lead agency would not be responsible for all aspects of execution, which would fall to all of the participating agencies and their contractors and grantees. R&D activities also need to be well coupled to the parts of DHS that are responsible for mitigation, preparedness, response, and recovery activities to ensure that requirements are grounded in operational needs and to ensure that solutions can be transferred into federal operations and the parts of DHS responsible for developing policy to ensure that technological and organizational questions are considered together.

KEY IT-ENABLED CAPABILITIES More robust, interoperable, and priority-sensitive communications. Disaster management requires robust, prioritysensitive communications systems capable of supporting interoperation with other systems. Providing these requires communication networks that are more resilient to disruption than today’s commercial networks, that can last longer without utility power, that can expand capacity to meet emergency needs, that can autonomously reconfigure themselves, that can handle the range of communication needs and environmental conditions that arise in disasters, that have well-defined points of interoperability, and that are able to distinguish between and properly prioritize communications. Better situational awareness and common operating picture. Situational awareness is the ability for actors in a disaster—from national coordinators to emergency responders to the general public—to have information about an incident, to understand what that information means in the context of the situation and their goals, and to project patterns and trends. The common operating picture is a shared understanding of a situation by a group of people who need to act together to achieve common goals. The aim is to improve a person’s ability to do his or her job more effectively. Improved decision support and resource tracking and allocation. Whereas situation awareness provides decision makers with information relevant to their tasks and goals, decision support focuses on assisting them in formulating prospective actions—helping them understand and assess

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characteristics and consequences of alternative courses of action and follow-up on decisions, closing the feedback loop from decision to result. The federal government should leverage the capabilities of its agencies to carry out multidisciplinary research in pursuit of six key IT-enabled capabilities—more robust, interoperable, and priority-sensitive communications; better situational awareness and a common operating picture; improved decision support and resource tracking and allocation; greater organizational agility for disaster management; better engagement of the public; and enhanced infrastructure survivability and continuity of societal functions—and establish a coordinating mechanism for those research activities. Roadmapping as a Tool to Engage Stakeholders and Inform R&D Investments Until fairly recently, the technology choices facing most disaster management organizations were few, with much of the investment focused on building specialized communications systems in close partnership with Greater organizational agility for disaster management. The use of IT has enabled and driven changes to organizational structures and processes (e.g., more distributed decision making). Agility is at a premium in disasters because no one type of organization or group of organizations is always best suited for the variety of problems that arise. Related issues with significant IT implications include building rapport among people who do not share a history of cooperation and more quickly integrating the operations of multiple organizations. Better engagement of the public by (1) supplying information and (2) making use of information and resources that members of the public can supply. Although IT is used today to alert and inform the public before, during, and after a disaster, more use could be made of new communications modalities, and information could be better tailored and targeted to the needs of particular populations. More attention should be paid to the information and resources held by the public because members of the public collectively have a richer view of a disaster situation, may possess increasingly sophisticated technology to capture and communicate information, and are an important source of volunteers, supplies, and equipment. One important factor is how to engage the entire

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population, given the existence of groups with cultural and language differences and other special needs. Enhanced infrastructure survivability and continuity of societal functions. Large disasters upset physical infrastructure, such as the electric grid, transportation, and health care—as well as IT systems. IT infrastructures themselves need to be more resilient; IT can also improve the survivability and speed the recovery of other infrastructure by providing better information about the status of systems and advance warning of impending failures. Finally, IT can facilitate the continuity of disrupted societal functions by providing new tools for reconnecting families, friends, organizations, and communities. a small set of vendors. Today, the set of technologies to choose from is much wider, and many more choices are possible in any particular area. But because disaster management is a system-level problem, there are no IT “silver bullets.” Dramatic improvements in one area of technology or process may have relatively little overall impact unless other interconnected pieces are modified to make use of such advances. Too much invested in radios and not enough in logistics might mean, for instance, that one can call for help but cannot get it. A clear vision of end-user goals, a detailed understanding of the individual pieces of the problem and their interrelationships, a detailed understanding of the required technologies, and defined paths for progress would help greatly to inform investment decisions. These are among the elements of a roadmap—an agreed-on, coordinated vision that can help organizations to plan development and investment strategies that can bring technologies together at the right time. Roadmaps are used in a number of sectors to accomplish this sort of alignment and cooperation. A number of stakeholders, including first responders, public safety and emergency management agencies, government officials, medical providers, volunteer organizations, infrastructure and transportation system owners, vendors, IT researchers, and disaster researchers, have important perspectives on how to build on existing organizations and technology where possible and how to drive the creation of new, cost-effective technologies and organizational structures where needed. However, an institutional

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home is needed to launch and sustain such activity. The federal government should develop and regularly update an IT R&D roadmap for disaster management with the involvement of a full range of stakeholders. IMPROVING ACQUISITION AND ADOPTION OF INFORMATION TECHNOLOGY Adoption of IT for disaster management is challenging for a number of reasons, including the following: Disaster management organizations often lack the resources to acquire valuable capabilities. The development and deployment of many promising technologies are risky and costly given the limited opportunities presented by commercial markets for these technologies. In most agencies with disaster management responsibilities, there is no person or unit specifically charged with tracking IT, identifying promising technologies, integrating them into operations, and interacting with IT vendors to make sure needs are addressed. Decisions regarding IT tend to be made independently by local organizations that must work together in disasters. Disaster management is concerned with environments that are intrinsically uncertain and unstable. Important sources of funds are typically only available once a disaster has been declared and also must be spent in a short time window. Diversified Acquisition Strategy and Attention to Design Issues Disaster management has traditionally relied heavily on specially built technology and on a traditional “waterfall” acquisition model in which a full set of specifications is developed and a vendor is selected to build a system in compliance with the specifications. In the commercial world and in sectors such as defense, there is growing acceptance of a richer, more diversified acquisition strategy that employs a mix of traditional (purpose-built) systems, adoption and adaptation of commercial off-the-shelf (COTS) technology and services, and use of open source software, open standards, and community-driven development approaches. Such a strategy for disaster management should draw on the strengths of the traditional vendor community yet also foster bottom-up development as a complement to traditional acquisition practices and more formal top-down development; tap the nation’s

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technology base; and also encourage the “can-do” spirit of commercial developers, professionals, and volunteers involved in disaster management. As mentioned above, COTS technology alone is unlikely to deliver all of the desired capabilities. But it is important in two ways— (1) adoption and adaptation of readily available technologies offer a path for building up disaster management capabilities in the short term, and (2) the interoperability often characteristic of COTS technologies makes them useful as building blocks for disaster management systems. Federal, state, and local agencies should embrace a diversified acquisition strategy that includes increased use of commercial information technology and greater use of open source software and open standards development as a complement to more traditional acquisition approaches. Reliance on turn-key systems has meant that disaster management organizations have paid less attention to the underlying design issues that ultimately affect the functionality of their IT systems. Often technologies have been acquired as stand-alone products with little consideration for how they integrate with other technologies already in use, even within the same agency. However, with networking becoming increasingly pervasive, careful attention should be given to how each particular IT system fits into the broader context of interconnected systems. Off-the-shelf technology such as desktop computers or network routers can provide basic building blocks, and some elements of design are also well established such as the Internet Protocol standard for packet networks, but a domain-specific architecture understood and owned by the organization is also needed. To accomplish this, organizations have to develop the necessary technical and technology management capabilities. Recommendation 5: Disaster management organizations should work closely with technology providers to define, shape, and integrate new technologies as a coherent part of their overall IT system. The committee believes that more can be done to embrace proven approaches for IT acquisition. Best practices for

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acquisition include an emphasis on iterative development, increased opportunities to test and evaluate technology in practice together with realistic concepts of operations, and design and evaluation processes that allow for strong coupling among practitioners, researchers, and industry. The committee also identified four design principles that have particular importance for disaster management systems: Build emergency management systems for effective scaling from routine to disaster operation; Exploit redundancy and diversity to achieve resilience; Design systems with flexibility, composability, and interoperability as core guiding principles; and Distinguish between the user interface and the underlying technologies used to deliver a capability. Training and Practice Through Routine Use of IT Unless experience is gained through routine use or regular training, the full benefits of investment in IT systems are unlikely to be realized. Training, drills, and exercises all play an important role in the introduction of new technologies into organizational practice. Moreover, it is through routine use that the competence and confidence required to successfully use a technological capability, especially in the high-stress situation of disasters, are best developed. However, training large numbers of people to deal with infrequent events poses logistical challenges and is also costly. In the design, acquisition, and operation of IT systems, disaster management organizations should emphasize the incorporation of disaster response capabilities into the systems that support routine operations. Measurement and Assessment to Enhance Effectiveness As the saying goes, one can only manage what one can measure. Because the resources available for disaster management are limited, decision making always involves tradeoffs. Weighing the benefits from particular IT investments against the returns on other sorts of investment is challenging. Although having measures of effectiveness is necessary to making such assessments, few applicable metrics are currently available. Above all, acquisition of IT and associated organizational changes should be driven by a focus on improving the effectiveness of those whose actions are integral to effective disaster management. The emphasis should be on measuring the resulting net

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effectiveness of disaster management activities, not the performance of the IT per se. For example, rather than focusing on the performance of particular systems (e.g., a firefighter radio system has 90 percent coverage), it is important to try to gauge net effectiveness (e.g., better communications coverage allows firefighters to better coordinate their response, improving capabilities for fighting forest fires by 20 percent). The development of such metrics is an area for further research. Disaster management organizations should employ metrics to inform cost-benefit decisions for investment in IT for disaster management and should make enhanced end-user performance a primary objective of disaster management acquisition programs. Independent mechanisms for assessment, such as the Transportation Safety Board, the U.S. Chemical Safety and Hazard Investigation Board, and the NASA Aviation Safety Reporting System, have proven useful in their respective domains. A critical requirement of these organizations is their independence from the agencies that have operational responsibilities. It may be advantageous to employ several organizations rather than a single national one, with each one focusing on a particular type of disaster or the range of disasters typical in a particular region. It is also important for assessments to be founded on multiple areas of expertise, including technical, social, and organizational dimensions. Obviously, the effectiveness of IT use is just one facet of an assessment of the overall effectiveness of disaster management activities for any particular incident, albeit an important one. Disaster management organizations should make use of independent mechanisms for assessing the effectiveness of disaster management operations, including the use of IT, and for disseminating lessons learned and best practices. Systematic Collection of Data It is well understood as a result of endeavors in many areas (e.g., aircraft accident investigations) that making significant improvements depends on putting in place processes that allow learning from experience. IT can play a critical role in enhancing the science of disaster management by helping to support continuous improvement. Collecting adequate and

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trustworthy data is essential for the feedback necessary to drive improvements in disaster management. Doing so requires better documentation of disasters and the responses to them, including the role of supporting technology. The widespread introduction of IT into disaster management provides opportunities for large-scale, automated, comprehensive collection of data about operations, decision making, and situational knowledge throughout a disaster. This information can be processed after the fact to improve understanding of the process of disaster management. IT can also help to make these lessons learned available in real time, putting them into the hands of decision makers when they are most needed. Accomplishing this goal requires enhanced technical capabilities to capture data during the course of a disaster. In some cases, it may be necessary to find ways to anonymize data so that accurate statistics can be gathered without the difficulty of dealing with potential liability issues. Policy changes (analogous to the adoption of Good Samaritan laws) may also be needed to ensure that individuals involved in a disaster response can be protected from liability (e.g., amendments to the Health Insurance Portability and Accountability Act [HIPAA] may be needed). Legislation may also be needed to ensure that intellectual property, privacy, liability, and other concerns of information providers are addressed if they are required to share such data for research purposes. COUPLING RESEARCH AND PRACTICE Effective development, use, and deployment of IT depend on a solid understanding of context and user needs. Moreover, the introduction of new IT often presents opportunities for new organizational approaches, and these opportunities should be considered in reorganization efforts. Similarly, successful technology development requires consideration of organizational context. This issue of co-development of technology and organizational practice seems especially important at present. In the wake of Hurricane Katrina, a number of organizational structures, policies, and procedures are being examined. Also, a number of relevant technologies have reached a sufficient level

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of maturity to allow innovative organizational approaches to disaster management. The interdependence of technology and practice suggests that developing a cadre of people with expertise in both disaster management and IT is likely to yield significant payoffs. Such a cadre of people is likely to be more astute at translating user requirements to technical needs. One basic need, of course, is to train a group of first responders and others responsible for disaster management in IT skills that go beyond those of a general user and to train a group of IT workers (e.g., database and system administrators and application builders) to have domain expertise in disaster management. Deeper expertise spanning both domains could be fostered through a number of mechanisms, including the following: A combination of fellowships, shorter-term visits to research centers, and other training and educational activities that help technology experts and other practitioners to stay abreast of the latest developments in both practice and technology; Field tests and field work conducted by IT researchers working with disaster management practitioners; and Combined disaster management-IT expert teams that jointly analyze the performance of processes and systems after a disaster. Disaster management organizations should support the development of a cadre of people with expertise in both disaster management and IT. Especially in light of the significant nontechnical factors affecting adoption of IT for disaster management, it is critical to establish mechanisms that ensure that researchers are exposed to real problems and that practitioners are exposed to new technology opportunities. Because most practitioners are distributed across local agencies, forging such ties is likely to be harder in disaster management than in sectors like defense, but it is no less important. Collaborative research centers could bring together experts from diverse domains in a neutral environment conducive to collaboration. Such centers could (1) develop a shared understanding of the challenges in all phases of disaster management from both a technological and an organizational perspective, (2) evaluate the application of technology advances to disaster management practice,

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A number of academic centers exist that offer a capacity for at least some of these efforts. Practitioners in multiple disciplines could contribute to such centers, including scientists, engineers, and hazard and disaster researchers, and centers should include partnerships with federal, state, and local disaster management agencies. Indeed, it is critical that experienced and capable officials and operational elements of disaster management organizations be deeply involved in the work of these centers. One approach for engaging these groups would be to provide incremental funds to agencies specifically for working with researchers and developing next-generation technologies. Having multiple centers (rather than a single entity) also helps to ensure healthy intellectual competition, cross-fertilization of ideas, specialization in specific types of disasters and specific technology capabilities, and attention to the comprehensive needs of particular geographical areas. Research centers could also act as a resource for agencies seeking to implement a diversified acquisition strategy and incorporate the latest best practices and a mechanism for disaster managers and responders to share experiences and communicate requirements to guide further technology developments. The federal government should sustain (and develop as needed) a network of research centers where IT researchers, hazard and disaster researchers, and disaster management practitioners can collaborate to study and evaluate the use of IT for disaster management from both a technological and an organizational

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perspective, to transition knowledge and technology to those who practice disaster management, to build human capital at the intersection of IT and disaster management, and to develop future IT capabilities. INTRODUCTION AND CONTEXT This volume is the final report from the National Research Council’s Committee on Using Information Technology to Enhance Disaster Management, which was established in response to a congressional request for a study to examine the use of information technology “to enhance crisis preparedness, response, and consequence management of natural and manmade disasters.” Drawing on a June 2005 workshop and a series of briefings and site visits, as well as the experience and expertise represented on the committee itself, the committee sought to identify promising applications of information and communication technology (hereafter referred to as IT) to disaster management, promising areas of research for improving the effectiveness of IT, and mechanisms that would enhance research, development, and deployment efforts. The resulting report is intended to inform federal, state, and local policy makers and public safety and emergency management professionals about future opportunities for the application of IT to disaster management. It is not intended as a comprehensive look at the complex, highly multidisciplinary topic of disaster management. Nor do the committee’s findings and recommendations explicitly address tradeoffs between investments in information technology and other capabilities for disaster management or offer advice about levels of funding for IT or other disaster management activities. This chapter provides a brief overview of challenges confronted in disaster management, focusing particularly on the use and role of IT; presents several different ways of thinking about information and communication needs in disasters, which together provide a framework for understanding the various roles that IT plays in disaster management; and places the issue of IT use into the broader social context of disasters and disaster management.

