IMPLEMENTING APSED 2010: Securing the health of future generations
Western Pacific Region
IMPLEMENTING APSED 2010: Securing the health of future generations
Western Pacific Region
Table of contents
The Urgency of Achieving National, Regional, and Global Health Security................. 1
A continuing response: The APSED (2010) evolution................................................ 2 The Beginning of Another Era.......................................................................... 2 Decision-Making Through Dialogue.................................................................. 3 Ownership and Accountability: Building Blocks for Commitment..................... 3 An Overview of APSED (2010)................................................................................. 4 Vision............................................................................................................ 4 Goal............................................................................................................... 4 Objectives...................................................................................................... 4 Focus Areas............................................................................................................ 5 Workplan Development.................................................................................. 7 Common Framework to Promote Cooperation................................................. 7 Workplan Development to Ensure Success....................................................... 8 Surveillance, Risk Assessment, and Response................................................ 10 Laboratories................................................................................................. 12 Zoonoses..................................................................................................... 14 Infection Prevention and Control................................................................... 16 Risk Communication..................................................................................... 18 Public Health Emergency Preparedness.......................................................... 20
Regional Preparedness, Alert, and Response.................................................. 22 Monitoring and Evaluation............................................................................ 24
Special considerations under APSED (2010).......................................................... 27 Gender Mainstreaming.................................................................................. 27 Special Consideration for Pacific Island Countries and Areas........................... 27 Confronting the Threat of Emerging Diseases................................................ 28 Supporting Partners
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IMPLEMENTING APSED 2010: Securing the health of future generations
The urgency of achieving national, regional, and global health security Emerging and epidemic-prone diseases pose serious public health threats in the Western Pacific Region. Over the past years, the Region has experienced significant outbreaks of newly emerging diseases, including Nipah virus, severe acute respiratory syndrome (SARS) and avian influenza. Outbreak of known communicable diseases such as dengue, meningococcal infection, typhoid fever, cholera and leptospirosis continue to occur regularly in the Region. With most Asian countries experiencing rapid social, economic and environmental changes, including globalization and urbanization, the risk of cross-border transmission of emerging diseases is higher than ever. Moreover, as the Region is home to more than 50% of the world population, true global public health security depends to a large degree upon how successful this Region is in developing and sustaining functional national and regional systems and capacities for managing emerging diseases and acute public health events and emergencies. Consequently, there is an urgent need to strengthen inter-country collaboration. The recently revised International Health Regulations (IHR 2005) require WHO Member States to assess, develop, strengthen and maintain their country’s capacity at a level to meet the minimum core capacity requirements for disease surveillance and response. There is an increasing need to develop and implement joint activities so that we can strengthen national and regional capacity to detect and respond rapidly and effectively to emerging diseases and other health emergencies of national and international concern.
Surveillance, risk assessment, and response
1
A continuing response: The APSED (2010) evolution
The beginning of another era As APSED (2005) term drew to a close, Member States were faced with a pressing question: what should be done next? Had APSED (2005) been enough to equip them with the capacities required to tackle emerging diseases on their own? Or was there still a need for an overarching framework to guide and coordinate action? During an intense period of reflection and programme evaluation it was determined that despite having made significant progress in improving health security, the region still suffers from certain vulnerabilities in the area of public health. The next issue at hand was to consider whether or not APSED (2005) had
2
IMPLEMENTING APSED 2010: Securing the health of future generations
been a worthwhile investment. The answer to this question was a resounding yes— bolstering health security is still a priority in the region, and since APSED (2005) demonstrated the high value of sharing a common framework between countries, Member States requested the development of an updated strategy so they could continue to work towards the same goals. Accordingly, APSED (2010) was designed to address existing gaps, and to guide efforts in the prevention and control of emerging diseases and other public health emergencies. Like its predecessor, APSED (2010) will focus primarily on building national and local competences based on key public health concerns and requirements for capacity-building over the next five years. The advantages of attaining health security extend through space and time: the international community as a whole will benefit from increased health security in the Asia Pacific Region, and the fruits will be enjoyed not only by existing generations, but also by upcoming generations.
