7200AA23R00053 Attachment 1_WHO IEHK 2017.pdf

HEALTH

programme

EMERGENCIES

THE INTERAGENCY

EMERGENCY HEALTH KIT

Medicines and medical devices for 10 000 people for approximately three months

2 INTERAGENCY EMERGENCY HEALTH KIT 2017

The interagency health kit 2017: medicines and medical devices for 10 000 people for approximately three months

ISBN 978-92-4-151522-1

World Health Organization 2019

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3INTERAGENCY EMERGENCY HEALTH KIT 2017

THE INTERAGENCY

EMERGENCY HEALTH KIT 2017

Medicines and medical devices for 10 000 people for approximately three months

World Health Organization International Committee of the Red Cross International Federation of the Red Cross and Red Crescent Societies Médecins Sans Frontières United Nations Children’s Fund United Nations High Commissioner for Refugees United Nations Population Fund

4 INTERAGENCY EMERGENCY HEALTH KIT 2017

Abbreviations and acronyms COPD chronic obstructive pulmonary disease EML Essential Medicines List EPI Expanded Programme on Immunization IATA International Air Transport Association IEHK Interagency Emergency Health Kit ICRC International Committee of the Red Cross IFRC International Federation of Red Cross and Red Crescent Societies INCB International Narcotics Control Board MSF Médecins Sans Frontières NCD noncommunicable disease ORS oral rehydration salts PEP post-exposure prophylaxis SAM Severe acute malnutrition SARS Severe acute respiratory syndrome TST Time, steam, temperature UN United Nations UNFPA United Nations Population Fund UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children’s Fund WHO World Health Organization

5INTERAGENCY EMERGENCY HEALTH KIT 2017

Contents Abbreviations and acronyms 4 Acknowledgements 6

Chapter 1: Introduction 7 History of the IEHK 7 Principles behind the Interagency Emergency Health Kit 2017 7 Selection of medicines 7 Key points about the kit 8 Major changes since the IEHK -2011 8

Chapter 2: Contents of the IEHK 2017 10 Overview of the IEHK 2017 10 Contents 10 Basic module (for 1 000 people for three months) 11 Supplementary module (for 10 000 people for three months) 13

Chapter 3: Ordering the IEHK 2017 23 Obtaining the IEHK 2017 23 Before ordering the IEHK 2017 23 Cost of the IEHK 2017 23 Packaging 24 Packaging and shipping of cold chain items 24 Additional supplies to be considered to complement the IEHK for management of NCDs 25 Quality Assurance 25 Feedback 25

Annex 1: Resources 27 Annex 2: Complementary kits for use in emergencies 29 Annex 3: Sample health card 30 Annex 4: Sample daily medicine consumption form 31 Annex 5: Sample stock card 32 Annex 6: Management of controlled substances in emergencies 33

Model regulatory aspects of exportation and importation of controlled substances 33 Introduction 33 Standard procedure for international transfer of narcotic and psychotropic substances 33 Procedure to be followed in disaster relief 34 Outline of standard agreement between the supplier and control authorities of exporting countries 35 Shipment request/ notification form for emergency supplies of controlled substances 37

Annex 7: Information slips 39

6 INTERAGENCY EMERGENCY HEALTH KIT 2017

Acknowledgements The following individuals and organizations contributed to the development of this revision and their advice and support are gratefully acknowledged.

Groningen University: Hans Hogerzeil

International Committee of the Red Cross (ICRC): Stephanie Arsac-Janvier

International Federation of Red Cross and Red Crescent Societies (IFRC): Selma Bernardi

Médecins du Monde: Gerardo Muñoz

Médecins Sans Frontières (MSF): Tamma Aloudat, Myriam Henkens

Save the Children: Elizabeth Berryman

United Nations Population Fund (UNFPA):

Johnny Abas, Wilma Doedens, Giovanni Masiello, Roberto Mena

United Nations Childrenʹs Fund (UNICEF):

Brenda Kaaya-Hallen, Natasa Moracevic, David Muhia, Henrik Nielsen, Atieno Ojoo

United Nations High Commissioner for Refugees (UNHCR):

Ann Burton, Heiko Hering, Javier Utande

World Health Organization (WHO) Evidence, Research, Action on Mental & Brain Disorders:

Tarun Dua, Mark Van Ommeren

WHO Management of Noncommunicable Diseases:

Gojka Roglic, Marcello Tonelli

WHO Essential Medicines and Health Products:

Francisco Blanco, Bernadette Cappello, Gilles Forte, Lisa Hedman, Anita Sands, Adriana Velazquez

WHO Corporate Procurement Policy and Coordination:

Sophie Laroche

WHO World Health Emergencies:

Olexander Babanin, Rudi Coninx, Hyo-Jeong Kim, Alejandra Velez

7INTERAGENCY EMERGENCY HEALTH KIT 2017

CHAPTER 1: INTRODUCTION

History of the Interagency Emergency Health Kit The Interagency Emergency Health Kit (IEHK) was first developed in 1990. Since its inception it has been revised several times to better fit the changing needs of various emergency situations and the health profiles of affected populations.

The last revision was conducted in 2011 and incorporated content to better address mental health and special needs of children. The malaria and post-exposure prophylaxis modules were further reviewed in 2015. The revision of the IEHK 2017 has followed the same process as was used in 2011, involving several expert consulta-tions with representatives from different partner agencies. The World Health Organization (WHO) acts as the Secretariat for coordination of updates of the kit. The IEHK has been widely accepted and used to respond to various emergencies. It is one of the most popular emergency health kits available and has been benchmarked for the development of other health kits.

Principles behind the Interagency Emergency Health Kit 2017 The IEHK 2017 is designed principally to meet the priority health needs of a population affected by emergencies, who have limited access to routine health care services. The kit is designed primarily for “life-saving” purposes, not for health conditions requiring continued care. Given its use in emergency situations, the IEHK fills immediate medical gaps; it does not aim to replace existing medical supply chain mechanisms.