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DISASTERS, DISASTER MANAGEMENT, AND INFORMATION TECHNOLOGY Disasters are events that disrupt the normal functioning of the economy and society on a large scale. Natural, technological, and willful (terrorist initiated) sources of disasters all cause dramatic losses of life and property. A variety of terms are used in the fields of emergency and disaster management. Over time, a fairly standard set of definitions has emerged, as reflected in a series of reports from the National Research Council and other groups. Emergencies, disasters, and catastrophes, for example, are distinct events with important differentiating characteristics. This report does not specifically consider “emergencies”—a term that connotes “everyday” events that can be handled within the normal operational limits of public safety agencies—nor does it distinguish between disasters and larger-scale events that might be called catastrophes, even though it is likely that the value of IT capabilities increases as the complexity and scale of communication problems become greater. Throughout this report, the term “disaster” can be read as “disaster and catastrophe.” This report uses the following set of definitions, adapted in part from Facing Hazards and Disasters: Understanding Human Dimensions: Disasters are non-routine events in societies, regions, or communities that involve conjunctions of physical conditions with social definitions of human harm and social disruption. The term “disaster” has significant policy implications; for example, a declaration of an event as a disaster is needed before certain resources are made available. Hazards are a source of potential or actual harm. Hazards may be natural, technological, or willful in origin. Examples of natural hazards include floods, hurricanes, earthquakes, tsunamis, tornados, and so on. Technological hazards include industrial accidents and other human-made sources of potential harm. Bhopal and Chernobyl are examples. Terrorist attacks such as those on September 11, 2001, and the bombing in Oklahoma City are examples of willful hazards. Incident (or event) is the specific occurrence of a disaster. A single disaster incident may lead to additional incidents.

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For instance, an earthquake may lead to a tsunami and the tsunami may lead further to flooding. The term “incident” also has important bureaucratic meaning (e.g., incident period) that determines, for instance, who qualifies for financial assistance. Risk is a function of the likelihood (i.e., probability) of a specific event occurring and the potential consequences of harm should it in fact occur. Hazard vulnerability is the potential for physical harm and social disruption to societies and their larger subsystems associated with hazards and disasters. There are two general types of vulnerability: physical vulnerability and social vulnerability. Physical vulnerability represents threats to physical structures and infrastructures, the natural environment, and related economic losses. Social vulnerability represents threats to the wellbeing of human populations and related economic losses. Hazard mitigation is an ongoing effort to reduce the physical and social impact of future disasters. It includes interventions made in advance of disasters to prevent or reduce the impact. There are two major types of hazard mitigation: Structural mitigation involves designing, constructing, maintaining, and renovating physical structures and infrastructures to resist the physical forces of disaster impacts. Nonstructural mitigation involves efforts to decrease the exposure of human populations, physical structures, and infrastructures to hazardous conditions. Disaster preparedness includes actions taken in advance of disasters to deal with anticipated problems of disaster response and recovery. Actions include training and exercises to improve readiness; development and refinement of response and recovery plans; development, deployment, testing, and maintenance of systems used for disaster management; and public education and information programs for individuals, households, firms, and public agencies. Disaster response provides for the immediate protection of life and property, reestablishing control and minimizing the effects of a disaster. It encompasses the issuance and dissemination of predictions and warnings; planning and preparation immediately before an event (such as preparations following a hurricane warning); evacuation and other forms of protective action; mobilization and organization of emergency personnel, volunteers,

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and material resources; search and rescue; care of casualties and survivors; damage and needs assessment; damage control and restoration of public services; and maintenance of the political and legal system. Disaster recovery encompasses both short-term activity intended to return vital physical and social systems to operation and longer-term activities designed to restore these systems to their pre-disaster state. The concept of recovery encompasses both objective measures, such as reconstruction and assistance efforts, and the subjective experiences of disaster victims and processes of psychological and social recovery. One of the essential characteristics of disasters is their complexity. Although disasters may have relatively discrete origins, their effects propagate and interact in ways that intensify the complexities and uncertainties of dealing with them effectively. One major result is that disasters must be responded to in an environment that can be overwhelming, unfamiliar, and disorienting. These challenges are quite familiar to experienced emergency managers and first responders, as manifest in a homespun sign found in many U.S. emergency operations centers. This sign stands in marked contrast to a sign described by a reviewer of this report in draft form that lists what emergency managers aspire to— and often achieve despite the many obstacles—in a disaster. Disaster management is a multifaceted process aimed at minimizing the social and physical impact of these large-scale events. The difficult nature of disaster management is well illustrated by the Catastrophic Incident Annex to the National Response Plan, which lists some of the potential problems faced in the aftermath of a disaster.

CATASTROPHIC INCIDENT ANNEX TO THE NATIONAL RESPONSE PLAN The response capabilities and resources of the local jurisdiction (to include mutual aid from surrounding jurisdictions and response support from the State) may be insufficient and quickly overwhelmed. Local emergency personnel who normally respond to incidents may be among those affected and unable to perform their duties. A detailed and credible common operating picture may not be achievable for 24 to 48 hours (or longer). As a result, response activities must begin without the benefit of a detailed or complete situation and critical needs assessment. Federal support

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must be provided in a timely manner to save lives, prevent human suffering, and mitigate severe damage. This may require mobilizing and deploying assets before they are requested via normal NRP protocols. Large numbers of people may be left temporarily or permanently homeless and may require prolonged temporary housing. A catastrophic incident may produce environmental impact that severely challenges the ability and capacity of governments and communities to achieve a timely recovery. A catastrophic incident has unique dimensions/ characteristics requiring that response plans/strategies be flexible enough to effectively address emerging needs and requirements. A catastrophic incident results in large numbers of casualties and/or displaced persons, possibly in the tens of thousands. A catastrophic incident may occur with little or no warning. Some incidents, such as rapid disease outbreaks, may be well underway before detection. The incident may cause significant disruption of the areas of critical infrastructure, such as energy, transportation, telecommunications, and public health and medical systems. Largescale evacuations, organized or self directed, may occur. The healthrelated implications of an incident aggravate attempts to implement a coordinated evacuation management strategy. Mitigation efforts aimed at preventing or reducing the threat and by preparedness measures meant to increase the capability or capacity of response and recovery efforts from anticipated problems in advance of an actual disaster event. Examples of mitigation include constructing buildings to accommodate impacts, identifying and measuring hazards to avoid putting social or physical assets in harm’s way, and designing computer networks to degrade gracefully and recover from cyberattacks. Examples of preparation include detailed response planning, positioning resources prior to the onset of an event, setting up operations centers, training responders, and creating emergency management plans. Immediate response seeks to contain the event and minimize loss of life and injuries (rescue), health impacts, and property loss. Examples of immediate response include search and rescue operations. Sustained response seeks to restore critical systems to functionality and meet basic social needs. Examples of sustained response include restoration of sewers, water, and

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communications. Recovery seeks to minimize cascading impacts and facilitate long-term restoration to the pre-event situation. Widespread efforts at managing disasters in a comprehensive fashion are a relatively modern phenomenon. Disaster management in the United States has historically been and remains a highly localized task that depends largely on local resources. Still, regional, state, and national efforts have grown out of the need to meet the increasing scale of disasters and the associated costs of managing them. Major Milestones in the Evolution of the Functions and Profession of Federal-Level Disaster Management in the United States Development of the comprehensive emergency management taxonomy based on an all-hazards approach and the four phases of mitigation, preparedness, response, and recovery by the National Governors’ Association in the 1970s. Establishment of the Federal Emergency Management Agency (FEMA) in 1979, which consolidated federal mitigation, preparedness, and response activities into one agency, reporting directly to the President. Responsibility for response to terrorist events, oil and hazardous materials releases, nuclear incidents, and health emergencies remained the province of other agencies, including the Department of Justice (DOJ), Environmental Protection Agency (EPA), U.S. Coast Guard, Department of Energy (DOE), and Department of Health and Human Services (DHHS). Publication of the Federal Response Plan (FRP) in 1991, providing a mechanism for organizing and coordinating the resources of 23 (later 27) federal agencies and departments and the American Red Cross. Amendment of the FRP in 1999 to include a terrorism annex for coordinating emergency management (termed consequence management) and law enforcement (termed crisis management) during a terrorist attack. Creation of the Department of Homeland Security (DHS) in 2002 and the movement of FEMA, the Office for Domestic Preparedness, and the U.S. Coast Guard under DHS, consolidating all emergency management functions into one department. Issuance of Presidential Decision Directive Number Five (HSPD-5) in 2003, directing DHS to create a national system for the management of all domestic incidents. Publication of the National Response Plan (NRP) in 2004, establishing protocols for

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the management of all incidents under DHS/FEMA direction. The NRP superseded and incorporated the FRP, the National Contingency Plan, and the Federal Radiological Emergency Response Plan. Issuance of the National Incident Management System (NIMS) in 2004, the creation of the NIMS Integration Center, and establishment of the requirement that state, local, and non-governmental emergency management organizations must be NIMS compliant in order to receive federal funds. IT to weather forecasting that has resulted in more accurate and timely warnings of hurricanes and floods. IT has the potential for even greater impact on enhancing disaster management practice across all of its phases—mitigation, preparedness, response, and recovery—provided it is used consistent with the knowledge of hazards, disasters, and disaster management practices that has been gained from the diverse range of disciplines that contribute to that knowledge base. Responding to disasters involves such information- and communication-intensive activities as marshaling available resources and materiel, mobilizing and organizing sufficient skilled personnel, deploying them with those resources to where they are needed, and finally coordinating their actions. Specific tasks include establishing connectivity with potential resource providers, authorizing the use of resources and coordinating their use into something akin to a supply chain, integrating information from diverse (including ad hoc) sources, reducing the volume of data to relevant information for recipients, directing ongoing operations based on an overall awareness of the situation, adjusting and altering prior plans and commitments based on the evolving situation, and supporting collaboration and distributed decision making. The mitigation process is similarly complex and can involve many situation- and location-specific details, and it relies heavily on tools such as predictive models of the impacts of particular disasters. It is thus not surprising that IT has become a critical tool for facilitating the communications and informationprocessing activities in managing disasters. The larger human and organizational context of disaster management was the subject of a recent National Research Council study. Facing Hazards and Disasters: Understanding Human Dimensions describes research

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undertaken during the past three decades by social scientists on hazards and disasters and recommends a continuing research agenda. Cautions that events such as Hurricane Katrina provide a vivid demonstration that technology alone does not guarantee an effective organizational and public response to disasters.8 Indeed, an important lesson from past disasters is that applying IT in a vacuum (i.e., without considering the broader organizational and social context) may not only be ineffective but detrimental by, among other things, creating the perception that technology will solve all problems.9 Put another way, there is no IT “Band-Aid” that will by itself overcome underlying organizational problems or problems rooted in systemic process, procedural, and policy issues that have never been reconciled. Nor can IT alone address societal decisions such as settlement and land use patterns, construction standards and practices, and issues of social justice and equity. All of these factors and many others may increase vulnerability to hazards of large segments of the population and property. IT does, however, provide useful capabilities for tackling many of these challenges. This experience is consistent with what is understood about the role that IT has played in productivity and quality advances in other sectors, ranging from defense to banking and finance. The empirical evidence shows, for example, that IT is not simply a tool for automating existing processes and that its real impact is as an enabler of organizational changes.11 It is the complementary investment in decentralized decisionmaking systems, training, and business processes along with technology that allows organizational efficiency improvements. There are a number of barriers to the adoption and use of IT in disaster management, growing out of the unique character of the institutions responsible, the organizational structure of the community as a whole, their need to focus on day-to-day operational missions, and their need to actively cooperate only under the most trying circumstances.

Some Examples of Uses of Information Technology in Disaster Management Remote Human-to-Human Communications—Starting with the first use of radios in coordinating disaster responses, voice

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communication over radio has been the primary role for IT in managing disasters. Indeed, by 1912 radio was recognized as critical to disaster response with the enactment of a law, in response to the Titanic disaster on April 14 of that year, which required all ships to have radios with two operators and auxiliary power and licensed transmitters. Remote Sensing—Networks of sensors are used in many ways, such as providing data for weather prediction and earthquake detection, to mitigate the impact of and to prepare for many natural disasters. Sensors are also extensively used to prevent or control human-made disasters. Doppler radar is used to identify and track hurricanes, tornados, and other weather phenomena. Networks of earth and structure motion detectors provide information about the severity and nature of earthquakes. Satellite imagery is used to map and plan operations in major wildland fires. Tsunami detectors provide advanced warning of the location and nature of tsunamis. Interferometric synthetic aperture radar (IfSAR), which uses an aircraft-mounted sensor to measure surface elevation, produces topographic imagery. Light detection and ranging (LIDAR) technology can measure the speed, distance, rotation, and chemical composition of a remote target, where the target can be either a clearly defined object, such as a building, or a diffuse object, such as a cloud. Other optical methods can also be used to remotely measure chemical composition of air masses to track toxic materials. Warning and Alerting—Sirens systems have been used for over 100 years as a means to alert as many people as possible as quickly as possible. One familiar IT-based warning system is the Emergency Alert System (EAS) established by the Federal Communications Commission (FCC) in November 1994; EAS replaced the Emergency Broadcast System (EBS) as a tool to warn the public However, as was illustrated in testimony to the committee and in after-action reports of disaster responses, inventiveness, improvisation, and ingenuity have partially compensated for some of these shortcomings. Indeed, the often tacit knowledge of practitioners of disaster management about the realities of what works must also be incorporated if strategies for improving the use of IT in disaster management are to have maximum effect. The committee was mindful of this “can-do”

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spirit as it examined the needs and opportunities for using IT and ways of overcoming obstacles to its successful deployment and use. EAS includes AM and FM radio and broadcast and cable television (satellite operators can participate voluntarily). The National Oceanic and Atmospheric Administration (NOAA) Weather Radio All Hazards network of radio stations broadcasts continuous weather information directly from a nearby National Weather Service office along with localized warnings, watches, forecasts, and other hazard information. Recent years have seen efforts to extend warning systems to newer IT such as cell-phoneand Internet-delivered text messages. Emergency Call Systems— The 911 emergency call systems for wired phones have been deployed over a 20-year period across the United States and have now reached near universal coverage. The 911 service for mobile phones has recently been enhanced to provide location information about the caller. Reporting— Satellite communication hubs have enabled media to report from disasters. The public is also able to participate in new ways through the use of mobile phones, text messaging, and the Internet. While the technical capability for public participation in disaster reporting continues to grow, it has gone largely unrealized, even though recent disasters have shown that these alternative communication techniques are more robust than previously thought. Modeling and Simulation—Increasingly sophisticated models are being created of weather, storm surge, earthquake ground motion and shake intensity, toxic plume modeling, hazard prediction, and loss analysis. Culturally dependent models of population response would also be important for managing evacuations and other aspects of disaster management. Types of information that can be communicated from many information sources. Indeed, the types of information available continue to grow with ongoing advances in IT. There is also a broad range of information actors and organizations involved in managing disasters; their ability to make appropriate decisions and function effectively can be greatly enhanced by IT and may depend on it for dealing with increasingly complex situations. Given the heterogeneity of the information, the dynamics of the