Decision-making through dialoque The consultative process of developing APSED (2010) involved engaging the different stakeholders involved with APSED (2005), with a view towards receiving constructive feedback and incorporating some of the key lessons learned. Dialogue between Member States, government agencies and implementing bodies, civil society organizations, donors, and other partners was encouraged, and in the end a variety of perspectives shaped the revised APSED (2010) strategy. To gather qualitative information, country and regional consultations were used as an opportunity to reflect upon and discuss lessons learned from pandemic preparedness and response. These interpretations were bolstered with quantitative data, namely the results from measuring APSED (2005) Common Indicator Assessments. The analysis of these results revealed some of the strengths and weaknesses of the implementation of the strategy, and these findings were applied to steer the development of APSED (2010). As a result of these inputs and consultations, 23 technical papers were developed and after further review 8 of them were selected as key focus areas for APSED (2010).
Ownership and accountability: Building blocks for commitment Ultimately, the revised APSED (2010) strategy reflects a strengthened sense of accountability and ownership on the part of Member States. The inclusivity of the consultative process behind the development of APSED (2010) has inspired a heightened commitment to following through with the Strategy, and this will undoubtedly translate into positive and tangible results. APSED (2010) provides a sound approach to confronting the threat of emerging infectious diseases, and support for this project will contribute significantly towards the enhancement of regional health security in Asia.
Surveillance, risk assessment, and response
3
An overview of APSED (2010)
Building upon the success of APSED (2005), the revised vision of the Strategy
AsiA PAcific strAtegy for emerging DiseAses
will continue to promote national and regional health security through collective efforts and actions. The consultation process that led to the development of APSED (2010) gave stakeholders a chance to revisit the vision, goals, and objectives of the Strategy. While different parties identified different priorities, the general consensus was that APSED (2010) provides the most relevant and
2010
implementable framework for dealing with emerging infectious diseases while expanding to include other public health emergencies.
Vision An Asia Pacific region prepared to mitigate the risk and impact of emerging South-East Asia Region
Western Pacific Region
diseases and other public health emergencies through collective responsibility for public health security.
Goal To build sustainable national and regional capacities and partnerships to ensure public health security through preparedness planning, prevention, early detection and rapid response to emerging diseases and other public health emergencies.
Objectives To achieve this Vision and Goal, APSED (2010) identifies five interrelated objectives: OBJECTIVE 1: Reduce the risk of emerging diseases. OBJECTIVE 2: Strengthen early detection of outbreaks of emerging diseases and public health emergencies. OBJECTIVE 3: Strengthen rapid response to emerging diseases and public health emergencies. OBJECTIVE 4: Strengthen effective preparedness for emerging diseases and public health emergencies. OBJECTIVE 5: Build sustainable technical collaboration and partnership in the Asia Pacific region.
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IMPLEMENTING APSED 2010: Securing the health of future generations
Focus Areas
APSED (2010) is centered on eight key focus areas, including Surveillance, Risk Assessment, and Response; Laboratories; Zoonoses; Infection Prevention and Control; Risk Communication; Public Health Emergency Preparedness; Regional Preparedness, Alert, and Response; and Monitoring and Evaluation.
APSED (2005)
Surveillance and Response
Laboratory
APSED (2010)
Surveillance, Risk Assessment and Response
Zooneses
Laboratory
Infection Control
Zooneses
Risk Communication
Infection Prevention and Control
Risk Communication
Public Health Emergency Preparedness
Regional Preparedness, Alert and Response
Monitoring and Evaluation
Focus Areas
5
6
IMPLEMENTING APSED 2010: Securing the health of future generations
Workplan Development
Common framework to promote cooperation Tremendous efforts have been made by individual countries and the international community to confront emerging disease threats in recent years, but the need for a common regional strategic framework has been recognized by countries and areas in the Asia Pacific, the World Health Organization, donors and partner agencies. To address this need, APSED (2010) has been developed to serve as a road map to guide countries towards building capacities and partnerships in order to achieve regional and ultimately global health security. APSED (2010) has been designed to promote public health security through preparedness planning, prevention, early detection and rapid response to emerging diseases and other public health emergencies. The strength of APSED (2010) is that it provides a way for countries to work towards a common goal. The Strategy calls for collective responsibility and actions to address the shared regional health security threat with a greater emphasis on preparedness-driven investments in health security.