The kit contains essential drugs, supplies and equipment to be used for a limited period of time and target a defined number of people. Some of the medicines and medical devices contained in the kit may not be appropriate for all cultures and countries, or every kind of emergency. This is inevitable as it is a standardized emergency kit, designed for worldwide use, which is pre-packed and kept ready for immediate dispatch.

The kit and its modules are not intended as re-supply kits and, if used as such, may result in the accumulation of items and medicines which are not needed.

It must be emphasized that, although supplying medicines and medical devices in standard pre-packed kits is convenient early in an emer-gency, specific local needs must be assessed as soon as possible and further supplies must be ordered accordingly. Therefore, once basic health care services have been established, the health care coordinator should assess primary health care needs and re-order medicines, renewable medical devices and medical equipment based on consumption of these items. All efforts should be made to strengthen or develop a medical supplies logistics management information system that can enable appropriate quantification and stock management as soon as the emergency situation stabilizes.

Selection of medicines The selection of medicines in the kit is based on the global burden of disease, expert knowledge on the types of health conditions presented by the affected population in recent emergencies and recommendations of the WHO Expert Committee on Selection and Use of Essential Medicines. The IEHK includes relevant clinical guidelines and information to support appro-priate use (a full list of documents included is described in Annex 1).

8 INTERAGENCY EMERGENCY HEALTH KIT 2017

Key points about the kit

• The full IEHK contains medicines and medical devices for 10 000 people for approximately three months.

• The IEHK is designed for use in the early phase of an emergency situation.

• The IEHK is designed to be self-sufficient and is made up of a basic module for use by health care workers with limited training and a supplementary module for use by physicians or senior health care workers.

• The supplementary module should only be used together with at least one basic module.

• The IEHK is updated on a regular basis using the most up-to-date information available.

• The IEHK is not designed to cover needs for:

◦ immunization and nutrition

◦ reproductive health services

◦ HIV/AIDS, tuberculosis and leprosy diagnosis and treatment

◦ chronic management of noncommunicable diseases

◦ major surgery.

Information on other kits available to complement the IEHK is included in Annex 2.

Major changes since the IEHK 20111

1 A full report that contains all the changes from the 2011 version can be found on the WHO website: http://www.who.int/medicines/ publications/emergencyhealthkit2011/en/ 2 Ibuprofen is not indicated in children aged less than three months

BASIC MODULE

• Removal of magnesium trisilicate and replacement with omeprazole in line with Essential Medicines List (EML) recommendations.

• Lower strength of ibuprofen from 400 mg to 200 mg to cater to children’s needs2.

SUPPLEMENTARY MODULE

Cardiovascular diseases

• Inclusion of medicines for treatment of acute severe hypertension, acute coronary syndrome, acute stroke and acute heart failure (acetylsalicylic acid, amlodipine, enalapril, glyceryl trinitrate, furosemide and heparin sodium).

• Increase in the quantity of hydrochlo-rothiazide to allow for treatment of acute severe hypertension.

• Replacement of atenolol by bisoprolol (based on EML update).

Diabetes

• Inclusion of human insulin (and insulin syringes) for stabilization of acute life-threatening hyperglycaemia or diabetic ketoacidosis.

• Inclusion of glucometer and urine test strips for ketones, glucose and albumin.

9INTERAGENCY EMERGENCY HEALTH KIT 2017

Pulmonary diseases

• Inclusion of beclomethasone and increase in the amount of salbutamol inhalers for treatment of acute asthma and acute chronic obstructive pulmonary disease (COPD) exacerbation.

• Increase in the quantity of prednisolone 5 mg tablets to cover treatment of COPD and asthma.

• Inclusion of pulse oximeter for monitoring acute respiratory distress.

Other changes

• Inclusion of morphine tablets

(immediate release) 10 mg.

• Replacement of phenobarbital with carbamazepine 200 mg scored tablet for easier importation. Phenobarbital remains a secondary option in case carbamazepine is not available, or if the country allows for phenobarbital importation.

• Revision of anti-infective medicines (replacement of cloxacillin by cefalexin to adapt to new recommendations;

miconazole muco-adhesive tablets by nystatin suspension; and removal of procaine benzylpenicillin – the latter two due to unavailability of quality-assured products).

• Removal of promethazine (no longer on EML).

• Replacement of amitriptyline by fluoxetine following EML.

• Increase in the amount of glucose for treatment of acute severe hypoglycaemia.

• Introduction of new types of sutures to cover skin and face.

• Inclusion of guidelines on mental Health31and non/communicable diseases4.2

3 mhGAP humanitarian intervention guide (mhGAP-HIG).

Clinical management of mental, neurological and substance use conditions in humanitarian emergencies.

Geneva: WHO/UNHCR; 2015 4 Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization; 2010

Items for treatment of malaria and post-exposure prophylaxis (PEP) were changed during an interim update in 2015 and these changes are incorporated in the IEHK 2017. The main changes from the IEHK 2011 are the following.

Malaria

• Removal of quinine tablets 300 mg from the basic malaria unit.

• Removal of artemether injection and quinine injection from the supplemen-tary malaria unit and replacement with artesunate injection 60 mg.

• Addition of injection devices and guidelines for management of severe malaria and reconstitution of artesunate injection.

Post-exposure prophylaxis

• Replacement of antiretroviral medicines to align content with updated treatment guidelines.

• Introduction of lamivudine + tenofovir tablets 300 + 300 mg and atazanavir + ritonavir tablets 300 + 100 mg for adults and adolescents. Introduction of lamivudine + zidovudine dispersible tablets 30 + 60 mg, lopinavir + ritonavir tablets 200 + 50 mg and lopinavir + ritonavir tablets 100 + 25 mg for children.

10 INTERAGENCY EMERGENCY HEALTH KIT 2017

CHAPTER 2: CONTENTS OF THE IEHK 2017

Overview of the IEHK 2017

Contents The IEHK comprises two modules, basic and supplementary.