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situation, and the diversity of actors, it is not surprising that there are a number of tensions that arise between more centralized, topdown, and planned disaster management activities and more decentralized, bottom-up, and ad hoc activities. For example, consider the following: The needs of “official” first responders versus those of emergent groups of people, Command-and-control decision making versus distributed decision making, The needs of first responders in the field versus the needs of higher-level decision makers, and The need for security and privacy protection versus the benefits of broadened access to information. There are also inherent tensions between local governments and among federal, state, and local levels of government. In each of these cases, the design and deployment of an IT system can make the tensions more acute and more visible. Moreover, IT cannot be used to paper over organizational problems—but its appropriate use may enable disaster managers to successfully accommodate a wider spectrum of disaster management activities, and do so more effectively and efficiently. Examples of the Kinds of Information Useful in Disaster Management The first applications of IT to disasters were in the form of voice communications. Advances since then have led to many additional forms of information that have been included in disaster management practices to varying degrees, including text, geospatial data, video, sensor data, and collections of these and other types of data in databases or other electronic forms. The number of available information sources has expanded considerably in recent years to include surveillance cameras; ground, air, and satellite sensors; telemetry from assets and personnel; unmanned vehicles; and eye witnesses with more technology. Some of these data sources have been well integrated into disaster planning. Other sources could improve situation awareness with efforts at better integration. The National Research Council study Reducing Disaster Losses Through Better Information catalogs a number of potential information sources (base data, scientific data, engineering data, economic data, environmental data, response data) and major types of information held and being gathered by federal agencies (e.g., base cartographic, land-use, seismic, hazardous site,

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demographic, aircraft route, river flow, and meteorological information). Although some of these data sources are currently being used by disaster researchers for vulnerability assessment, they are often inaccessible, unused, out of date, unusable, or inadequate for disaster managers, especially during response. Further advances in sensor technology (both pre-positioned and post-incident deployable) are likely to lead to opportunities for further improvements in both the volume and quality of data available. A number of factors affect data quality—completeness, timeliness, accuracy, and consistency—and advances should target all of them. IT Needs and the Incident Time Line In thinking about the use of IT in a disaster it is useful to think of an incident time line consisting of three segments: pre-incident, trans-incident, and post-incident. In fact, the value of considering disasters and disaster management chronologically is unquestionable and taken for granted.16 Disaster management can be viewed as roughly divided into three parts: (1) reducing exposure to and preparations for a hazard under routine, pre-incident circumstance; (2) preparations and actions immediately prior to and during an event; and (3) dealing with the consequences once it has occurred. Thinking in terms of time is also essential for understanding the different requirements for disaster management depending on the type of disaster. IT plays important roles in each time segment, and the committee considered the potential for increasing effectiveness in each one. Examples of the Kinds of Data Communicated in the Response to a Disaster One important kind of data communicated in a disaster is directives and authorizations for inter- and intraagency coordination. These are largely synchronous exchanges about where to go, where to meet, and reporting status. They can generally be accomplished through low-band-width mechanisms such as voice and text (e.g., e-mail, text messaging) and can be transmitted using both real-time media (voice or chat) and nearreal-time media (such as e-mail). Coordination tasks result in interdependencies where Agency A cannot proceed with a task without authorization from or the arrival of Agency B—waits that can introduce significant delays in response activities if robust

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communications are not available. Another important kind of data is requests for distributed decision making, especially logistics and planning. The content of these exchanges is akin to those that arise in dynamically creating a supply chain or a business enterprise where requests are tracked and processed. The exchanges may be more asynchronous where text and other files are sent and the time for a response is less immediate. Bandwidth requirements may generally be modest and traffic levels relatively low, but large files may need to be shared and databases kept synchronized. Data are also needed to inform decision making at all levels and to help form a common operational picture. Relevant data include the following: Human observations from direct response activities. These are the reports from observers in the field, such as from local emergency operations centers, country transportation workers, pre-positioned trained observers, or other responders. The exchanges are largely onedirectional, from the observer to a commander. Voice (e.g., cell and satellite phones) and text are both useful. Geographic information system (GIS)-oriented data. GIS information flows both to and from the field, with maps and projections such as flooding pushed to responders or tracking of personnel and assets collected by commanders. GIS information is typically in the form of high-resolution maps. If appropriate map sets have not been pre-positioned, large amounts of data may need to be transmitted; otherwise communications will generally take the form of updates and overlays to base maps. Visual-oriented data. Overhead imagery, satellite photos (before and after), and pictures and video of the disaster from other sources such as the public or other responding agencies can be extremely valuable. These data are inherently high-bandwidth and often need to be shared among agencies, even if a common operating picture (a shared understanding of a situation by a group of people who need to act together to achieve common goals) is not established. Consider, for example, that a high-resolution overhead image of a coastline would help urban search-and-rescue units prioritize searches and allow transportation and law enforcement officials to determine avenues of access for supplies, controlling access,

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and so on. Logistical information. Information about the location and status of resources provides an important part of the common operational picture. Relevant data include databases and schedules describing where resources are, what and who has been dispatched to which affected areas, and so on; and what resources are needed by whom, where, and when, and the specific capabilities and limitations of those resources. Sensor data. Information about the status of built infrastructure and environmental factors provided from pre-deployed instrumentation and devices deployed postincident.

Examples of Sources of Data for Response The source of data may have implications for their use as well as whether and how they are transmitted. Improving the effectiveness of data sources may include improving the usefulness of and access to the data. Valuable data sources exist for all phases of disaster management. Some sources of data for response include the following: Data being “pushed” from the field. During response, some sources of valuable data include data mapping damage, locations of responders and other resources, information on the status of response activities, and sensor data. High-fidelity (and thus high-bandwidth) data are required for some applications. For example, pictures or video of damage to a bridge could be transmitted to off-site experts for structural assessment. The Internet offers the prospect of identifying and creating information resources dynamically from a wide variety of official and non-official sources. Tactical Versus Strategic Operations Tactical operations focus on the response operations in the affected area. They may involve stabilizing the situation sufficiently to carry out those operations. (In the case of a terrorist incident, this could involve capture or neutralization of the threat as well as responding to it.) Decisions are often immediate, based on direct observation and a priori knowledge. Any available information useful for gaining a broader understanding of the situation to aid in the decision-making process may help answer questions critical to tactical operations such as, What resources are nearby that I can use? How extensive is this problem? Can neighboring resources/ units be directed my way? When can I expect help to get here? A secondary role of tactical operations is as general information

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gatherers for the strategic operations. Strategic operations, by contrast, are essentially “enterprise” decisions and may span weeks to months. Information flow for strategic operations is highly computer-centric and more akin to the flow of information in a supply chain management system. A particular challenge—and one where IT can play an important role—in disasters is connecting tactical operations and strategic operations. The physical distance between the tactical and strategic decision makers, as well as the differing time spans for decisions, poses additional challenges for cooperative work and information sharing. Another area requiring further research is in understanding what the roles should be for strategic and tactical operations and how IT should be structured in order to properly support those roles. A FRAMEWORK FOR CONSIDERING USE OF INFORMATION TECHNOLOGY IN THE BROADER SOCIAL CONTEXT As suggested above, both successes and failures in disaster management depend on the effectiveness and resilience of human as well as technological systems. As a result, broad statements about IT failures during disaster, although often true, can be a major source of confusion about the complex sources of disaster management failures. A four-layer “stack” model developed by the committee illustrates the range of issues that are sometimes lumped under the rubric of “communication,” “interoperability,” and “information technology” issues. The model includes the following elements: Organizational and social context comprises the goals, metrics, priorities, and beliefs of each organization involved, as well as those of “meta-organizations” such as an incident command structure or an emergency operations center that involves multiple organizations. It is concerned with the purpose, content, and partners in communication. The social side goes beyond the logical layer that facilitates transmitting content. It includes the cultural and organizational constraints and workarounds to organizational barriers, such as informal social networks between trusted friends in different organizations. One source of “communication” problems at this level can be simple misalignment between the goals and priorities

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of different organizational elements; for example, at a potential terrorism site there might be a “disconnect” between organizations focused on criminal investigation and others concerned chiefly with rescue or restoration of services. Human behavioral context includes the many variables of individual human performance, including skill sets, training, experience, health, personal stress, and other personal factors. Despite efforts at standardization, human beings inevitably bring a degree of variability into the execution of procedure and the pursuit of organizational goals and values. This is not necessarily a bad thing; indeed human originality and adaptability are often critical to meeting unforeseen challenges. But they can insert an only partly controlled variable into the performance of carefully planned processes and can give rise to problems that are sometimes mischaracterized as technologyrelated communications problems, especially under conditions of high stress or uncertainty typical in disasters. Procedural and policy framework refers to predictable patterns of behavior. Sometimes these are formalized and documented, but often they are unwritten and even unconscious artifacts of an organizational or disciplinary culture. Procedures are often event-driven, that is, expressed in the form “when X happens, do Y.” A great deal of implicit knowledge about the immediate system and its environment is encoded in such procedures. As a result, they can be confounded by the profound changes in context that may accompany a disaster. For example, an emergency communications plan can be disrupted by loss of, or interference with, expected technical channels. Without an effective way to devise and transition to an alternate plan, such disruptions can lead to perceived major failures of communication, even when significant technical capability remains. Technology includes the bulk of what is frequently understood in the terms “communications,” “interoperability,” and “information technology.” Technology is the medium through which communications and infrastructure needs are met, and can be thought of as the physical layer of communications. It includes all of the capital infrastructure investment for communications and information technology. Although technical failures are by no

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means uncommon, they can frequently be circumvented using alternate technologies, provided the procedures, skills, and organizational will remain to implement such expedients. This conceptual model presents a number of useful insights. First, problems (and the perceptions of problems) tend to propagate downward (from 1 to 4) through the stack, so that various nontechnical issues can end up being framed as technology failures. For example, police and firefighters at a traffic accident might have subtly different organizational priorities. The firefighters might be focused on the well-being of victims at the scene, while the police might be tasked with reestablishing unhampered traffic flow for the larger community. This organizational difference might lead to personal and procedural conflicts that ultimately might be (mistakenly) characterized as a “communication problem” and then (also mistakenly) interpreted as a failure of “interoperability,” which is frequently assumed to be a technical issue. Second, change tends to propagate upward (from 4 to 1) through the stack. Effective use of new technologies requires and enables new procedures, which in turn require new skills and create new challenges, to which organizations ultimately must adapt. For example, in many large organizations, computerbased word-processing software was first introduced in a “wordprocessing pool” office, by analogy to previous typing and dictation pools. Over time the opportunities that provided for faster and more flexible service moved the new technology out to secretarial desks in the operating departments, and eventually onto the desktops of commanders and executives. The word-processing pool, and in some cases the secretary as well, faded into organizational history. Third, many interoperability and datasharing challenges are not fully or even mostly technical in nature. Indeed, as noted in the report summarizing a workshop convened as part of this project, better “human organization, willingness to cooperate, and a willingness of government at higher levels to listen to those at local levels who really do the work and who are the actual responders are all critical factors in making better use of information technology for disaster management.”19 As a result, many inter- operability and data-sharing challenges may not be amenable to technical solutions alone—or at all.

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10 The Potential to Enhance Disaster Management Key IT-Based Capabilities How could better application of information technology (IT) to disaster management reduce the human and economic costs of catastrophic events? This chapter outlines a vision for IT-enhanced disaster management in terms of six areas of IT-based capabilities. Three scenarios developed by the committee describe specific fictional disasters to help place those capabilities in the context of existing IT use in disaster management and to highlight how progress would have tangible positive impacts. Reducing the impact of disasters requires a complex mix of technical and social endeavors, and no single prescription or discipline can provide all the answers. Indeed, disaster researchers have frequently expressed concerns that technology not be viewed as a panacea technological, organizational, and social factors and depends on a solid understanding of disaster management as well as the technologies. Nonetheless, IT represents an important point of leverage for enhancing disaster management. Briefings to the committee suggested that progress continues to be made toward ever more effective use of information technology to enhance disaster management. Better preparation and training of public safety officials and the public, improved mitigation and prevention measures, more efficient and effective response, and more rapid recovery are all possible. Furthermore, the public has high expectations that technology that it sees deployed ever deeper

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into other societal systems will be applied to improve the handling of disasters. This chapter discusses six key IT-based capabilities that were selected by the committee because they (1) have the potential to address major problem areas in current disaster management practice and (2) represent areas where there appears to be significant potential for further advancement of the current state of the art. These capabilities span areas that could improve hazard mitigation, disaster preparedness, disaster response, and disaster recovery. They also aim to address requirements of practitioners at all levels—first responders, local or regional emergency managers, and national emergency managers. Improving these capabilities is applicable to addressing natural, accidental, and terrorist-induced disasters, though some capabilities may be more specific to one type. Some of these technology areas are already the focus of significant federal research and development investment. For example, self-managing and repairing networks are the focus of a Defense Advanced Research Projects Agency (DARPA) research program. Some technologies are the focus of considerable research and development investment from the private sector, such as wireless mesh.