WHY APSED is ‘practical’? 1. It was developed by the people who use it 2. It was ‘customarized’ to the regions using it 3. A ‘horizontal approach’ across focus areas, across other work areas adopted 4. A set of clear vision, goals and objectives identified 5. Principles based on were ‘sound’ and ‘correct’ in guiding activities proposed 6. Activities proposed are ‘do-able’ and Progress is ‘measurable’
Focus Areas
7
Work plan development to ensure success On one hand, the final outcome of APSED (2010) is intended to be the establishment of regional and global health security. Of course, this cannot be achieved if individual countries fail to make progress at the national level. The Region will only be as strong as its weakest link, and so Member States must be committed to implementing the strategy adapted to their local needs. APSED (2010) provides an overall blueprint, but it is up to Member States to capitalize on strengths, develop capacities, and build bridges to fill in the gaps. For this reason, work plan development is an absolutely vital step in the APSED (2010) implementation process. Member States will be invited to develop individualized work plans according to their capabilities and in line with national priorities. This will provide countries with a stronger sense of ownership will reinforce dedication and commitment, which in turn will increase the likelihood that our region will walk step by step towards attaining health security and then contributing to the global health security.
8
IMPLEMENTING APSED 2010: Securing the health of future generations
Pathogens travel without passports. Borders are utterly ineffective as barriers to emerging infectious diseases. Strategic work plan development allows states to focus on the common goal of improving regional health security. Collectively, states can concentrate efforts towards confronting infectious diseases. The region is only as strong as its weakest link, so states must work to ensure widespread capacity and preparedness.
Focus Areas
9
SURVEILLANCE, RISK ASSESSMENT, AND RESPONSE
Surveillance, risk assessment, and response are a major part of
be interpreted to provide a timely warning about trends of
APSED (2010). The early detection of emerging diseases and
impending health emergencies. The enhanced foreseability
swift response to outbreaks will save more lives. A weakness
of disease outbreaks and pandemics will trigger targeted
in country-level disease surveillance and response can have
risk communication, which in turn will allow for preventive
negative repercussions on a wider scale: the late recognition
measures to be put in place. Essentially, IBS is geared towards
of emerging pandemics puts neighboring countries at risk and
monitoring of disease trends. The data obtained through
a scattered response to emerging pandemics contributes to
IBS enhances the ability of government officials to plan and
serious human and economic losses.
develop disease control initiatives and programs. IBS system implemented with complementary IT structure can be the
This APSED (2010) focus area places a renewed emphasis
key to developing a comprehensive surveillance structure in
on indicator-based surveillance (IBS) as a tool to monitor
countries, including laboratory information sharing. This can
public health. IBS provides a structured means of recording
also lead to more timely and reliable information availability
data on known diseases on agreed basis, and this data can
for effective risk assessment.
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IMPLEMENTING APSED 2010: Securing the health of future generations
Risk assessment is a tool when carried out successfully can bring immeasurably value to response to a public health emergency. It can be used to plan strategies and tactics for health intervention; to guide the appropriate management of health resources; and ultimately to reduce morbidity
Information is the key element in crisis management.