The basic module is to cover the primary health care needs of a catchment population of 1000 people. It contains oral and topical medi-cines, medical devices and a malaria unit with oral antimalarial medicines and rapid diagnostic tests. The basic malaria unit can be removed on request. One full IEHK contains 10 basic modules.

The supplementary module is to cover the primary health care needs and basic hospital care needs of a target population of 10 000 people, when used together with 10 basic modules (total 10 basic modules and 1 supplementary module).

It contains medicines and medical devices as well as a malaria unit for treatment of severe malaria and a PEP unit. The supplementary malaria unit and the PEP unit are included unless there is a specific request not to include them.

Some of the items in the supplementary module might be withdrawn by implementing agencies according to their own protocols and comple-mentarity with other kits.

11INTERAGENCY EMERGENCY HEALTH KIT 2017

Basic module (for 1000 people for three months)

Item description Unit Quantity Medicines Albendazole, chewable tablets 400 mg tablet 200 Amoxicillin, dispersible tablets 250 mg tablet 3000 Benzyl benzoate, lotion 25% bottle, 1 litre 1 Chlorhexidine digluconate, solution 5% bottle, 1 litre 1 Ferrous sulfate + folic acid, tablets 200 mg + 0.4 mg tablet 2000 Ibuprofen, tablets 200 mg tablet 4000 Miconazole, cream 2% tube 30 g 20 Omeprazole, solid oral dosage form 20 mg tablet/capsule 100 ORS (oral rehydration salts) powder for dilution sachet for 1 L 200 Paracetamol, dispersible tablets 100 mg tablet 1000 Paracetamol, tablets, 500 mg tablet 2000 Povidone iodine, solution 10% bottle, 200 ml 12 Tetracycline, eye ointment 1% tube 5 g 50 Zinc sulfate, dispersible tablets 20 mg tablet 1000

Medical devices, renewable Bandage, elastic, 7.5 cm x 5 m, roll unit 20 Bandage, gauze, 8 cm x 4 m, roll unit 200 Compress, gauze, 10 x 10 cm, non-sterile unit 500 Cotton wool, 500 g, roll, non-sterile unit 2 Gloves, examination, latex, medium, single use unit 100 Soap, toilet, bar, approximately 110 g, wrapped unit 10 Tape, adhesive, zinc oxide, 2.5 cm x 5 m unit 30

Stationary Book, exercise, A4 size, 100 pages, hard cover unit 4 Envelope, plastic, 10 cm x 15 cm unit 2000 Health card unit 500 Pad, note, plain, A6 size, 100 sheets unit 10 Pen, ball-point, blue unit 10 Plastic bag, for health card, 11 cm x 25 cm, snap-lock fastening unit 500

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12 INTERAGENCY EMERGENCY HEALTH KIT 2017

Basic module (for 1000 people for three months) ... continued

Item description Unit Quantity Guidelines for IEHK 2017 users Flash drive with full set of guidance documents51 unit 1 Content list of the complete kit IEHK 2017 unit 1

Medical devices, equipment Basin, kidney, stainless steel, 825 ml unit 1 Bottle, plastic, 1 L, wash bottle unit 3 Bottle, plastic, 250 ml, with screw cap unit 1 Bowl, stainless steel, 180 ml unit 1 Brush, hand, scrubbing, plastic unit 2 Drum, sterilizing, approximately 150 mm x 150 mm unit 2 Pail, with water scoop, handle, polyethylene, 10 L or 15 L unit 2 Scissors, Deaver, 140 mm, straight, sharp/blunt unit 2 Surgical instruments, dressing set62 unit 2 Thermometer, clinical, digital, 32–43 Celsius unit 5 Tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1 Water container, PVC/PE, collapsible, 10 L or 15 L unit 1

Malaria unit in the basic module (can be with held from the order upon request)

Item description Unit Quantity Artemether + Lumefantrine, dispersible tablets 20 mg + 120 mg, 6 tablets, blister Box, 30 blisters 5

Artemether + Lumefantrine, dispersible tablets 20 mg + 120 mg, 12 tablets, blister Box, 30 blisters 1

Artemether + Lumefantrine, tablets 20 mg +120 mg, 18 tablets, blister Box, 30 blisters 1

Artemether + Lumefantrine, tablets 20 mg +120 mg, 24 tablets, blister Box, 30 blisters 6

Malaria rapid diagnostic tests7,3with lancets and buffer unit 800 Safety box, for used lancets 5 L84 unit 2 Biohazard bag, 2-5L unit 10

51The full list of documents is described in Annex 1. The flash drive should be placed in a plastic pouch attached to the inner side of box number 1 6 Dressing set:

• 1 forceps, artery, Kocher, 140 mm, straight

• 1 forceps, dressing, standard, 155 mm, straight

• 1 scissors, Deaver, 140 mm, straight, sharp/blunt

• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover

7 For selection follow latest WHO guidance (http://www.who.int/malaria/areas/diagnosis/en/).

Kit should be prequalified by WHO and include test devices, assay buffer, sample cups, alcohol swabs and blood lancets 8 Other sharps containers can be considered

13INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module (for 1000 people for three months)

Item description Unit Quantity Medicines

Anaesthetics Ketamine, injection 50 mg/ml 10 ml/vial 25 Lidocaine, injection 1% 20 ml/vial 50

Analgesic91 Morphine, injection 10 mg/ml [controlled substance] 1 ml/ampoule 50 Morphine, tablet 10 mg (immediate release) [controlled substance] tablet 200

Already in basic module Ibuprofen, tablets 200 mg (10 x 4000) 40000 Paracetamol, dispersible tablets 100 mg102 (10 x 1000) 10000 Paracetamol, tablets, 500 mg (10 x 2000) 20000

Antiallergics Hydrocortisone, powder for injection 100 mg (as sodium succinate) vial 50

Prednisolone, tablet 5 mg tablet 1000

Anticonvulsants/antiepileptics Carbamazepine, tablets (scored) 200 mg113 tablet 2200 Diazepam, injection 5 mg/ml [controlled substance] 2 ml/ampoule 200 Magnesium sulfate, injection 500 mg/ml 10 ml/ampoule 30