M ORE R OBUST , I NTEROPERABLE , AND P RIORITY - SENSITIVE COMMUNICATIONS During a disaster, both commercial and public safety communication infrastructure—telephone lines, radio towers, communication switches, network operation centers, and the requisite power needed—is often degraded or damaged. Simultaneously the demand on communication increases from the public and from first responders. Mobile communication demand is especially acute. New users from external public safety jurisdictions enter the disaster region. The public may have to be mobilized for evacuations. Moreover, environments confronted by first responders, such as collapsed buildings, place unusual requirements on communications capabilities. And, finally, hostile action may compromise even those resources that survive the initial disaster. Simple availability of communications is thus a

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critical starting point for disaster response. Communication robustness can be improved by applying well-understood techniques for improving the availability of systems, that is, hardening infrastructure, improving network resilience and adaptability, providing redundancy and diversity, improving component robustness, and optimizing recovery speed. Notably, many communications problems are caused by the destruction of communication devices or communication lines, by the loss of power to radio towers, switches, and other infrastructure, and by the lack of ability to recharge handsets and other mobile devices. These are often the result of damage to physical structures (buildings, cell towers). Although it is not economically feasible to harden all relevant equipment for worst-case scenarios, improvements are certainly possible. Commercial services could provide a valuable complement to dedicated disaster management communications systems by providing redundant infrastructure for voice and data communications. Generally implemented on a different technology base than that of dedicated systems, they also add diversity. Commercial infrastructure, such as the cellular network, is also, by design, highly interoperable. (Mobile callers can readily communicate with a subscriber to their carrier, any other carrier, or a landline subscriber.) The participation of wireless Internet service providers in Hurricane Katrina response and relief efforts hints at the possibilities of embracing and integrating another type of commercial technology into disaster management practice. Of course, one reason for deploying separate public safety radio systems is that they are designed to be more resilient that commercial infrastructure. And public safety radios are designed to much more stringent operational standards than mobile phones. Yet, both commercial and public safety communications infrastructures have suffered breakdowns in recent disasters. One critical issue that arises in considering commercial services is priority access. When using commercial services, priority could be provided in a variety of ways. For example, it is possible to set up a cellular network in a spectrum band that is dedicated to disaster management, though cellular handsets would have to be modified (at a significant additional cost) to support this (and the

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spectrum allocated). Alternatively, a commercial service can be used, with arrangements made (preferably prior to an incident) to reserve a certain fraction of the capacity for prioritized disaster management traffic. Of course, priority access to commercial services requires a contractual and regulatory framework as well as technology adaptation. Commercial technology (and adaptations of commercial technology), whether used as part of commercial services or incorporated into dedicated disaster communications systems, could be used to more quickly leverage the latest technology advances and capabilities. Commercial technologies provide a range of capabilities supporting voice and data at rapidly increasing transfer rates. Two examples of commercial technologies widely embraced by the public which hold potential for disaster management are cellular telephony and 802. standards-based wireless networking. Cell phones are now used by a large majority of people on a daily basis, so it is natural to continue to use them in a disaster. Besides traditional voice calls, cell phones often also support push-to-talk capabilities, text messaging, and Web access, all of which could be usefully employed. Wireless networking is also becoming ubiquitous in many areas and is supported on laptops and handheld devices. More generally, Internet Protocol (IP)-based communications networks could allow support of emerging IP-based multimedia services, high-data-rate access, and mission-critical tactical group voice and interoperable communications during emergency responses. Although some commercial communication technologies have been successfully adopted by some first responders, there is certainly additional scope for using these technologies, often with minimal adaptation, to improve disaster response. Rapid deployment of wireless, cellular, and satellite infrastructure to replace infrastructure damaged in a disaster is one such opportunity. Mobile, rapidly deployable infrastructure has the advantage of leveraging commercial technology without necessarily relying on commercial service providers. Mobile infrastructure can be brought in after an event to quickly reestablish communications, (partially) replacing infrastructure lost during the event. Mobile cellular technology might also be used to bring

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cellular infrastructure to rural or other areas lacking pre-deployed cellular service just as it has already been demonstrated to bring such service to areas where existing cellular infrastructure was destroyed. There are, however, important communications problems that arise in disaster management, especially in response activities, that are unlikely to be addressed in the commercial market. One notable example is meeting communications needs inside buildings or other enclosed spaces, including damaged structures. Possible approaches include mandating the deployment of hardened repeaters in buildings, developing and deploying special lowfrequency radios, and developing and deploying low-cost “bread crumb” repeaters for first responders. Another example of such a communications problem is the congestion (both local and systemwide) that arises when and where communication is most needed, resulting in a spike in communications traffic, especially in the area where infrastructure is likely to be most damaged. Handling surging demand that coincides with reduced capability will require new approaches. Not surprisingly, given the number of organizations that must come together to cope with a major disaster, the interoperability of communications and other IT systems is often cited as a major concern. The overall evolution of communications systems (and, indeed, IT more broadly) in disaster management has been characterized by local, agencylevel acquisition and deployment driven by local budgets from local taxing bodies and by local priorities. This has led to the creation of a heterogeneous mixture of voice and (more recently) data systems across the United States. The result is that different public safety agencies (e.g., police, fire, and emergency medical), even in the same community, are often unable to communicate or share information with each other. Interoperation is not typically considered when IT is acquired. Thus, it is not surprising that limited technical interoperability exists. Concerns about public safety communications interoperability are not new, though they have received increasing attention in recent years. For example, the Public Safety Wireless Advisory Committee (PSWAC), in a 1996 report to the Federal Communications

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Commission and the National Telecommunications and Information Administration (NTIA), concluded that “unless immediate measures are taken to alleviate spectrum shortfall and promote interoperability, public safety will not be able to adequately discharge their obligation to protect life and property in a safe, efficient, and cost-effective manner.” A 1997 National Institute of Justice (NIJ) study that surveyed state and local law enforcement agencies confirmed and quantified a number of issues identified in the PSWAC report. Additional emphasis has been placed on interoperability and associated issues in the wake of the 9/11 attacks, the debate on the transition to digital television, and the response to Katrina. The 9/11 Commission, for example, cited first responder voice communications interoperability as a considerable issue in the response to the attacks and concluded that the highest-priority remedy was assignment of additional radio-frequency spectrum as a way of achieving interoperability. It recommended that Congress enact legislation providing for the “expedited and increased assignment of radio spectrum for public safety purposes.” The 9/11 Public Discourse project report-card-like “Final Report on 9/11 Commission Recommendations” gave an “F” to progress on providing adequate radio spectrum for first responders, citing lack of progress freeing up the analog television broadcast spectrum and reserving some of it for public safety purposes. More recently, legislation was enacted that calls for a handover in 2009. First responder interoperability is often cited as a major problem in responding to disasters, and recommendations aimed at addressing interoperability frequently appear prominently in after-action reports on major disasters. Indeed, improved first responder communications would have important benefits in terms of enabling communications across jurisdictions and among fire, police, and medical services. The issue has deservedly received attention from the public, government officials, and lawmakers. However, to place this issue in context, it is worth noting that interoperability is only one of many significant communications issues facing first responders, and first responder communications are not the only technologyrelated disaster management need.

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Furthermore, interoperability issues arrive in many guises, from compatibility of waveforms and message formats (technical), to terminology and definitions (semantic), to practices and procedures (organizational). Much of the public attention has been focused on voice communications, but within the public safety community, data communications interoperability is an increasingly critical component and central part of any communications system. Data communications interoperability, while having some issues in common with voice communications, raises a number of specific issues that arise when sharing information from different sources. The 1997 NIJ study noted the trend toward increasing reliance on information sharing and the importance of data communications interoperability to enable it. A number of efforts are underway to increase technical standardization, and a number of technical solutions have been developed that allow systems such as first responder radios to be “patched” together. However, interoperability should not be viewed as solely a technical problem. The harder problem is deciding when the various users across these interoperable systems should talk to each other, the protocol for doing so, who can make those decisions, and how teams get formed and dissolved. Although information could, in principle, flow arbitrarily in distributed networks, in order to act, some sort of structure is needed. Most information is hierarchically organized, but there are many different possible hierarchies, reflecting the need and point of view of the creators. 9/11 Public Discourse Project, “Final Report on 9/11 Commission Recommendations,” December 5, 2005. Interoperability in Context Interoperability is only one of many significant communications issues facing first responders. Consider the following, for example: One cannot interoperate without being able to operate in the first place. Simple availability of communications (i.e., operability) is an important consideration because disasters often cause damage to communications systems. Both agility, which makes it possible to more rapidly reconstitute communications, and robustness, which makes it easier to keep communication systems operating, are at a premium. Moreover, environments such as collapsed buildings that confront first

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responders place unusual requirements on communications capabilities. No single communication or information system is likely to suffice in a major disaster, no matter how comprehensive its scope or how much investment has been made in its interoperability or technical robustness. A variety of communications systems may end up being pressed into service, reflecting the value of redundancy. Technical communications interoperability does not address the challenges of data interoperation among organizations. Disaster response often requires access to information held by multiple independent organizations. However, each organization’s information is structured first to benefit its own routine needs and secondarily to meet non-routine external needs. Experience from many domains shows that working across these so-called silos cannot be addressed simply by imposing a single standard across all organizations.1 First responder communications are far from the only technology-related disaster management need. Consider the following: The very first individuals on the scene of a disaster are likely not first responders but members of the public. Many other actors and organizations (other than first responders) are involved in managing disasters; their ability to make appropriate decisions and function effectively also depends on IT. Communications and information-processing requirements in a disaster are very heterogeneous, varying according to context, use, time, latency, distance, and bandwidth. There are numerous examples where elements are covered in different hierarchies, and for good reasons. Efforts to determine a priori a “correct” information hierarchy are often ineffective. Thus, simply making communications and systems technically capable to interact may create more problems than it solves, unless the deeper meaning of interoperation is understood and addressed.

IMPROVED SITUATIONAL AWARENESS AND A COMMON OPERATING PICTURE Situational awareness capabilities, like communications capabilities, have received considerable attention recently, especially in the aftermath of Hurricane Katrina. Involving much more than “having all the information,” situational awareness is

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an achieved mental state; it does not begin or end with the presentation of data on a display. It is the degree to which one’s perception of the situation reflects reality. Improving situational awareness capabilities must include advancing and integrating technology that assists disaster managers in building an accurate and complete mental model, in addition to improving the amount and quality of the information available. Reflecting the difficulties of achieving situational awareness, one researcher has compiled a list of the “demons of situational awareness.” Just as it is important to caution that solving technical interoperability is not enough to achieve interoperation among organizations, it is important to clearly caution that solving technical situational awareness is not enough. IT could enable implementation of solutions to situational awareness demons, but the solutions must come from an understanding of the human dimensions of those demons, and the IT systems incorporate that understanding. An increasing amount of information can potentially be brought to bear in disaster management. More information about a disaster may initially seem like a good thing. Yet, data from disparate sources can be difficult to assimilate into useful information because of a multitude of formats, the difficulty of placing sensors where they are needed, and the difficulty of communicating sensor data to those who need it. Moreover, without filtering by human or automated mediators, those receiving the information are likely to become overloaded and to ignore excessive inputs as distractions or to devote already-scarce resources to monitoring or processing them. Research to identify leverage points for IT to augment and amplify the human ability to make sense of data may improve the effectiveness of disaster management. “Sensemaking” is “the process of searching for a representation and encoding data in that representation to answer task-infrastructure was fixable, or there were backups and alternatives. However, the lack of access because of the security ring around New Orleans and limited means for authorities to quickly validate people’s credentials meant that repairs could not be effected; generators ran out of fuel and alternatives could not be switched in. Similar problems involving physical access were cited during

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the response to 9/11.21 Recent credentialing efforts for emergency responders, including databases to keep track of volunteers, have been advancing and expanding to include telecommunications specialists, utilities workers, and other private-sector disaster response workers. Authentication and credentialing constitute a complex topic, involving many technical and non-technical issues. A few example areas of where further IT research might bear fruit include voice print analysis in the network, fingerprint sensor on the push-to-talk radio buttons, RFID tags (badges), and verbal authorization codes issued to first responders and other authorized personnel (e.g., city workers, volunteers, and so on) that are linked to the radios. In addition, back-end database and architectural considerations regarding the identity and credentialing management system as a whole also merit attention. Currently, as with Internet purchase orders, identity authentication is accomplished through the verification of several independent pieces of information, not one code or password. In the case of false negatives, lost tags, mismatches between tag and radio, and so on, one model of mitigation is for the system to transfer the transaction to a dispatcher who could decide whether sufficient evidence exists to authorize authentication. The entire realm of credentialing and identity management is clearly a fruitful research area. Further advances are needed to improve understanding of how communication structures map onto organizational structure requirements. Dynamic authority mapping is one potentially useful tool. In the short term, information technology is likely to be applied chiefly to automate and accelerate traditional disaster management processes and practices. In the midterm to long term, however, increases in information-processing capacity offer the potential to enable a transformation of those very processes by enabling innovation in organizational practices. Such IT-driven shifts have occurred in many sectors, with major organizational implications. Although these transformations are not entirely predictable, the empirical evidence suggests a number of possibilities. The military’s hierarchical command chain is one well-known organizational model for managing extremely complex, distributed activities. It reflects the development over many years of a clear sense of what

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to centralize and what to decentralize. In recent years, the military has undertaken significant, IT-enabled revisions to doctrine based on the idea of providing more information to individual units or warfighters and enabling increasingly distributed network-centric operations. The committee believes that a similar analysis and evolution of doctrine that takes into account the unique characteristics of disaster management (such as diverse actors and jurisdictions in a federal system and the important role of privatesector organizations) as well as new technological capabilities are also needed. One such possible shift would be from information-centered architectures updated in batches (e.g., “reports”) toward distributed processing of continual messaging-streams fed by pervasive sensors providing real-time situational awareness data, with different users detecting trends and transitions according to their local requirements. There could be a corresponding shift from specialized management systems that are activated for disasters and deactivated afterward to an “always-on” state of activation that varies more in scale than in nature as events occur. A move should also be possible from command models of resource management toward negotiated “brokerage” approaches working with current models of the best actions that can be taken with available resources. Another possibility is the ability to reach a mature compromise between the dual extremes of rigid bureaucracy and all-to-all interoperability toward a “managed ad-hoc-racy” of disaster management and responder organizations that can evolve seamlessly and continuously over the entire course of a disaster. Finally, a role-based concept of individual and unit identity could reduce the significance of jurisdictional, disciplinary, and even official/civilian distinctions. The cumulative effect of these changes could be a shift from a mechanical focus on preserving and restoring the status quo ante toward a flexible strategy of resilience and adaptability to the dynamics and inherent complexities of disasters. A common organizational theme is the strong tension between central authorities, which want to assert hierarchical control over disasters, and the distributed nature of most disasters. Authorities may want to be seen as “in charge,” even though most of the

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actual work in disasters results from the many less-coordinated and distributed actions of individuals. Responders typically bring tremendous energy to the scene. One response is to put someone in charge to channel (and bind) this energy. Another is to let the energy emerge and then harvest it. Organizations have a hierarchical comfort zone that has driven them to the former response, but disasters are also accompanied by the rapid development of emergent multiorganizational networks. These networks form the locus for collective sensemaking and organizational learning under conditions where ambiguity and uncertainty are an inherent part of the environment. Information technology could support emergent networks by helping them deal more effectively with unpredictable information sources, lowering barriers to information flow, making organizational boundaries more permeable, and easing coordination between diverse and distributed actors. For example, a number of emergent groups, existing in entirely virtual space and formed using the Internet and technology such as blogs and wikis, performed important services during Hurricane Katrina. Research to find more systematic ways to leverage such technology may yield new means for supporting emergent networks. While this report is primarily limited to the IT aspect of disaster management and did not specifically look at problems from an organizational theory or management theory point of view, the potential contributions that management and organizational science can make to better understanding the situation in command centers and to improving other aspects of disaster management are undoubtedly significant. Moreover, as research progresses in these areas, analysis both of the impacts that greater use of IT may have and of how IT can help ameliorate other problems will be useful. For instance, organizational research on collective sensemaking could help focus IT research on how to address confusion that stems from ambiguous information rather than simply finding better ways to reduce ignorance arising out of uncertainty by increasing the quantity and quality of information. But in a disaster situation, cooperation is often required between people who are strangers with no existing trust relationship. Thus, approaches and supporting technologies are

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needed that aid coordination and structure across people and organizations that have little trust but some common goals. IT’s ability to enhance organizational agility in disaster management may be limited by the extent to which it is unable to overcome barriers to working in an environment of limited trust. Applying existing understanding about the relationship between trust and technology and extending that knowledge through further research will be critical to advancing organizational agility.