and mortality. Decision-making through risk assessment also provides policymakers with defensible proof for their decisions and actions, and this enables them to better cope with public pressure and the uncertainty associated with public health events and emergencies. Information is the key element in crisis management. Public health officials need to be able to make logical and effective evidence-based decisions about health interventions. Surveillance data, risk assessment are the first step towards ensuring early detection and rapid response. As a result, strong capacities in this focus area are the basis for public health security at the national, regional, and global levels. Or aliquam doluptatur, nos es dem alibusape con eius rehendeliqui quunte est, num eat hillabo. Neque is dolori ommolup taquoditatem volent. Ullorum sundelit et re et quae pedicto quo occulparum
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Key Points: •
Effective national and regional surveillance systems generate reliable information for timely risk assessment, and this data informs decisions on rapid public health actions in response against an outbreak
•
IBS provides a structured means of recording data on known diseases on a regular basis and is reported from sub-national to national level
•
Decision-making through risk assessment will provide an evidence base for providing choices and optimize resource usage
Focus Areas
11
LABORATORIES
The development of public health diagnostic laboratories will
surveillance and response. Through standardized reporting
make laboratories more accessible by bringing them closer
and proper data management systems, laboratory findings
to the front line. Laboratories must provide key information
can be incorporated to IBS. Further, laboratory information
for public health surveillance and response.
can give quality data needed for effective risk assessment process.
The public health diagnostic laboratories proposed by APSED (2010) will adopt a ‘syndromic’ approach, so as to avoid the
Without proper functioning laboratories, countries would
tendency of pre-biasing diagnoses. APSED (2010) also calls
be more vulnerable to outbreaks and pandemics. Currently
for a focus on national networking to develop a laboratory
most Member States have at least some basic laboratory
system which will further enhance Member States’ ability to
infrastructure to support public health services, but these
detect unknown pathogens more effectively.
laboratories are often disease-specific vertical support providers. As such, the use of a ‘syndromic’ approach
Laboratory activities provide indispensable support to other
where every sample is tested for few symptomatic diseases
APSED (2010) focus areas, most notably with respect to
and negative samples referred to reference laboratories,
12
IMPLEMENTING APSED 2010: Securing the health of future generations
represents a progressive step towards improving capacities for the early detection of new pathogens. Establishing Public health diagnostic laboratories can in future lead to a positive public health system transformation, with being able to detect unknown, undetected new pathogens, use of new data management tools and more laboratory networking.
Laboratories must provide key information for public health surveillance and response.
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Key Points: • • •
•
Laboratories play an important supportive role in early detection of disease outbreak and public health events In order to comply with IHR (2005), Member States should have basic capacities for the early detection of both familiar and novel pathogens that may lead to events of national or international concern Public health diagnostic laboratories will focus on a more syndromic approach to testing samples. • In the initial screening samples will be tested for a few similar symptomatic approaches • Samples that remain unidentified will be shared with a reference laboratory in order to minimize the chance of inadvertently overlooking a potentially new disease National networking development will further enhance Member States’ ability to screen and detect unknown pathogens more effectively Focus Areas
13
ZOONESES
Zoonotic diseases account for approximately 75 per
coordination
cent of emerging diseases. The overwhelming incidence
collaboration.
of
capacity-building
and
regional
of zoonotic diseases earns this particular category of illness recognition as a core focus area in APSED (2010).
Under APSED (2005) the coordination mechanism was
The prevalence of zoonotic diseases presents a threat
used primarily to harmonize responses between the
on several fronts, ranging from the social and economic
human and animal health sectors, but APSED (2010)
issues of poverty reduction, food security, food safety,
takes on a more active role: the revised Strategy calls
and trade. In order to effectively confront the challenges
for the development of risk reduction strategies for
posed by endemic, emerging and re-emerging zoonoses,
priority zoonotic diseases, the sharing of epidemiology
it is imperative that countries strengthen coordination
and laboratory surveillance information between animal
and collaboration across human and animal health
and human sectors, and coordinated outbreak response.
sectors. APSED (2010) has the unmatched potential to
In keeping with the outlook of the One Health initiative,
provide a common framework for the interdisciplinary
the aim is to promote cooperation and understanding
14
IMPLEMENTING APSED 2010: Securing the health of future generations
between the human and animal health sectors through the coordination of activities and exchange of advice and assistance whenever possible. At the end of the day, the effective detection and treatment of zoonotic diseases cannot take place if the human and animal health sectors work in isolation. The development of
Zoonotic diseases account for approximately 75 per cent of emerging diseases.