Antidotes Calcium gluconate, injection 100 mg/ml 10 ml/ampoule 10 Naloxone, injection 0.4 mg/ml 1 ml/ampoule 10

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9 Analgesics included in the supplementary module are classified as controlled substances and their importation might be subject to special controls by the authorities. Guidance on management of importation of these substances in the context of emergencies is included in Annex 6 10 Dispersible tablets are preferred for children, if available from supplier and quality assured. If not available, it is possible to procure non-dispersible tablets 11 Phenobarbital tablets 50 mg is an alternative if carbamazepine is not available or if inclusion does not impact importation

14 INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module (for 1000 people for three months) ...continued Item description Unit Quantity Medicines

Anti-infective medicines Benzathine benzylpenicillin, powder for injection

2.4 million IU (1.44 g)/vial vial 50

Benzylpenicillin, powder for injection 5 million IU (3 g)/vial vial 250 Cefalexin, solid oral dosage form 250 mg tablet/capsule 2000 Ceftriaxone, powder for injection 1 g vial 800 Clotrimazole, pessary 500 mg pessary 100 Doxycycline, tablets 100 mg tablet 3000 Metronidazole, tablets 500 mg tablet 2000 Nystatin, oral liquid 100 000 IU/ml12 bottle, 30 ml 50

Already in basic module Albendazole, chewable tablets 400 mg (10 x 200) 2000 Amoxicillin, dispersible tablets 250 mg (10 x 3000) 30000

Cardiovascular medicines Acetylsalicylic acid, tablets 75–100 mg132 tablet 1500 Amlodipine, tablets 5 mg143 tablet 500 Bisoprolol, tablets 5 mg154 tablet 2000 Enalapril, tablets 5 mg165 tablet 5000 Glyceryl trinitrate, tablets 500 mcg176(sublingual) tablet 500 Hydralazine, powder for injection 20 mg ampoule 20 Methyldopa, tablets 250 mg tablet 100

Dermatological medicines Silver sulfadiazine, cream 1% tube, 50 g 30

Already in basic module Benzyl benzoate, lotion 25%187 (10 x 1 L) 10 Miconazole, cream 2% 30 g (10 x 20) 200 Povidone iodine, solution 10% 200 ml (10 x 12) 120 Tetracycline, eye ointment 1% 5 g (10 x 50) 500

12 1 bottle for 1 treatment of 7 days, adults and children 13 For acute coronary syndrome and acute stroke. Tablets in strength 75–100 mg are suitable 14 For acute severe hypertension. Can also be used for pregnancy-induced hypertension if required 15 Replaces atenolol tablets. Quantity increased due to inclusion of treatment for acute heart failure 16 For treatment of acute severe hypertension and acute heart failure 17 For treatment of acute coronary syndrome and acute heart failure. Small pack size preferred.

18 Can be procured in smaller sizes for single patient use

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15INTERAGENCY EMERGENCY HEALTH KIT 2017

Item description Unit Quantity Medicines

Disinfectants and antiseptics Sodium dichloroisocyanurate (NaDCC), tablet 1.67 g tablet 1200

Already in basic module Chlorhexidine digluconate, solution 5% (10 x 1 L) 10

Diuretics Furosemide, injection 10 mg/ml 2 ml/ampoule 20 Furosemide, tablets 40 mg19 tablet 50020 Hydrochlorothiazide, tablets 25 mg tablet 500

Gastrointestinal medicines Atropine, injection 1mg/ml 1 ml/ampoule 50

Already in basic module Omeprazole, solid oral dosage form 20 mg (10 x 100) 1000

Hormones, other endocrine medicines and contraceptives Intermediate-acting insulin, injection213100 IU/ml [cold chain] 10 ml/vial 20 Soluble insulin, injection 100 IU/ml [cold chain] 10 ml/vial 20

Medicines affecting the blood Folic acid, tablets 5 mg tablet 1000 Heparin sodium, injection 5 000 IU/ml224 vial 5 ml 25

Already in basic module Ferrous sulfate + folic acid, tablets 200 mg + 0.4 mg (10 x 2000) 20000

Oxytocics Misoprostol, tablets 200 mcg tablet 60 Oxytocin, injection 10 IU/ml [cold chain] ampoule 200

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19 Oral dose introduced for treatment of acute heart failure 20 Quantity increased, for treatment of acute severe hypertension 21 For stabilization of acute life-threatening hyperglycaemia or diabetic ketoacidosis 22 For treatment of acute coronary syndrome; no cold chain required

16 INTERAGENCY EMERGENCY HEALTH KIT 2017

Item description Unit Quantity Medicines

Mental health medicines Biperiden, tablets 2 mg tablet 400 Diazepam, tablets 5 mg [controlled substance] tablet 240 Fluoxetine, tablets 20 mg231 tablet 5000 Haloperidol, injection 5 mg/ml 1 ml/ampoule 20 Haloperidol, tablets 5 mg tablet 1300

Medicines acting on the respiratory tract Beclomethasone, inhaler 100 mcg/dose24 unit 75 Epinephrine (adrenaline), injection 1 mg/ml 1 ml/ampoule 50 Salbutamol, inhaler 100 mcg/dose unit 75253

Medicines used in diarrhoea Already in basic module ORS (oral rehydration salts) powder for dilution (10 x 200) 2000 Zinc sulfate, dispersible tablets 20 mg (10 x 1000) 10000

Solutions correcting water, electrolytes and acid-based disturbances Compound solution of sodium lactate (Ringer’s lactate), injectable solution, with giving set and needle

500 ml bag 200

Glucose 5%, injectable solution, with giving set and needle264 500 ml bag 100 Glucose 50%, injectable solution (hypertonic) 50 ml/vial 100275 Water for injection 10 ml/plastic vial 2000

Vitamins Ascorbic acid, tablets 250 mg tablet 4000 Retinol (vitamin A), capsules 200 000 IU capsule 4000

23 To treat 54 patients for 60 days 24 For immediate follow-up treatment for acute asthma and acute COPD exacerbation 25 Amount increased from 50, to treat acute asthma and acute COPD exacerbation 26 Glucose 5% solution is kept for management of NCDs 27 Increased from 50 to 100 for treatment of acute severe hypoglycaemia

17INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module - Malaria unit (can be withheld from the order upon request) Item description Unit Quantity Malaria Artesunate injection 60 mg

Each box contains the following:

• One vial of artesunate (as anhydrous artesunic acid), pow-der for injection, 60 mg

• One ampoule of 5% sodium bicarbonate.