BETTER ENGAGEMENT OF THE PUBLIC Two distinct aspects of better engagement of the public through better use of IT involve (1) the use of warning systems and broadcast alerts to inform the public of actions that they should take to protect themselves and their property and (2) the ability to leverage the public as providers of information and sources of valuable technology tools. The potential to improve the use of IT in both areas is substantial, although the second will also require considerable shifts in culture among public safety and emergency management professionals. Alerting and Warning Systems Improving warning systems for various types of disasters has received considerable attention, especially in the aftermath of the 2004 Indian Ocean tsunami. Effective warnings save lives, reduce damage, and speed recovery. Warnings are most effective under the following circumstances: They are accurate and result in appropriate action. Any probabilistic aspects (e.g., likely hurricane landfall probabilities) are clearly communicated. They are standard, consistent, and easily understood. They are delivered to just the people at risk and in a timely manner. They are delivered through a variety of mechanisms to achieve maximal reach. Technology has greatly improved the ability of forecasters to make accurate predictions about natural disasters. Public education has improved actions that people take in response to warnings. Experience and policy changes have made authorities better at communicating consistent, clear messages. Further improvements are possible in all of these areas—especially through broader deployment of sensor systems and further advances in sensor technology. But, there is now a significant gap in how warnings are delivered and what is possible with existing technology. Forecasting and sensing technology has made it possible for siren-

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based warnings to be issued minutes to seconds before the onset of a disaster where previously no warning was possible, and future advances may improve detection and lengthen warning times (earthquake detection is one such promising area). Where the time for delivering alerts is still very short, sirens can be highly effective because they can be rapidly and broadly disseminated. Sirens require people to know what action to take (e.g., for a tornado find shelter, under ground if possible). Public education and drills are used to instill this knowledge. State-of-the-art siren technology can now include a public address capability, allowing more specific information to be communicated. However, sirens are inherently outdoor systems. They are valuable because they may reach people who would otherwise receive no warning. They will continue to play an important role in alerting the public, and technology advances can make them even more effective. Warning systems using information and communications networks can be significantly upgraded using existing and emerging technologies. The Congressional Research Service report Emergency Communications: The Emergency Alert System (EAS) and AllHazard Warnings describes a number of government efforts to develop a digital warning system, including the ongoing pilot projects of the Federal Emergency Management Agency, the Information Analysis and Infrastructure Protection directorate at DHS, and the Association of Public Television Stations to develop an integrated public alert and warning system These reports note the potential of new technologies (satellite, cellular, pagers, Internet, wireless) to send more targeted messages. As the FCC review of EAS notes, “wireless products are becoming an equal to television and radio as an avenue to reach the American public quickly and efficiently.”33 One common technological denominator in recent efforts has been the Common Alerting Protocol (CAP), a warning format standard developed by emergency managers, promoted by the Partnership for Public Warning, and codified by the Organization for the Advancement of Structured Information Standards (OASIS) standards organization. CAP has been used in most of the major warning system prototypes in recent years and features prominently in the FCC proceedings on the future of EAS. Communication with the

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Entire Affected Population The importance and challenge of reaching the entire affected population—including all social and socioeconomic groups, disabled, elderly, and other special-needs groups—before, during, and after a disaster strikes were highlighted by Hurricane Katrina. More generally, reaching these groups is among the most significant of issues relating to engaging the public to ensure their own survival and recovery during disasters. Hurricane Katrina tragically demonstrated the error in assuming that better communications alone guarantees effective public engagement. Risk Communication Understanding what information should be provided to the public before, during, and after a disaster falls under the general topic of risk communications, which an earlier National Research Council report defines as “an interactive process of exchange of information and opinions among individuals, groups, and institutions [and] a dialog involving multiple messages that express concerns, opinions, or reactions to risk messages or to legal and institutional arrangements for risk management.”35 Insights from such work can be used to inform future efforts to apply IT for improved risk communication. The Public as an Information and Technology Resource While warning and alerting systems are important, their perspective is of the center talking out to the masses. The committee finds vast potential to further engage the public by changing this perspective to embrace two-way communications between authorities and the public. Interactions with the public are an important part of disaster management, yet these interactions have received relatively little attention. Changes in technology available to the public mean that there are not only new ways to reach them (with warnings), but also new ways for the public to both gather and communicate information. One typically thinks of the public playing a passive role of information receiver in a disaster. People have thus far been engaged only marginally and conditionally as sources of information with valuable technology in critical or otherwise unreachable locations (e.g., certified amateur radio operators). The now ubiquitous 911 emergency calling system is an example of how responders can get useful information from the public. It is a simple mechanism for allowing the public to

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report information. Yet, there is potential for the public to play a much larger role during a disaster, and information technology is increasingly making it possible to engage the public in a variety of ways. Civilians—people on the street— are nearly always the very first people on the scene of disaster, especially in situations with little or no warning. Collectively they have a richer view of at least a small portion of a disaster situation than is available from within an emergency operations center. Even 10 years ago most people carried little or no technology around with them. Today, much of the public has sophisticated mobile communication and sensing capability. Camera phones, wikis, the Web, and text messaging are all capabilities increasingly available to people on the scene. Harnessing these sources of valuable information holds great promise for providing critical information to disaster managers, especially in the initial response stages. Victims can be transformed into actively engaged responders if given a meaningful and appropriate means to participate. They can be recruited to assist in disaster response. They can be kept informed as to how and when to act appropriately. Furthermore, they can offer critical redundant IT resources as traditional sources are impacted by a disaster. IT mechanisms that interface disaster response agency information systems to interactive public communications channels (e.g., Internet, wireless communication) could provide information gathering and dissemination mechanisms that ameliorate problems of agency overload from affected populations seeking situational information or having the ability to provide local information. The redundancy of this approach would also improve the reliability of the communications with the attendant advantages of improved performance and public perception of appropriate actions. Valid concerns about the trustworthiness of information have inhibited any major steps toward incorporating these types of changes more fully. Yet, changes in the amount and quality of technology carried by individuals and continuing advances in filtering, qualifying, and analyzing information of uncertain quality means that a major opportunity may be missed for making better use of IT, especially given limited resources available to public officials. The Strong Angel exercises have explored “techniques

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and technologies that support the principle of resilience within a community” with the objective of effectively tapping “the expertise and creativity within an affected community, including through public-private partnerships. A second overarching objective is the development of social tools and techniques that encourage collaborative cooperation between responders and the population they serve during post-disaster reconstruction.” Research is needed into technologies that do dynamic capability profiling and credentialing, semantic routing, and filtering of multimodal public input, and research is also needed to optimize data formatting for diverse terminal devices. ENHANCED INFRASTRUCTURE SURVIVABILITY AND CONTINUITY OF SOCIETAL FUNCTIONS Disasters inherently cause disparate communities, infrastructures, and organizations to interact (and not interact) in unanticipated ways. Hurricane Katrina is an obvious example, having displaced much of an entire metropolitan region, with residents being dispersed across the country. But smaller-scale disasters also disrupt societal functions. Families and friends are separated. Families need access to housing, schools for children, and social services. People lose access to medical facilities and medical records. Jobs are lost. Important cultural institutions are disrupted. There is considerable opportunity for improving the use of IT to reconnect people, provide a temporary bridge to restore and maintain relations and interactions, and to speed their restoration. Hurricane Katrina demonstrated that people can come together, using the Internet and other information and communications technologies, to apply knowledge, skills, and technology to have a positive impact on the lives of those affected by a disaster. Another well-publicized example of an emergent use of IT was the creation of wikis38 that enabled volunteers to connect with victims. Some of the functions wikis served in the aftermath of Katrina were listing helpline numbers, posting offers of temporary shelter, identifying where and how to make donations, serving as a clearinghouse for identifying government resources, offering health and safety information, sharing advice and

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experience on relocation, publicizing fund-raising events, providing information about lost and found pets, reconnecting families, and posting help-needed notifications. The emergent behavior exhibited by these wikis is one of their great strengths— rising to meet an unanticipated and highly diffuse need. They are highly flexible and adaptable and demonstrate just one way that the emergence and ongoing advance of collaborative tools could contribute to disaster management. The challenge for disaster managers is to leverage the power of these emergent uses of IT—and support research and development to advance their application to disaster management—without destroying their inherent flexibility and adaptability. In addition to making better use of IT to help people, IT can be used to improve the survivability of critical infrastructure—another major factor in speeding recovery and restoring societal functions. The committee heard numerous possibilities for advancing IT and extending its applications to improve the resilience and management of critical infrastructure systems, such as the electric grid, water, transportation, housing, and health care. The interdependencies between these systems are often not well understood and rarely proactively engineered for resilience because they are usually designed and operated by independent entities over a long period of time. The structural couplings between these systems may also manifest themselves on a wide range of spatial and temporal scales, making it difficult to quantify them. Solving these problems requires different jurisdictions—cities, counties, states—to work closely with each other and with federal agencies. The restoration of New Orleans, for example, is widely understood to require a concerted rebuilding across government agencies, public safety organizations, businesses, and public utilities. Simply clearing damage, processing insurance claims and other compensation, and rebuilding residential, government, and commercial infrastructure constitute a very complex, multifaceted process that is likely to take years to complete. Advances in IT can revolutionize other technical disciplines with direct and indirect implications for advances in disaster management. A salient example is the entirely new class of monitoring and control

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capabilities made available to civil and mechanical engineers by the creation of small sensors, microprocessors and wireless communication devices. Many applications require the deployment and use of sensors on a wide scale—capabilities that are starting to emerge from research into distributed sensor networks. When terrorists attacked the World Trade Center in New York in September 2001, thousands of occupants of those doomed structures had an hour to escape. But delays in the assessment of the structures’ integrity stole crucial minutes from the evacuation and ultimately doomed thousands of innocent civilians. Today it is possible to instrument such structures using sensors and wireless connections, in such a way that the changing forces within the towers’ structures could be recognized and evaluated almost instantly. On a larger scale, ubiquitous monitoring of the condition and utilization of highways could trim minutes or even hours from the travel time of responders by routing them around damaged or clogged routes. Supervisory Control and Data Acquisition systems for water, gas, and other utilities are being enhanced to provide detailed analysis of damage due to earthquakes or explosions, enabling system operators to speed restoration and minimize peripheral disruptions of service. The benefits of comprehensive monitoring and management of engineered systems can extend beyond their own boundaries, for example managing interactions between systems, such as the power grid and the communication networks that rely on them. This underscores the importance not only of collecting systemspecific data but also of normalizing and exchanging real-time assessment data between systems. Buildings, roads, and other constructed infrastructure exhibit significant resilience and robustness in the face of disaster. However, infrastructure that appears to be intact may in fact have been severely damaged in ways that are not readily apparent. For example, in the wake of an earthquake, a building might be on the verge of collapse or a bridge might be ready to fail after even the smallest aftershock. By making hidden damage more apparent, sensors combined with information technology can enhance response and recovery operations by reducing uncertainty about the state of infrastructure.

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Continuous monitoring and analysis of critical infrastructure could be done by developing new instrumentation capabilities. This would enable the routing of sensor information from buildings, bridges, and infrastructure systems—for example, roads and water, gas, sewer, communications, and power systems—to monitoring locations, providing responders with information about the robustness and safety of the infrastructure affected. As in other areas, power supply independent of the electric grid is a critical issue that must be addressed to extend sensor capabilities. Improving Acquisition and Adoption of IT for Disaster Management This chapter focuses on information technology (IT) acquisition and adoption issues confronting the various federal, state, and local agencies and private organizations (hereinafter called disaster management organizations) that have official responsibility for disaster management. It does not explore the complex issues of IT acquisition or adoption by individuals or private firms for use in disasters; however, it does briefly consider opportunities for leveraging IT systems and services of privatesector firms, citizens, and non-governmental organizations. The chapter starts by considering some of the key barriers to more effective use of IT in disaster management. It then discusses some best practices and design principles that would help address these barriers. It concludes with a discussion of roadmapping as a technique for guiding overall investment in research and development and a discussion of multidisciplinary centers as a way of better coupling IT research and practice.

OVERVIEW OF NON-TECHNICAL BARRIERS Many sectors, such as banking, manufacturing, and services, have been able to adopt new IT technologies routinely and aggressively. Some disaster management organizations have also been quite effective in integrating state-of-the-art IT technologies into their day-to-day operations (e.g., the use of Internet Protocol [IP]-based emergency management tools, the use of cell phones to listen in on first responder land mobile radio traffic, and the use of laptops and wireless local area networks). However, in the committee’s view, the disaster management community has not been nearly as broadly successful.

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The following are among the complicating factors: Disaster management organizations often lack the resources to acquire valuable capabilities. Responsibility for disaster management is widely distributed among agencies and organizations at all levels of government— with resources and operational responsibilities mainly concentrated at the local level. These organizations have vastly different technologies and capabilities. These characteristics lead to highly scattered adoption and lengthy adoption cycles and a highly fragmented market for disaster management IT. Moreover, many of the organizations are small and have very constrained budgets for IT. Most acquisition resources are focused on capabilities to improve day-to-day operations, whereas disaster management is, by definition, not a routine activity. Some of what agencies do acquire specifically for disaster incidents nonetheless becomes “shelf-ware”—unused even when the need for which it was acquired arises. Both the development and the deployment of many promising technologies are risky and costly compared with the opportunity presented by the commercial market for these technologies today. For example, there are sensors that would be very useful for assessing in real time the status of the built environment. However, developing and manufacturing such sensors for the uncertain and highly cost-constrained disaster management market do not constitute attractive commercial opportunity at this time. In most agencies with disaster management responsibilities, there is no one who is charged specifically with tracking IT technology, identifying promising technologies, integrating them into operations, or interacting with IT vendors to make sure that needs are addressed. Many organizations are too small to grow and support significant in-house expertise, and they naturally look to vendors to provide turn-key solutions, which may mean that the organization’s long-term, broad needs are not fully met. Long intervals occur between acquisitions, with the result that any institutional learning that does occur is likely lost in the interim. The acquisition dynamics created by this situation tend to limit the potential market, leading IT vendors to adapt IT technologies only slowly for use in disaster management. There is no focal point for addressing these issues at the federal level,

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further contributing to the problem. Finally, the complexity of IT systems and the organizational changes that they introduce are often met with resistance and ambivalence by both managers and users, especially in the absence of a technology “champion.” Decisions regarding IT tend to be made independently by local organizations that must work together in disasters. Organizations with disaster management responsibilities are typically highly independent and have limited regular contact with one another. However, these organizations find themselves having to collaborate in disasters, giving rise to interoperability issues at many levels. State and federal organizations charged with disaster management face similar coordination challenges, further complicating collaboration in responding to a disaster. Acquisition managers concerned about collaboration typically have no place to go to determine if the technologies they are acquiring will interoperate with those of their peers. Further, no mechanism exists for them to synchronize technology acquisitions in order to make them compatible. Recent trends toward the establishment of regional groups to address IT and related disaster management issues are a promising trend. Disaster management is concerned with environments that are intrinsically uncertain and unstable. This contrasts with the typical IT acquisition environment, where development, deployment, operation, and maintenance take place in fairly well understood and stable environments and where requirements are better understood. Important sources of funds are typically only available once a disaster has been declared and must also be spent in a short window of time. Funds tend to become available in much greater quantity during a period of time after disaster declarations. Experienced emergency managers are well aware of this recurrent “window of opportunity” effect, and many of them keep IT and communications projects in draft, ready to proceed as soon as a disaster redirects attention and money to their needs. However, these purchases are naturally driven by immediate concerns rather than longer-term considerations. One conclusion (overly pessimistic in the committee’s view) given these barriers would be that advanced IT solutions are impractical for most local governments and emergency management agencies. Such a view