functional and sustainable interdisciplinary partnerships will increase the effectiveness and efficacy of coordinated risk reduction and outbreak response. Tools developed for Risk assessment can consider including zoonoses risk reduction as part of them in the future. Zoonoses can be linked with laboratory through bio a safety mechanism which is an important component for both animal and human health sectors. Strengthening the capacity of the human health sector will encourage linkages with the animal health sector; indeed, the spill-over effects of training the human health sector will benefit the animal health sector. Explique planihic temque presequidit hit reroremquo beat Strengthening coordination and collaboration between
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countries to better address the urgent threat of zoonotic
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Key Points: •
The development of a coordination mechanism between human and animal health sectors is critical in the effective management of zoonotic related events and for the development of longer term risk reduction strategies
•
The benefits of a functional coordination mechanism between relevant sectors include:
• •
reduced time to obtain information for a coordinated response;
• •
the establishment of formalized channel of communication;
the creation of a forum for data sharing, discussion, risk assessment and risk reduction strategy development and implementation; respect and understanding of each other’s roles and functions Focus Areas
15
INFECTION PREVENTION AND CONTROL
The implementation of effective infection prevention and In order to attend to the issue of inadequate IPC practices, control (IPC) practices in health care settings plays a major APSED (2010) calls for (1) the establishment of comprehensive role in the containment of disease outbreaks. Without national policy and guidance; (2) the development of a operational IPC practices the risk of disease transmission national functional organizational structure; and (3) the in health care facilities increases substantially. Infection creation of a technical focal point in the field of IPC. can occur among health care workers, patients, and their families—this subsequently exposes entire communities The main focus for Infection prevention and control area is to the danger of infection. In fact, facilities that lack the development of a ‘national IPC resource centre’ in order IPC procedures can become epicenters for the spread to address the gaps identified. of infection during outbreaks. Paradoxically, this makes hospitals, clinics, and laboratories part of the problem rather Firstly, by promoting and standardizing the guidelines and than part of the cure.
16
trainings, the health care workers are given equal access
IMPLEMENTING APSED 2010: Securing the health of future generations
for information they need regarding IPC in order to be able to espouse and implement IPC practices. Secondly an organizational structure for national IPC programs will be charged with the responsibility of ‘’functioning body’’ overseeing national programmes and will have the responsibility of ensuring that IPC policies and practices are well-organized nationally and play an ubiquitous role in the health care system. Finally, a national IPC committee would be complemented by the efforts of a national IPC resource centre which will provide standardized IPC guidelines and
Infection can occur among health care workers, patients, and their families—this subsequently exposes entire communities to the danger of infection.
ongoing training for health care workers, and offer technical advice during outbreaks Consolidating IPC knowledge and expertise into a single national resource centre will facilitate better coordination, and will certainly lead to the development of more effective IPC practices. Moreover, it is important to have a ‘technical support hub’ in a country so that health care workers can receive immediate support in the event of an outbreak to protect themselves, and to be responsible to protect the communities from hospital related infection spreading. sequi tem ea dignim volendaepta volo cus et quidunte Ictumendit vendiamus sit, undis ent, ut quiam verisim vel
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Key Points: •
Facilities that lack IPC procedures can become epicenters for the spread of infection during outbreaks—a technical support hub in a country so that health care workers can receive immediate support in the event of an outbreak to protect themselves and the community
•
Consolidating IPC knowledge and expertise into a single national resource centre will facilitate better coordination, and will certainly lead to the development of more effective IPC practices
•
Good planning and coordination through national IPC resource centers will result in rigorous infection prevention and control practices, and this will increase the responsibility of the healthcare centers towards its own workers and the general public during outbreaks. Focus Areas
17
RISK COMMUNICATION
Risk communications is an integral component of public
outbreak. During health emergencies if trusted official
health risk management, and APSED (2010) places a
sources are not forthcoming with updates there is a risk
particular emphasis will be placed on health emergency
that these information gaps will be filled by misleading and
communication. The purpose of this activity is to keep the
potentially damaging rumors. In order to avoid this situation,
public informed about ongoing health crises, and to respond
APSED (2010) calls for improved risk communication, in
to community concerns about the same. In light of the
the hopes that effective communication will result in a
emergence of new diseases and public health emergencies,
population that is better informed and well-equipped to
it is especially important to have robust risk communication
deal with outbreaks in an appropriate manner.