• One ampoule of 0.9% sodium chloride injection vial 500

Syringe, 5 ml with needle 18G or 21G, sterile, single use unit 1200 Syringe, 5 ml, sterile, single use unit 500 Needle, 21G (0.8 x 40 mm), sterile, single use unit 500 Needle, 23G (0.6 x 25 mm), sterile, single use unit 500 Needle, 25G (0.5 x 16 mm), sterile, single use unit 500 Guidelines for administration of injectable artesunate

– poster A3 (English) unit 2

Guidelines for administration of injectable artesunate

– poster A3 (French) unit 2

Guidelines for administration of injectable artesunate

– poster A3 (Portuguese) unit 2

Management of severe malaria: a practical handbook.

Third edition, 2013. WHO unit 1

Flash drive with full set of guidance documents281 unit 1

Already in basic module malaria unit Artemether + Lumefantrine, dispersible tablets 20 mg + 120 mg, 6 tablets, blister

(10 x 30 x 5) 1500

Artemether + Lumefantrine, dispersible tablets 20 mg + 120 mg, 12 tablets, blister

(10 x 30 x 1) 300

Artemether + Lumefantrine, tablets 20 mg +120 mg, 18 tablets, blister

(10 x 30 x 1) 300

Artemether + Lumefantrine, tablets 20 mg +120 mg, 24 tablets, blister

(10 x 30 x 6) 1800

Malaria rapid diagnostic tests, with lancets and buffer (800 x 10) 8000 Safety box, for used lancets 5 L29 (10 x 2) 20

28 The full list of documents is described in Annex 1. The flash drive should be placed in a plastic pouch attached to the inner side of box number 1.

29 Other sharps containers can be considered

18 INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module - Post-exposure prophylaxis (PEP) unit (can be withheld from the order upon request) Item description Unit Quantity PEP unit, 50 treatments adults + 10 children Azithromycin, powder for oral suspension, 200 mg /5 ml bottle, 15 ml 10 Azithromycin, tablets/capsules 250 mg tablet/capsule 200 Cefixime (as trihydrate), powder for oral suspension, 100 mg/5 ml301 bottle, 50 ml 10 Cefixime, tablets 200 mg312 tablet 112 Atazanavir (ATV) + ritonavir (r), tablets 300 + 100 mg tablet 1500 Lamivudine (3TC) + tenofovir (TDF), tablets 300 + 300 mg tablet 1500 Lamivudine (3TC) + zidovudine (AZT), tablets 30 + 60 mg tablet 1800 Lopinavir (LPV) + ritonavir (r), tablets 100 + 25 mg32 3 tablet 180 Lopinavir (LPV) + ritonavir (r), tablets 200 + 50 mg tablet 480 Levonorgestrel, tablets 1.50 mcg tablet 50 Pregnancy test, (urine dipstick) unit 50 Flash Drive with full set of guidance documents334 unit 1

Supplementary module - Guidelines Item description Unit Quantity Guidelines Flash Drive with full set of guidance documents33 unit 1 IEHK 2017 Booklet (English)345 unit 2 IEHK 2017 Booklet (French) unit 2 IEHK 2017 Booklet (Spanish) unit 2 IEHK 2017 Booklet (Arabic) unit 2 MSF Essential drugs guideline (English) unit 1 MSF Essential drugs guideline (French) unit 1 MSF Essential drugs guideline (Spanish) unit 1 MSF Clinical guideline (English) unit 1 MSF Clinical guideline (French) unit 1 MSF Clinical guideline (Spanish) unit 1

30 Can be substituted by cefixime dispersible tablets 31 Could be interchanged with 400 mg 32 LPV/r tablets must be swallowed and should not be crushed or dissolved in liquid. Children who are unable to swallow LPV/r tablets should use LPV/r liquid. If this is not available, an alternative age-appropriate drug should be used (refer to PEP guidelines). Lack of a suitable third drug should not be a barrier to prompt initiation of PEP with AZT/3TC 33 The full list of documents is described in Annex 1. The flash drive should be placed in a plastic pouch attached to the inner side of box number 1 34 The IEHK 2017 booklet is to be included in as many languages available at the time of kit deployment

19INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module - Medical devices, renewable Item description Unit Quantity Medical devices, renewable Bag, urine, collecting, 2000 ml unit 10 Cannula, IV short, 18G (1.3 x 45 mm), sterile, single use unit 100 Cannula, IV short, 22G (0.8 x 25 mm), sterile, single use unit 50 Cannula, IV short, 24G (0.7 x 19 mm), sterile, single use unit 50 Catheter, Foley, CH12, sterile, single use unit 10 Catheter, Foley, CH14, sterile, single use unit 5 Catheter, Foley, CH18, sterile, single use unit 5 Clamp, umbilical, sterile unit 100 Compress, gauze,10 x 10 cm, non-sterile unit 2000 Compress, gauze,10 x 10 cm, sterile unit 1500 Gloves, examination, latex, large, single use unit 100 Gloves, examination, latex, medium, single use unit 100 Gloves, examination, latex, small, single use unit 100 Gloves, surgical, 6.5, sterile, single use, pair unit 50 Gloves, surgical, 7.5, sterile, single use, pair unit 150 Gloves, surgical, 8.5, sterile, single use, pair unit 50 Indicator, time, steam, temperature (TST) control spot, for sterilization pack unit 300