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assumes that the existing problems are insurmountable, whereas the committee believes that many of these problems can be mitigated if best practices and principles are followed and if appropriate mechanisms are put in place to support their adoption, such as the research centers that couple technology advancement with practice and community-wide technology roadmapping. Another related potential misreading of the challenge is that technology that is “advanced” or “leading-edge” is necessarily more complex— and is thus unsuited for organizations without considerable in-house technology expertise. In fact, some trends in information technology are in exactly the opposite direction, with advances aimed at reduced complexity from the standpoint of those acquiring, managing, or using the technology. A reflexive avoidance of advanced technology and new developments could thus counterproductively translate into a failure to adopt systems that are more robust, reliable, and usable. BEST PRACTICES FOR ACQUISITION Best practices for acquisition include an emphasis on iterative development; increased opportunities to test and evaluate technology in practice, together with realistic concepts of operations; and design and evaluation processes that allow for strong coupling among practitioners, researchers, and industry. From Waterfall Acquisition to Iterative Development Historically, as in many other areas, the introduction of technology in disaster management has been characterized by a series of major deployments, occurring at intervals sometimes measured in years or even decades. These long cycle times reflect in part the traditional “waterfall” acquisition process. This acquisition model presumes a linear development process that proceeds in stages from development of a comprehensive requirements specification to design, then to implementation followed by integration, next to testing, then to installation, and finally to maintenance. Modified versions of the model acknowledge some role for feedback between each of these stages and preceding ones the system development leaves the initial requirements stage are difficult and expensive to incorporate. The reason is that many artifacts of a system grow organically. The practical reality is that large systems emerge from incremental

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additions in ways entirely unanticipated by the designers of the original system. If the original system is successful, users will almost certainly want to add new functionality. The new functionality desired is by definition unanticipated—if the designers had known it would be useful, they would have included it in the first place. Indeed, it is essentially impossible in practice for even the most operationally experienced IT systems developers to be able to anticipate in detail and in advance all of a system’s requirements and specifications. Often users change their minds about the features they want, or (even more difficult to deal with) they want contradictory features. And, of course, it is difficult indeed to anticipate all potential uses. Thus, system requirements and specifications are inherently incomplete, even though they underlie and drive the relationships among various components of the system. Put differently, the paradox is that successful system development requires non-trivial understanding of the entire system in its ultimate form before the system can be successfully developed. System designers need experience to understand the implications of their design choices. But experience can be gained only by making mistakes, learning from them, and having a mechanism to modify and evolve systems overtime as the understanding of both user and designer grows and as requirements and technology evolve. For these reasons, development methodologies have been developed that presume an iterative approach to building systems. An iterative process uses multiple, short acquisition cycles, which over time deliver and improve on system capabilities. Such a process encourages feedback from users and allows them to play a constructive and central role in a system’s evolution. An iterative process requires, among other things, mechanisms for users to provide feedback to technology innovators and providers. (The committee discusses some possible mechanisms for supporting this process later in this chapter.) With iterative development, systems that initially include limited functionality are often introduced. As users adopt the technology, they have a mechanism for identifying improvements to that functionality and for identifying desirable new features that technology providers can incorporate into the new product versions. The

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progression of mobile phone functionality to incrementally include increasingly greater performance and a wider range of features is a familiar example of this process. An iterative acquisition process has other advantages. Often requirements thought to be essential turn out to be relatively unimportant or little used once deployed. The functionality supporting those requirements can be dropped from future product versions, helping minimize complexity creep. Essential features frequently go unidentified until the system begins to be widely used. These features can be added in a more orderly fashion, evolving the system with continuing feedback from users. Incremental introduction of technology also allows one to exploit the current technology “sweet spot”—where the costs of components such as microprocessors are lowest—keeping down costs and making more frequent acquisition cycles possible. In disaster management a tension inevitably arises between a natural desire to fully meet demanding or perceived unique requirements and the cost and speed of development and deployment. Disaster management professionals often say that they must be able to depend “absolutely” on the technology they employ—noting the life-ordeath nature of their work. An iterative process allows time for users to build trust in the system’s ability to deliver on those critical requirements and a mechanism for providing feedback to request (or demand) changes as needed. It also allows an opportunity to minimize initial demands for unique requirements involving specialized equipment and maximizing the opportunity to incorporate “commodity” components, thus minimizing cost and delays. Metrics-Driven Investment As the saying goes, one can only manage what one can measure. The resources available for disaster management are limited, and decision making always involves tradeoffs. To motivate the IT expenditures needed to provide adequately for disaster management, there must be an understanding of the benefits that are obtainable. Weighing the available benefits from particular IT investments against the returns on other sorts of investment is challenging. When considering the effects of disasters, these tradeoffs can easily be driven by emotions, even more than in many other sectors. Having metrics allows an analytical assessment

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to be made, comparing the costs of preventive and mitigating investments with the likely impacts of disasters, and with other potential investments. The sections that follow briefly discuss several aspects of metrics-based decision making. The development of suitable metrics to guide investment in IT for disaster management is a topic for further research and something that a roadmapping effort (described later in this chapter) might address. Estimating Risks Estimating the risks of infrequent events is hard, but failing to consider risks explicitly cripples any rational decision-making process. Gathering the necessary information will necessarily be an iterative process, with initial information providing a basis for further discussion, expansion, and revision. An additional benefit of systematizing this process is the potentially useful feedback on needs and opportunities that it can provide to the technology research and development community. Costs and Benefits The economic model needed to assess the trade-off of the costs versus the benefits of investing in technology for disaster mitigation differs from business investment models. Typical business investments are related to a steady income stream, not to a variety of infrequent future costs and benefits. An economic model for disaster management must combine initial investments, ongoing costs, and infrequent events. An investment is based on the net present value, computed using some discount rate for all those components. Those rates incorporate the expected lifetime of the assets and the risks associated with deriving income from those assets over that period. For business IT investments, those rates typically vary from 12 to 20 percent. Communication infrastructure has used much lower discount rates in the past, but the merger of those technologies is forcing the rates for those investments upward. Any technology deployment has initial costs, as well as ongoing maintenance and training costs, and a finite life. This long horizon requires using discounting of future benefits, as well as ongoing costs. Since the occurrence, magnitude, and timing of future disasters are uncertain, appropriate discount rates may have to be quite high, so that results adequately reflect the intuition of the participants and funders of disaster mitigation expenses. While economic cost

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estimates of disaster impacts are never precise, they do provide order-of-magnitude estimates needed to allow projects and proposals to be ranked. Estimation of the savings resulting from reduced impact due to mitigation efforts is particularly difficult. Many IT benefits will be due to being able to respond more rapidly. Developing models on how faster response can reduce eventual costs is a substantial, but interesting, challenging, and rewarding task. An actual economic quantification of the cost of disaster mitigation versus the benefits obtained could be a fruitful area for research. Use of a Cost-Benefit Model Any recommendation for new and increased outlays must be accompanied by a quantification of their benefits. While costs are easy to quantify, the benefits of disaster mitigation are hard to quantify, but a reasonable attempt is required. It is expected that the costs of improving the technology available for disaster mitigation will be offset by substantial benefits accruing to the country. The most important of these benefits cannot be directly quantified, since they represent the human dimension: reduction of suffering, preservation of family stability, and prevention of losses of items of purely personal value. Other benefits of disaster mitigation can and should be quantified. The low frequency of major disasters greatly reduces the priorities that local planners, faced with many short-term needs, actually assign to accumulating and maintaining the resources that are adequate for dealing with disasters. While some supplies can be stockpiled for decades, IT becomes obsolescent much faster and requires an ongoing infusion of funds. In the commercial world, a spending rate of 15 percent of the initial and upgrade investments is expected. Costs are reduced when obsolete systems are taken out of service. For many systems, the military tends to spend less annually but is then faced with huge, wholesale replacement costs every 12 years and has an inadequate system for more than half of that period. Readiness for mitigating disasters requires a modest but steady investment in technology. The total benefits are due to cost reduction that occur at unpredictable times and are of unpredictable magnitude.

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Major, quantifiable benefits are due to infrequent events. For an individual county, the investment in disaster mitigation technologies appears to represent an instantaneous expense, sometimes aided by state or federal grants. Maintenance costs are in different budgets and are hard to assess. Technology Evaluation The decentralized nature of disaster management, spread across thousands of agencies—from the smallest volunteer fire department, to sophisticated urban police departments, to state, regional, and federal agencies—presents particular problems for effective technology evaluation and diffusion. Today, many managers responsible for the acquisition of technology for public safety and emergency management are, quite understandably, unable to keep-up-to date with the volume of technology and choices available. Managers often rely on vendors to tell them what they need and have to base decisions largely on the oftenconflicting “advice” of various vendors. Professional conferences, workshops, and other meetings held by public safety and emergency management associations are one mechanism for facilitating diffusion of the latest technology. IT capabilities, most notably the Internet, may prove useful as well by providing a conduit for sharing and discussing information about what works. More systematic approaches to evaluation would likely yield deeper and broader technology adoption over the long term. One option is to make use of formal mechanisms for providing unbiased evaluations and guidance—a sort of Consumer Reports for disaster managers. The military’s experience with technology demonstrations, described in the next section, may provide one model for this type of “clearinghouse” approach. Important differences exist between the defense and disaster management contexts regarding technology evaluation. For instance, the military has a somewhat-well-defined acquisition chain that flows from initial ideas to deployment agencies. In civilian disaster management, development and procurement are far more decentralized. Decentralization introduces hand-off issues for successfully demonstrated technology. Still, adapting the lessons of military technology transfer to civilian disaster management yields at least two insights. The first insight is that technology demonstration will be successful

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to the extent that more knowledgeable technology adopters are available for experimentation. The next two sections—on processes that bring technology developers and practitioners together and on building capacity at the intersection of IT and disaster management—discuss mechanisms and examples for growing the capacity of practitioners as knowledgeable technology adopters. A second insight is the importance of an honest broker serving as a neutral technology clearinghouse that can help provide the expertise to identify and evaluate technology. There are a few examples, from which others have successfully learned, where local and state agencies have taken the lead in demonstrating the viability of a technology. Some states (e.g., South Dakota and Indiana) have taken on this role, identifying and evaluating technology, infrastructure, and services, and in several cases providing one or more of these to local agencies. Private-sector integration centers aimed at bringing together diverse technologies can have value in getting vendors to make their products work with those of other vendors. But, they are necessarily designed to promote both their particular partner’s products and their own consulting and integration services. These vendor-driven efforts will likely fall short of being truly neutral. One option for achieving the neutrality of an honest broker to vet technology intended for disaster management is used for similar reasons in other government mission areas. It is the Federally Funded Research 2 Based on the testimony of Otto Doll, Bureau of Information Technology, state of South Dakota, and Dave Smith, Indiana Integrated Public Safety Commission, at the committee’s June 2005 workshop. FFRDCs are independent, non-profit entities sponsored and funded by the U.S. government to meet specific long-term technical needs. FFRDCs typically assist government agencies with scientific research and analysis, systems development, and systems acquisition. They draw together expertise and perspectives from government, industry, and academia to address complex technical issues. An FFRDC for disaster management would not have any operational responsibilities. Rather, it would serve the disaster management community by identifying, developing, and assessing technologies and concepts of operation for using those technologies.

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Processes That Bring Technology Developers and Practitioners Together An iterative development process goes hand in hand with an acquisition process which assumes that technologies and organizational processes will co-evolve. Coordinating technological advances and organizational process changes requires new knowledge and skills on the part of both practitioners and technology developers and new relationships between them. Such coordination depends on practitioners and developers gaining a better understanding of one another’s methods and on mechanisms that maintain dialogue between them in order to identify promising technologies, define appropriate uses for them, and evaluate and disseminate the outcomes. The Department of Defense has a broad set of programs aimed at bringing together technology developers and users, speeding innovation, and transitioning it into use in the field. One notable model with considerable applicability to disaster management is the Advanced Concept Technology Demonstration (ACTD) model,3 which also pays particular attention to the interplay between technology and organization. An ACTD is used at the phase where promising technologies have been developed together with a vision of how they could be used. An ACTD provides a framework in which to assemble a group that is willing to be an early adopter and a context into which the technology can be inserted and evaluated. A well-run ACTD includes a phase where the system, organization, and technology are all analyzed together, and modifications to each are identified and implemented. A particular strength of the ACTD approach is that it recognizes that it is not enough to build the technology. One needs to analyze the organization and look at how processes are going to change as a result of having the technology. The idea is to simultaneously develop requirements for organizational change and adaptations of technology to fit that. To use the ACTD approach effectively, patience is required. Otherwise, the design phase may be overly compressed to the detriment of the ultimate product. Promising innovations may wither while waiting to be adopted, or problems identified during the acquisition phase may result in a technology’s being abandoned before researchers are able to find solutions. Building Capacity at the Intersection of IT and Disaster

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Management. The committee heard from state and local agencies that one of the major barriers to advancing practice and adoption of technology was a lack of resources to allow staff time for ongoing development of technical expertise. Yet, without the inhouse development of technology expertise able to draw on external resources (such as centers of excellence), adoption of technology will continue to lag and is unlikely to be optimally implemented when adopted. The interdependence of technology and practice means that developing a cadre of experts at the intersection of disaster management and IT is likely to yield significant payoffs. Expanding the human assets available involves both the promotion of cross-fertilization between the technology and practitioner communities and the promotion of a culture of innovation in both. Such a cadre of people will be more astute at translating user requirements to technical need, and will serve as a self-reinforcing feedback mechanism between technology advances and disaster management practices. A number of mechanisms could contribute to increasing human capital along these lines. These include both mechanisms for fostering innovative environments wherever possible and mechanisms for disseminating their results elsewhere. For example, programs could be established to support fellowships, field tests and other experiments, and training and educational activities. Also, programs that incorporate both disaster and IT expertise could be funded to analyze the performance of systems after a disaster. Federal grants could support creation of expertise within state and local agencies by, for instance, sending people from public safety agencies to regional centers for training and to interact with technology experts and other practitioners to stay abreast of the latest developments in both practice and technology. Improving Disaster Management: The Role of IT in Mitigation, Preparedness, Response, and Recovery by organization and the nature of the barriers to be overcome. These barriers may include the time to secure the investment and to make the appropriate connection between that investment and the fully discounted net present value of the savings that the investment will accrue. Advances in general data processing, storage, communication, display, and software technologies will continue to make

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components of IT systems less expensive and more capable with time—aiding the adoption process. (Examples of technologies in this category and described in Chapter 4 include radio-frequency identification (RFID) for resource tracking and logistics; computermediated exercises; reverse 911 capability, i.e., two-way emergency reporting; and portable unmanned aerial vehicles and robots.) Adaptation—technology on the horizon and ready for transfer to disaster management practice. Effective systems to serve disaster management may be assembled by combining and adapting available commodity components. IT systems are mainly built using hardware that is available off the shelf and adapted using off-the-shelf software components. Some hardware components— such as personal computers and disk drives—have become commodities. Commodity hardware benefits from significant economies of scale, so that the hardware cost of a cell phone is roughly onetenth that of a police handheld radio. Part of the cost differential is due to specialized functionality and ruggedness requirements, but a significant portion of the difference comes from much higher production volumes. Adapting commodity hardware to disaster management (in contrast to developing wholly novel hardware) could significantly lower cost due to specialized requirements. Software exhibits more flexibility. Many software and Web-based applications are expressly designed to allow customization for specific uses. Some useful software exists that has been developed in an open and freely shared environment that lends itself to adaptation and customization. In such an environment, investment can be distributed, often close to the end users, making it possible for users and vendors to adapt many existing IT technologies to disaster management readily and rapidly. Useful results can be obtained on time scales measured in months. Development—technology on the horizon and development needed for use in disaster management. For some requirements the technology and design principles are fairly well understood, but existing technology is simply not adequate for disaster management. A concerted effort is required to develop significant software, hardware, and organizational structures to take advantage of them. In this case, a request-for-proposals process