infrastructure and to communicate regularly with the public during times of uncertainty.
Risk communication is also an important focus area because it addresses the reality that behavior is a key in transmission.
Effective health emergency communication will help stop
Even in the face of state-of-the art laboratory equipment,
the spread of confusion and panic in the event of a disease
well-trained health professionals, and fully operational
18
IMPLEMENTING APSED 2010: Securing the health of future generations
surveillance systems, the fact remains that communities are the first line of defense against disease outbreaks. Risk communications help people make informed decisions on how to protect themselves; this speeds up the containment of outbreaks, thereby reducing the negative social and economic impacts of health crises.
Effective strategies account for the success or failure of public health interventions.
Risk communication is a significant factor in determining the severity of a given public health emergency—effective strategies account for the success or failure of public health interventions. Cae
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Key Points: •
Proper risk communication can make the difference between widespread panic and the successful containment of an outbreak
•
if trusted official sources are not forthcoming with updates during public health emergencies, there is a risk that these information gaps will be filled by misleading and potentially damaging rumors
•
Clear, honest, and open communication enables individuals to protect themselves and their loved ones during times of uncertainty, thus mitigating the negative feelings of fear, mistrust, and anxiety that tend to emerge during outbreaks Focus Areas
19
PUBLIC HEALTH EMERGENCY PREPAREDNESS
A new APSED Focus Area
Public health emergencies can have devastating effects on
The highlight of this focus area is the development of a public
the communities, nations, and even regions which they afflict.
health emergency “command, control and coordination”
National preparedness for response to acute public health
structure that will be supported by an Emergency Operations
emergencies is vital to mitigate negative impacts on public
Centre (EOC). An unpredictable event can be best handled
health and well-being. Economic and social development
through efficient coordination among multiple departments.
also suffers as a result of disease outbreaks and pandemics, but it is possible to minimize these costs through timely
The functions of an EOC can be,
and effective response. And so, APSED (2010) proposes an
•
updated public health emergency response plan. The plan
Provide a platform for acute response in an outbreak situation or a public health emergency situation
will be developed by incorporating lessons learned from
•
Public health emergency preparedness planning process
previous cases of pandemic response, with an influenza focus.
•
National Risk assessments during outbreaks
However, the response plan will be designed to be flexible
•
To hold national APSED meetings and others
enough to address more generic public health emergencies.
20
IMPLEMENTING APSED 2010: Securing the health of future generations
The EOC will bring together surveillance officers, risk assessment experts, logisticians, risk communication
Public health emergencies can have devastating effects on the communities, nations, and even regions which they afflict.
officials and other technical and administrative officers into one place during an outbreak situation, allowing everyone to share information, interact and come to decisions collectively. This system will enhance coordination during public health crises, and make public health officials capable of more evidence-based and consistent responses to health crises. As an added benefit, the strengthening of capacities at the national level will prepare Member States for handling potential or declared public health emergencies of international concern in a more systematic manner. Member States will be encouraged to consider having an overarching flexible national PHEP and an incident command system in place to effectively respond in case of an emergency. Strong public health emergency preparedness will ensure the most efficient and effective response to outbreaks possible, and this will effectively curtail the destructive effects of outbreaks and pandemics.