Masking tape, 2 cm x 50 m, for sterilization pack unit 1 Needle, 19G (1.1 x 40 mm), sterile, single use unit 2000 Needle, 21G (0.8 x 40 mm), sterile, single use unit 1500 Needle, 23G (0.6 x 25 mm), sterile, single use unit 1500 Needle, 25G (0.5 x 16 mm), sterile, single use unit 100 Needle, scalp vein, 21G (0.8 x 19 mm), sterile, single use unit 100 Needle, scalp vein, 25G (0.5 x 19 mm), sterile, single use unit 300 Needle, spinal, 22G (0.9 x 90 mm), sterile, single use unit 25 Needle, spinal, 22G (0.7 x 40 mm), sterile, single use unit 25 Paper sheet, crepe, approximately 1 m x 1 m, for sterilization pack unit 100 Razor, safety, single use unit 100 Safety box for used syringes/needles, 5 litres351 unit 50 Scalpel blade, no. 22, sterile, single use unit 100 Suture, non-absorb., synthetic, monofilament, DEC 2 (3/0), curved needle 3/8 circle, 18 mm, cutting362or reverse-cutting, triangular point unit 144

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35 Other sharps containers can be considered 36 Both cutting and reverse-cutting needles are considered as options

20 INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module - Medical devices, renewable .... continued Item description Unit Quantity Medical devices, renewable Suture, absorbable, synthetic, braided DEC2 (3/0), curved needle 3/8 circle, 26 mm, round body unit 144

Syringe, 20 ml, sterile, single use unit 100 Syringe, 10 ml, sterile, single use unit 600 Syringe, 5 ml, sterile, single use unit 2000 Syringe, 2 ml, sterile, single use unit 700 Syringe, 1 ml, sterile, single use unit 200 Syringe insulin, 1 ml with needle, graduated, single use371 unit 400 Syringe, feeding, 50 ml, conical tip, sterile unit 10 Syringe, feeding, 50 ml, Luer tip, sterile unit 10 Tongue depressor, wooden, single use unit 500 Tube, aspirating/feeding, CH16, L125 cm, conical tip, sterile, single use unit 10

Tube, feeding, CH08, L40 cm, Luer tip, sterile, single use unit 50 Tube, feeding, CH05, L40 cm, Luer tip, sterile, single use unit 20 Urine test strips for ketones, glucose and albumin382 unit 100

Already in basic module: Medical devices, renewable Bandage, elastic, 7.5 cm x 5 m, roll (10 x 20) 200 Bandage, gauze, 8 cm x 4 m, roll (10 x 200) 2000 Compress, gauze, 10 x 10 cm, non-sterile (10 x 500) 5000 Cotton wool, 500 g, roll, non-sterile (10 x 2) 20 Gloves, examination, latex, medium, single use (10 x 100) 1000 Soap, toilet, bar, approximately 110 g, wrapped (10 x 10) 100 Tape, adhesive, zinc oxide, 2.5 cm x 5 m (10 x 30) 300

Already in basic module: Stationery Book, exercise, A4 size, 100 pages, hard cover (10 x 4) 40 Envelope, plastic, 10 cm x 15 cm (10 x 2000) 20000 Health card (10 x 500) 5000 Pad, note, plain, A6 size, 100 sheets (10 x 10) 100 Pen, ball-point, blue (10 x 10) 100 Plastic bag, for health card, 11 cm x 25 cm, snap-lock fastening (10 x 500) 5000

37 Added for administration of insulin 38 For diagnostic and management of acute severe hyperglycaemia

21INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module - Medical devices, equipment Item description Unit Quantity Medical devices, equipment Apron, protection, plastic, single use391 unit 100 Basin, kidney, stainless steel, 825 ml unit 2 Bowl, stainless steel, 180 ml unit 2 Brush, hand, scrubbing, plastic unit 2 Drawsheet, plastic, 90 x 180 cm unit 2 Drum, sterilizing, approximately 150 mm x 150 mm unit 2 Filter, drinking, candle, 10–80 litres per day unit 3 Forceps, artery, Kocher, 140 mm, straight unit 2 Glucometer including 250 glucose strips and 250 blood lancets402 unit 2 Otoscope set, cased413 unit 1 Pulse oximeter fingertip, adult, spot-check424 unit 1 Scale (only), infant, spring type, 25 kg x 100 g unit 3 Scale, electronic, mother/child, 150 kg x 100 g unit 1 Scissors, Deaver, 140 mm, straight, sharp/blunt unit 2 Spare battery, R6 alkaline AA size, 1.5V (for otoscope) unit 12 Sphygmomanometer (adult), aneroid unit 4 Sterilizer, steam, 21 or 24 litres unit 1 Stethoscope, binaural, complete unit 4 Stethoscope, fetal, Pinard unit 1 Stove, kerosene, single-burner, pressure unit 1 Surgical instruments, delivery set435 unit 1 Surgical instruments, dressing set446 unit 5

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39 Alternative: apron, protection plastic, reusable, 2 40 For management and immediate follow up of acute severe hyperglycaemia. Display units in mg/dL. Suitable for use with multiple patients . Glucose strips and blood lancets can be reordered as needed. Contains batteries; need to consider shipping requirements 41 Spare bulb must be included within the otoscope set 42 Simple finger version for monitoring of acute respiratory distress, including COPD exacerbation and asthma.