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can be used to solicit capable organizations to deliver a product that implements the desired technology. Development time depends on project complexity, but useful results can often be obtained within a year. (Examples of technologies in this category and described in Chapter 4 are volunteer mobilization systems, event-replay tools, and intelligent adaptive planning tools.) Applied research—issues requiring disaster-management-specific research. There remain some difficult issues in disaster management for which solutions are not at hand—for example, reliable radio communications inside buildings or rubble. Research aimed specifically at improving disaster management could be conducted by university, commercial, and government laboratories, and even volunteer relief agencies such as the Red Cross. This type of activity is managed and directed within the government by agencies such as the National Science Foundation, the Department of Homeland Security (DHS), the National Institutes of Health, and by defenserelated organizations such as the Defense Advanced Research Projects Agency and the service research laboratories. Support for smaller companies is given through Small Business Innovation Research and Small Business Technology Transfer programs administered by many of the above agencies. Because of the nature of disaster management and the types of challenges that the community faces, disaster-management-related IT research is becoming increasingly broad and interdisciplinary, involving contributions from multiple technical and social science fields. Fully realizing potential gains will often involve the fostering and management of collaborative research. Even so-called short-term research is typically a multiyear proposition and requires validation in the field at real disasters, as well as simulations. General research—issues requiring research followed by adaptation to disaster management. Some problem areas in disaster management overlap general needs in IT management. IT is a broad, active area of research, and relevant research aimed specifically at disaster management is performed at university, commercial, and government laboratories and is sponsored by the same constellation of agencies. Many of these labs are engaged in broad areas of research that have the potential to develop new

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IT capabilities which, though not directed specifically to that end, could be harnessed for disaster management. As with applied research, this research is typically a multiyear proposition. Further development or adaptation may also be needed for effective utilization in disaster management, which may add more time. Interdisciplinary Research for Enhancing Disaster Management Interdisciplinary approaches to disaster management have been discussed for quite some time. As noted in the recent NRC report Facing Hazards and Disasters, interdisciplinary research (i.e., research that blends researchers, expertise, and tools from a variety of disciplines to address compelling and crosscutting problems) has been gaining prominence in almost every field of scientific endeavor, including disaster management research. Indeed, the report cites earlier NRC work that describes four factors promoting the growth of interdisciplinary research: (1) the complexity of nature and society, (2) the desire to address scientific problems that cross disciplines, (3) the need to solve society’s problems, and (4) the power of new technologies. The benefits of interdisciplinary research for disaster management can be substantial. For example, Facing Hazards and Disasters describes a number of “exemplars” of interdisciplinary research in disaster management—from infrastructure failures and urban economics to casualty analysis through a common framework to decision making for risk protection. However, Facing Hazards and Disasters also goes on to describe how interdisciplinary research can be particularly challenging when overlapping social sciences with natural sciences (something one sees quite a bit of in disaster management research). According to the same report, interdisciplinary research for disaster management faces a number of significant challenges of its own (in addition to the normal challenges for such research, such as lack of funding and academic incentives) if it is to prove successful. For example, the report notes that some issues often stem from “the failure of a research team to function collaboratively” owing to such things as difficulties in spanning culture gaps between the disciplines or the devaluation or undervaluation by one discipline of the work of another. Another challenge cited revolves around how disaster management research is most often viewed as applied

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research rather than basic research geared toward advancing overall knowledge in a given area. Facing Hazards and Disasters surveys the available literature in the area and also suggests a number of factors contributing to the success of interdisciplinary research. First, it notes that problem-oriented research is probably best suited for interdisciplinary work in disaster management. Second, it notes that the particular characteristics and abilities of researchers—including such things as interpersonal skills—are very important for such interdisciplinary research. Third, it describes how studies that keep research teams relatively small and have stable membership appear to be more successful at integration and research. This report identifies topics that require general research, but it is not expected that funding specific for disaster management will be employed for these topics.

ROADMAPPING Any research agenda aimed at improving the long-term effectiveness of IT use in disaster management must be placed in the context of the technology pipeline and must prioritize the items in the agenda against each other, in particular noting where progress in one area may be dependent on progress in other areas or on organizational advances. An efficient approach to investment requires a clear vision of the path to improvement and a detailed understanding of the individual pieces of the problem and their interrelationships, together with a mechanism to measure progress. Disaster management is, ultimately, a system-level problem. Thus, improving IT use in disaster management requires a system-level approach. The research agenda is likely to have the most impact if it conforms to a clear vision of the path to improvement defined in a fully articulated roadmap. By establishing a process for making improvements, currently unimagined concerns can be efficiently addressed as they arise, and as both technology and practice evolve. A technology roadmap is a planning tool that can provide information to make better technology investment decisions by identifying critical technologies, technology gaps, and interdependencies between technologies that dictate coordination of research and development cycles. It can also help uncover interconnections between technologies and adoption issues related to organizational or

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human behavior characteristics. Perhaps most importantly, it can serve as a mechanism through which diverse participants, often with conflicting priorities but with common goals (i.e., saving lives and reducing economic and other impacts), can cooperate to address a larger problem of common interest—in this case the most effective handling of disasters possible. Until relatively recently, the technology choices facing most disaster management organizations were comparatively few, with much of the investment focused on building specialized communications systems in close partnership with a small set of vendors. Today, there is a much wider set of technology options available. There is also an increasing need for the diverse organizations with public safety and homeland security responsibilities to be able to cooperate during large-scale disasters. In response, efforts have been made to identify appropriate technologies (such as DHS’s Select Equipment List). An effective, useful roadmap is driven by a clear set of user-driven (not technology-driven) goals and needs to evolve continuously as a living document in consultation with the full range of stakeholders. Some pieces of a roadmap are in place (e.g., the National Incident Management System), but an overarching strategic vision of how IT can best be evolved and applied to disaster management is missing. A roadmap can serve as an anchor for a strategic vision and help policy makers avoid lurching from one priority to the next, driven by the most recent major disaster. Unfortunately, in the absence of a roadmap, more or less haphazard, reactionary IT investment is occurring and is likely to continue.10 New incidents (like a major hurricane) should trigger a reevaluation of the existing roadmap, potentially leading to some adjustments in priorities within the strategic framework. But the continuity of investments should result in continuous and more predictable improvements in the application of IT to disaster management. A roadmap can also assist policy makers and planners in balancing investments across different technologies appropriate at different times in the disaster management life cycle, that is, mitigation preparation, response, and recovery. A roadmap can also make explicit investment choices concerning tradeoffs among competing

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priorities and between tensions such as security versus openness and other such tensions previously identified. Finally, a roadmapping process provides an opportunity to consider the interrelationships between technology and organizational models and technology and policy. Successful technology development and deployment are widely understood to require active consideration of the organizational context in which they will be introduced. Similarly, potential policy barriers must be considered when developing new technologies and organizational approaches. Critical to the success of a roadmap activity is the inclusion of a broad array of stakeholders and an institutional home to get started and remain viable. All participants must make a long-term commitment to the resulting roadmap and to its continuing evolution as technological advances and organizational innovations are made. Examples of Successful Technology Roadmapping Roadmapping is a technique frequently used by firms to plan future research and development activities. The U.S. military, for example, uses a roadmapping approach in its Quadrennial Defense Review report11 to drive plans for incorporating technology advances into its future capabilities. The International Electronics Manufacturing Initiative has developed a sensors technology roadmap that examines technology capabilities and applications in a variety of sectors, including transportation, health care, and consumer electronics. Perhaps the most familiar application of roadmapping is the semiconductor industry’s roadmap. In the late 1980s, it became clear that the integrated circuit industry was not only a rapidly growing part of the global economy but also critically important to the economy and national security of the United States. Unfortunately, concerns grew that the United States, after an initial leading role, had fallen behind in technology leadership relative to other countries, especially those in Asia. A 1990 National Research Council report outlined the consequences of not maintaining a commercial and technological lead in this area.13 The Semiconductor Industry Association (SIA) would take on the role of pulling together a long-term technology roadmap for the industry based both on end-user needs and technology trends. This was not an industrial plan in the usual sense, but rather an agreed on, coordinated vision that would help each organization

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plan development and investment strategies that would bring the thousands of pieces of technology needed to make an integrated circuit together at the right time and the right level of development. A technology piece developed too early would be prohibitively expensive—developed too late it would not be profitable. Market forces would ensure that vendors and suppliers would tool up to meet a particular need at the right time, and even researchers understood the targets for conventional technology and could choose areas for research that, if successful, would have the most impact. Unlike other attempts at planning, this was not directed at a specific technology goal, but rather at the process of continuously improving a key technology over a span of decades. Each step along the way would have important economic and strategic value and would form the foundation for the next important advance. Built into the creation of the roadmap was a process that drove continuous updates and refinements, making it a living document with continued relevance and ensuring that it was up to date with advances in science, technology, and market needs. By the end of the 1990s, after three major updates and the associated strengthening of the U.S. semiconductor industry, there was a push to expand the roadmap process to a global scale so that the vision would match the expanding scale of the industry. Today it is a joint effort of industry, government, and academic representatives from the United States, Europe, Korea, Japan, and Taiwan. It is the critical common view driving ongoing investment in research, development, and manufacturing in one of the largest and most complex components of the global economy. The roadmap for disaster management would be quite different from that of the semiconductor industry. Specifically, the SIA roadmap was made possible when an entire industry needed to plan for future generations of fabrication equipment and realized that this highly capital-intensive equipment was beyond the means of any one industry participant— it required cooperation with other participants. This created an environment where cooperation within a specific framework, embodied by the SIA roadmap, was possible, while allowing continued competition in areas outside of that framework. In contrast, disaster management organizations and

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the associations that represent them would necessarily drive the roadmapping process envisioned here. Yet, the key element remains—the need to create a framework within which cooperation can happen in order to address common goals that are otherwise unattainable or suboptimal. By joining together to develop a roadmap, they would have a forum for speaking with a common and consistent voice to the vendor community about technology needs. There are also similarities from a process perspective; stakeholders create a living document that explicitly lays out a vision for continuous progress based on balancing value and cost, as well as carefully considering technical and organizational feasibility. Then, investment from all sectors can then be committed to track this vision as it evolves. A successful roadmapping process would ultimately result in full and active participation of the vendor community, just as the SIA roadmap process eventually included the entire worldwide semiconductor industry, including those who spurred its development as the perceived “adversaries.”

RESEARCH CENTERS: COUPLING TECHNOLOGY RESEARCH WITH PRACTICE Successful development, adoption, and utilization of IT for disaster management require several different communities be in regular and close contact with one another. Researchers tend to look for overarching themes, but experience has demonstrated the importance, in the field of disaster management, of starting with real problems faced by real practitioners, working back from there to overarching themes. Starting with overarching research themes will likely lead to dead ends and unimplementable technology.14 Practitioners must help define needs for new technology, thus acting as inspiration for researchers and developers. They must interact with developers and vendors throughout the prototyping cycle and development process to ensure that their needs are indeed addressed. IT researchers must have opportunities to expose practitioners to novel concepts in order to generate an understanding of potential new capabilities and how they might fit into current and future operations. Public administrators, social scientists, and IT researchers all play important roles in ensuring that IT innovations are introduced with the necessary organizational changes to enable new devices and systems to be

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smoothly integrated into practice. Forging organizational ties is harder in disaster management than it is in sectors like defense because the vast majority of practitioners are distributed across local agencies that are normally fairly isolated from each other and from the research community. Nevertheless, integrating the experiences and needs of these different agencies is crucial, since sooner or later when a disaster of a severe enough magnitude strikes, they are bound to have to work together. Some regional groups of organizations that have already experienced the need to work together have successfully initiated the process of forging organizational ties, suggesting that building from a bottom-up approach is likely to be most effective. Moreover, successful IT development is iterative. It is important to provide practitioners with initial prototypes to bootstrap the iterative process. Testbeds and exercises are particularly critical in the area of disaster management because they provide opportunities for feedback from actual users about critical requirements of responders that may not otherwise be apparent. In some cases, large-scale testbeds are required to understand issues that only emerge at scale. Simulations present opportunities not only for training but also for observation and assessment of IT capabilities such as decision support tools. Operational facilities that permit instrumentation, experimentation, and iteration are needed. Collaborative research centers could, therefore, play a highly useful role in advancing the effective application of IT to disaster management. The major goals of such centers would be sixfold—(1) to develop a shared understanding of the experiences and challenges in all phases of disaster management from both a technological and organizational perspective, (2) to evaluate the application of technology advances to disaster management practice, (3) to develop a culture and processes for transitioning knowledge and technology to the operational communities on a sustained basis, (4) to build human capital at the intersection of information technology and disaster management, (5) to serve as repositories for data and for lessons learned from past disasters and disaster management efforts, and (6) to provide forwardlooking analysis to inform the development of technology capabilities, associated organizational processes, and roadmap development. The research conducted by these centers would be

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multidisciplinary, combining the efforts of information scientists, engineers, and social scientists. Participants would be charged with collecting knowledge and experience from past disasters and using it to build a core set of knowledge that would inform the development of technology capabilities and associated organizational processes to enhance the management of future events. The centers would closely partner with federal, state, and local agencies responsible for disaster management. Indeed, experienced and capable emergency management officials and operational units from disaster management organizations should be deeply involved in the work of these centers. One approach for engaging these government agencies could be to provide them with incremental funds specifically for working with researchers and to develop next-generation technologies. To ensure that the work of the centers is informed by and responsive to the needs of disaster management, centers would bring in disaster management professionals from all levels of government as visiting fellows. To inform additional researchers about the problems of disaster management, university faculty and students would be offered internships and fellowships. Finally, to help encourage development of technology based on the research results, the involvement of relevant industry would be promoted through informational activities and the sharing of expertise and results. Multiple centers for research would have several advantages over a single research center. They would enable healthy intellectual competition and crossfertilization of ideas and allow for specialization in specific types of disasters, specific technology capabilities, or the comprehensive needs of particular geographical areas. Certain research centers could, for example, specialize in disasters common to their locations, in order to benefit from expertise residing in local emergency response organizations and other local government agencies. For instance, a center near known earthquake-prone areas may focus on technology related to improving earthquakespecific disaster management. Different centers could specialize in practical and response-oriented work, combining core as well as geography-specific expertise. Close coordination and sharing of information and expertise among centers would help avoid unnecessary duplication. A major