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Key Points: • •
Strong public health emergency preparedness will ensure the most efficient and effective response to outbreaks possible, and this will effectively curtail the destructive effects of outbreaks and pandemics. The functions of an EOC can be, • Acute response in an outbreak situation or a public health emergency situation
• • •
Public health emergency preparedness planning National Risk assessments To hold national APSED meetings and others
Focus Areas
21
REGIONAL PREPAREDNESS, ALERT, AND RESPONSE
A new APSED Focus Area
The experience of the Influenza pandemic taught the
level; Member States need to be equally aware of public
world a lesson. Member States need not only national
health in neighboring countries.
systems preparedness, but also regional preparedness and collaboration for dealing with bigger disasters. Additionally,
The development of a ‘regional technical hub’ as proposed by
things need to be in place before an unexpected event
APSED (2010) can build upon this necessity. This network will
occurs—waiting until the peak of an event to take action
provide quality services in monitoring and alerting emerging
makes it impossible to develop such systems, as the focus
diseases and acute public health emergencies. This includes
necessarily shifts to response.
producing risk assessment products, supporting rapid response through enhanced global and regional networking,
APSED (2010) seeks to reinforce existing regional networks
and sharing relevant information. By doing so, the regional
and institutions because a strong and sustainable regional
system will be able to support and serve Member States
system is critical to protect against emerging diseases. It is
better in their endeavours in preparedness for public health
not enough to merely focus on public health at the national
emergencies that may strike at an unexpected time.
22
IMPLEMENTING APSED 2010: Securing the health of future generations
Borders are no barrier to the spread of infectious diseases. Diseases such as dengue, hand foot and mouth disease, avian influenza, severe acute respiratory syndrome, and pandemic influenza have been able to permeate borders with relative ease.
Borders are no barrier to the spread of infectious diseases.
Data collection and analysis can be done at the regional level. Large data sets tend to be more reliable, particularly with
Strong regional preparedness, alert and response will lead to
respect to identifying patterns. The information collected
improved cross-border cooperation and coordination. Since
by regional surveillance teams can be used to conduct a
pathogens can travel freely without passports, it is essential
risk assessment for the region. Regional information feeds
to make use of regional systems in terms of being aware of
back to Member States for better-informed assessments at
emerging diseases.
the country-level, and looking at the bigger picture regional information benefits the international community as a whole.
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The risk assessment done for one situation can be shared
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with other countries; alternatively, if necessary, the private
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sector can have access to the data to help them make
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informed decisions based on sound information. Further regional IBS system for priority diseases can be maintained.
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Regional information gathered and analysed can be
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shared back with the Member States through Western
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Pacific Surveillance and Response (WPSAR) journal. Risk assessment findings can be regularly published. Regular
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public health interventions as publications can be shared
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with member states. Annual conference can be organized
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for further information sharing among countries. Enhanced
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ccollaboration at regional level will ensure that health
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considerations are taken seriously, and the establishment
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of networks will facilitate information-sharing to enable
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Member States to monitor situations and assess risks.
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Key Points: •
Health security cannot be achieved if all Member States are working in isolation: there must be cooperation and collaboration, particularly when planning national responses to disease outbreaks
•
Regional-level data sets are more reliable in terms of identifying patterns, and therefore regional surveillance plays an important role in priority disease control
•
Diseases such as dengue, hand foot and mouth disease, avian influenza, severe acute respiratory syndrome, and pandemic influenza have been able to permeate borders with relative ease.
Focus Areas
23
MONITORING AND EVALUATION
A new APSED Focus Area
Monitoring and Evaluation (M&E) is a newly developed focus
The highlight of the M&E focus area is the formation of a
area for APSED (2010), and it is intended to provide Member
national planning and review process, which will be used to
States with a renewed sense of ownership over activities
create an integrated national plan. This process will ensure
undertaken as part of the Strategy.
harmonization between M&E and work plan development within the country, so as to reduce the planning workload
M&E regimes are sometimes viewed as a burden that must be
that is currently placed on Member States. Regular
borne in order to receive funding support, but this attitude is
stakeholder’s planning and review meetings at country-level
counterproductive. In such cases the results-reporting tends
will plan priority activities, review and monitor country’s
to be done for the sake of donors, yet M&E should be designed
implementation progress and improve programs related to
to benefit project implementers. APSED (2010) takes a unique
EIDs and Public Health emergency programmes in line with
approach and puts power in the hands of Member States in
IHR (2005) and APSED (2010).
order to inspire commitment to the process of M&E, which will ultimately produce accurate and high-quality data.