Contains batteries; need to consider shipping requirements 43 Delivery set:

• 1 scissors, Mayo, 140 mm, curved, blunt/blunt

• 1 scissors, gynaecological, 200 mm, curved, blunt/blunt

• 1 forceps, artery, Kocher, 140 mm, straight

• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover

44 Dressing set:

• 1 forceps, artery, Kocher, 140 mm, straight

• 1 forceps, dressing, standard, 155 mm, straight

22 INTERAGENCY EMERGENCY HEALTH KIT 2017

Supplementary module - Medical devices, equipment ... continued Item description Unit Quantity Medical devices, equipment Surgical instruments, suture set451 unit 2 Tape measure, arm circumference, mid-upper arm circumference

(MUAC)

unit 50

Tape, measure, vinyl-coated, 1.5 m unit 5 Thermometer, clinical, digital, 32–43°C unit 10 Timer, 60 min unit 1 Tourniquet, latex rubber, 75 cm462 unit 2 Tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1 Weighing trousers for scale infant spring, set of 5 unit 3

Already in basic module:

Basin, kidney, stainless steel, 825 ml unit 1 Bottle, plastic, 1 L, wash bottle unit 3 Bottle, plastic, 250 ml, with screw cap unit 1 Bowl, stainless steel, 180 ml unit 1 Brush, hand, scrubbing, plastic unit 2 Drum, sterilizing, approximately 150 mm x 150 mm unit 2 Pail, with water scoop, handle, polyethylene, 10 L or 15 L unit 2 Scissors, Deaver, 140 mm, straight, sharp/blunt unit 2 Surgical instruments, dressing set unit 2 Thermometer, clinical, digital, 32–43°C unit 5 Tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1 Water container, PVC/PE, collapsible, 10 L or 15 L unit 1

45 1 scissors, Deaver, 140 mm, straight, sharp/blunt 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover

One suture set should be reserved for repair of postpartum vaginal tears. Abscess/suture set:

• 1 forceps, artery, Halsted-mosquito, 125 mm curved

• 1 forceps, artery, Kocher, 140 mm, straight

• 1 forceps, tissue, standard, 145 mm, straight

• 1 needle holder, Mayo-Hegar, 180 mm, straight

• 1 probe, double-ended, 145 mm

• 1 scalpel handle, No. 4

• 1 scissors, Deaver, 140 mm, curved, sharp/blunt

• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover

46 Alternative: tourniquet with Velcro

23INTERAGENCY EMERGENCY HEALTH KIT 2017

CHAPTER 3: ORDERING THE IEHK 2017

Obtaining the IEHK 2017 The IEHK 2017 can be ordered through different agencies that make it available for their own pro-grammes and for third-party organizations. It can also be obtained from commercial wholesalers.

Additional details on the provision of IEHK 2017 and on the procedures for ordering can be found at the following links and by contacting the organizations using the email addresses indicated.

WHO

email: procurement@who.int weblink: WHO Intranet 471

UNICEF

email: psid@unicef.org weblink: https://www.unicef.org/supply/

MSF logistique email: office@bordeaux.msf.org weblink: https://www.msflogistique.org/

MSF supply email: office-msfsupply@brussels.msf.org msfsupply.order@brussels.msf.org weblink: https://www.msfsupply.be

47 http://intranet.who.int/tools/wcat/Categories.aspx?catid=71739

Before ordering the IEHK 2017

• Undertake a rapid assessment of the local situation to confirm that the emergency health kits are needed, which types are needed and where they are needed. The IEHK could also be stockpiled in reasonable quantity and for specific purposes. When stockpiling it is essential to monitor expiry dates and ensure that the storage conditions are in line with WHO good storage practices.

• Base the quantity and type (basic and/or supplementary modules) of emergency health kits requested on the size of the population to be served, the location and type of health centres and the skills of health care providers in these centres.

• Ensure that necessary funds are available to cover the cost of clearance, distribution and safe storage.

• Determine if the malaria modules (basic and supplementary) are required.

Cost of the IEHK 2017 The cost of each kit changes periodically. The latest prices can be obtained by consulting the agencies listed above as well as from commercial suppliers. Additional overhead cost might apply and these should be confirmed with the provider early in the planning phase.

Airfreight costs: airfreight cost will vary widely depending on the route. The following weights and volumes can be used as reference for estimating cost.

24 INTERAGENCY EMERGENCY HEALTH KIT 2017

Module Approximate weight (kg) Approximate volume (m3)

Approximate number of boxes

Basic (without malaria unit) 38 0.22 2 Basic – Malaria 19 0.14 1 Supplementary – Medicines (ex-cold chain/controlled) 330 1.20 20

Supplementary – Medicines (controlled) 5 0.04 1 Supplementary – Medicines (cold chain) 20 0.15 1 Supplementary – Malaria 46 0.26 2 Supplementary – PEP 20 0.12 1 Supplementary – Medical renewable 110 0.80 5 Supplementary – Medical equipment 50 0.32 3 Full IEHK 2017 (10 basic + 1 supplementary modules) 1150 6.50 63

Packaging To facilitate logistics in the country, the boxes containing the supplies:

• are marked with the weight and volume of each module/unit;

• weigh no more than 25 kg, to be handled by one or two people;

• are clearly marked with kit number and box number, description, consignee and other rel-evant information;

• have a self-adhesive pouch attached to the outside, containing a detailed list of contents.

Each carton in the basic and supplementary mod-ule should contain an information slip in at least three languages (English, French and Spanish), with the text defined in Annex 7.

Packaging and shipping of cold chain items

• The IEHK contains medicines that require cold storage (insulin and most brands of oxytocin).

It is recommended that these medicines be packed together and shipped in consideration of manufacturer instructions.

• Products should be packed in a way to avoid breakage, contamination and theft. The packing should be adequate to maintain the storage conditions of the product during transport.

• It is recommended to place a temperature-monitoring device and instructions for use by recipient in the box to monitor temper-atures during transport. A list of WHO PQS validated data-loggers can be found in the PQS catalogue48.1

• Packaging systems should be validated before use. The supplier is responsible for ensuring product temperature compliance during transport. Refer to model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products:

WHO Technical Report Series, No. 961, 201149,2and its related Technical Supplement 12503

48 http://apps.who.int/immunization_standards/vaccine_quality/ pqs_catalogue/ 49 http://www.who.int/medicines/areas/quality_safety/quali-ty_assurance/ModelGuidanceForStorageTransportTRS961Annex9.

pdf?ua=1 50 http://www.who.int/medicines/areas/quality_safety/quality_as-surance/supplement_12.pdf?ua=1

25INTERAGENCY EMERGENCY HEALTH KIT 2017

• Adequate notification of shipment arrival should be provided to consignee to ensure timely completion of import formalities and clearance of cargo on arrival. The labels in the boxes should identify clearly the storage temperature, need for urgency in handling and clearance, and a label indicating need to avoid freezing.