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goal of these centers would be to develop a culture of continuously transitioning knowledge and IT between researchers and operational communities. This is very different from the usual academic model of licensing technology to a third party, or creating a start-up. A continuous process of reviewing user requirements, knowledge generation, collaboration, validation, acceptance, implementation, and incorporation of new user needs must be encouraged. Field research—working on large problems outside the labs—appears to be particularly valuable to making progress on using IT for disaster management. It pushes researchers in new directions. It also stresses the technology under the extreme conditions inherent in disaster situations, exposing issues unlikely to be discovered in a laboratory setting. Practitioners’ participation in such research gives them an opportunity to see the potential for new information technologies. It also gives them a chance to influence its direction. The goal is to close the gap between researchers and practitioners and create a unified core community that can speed up the process of delivering research results of immediate relevance to disaster management. Panelists at the workshop held by the committee cited the Disaster Management Interoperability Services (DMIS) Program and the Biological Warning and Incidents Characterization (BWIC) projects as successful examples of programs carrying out field research that involved the public safety community. Finally, as the use of advanced sensors, communication technology, and similar IT increases, it becomes ever easier to collect data about the process of dealing with a disaster in a completely unobtrusive manner. Such data ought to form a basis for studies that will ultimately lead to improving the disaster management process, and it should be used to help evaluate new proposed technologies and methodologies. Centers should serve as repositories for these data. Several research centers devoted to certain aspects of disaster management already exist. Some wellknown centers are the Natural Hazards Center at the University of Colorado at Boulder; the Disaster Research Center at the University of Delaware, which investigates the social science aspects of disasters; the Hazard Reduction and Recovery Center at Texas A&M University; and Dartmouth College’s Institute for

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Security Technology Studies.16 Such centers could provide the basis for a network of research centers where IT researchers, hazard and disaster researchers, and disaster management practitioners can collaborate to study and evaluate the use of IT for disaster management from both a technological and an organizational perspective; transition knowledge and technology to those who practice disaster management; build human capital at the intersection of IT and disaster management; and develop future IT capabilities. Elements of a Research Agenda: The six key information technology (IT)-enabled capabilities represent broad areas where there is significant potential for the application of IT to enhance disaster management. These IT-enabled capabilities are used here to provide a framework for organizing research and development needs and opportunities described in this section as part of a research and development agenda. This chapter is intended to provide an initial sketch of the kinds of items that would ultimately appear in an IT roadmap for disaster management. The committee sought in particular to identify technologies under investigation that may hold largely unrecognized promise for advancing disaster management, though more apparently promising technologies are described as well. Developers of a roadmap could use this survey as a starting point for developing a fully articulated plan, including a detailed set of research directions to be pursued. In developing this initial sketch of a research agenda for use in an IT roadmap, the committee made some assumptions about the continuation of a number of technology trends occurring independently of the needs of disaster management. The agenda is not aimed at influencing the direction of these trends, which the committee believes will continue regardless of the research agenda identified here. However, an IT roadmap would have to assume the continuation of current trends as a necessary foundation for the development and commercialization of major aspects of the disaster management research agenda and should incorporate them as base technology trends. Roadmap developers may need to account for deviations from those trends should they occur.

Bibliography

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Bibliography Alire, C. : Library Disaster Planning and Recovery Handbook, NealSchuman Publishers, Inc., New York, 2000. Ben Wisner : At Risk, Natural Hazards, People’s Vulnerability, and Disasters, London, Routledge, 1994. Bhatt, Mihir : Gender and Disaster, Perspectives on Women as Victims of Disasters, Gulbai Tekra, Ahmedabad, India, 1995. Brian Lesser : Disaster Preparedness and Recovery: Photographic Materials, American Archivist, Winter, 1983. Brooks, Constance : Disaster Preparedness, Washington, DC, Association for Research Libraries, 1993. Cronon, William :Uncommon Ground: Toward Reinventing Nature, New York, WW Norton and Co., 1995. Davis, Mike : Ecology of Fear, New York, Metropolitan Books, 1998. Drewes, Jeanne : Computers: Planning for Disaster, Law Library Journal, Winter, 1989. Dufka, Corrine : The Mexico City Earthquake Disaster, Social Casework: The Journal of Contemporary Social Work, 1988. Fox, Lisa L. : Management Strategies for Disaster Preparedness, Chicago, American Library Association, 1989. Grazulis, Tom P. : Significant Tornadoes 1680-1991, St. Johns Bay, Environmental Films, 1993. Greene, Mott : Natural Knowledge in Preclassical Antiquity, Baltimore, Johns Hopkins University Press, 1992. Hadfield, Peter : Sixty Seconds that Will Change the World: The Coming Tokyo Earthquake, Boston, C.E. Tutle, Co., 1992. Harris, Stephen L. : Fire and Ice: The Cascade Volcanoes, Seattle, The Mountaineers, 1980.

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Jane A. Bullock : Introduction to Emergency Management, Amsterdam, Butterworth-Heinemann, 2003. Jilovsky, C. : Disasters in Libraries, Prevention and Control, Cooperative Action by Victorian Academic Libraries Ltd, Melbourne, 1994. John D. : The Last Great Subsistence Crisis in the Western World, Baltimore, Johns Hopkins University Press, 1977. Jones S. : Building an Emergency Plan: A Guide for Museums and other Cultural Institutions, Getty Conservation Institute, Los Angeles, 1999 Jordan, William : The Great Famine, Princeton, Princeton University Press, 1996. Julia Niebuhr : Handbook for the Recovery of Water Damaged Business Records, Prairie Village, KS, Association of Records Managers and Administrators, 1986. Kahn, Miriam B. : Disaster Response and Planning for Libraries, Chicago, American Library Association, 1998. Keyes K.E. : Emergency Management for Records and Information Programs, ARMA International, Kansas, 1997. Laskin, David : Braving the Elements: The Stormy History of American Weather, New York, Doubleday, 1996. Ling, Ted. : Solid, Safe, Secure: Building Archives Repositories in Australia, National Archives of Australia, Canberra, 1998. Lundquist, Eric G. : Salvage of Water Damaged Books, Documents, Micrographic and Magnetic Media, San Francisco, Document Reprocessors, 1986. McPhee, John : The Control of Nature, New York, Farrar, Straus, Giroux, 1989. Norris, Debra Hess : Disaster Recovery: Salvaging Photograph Collections, Philadelphia, PA, 1998. Odum, Howard T. : Environment, Power and Society, New York, Wiley-Interscience, 1971. Peter Woodrow : Rising From the Ashes, Developing Strategies in Times of Disaster, Boulder, Colorado, Westview Press, 1989. Quarantelli, E.L. : What is a Disaster—Perspectives on the Question, New York, Routledge, 1998.

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Robert A. : Insurance for Libraries: Part I and Insurance for Libraries: Part II, Conservation Administration News, 1994. Saffady, William : Managing Vital Electronic Records, ARMA International, Kansas, 1992. Stephen J. : Fire in America: A Cultural History of Wildland Fire and Rural Fire, New Jersey, Princeton University Press, 1982. Stephen Reyna : The Political Economy of African Famine, Philadelphia, Gordon and Breach Science Publishers, 1991 Stommel, Elizabeth : Volcano Weather: The Story of 1816, The Year Without a Summer, Newport, Seven Seas Press, 1983. Thomas A. : Integrated Pest Management for Libraries, IFLA Publications 40/41, Munich, K. G. Saur Verlag, 1987. Varley, Anne : Disaster, Development Environments, New York, J. Wiley, 1994. Walker, Bridget : Women and Emergencies, Oxford, Oxfam, l994. Waters, Peter : Procedures for Salvage of Water-Damaged Library Materials, Washington, DC, Library of Congress, 1979. Watson, Lyall : Earthwork: Essays on the Edge of Natural History, London, Hodder and Stoughton, 1956. Webster, Noah : A Brief History of Epidemic and Pestilential Diseases, with the Principle Phenomena of the Physical World which Proceed and Accompany Them, Hartford, Hudson and Goodwin, 1799. Worster, Donald : Dust Bowl: The Southern Plains in the 1930s, New York, Oxford University Press, 1979. Zenaida, D. : Women and Children During Disaster: Vulnerabilities and Capacities, Elaine Enarson and Betty Hearn Morrow, 1995.

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Index A Absorption, 35, 48, 136. Agricultural Disaster Management System, 57. Anthrax, 2, 3, 4, 6, 7, 8, 9, 10, 233, 235, 236, 237.

B Biological Warfare, 1, 2, 4, 5, 6, 10, 11, 14, 17, 18, 19, 26, 28, 29, 45, 55, 60, 241, 244, 246. Bioterrorism, 1, 3, 9. Biowarfare, 3. Botulinum Toxin, 2, 3, 6, 27, 28. Brucellosis, 16, 17.

C Chemical Hazard, 43, 44. Chemical Terrorism, 41. Chemical Warfare, 31, 32, 35. Cholera, 2, 13, 14, 83, 98. Clinical Manifestation, 194. Community, 73, 91, 98, 100, 101, 105, 114, 117, 118, 119, 120, 124, 125, 126, 127, 128, 129, 130, 131, 132, 134, 136, 142, 147, 152, 153, 156, 175, 176, 177, 180, 182, 198, 206, 210, 211, 212, 213, 214, 215,

216, 217, 218, 224, 225, 229, 230, 241, 244, 248, 262, 271, 276, 278, 288, 291, 294, 297, 300, 304, 310, 311, 313. Conditions, 18, 35, 95, 127, 133, 135, 138, 146, 204, 206, 207, 209, 217, 237, 245, 256, 257, 270, 283, 313. Convention, 155, 184, 185, 186. Culture, 8, 9, 112, 134, 180, 254, 270, 284, 302, 305, 311, 313.

D Dengue, 24, 25, 86, 87, 191, 192, 193, 194, 195, 196, 197, 198, 199, 202, 203, 204, 206, 209, 210, 212, 213, 214, 215, 216, 217, 218, 219, 220, 221, 222, 223, 224, 225, 226, 227. Development, 12, 21, 31, 33, 62, 64, 68, 71, 72, 73, 76, 77, 78, 79, 80, 82, 85, 87, 88, 91, 92, 93, 95, 96, 98, 99, 100, 101, 102, 104, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 135, 136, 137, 138, 142, 145, 146, 147, 148, 149, 151, 153, 154, 155, 156, 157, 158, 160,

Index

319

161, 162, 163, 164, 165, 166, 167, 168, 172, 173, 177, 179, 181, 182, 183, 192, 206, 210, 211, 212, 215, 216, 217, 231, 242, 243, 244, 247, 248, 249, 250, 251, 252, 253, 254, 255, 257, 260, 273, 281, 283, 288, 289, 291, 292, 293, 294, 295, 296, 297, 299, 300, 301, 302, 303, 304, 305, 306, 308, 309, 310, 311, 312, 314. Disaster Management, 57, 59, 60, 66, 73, 138, 139, 140, 141, 142, 144, 146, 176, 178, 179, 184, 229, 230, 231, 233, 237, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253, 254, 255, 256, 257, 259, 261, 262, 263, 264, 265, 266, 267, 269, 270, 273, 274, 275, 276, 277, 278, 280, 281, 282, 283, 284, 285, 286, 288, 291, 292, 293, 294, 295, 296, 298, 299, 301, 302, 303, 304, 305, 306, 307, 308, 309, 310, 312, 313, 314. Disaster Planning, 228, 230, 265. Disaster Risk Management, 71, 73, 74, 138, 139, 142, 143.

E Evaluation, 73, 113, 172, 173, 174, 204, 294, 299. Evidence, 29, 53, 179, 194, 197, 219, 230,

162, 171, 212, 250, 186, 193, 262, 281.

F Family Planning, 84, 86, 95, 96, 97, 98, 158. Flood Management, 181.

G Genital Warts, 51, 52, 53, 55, 56. Government, 3, 4, 47, 62, 77, 80, 82, 84, 85, 89, 95, 97, 99, 102, 103, 108, 110, 111, 115, 118, 122, 123, 124, 125, 126, 128, 130, 131, 132, 133, 135, 140, 141, 142, 143, 148, 149, 150, 151, 152, 155, 159, 160, 161, 162, 164, 165, 167, 171, 183, 186, 198, 206, 210, 213, 231, 239, 240, 241, 244, 247, 248, 254, 265, 271, 285, 288, 289, 292, 300, 309, 312. Guideline, 229.

54, 69, 91, 105, 121, 127, 134, 144, 153, 163, 184, 214, 246, 277, 304,

H Health Systems, 87, 89.

L Labor Welfare, 131, 136. Literature, 1, 185, 306.

M Management, 34, 43, 57, 59, 60, 61, 66, 71, 73, 74, 77, 83, 86, 87, 109, 121, 135, 139, 145, 146, 149, 150, 151, 152, 153, 154, 155, 156, 158, 159, 160, 164, 166, 173, 176, 180, 186, 191, 194, 195, 197, 208, 209, 211, 224, 238, 239, 251, 252, 253, 255, 256, 257, 258, 259, 260, 261, 262, 263, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273, 274, 275, 276,

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277, 279, 280, 281, 282, 283, 284, 285, 286, 287, 289, 290, 293, 294, 295, 296, 297, 298, 300, 301, 302, 303, 304, 305, 306, 307, 309, 310, 311, 312, 313, 314. Medical Management, 34, 237. Monkeypox, 21, 22. Mycotoxins, 29, 30, 31.

N Nutrition, 73, 82, 84, 91, 92, 93, 94, 95, 101, 102, 129, 153, 157, 158.

O Observation, 193, 268, 311.

P Pathophysiology, 234, 238. Plan Development, 247, 309. Plan Implementation, 73, 74, 159, 161, 162, 173. Powers, 77. Protection, 6, 14, 23, 24, 43, 52, 77, 129, 131, 132, 133, 134, 135, 136, 143, 146, 147, 148, 150, 152, 154, 156, 181, 193, 194, 202, 212, 219, 227, 235, 237, 257, 260, 265, 285, 305.

Q Q fever, 6, 18, 19.

R Research, 2, 3, 25, 28, 57, 59, 108, 109, 110, 111, 178, 179, 183, 204, 211, 214, 240, 242,

243, 244, 246, 251, 252, 253, 254, 255, 256, 261, 262, 265, 269, 273, 280, 281, 283, 284, 285, 286, 288, 289, 290, 291, 294, 297, 298, 300, 304, 305, 306, 308, 309, 310, 311, 312, 313, 314. Ricin, 4, 6, 27, 28, 45, 46, 47, 48, 49, 50, 51. Risk Management, 71, 73, 74, 139, 142, 143, 286.

S Scholars, 109, 136. Smallpox, 2, 6, 19, 20, 21, 22. Social Welfare, 119, 127, 129, 130, 167.

T Technology, 73, 78, 109, 111, 112, 114, 135, 203, 240, 241, 244, 246, 247, 248, 252, 253, 254, 255, 265, 266, 269, 270, 273, 274, 275, 277, 281, 283, 284, 285, 288, 290, 291, 292, 295, 296, 297, 298, 301, 302, 303, 304, 308, 309, 310, 311, 314. Terrorism, 4, 41, 161, Traditions, 82. Tularemia, 6, 14, 15,

88, 118, 242, 249, 262, 271, 279, 286, 293, 299, 306, 312,

108, 124, 243, 250, 263, 272, 280, 287, 294, 300, 307, 313,

260, 269. 16.

V Viral Encephalitides, 22. Viral Hemorrhagic Fevers, 24, 25. 