• IATA Time and Temperature Sensitive Labels apply to all shipments booked as time- and temperature-sensitive cargo.514

Additional supplies to be considered to complement the IEHK 2017 for management of NCDs Provision of comprehensive diagnostics and management of noncommunicable diseases is complex and requires equipment and resources that depend on the needs and capacity existing in country. The IEHK 2017 includes a hand held glucometer and set of strips and lancets validated for use in multiple patients. Other types of gluco-meters more appropriate for hospital settings are not included in the kit, as their management with-in kits is challenging; however, they can be con-sidered for purchase after the needs assessment is done. It is also recommended that equipment such as electrocardiographs be considered for purchase after the needs assessment is conducted.

This type of equipment is usually available from stock of medical wholesalers.

Quality assurance Agencies and suppliers are responsible for ensuring the quality of the supplies provided in the IEHK. The model quality assurance system for procurement agencies525 should form the basis of the assessment of the capacity of kit suppliers to provide high-quality products. Suppliers should also have capacity to manage and supply the kits under applicable good distribution practices. The assessment and verification of the capacity of

51 http://www.iata.org/whatwedo/cargo/pharma/Pages/index.aspx 52 http://apps.who.int/medicinedocs/documents/s21492en/ s21492en.pdf suppliers is the responsibility of the agencies that prepare or purchase the kits. References to previous assessments can be requested from suppliers.

Feedback The IEHK is reviewed regularly to optimize its content and configuration to fit needs. Feedback from users is very important to ensure continuous improvement, especially in the following areas:

• appropriateness of content (selection, quantity, items not included)

• content and clarity of information provided (booklet, packing list, guidelines)

• Quality of kit’s contents and packaging.

Please send your feedback to the IEHK Secretariat (emp@who.int).

26 INTERAGENCY EMERGENCY HEALTH KIT 2017

27INTERAGENCY EMERGENCY HEALTH KIT 2017

ANNEX 1: RESOURCES

The documents listed below are included in electronic and/or hard copy in the basic and supplementary modules.

A full list of technical guidelines for health emergencies can be found at:

http://www.who.int/hac/techguidance/guidelines/en/.

MSF medical guidelines and additional information for medical field workers can be access through a mobile app available at medicalguidelines.msf.org.

Guidelines and resources Languages Web links

General Clinical guidelines. MSF; 2018 English, French, Spanish https://medicalguidelines.msf.org Essential drugs. MSF; 2018 English, French, Spanish, Arabic https://medicalguidelines.msf.org IEHK 2017 Handbook. WHO; 2018 English, French, Spanish, Arabic

Malaria Management of severe malaria – A practical handbook. Third edition.

WHO; 2013

English, French, Spanish http://www.who.int/malaria/publications/ atoz/9789241548526/en/

Guidelines for the treatment of malaria.

Third edition. WHO; 2015

English http://www.who.int/malaria/publications/ atoz/9789241549127/en/

Malaria control in humanitarian emergencies – An inter-agency field handbook. Second edition. WHO; 2013

English http://www.who.int/malaria/publications/ atoz/9789241548656/en/

Universal access to malaria diagnostic testing – An operational manual.

WHO, rev. 2013

English, French http://www.who.int/malaria/publications/ atoz/9789241502092/en

Injectable artesunate tool kit, including reconstitution and administration job aid (poster). MMV; 2015

English, French, Portuguese https://www.mmv.org/access/tool-kits

HIV (including post-exposure prophylaxis) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.

Recommendations for a public health approach – Second edition. WHO; 2016

English http://www.who.int/hiv/pub/arv/arv-2016/en/

Noncommunicable diseases (NCD) Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings.

WHO; 2010

English http://www.who.int/nmh/publications/essen-tial_ncd_interventions_lr_settings.pdf

28 INTERAGENCY EMERGENCY HEALTH KIT 2017

ANNEX 1: RESOURCES

Guidelines and resources Languages Web links

Mental health mhGAP humanitarian intervention guide (mhGAP-HIG).

Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. WHO/UNHCR; 2015

Arabic, English, French, Russian, Spanish, Ukrainian https://www.who.int/mental_health/publications/ mhgap_hig/en/

Medicines and diagnostics WHO Model Lists of Essential Medicines English http://www.who.int/medicines/publications/es-sentialmedicines/en/ WHO Model Formulary English http://www.who.int/selection_medicines/list

WHO Model List of Essential in Vitro Diagnostics

English http://www.who.int/medical_devices/diagnostics/ Selection_in-vitro_diagnostics/en/

Medicine management The logistics handbook:

A practical guide for the supply chain management of health commodities.

Arlington (VA): United States Agency for International Development; 2011

English, French, Spanish, Arab, Hindi, Portuguese https://www.jsi.com/JSIInternet/Resources/publi-cation/display.cfm?txtGeoArea=INTL&id=11497&-thisSection=Resources

MDS-3: Managing access to medicines and other health technologies.

Arlington (VA): Management Sciences for Health; 2012

English http://www.msh.org/resources/mds-3-manag-ing-access-to-medicines-and-health-technologies

Further resources can be found in Annexes 4 and 5, which contain samples of a daily medicine consumption form and stock card, respectively.

Waste management Safe management of wastes from health-care activities. Second edition. WHO;

English https://www.healthcare-waste.org/fileadmin/ user_upload/resources/Safe-Management-of- Wastes-from-Health-Care-Activities-2.pdf

29INTERAGENCY EMERGENCY HEALTH KIT 2017

ANNEX 2: COMPLEMENTARY KITS FOR USE IN EMERGENCIES

The IEHK is designed to cater to the basic health conditions that can present in an emergency situation. There are other emergency health kits that meet other needs. Some of the most commonly used interagency and WHO kits are listed below.

Kit description Agency Nutrition kits Nutrition kit Standard anthropometric kit containing weighing and measuring equipment for children aged under 5…