24
Effective M&E promotes ongoing learning and accountability,
IMPLEMENTING APSED 2010: Securing the health of future generations
which in turn allows stakeholders to ensure that resources are being invested effectively. On the one hand, learning is central to successful project planning: M&E provides an opportunity for critical reflection on a project, and the subsequent attempt to capitalize on its strengths and mitigate its weaknesses should be regarded as an important learning process. Accountability is an equally important upshot of M&E, because it reassures Member States, WHO, donors, and other partners that the goals
The APSED (2010) approach presents a progressive way of conceptualizing M&E and facilitating country ownership.
of the project have been properly prioritized, and that they are being achieved in an effective way. At its core, M&E is a means
through the information gathered from the national planning
of tracking progress towards meeting a project’s objectives: it
and review processes. The recommendations coming from
provides an opportunity to coordinate activities of different
TAG can be discussed at the country level and adapted to meet
initiatives so as to minimize gaps and duplications; it ensures
individual country needs and requirements.
that funds and other resources are being used appropriately; and, if designed properly, it allows Member States to maintain
The APSED (2010) approach presents a progressive way of
ownership of the program implementation.
conceptualizing M&E and facilitating country ownership. Member States are placed at the helm and can tailor M&E to
As a result of these meetings the country teams will have
meet their individual needs.
adequate data which can be used to fill up IHR core capacity monitoring tool and APSED (2010) performance indicators.
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These indicator sets can also be used to monitor national
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and regional progress in capacity development, including the
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functioning aspects and performance aspects of capacity
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building efforts under APSED (2010) focus areas.
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Member states further can share the information and findings of these national planning and review process, at the regional
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M&E forum or at the Technical Advisory Group Meetings.
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The TAG meeting can serve as a common regional platform
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where Member States, TAG members and experts, WHO
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representatives, donors and partners can sit together at one
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table to discuss the progress of APSED (2010) implementation
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and to recommend common priority activities on a yearly basis
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Key Points: •
The APSED (2010) approach to monitoring and evaluation will provide Member States with a renewed sense of ownership over activities.
•
M&E provides an opportunity for critical reflection on a project, and the subsequent attempt to capitalize on its strengths and mitigate its weaknesses.
•
The Asia Pacific region will have a simple, practical M&E system in place at the country and regional levels through establishing an integrated national and regional planning and review process that aims to monitor and improve the capacities for managing public health emergencies
Focus Areas
25
26
IMPLEMENTING APSED 2010: Securing the health of future generations
Special consideration under APSED (2010) Gender mainstreaming No disease is gender natural. For this reason, gender is a special consideration in APSED (2010), and it is treated as a cross-cutting theme that affects each of the core focus areas. A major objective of gender analysis for infectious diseases is to identify sex and gender related factors that put women and men at higher or
No disease is gender natural.
lower risk of infectious diseases; an awareness of these issues will enable public health officials to discourage harmful practices and encourage helpful ones. An awareness of the different ways in which men and women are affected by disease is crucial; taking such considerations into account can contribute towards the effectiveness of disease control programmes and the increase likelihood of better outcomes. APSED (2010) calls for the more consistent use of descriptive epidemiology and data disaggregation based on sex and age. Separating data according to sex and age facilitates the process of comprehensive gender analysis, and these findings can then be used to supplement surveillance results. The analysis matrix proposed examines factors such as exposure to pathogens, access to health services, health-seeking behavior, risk perception and communication, and susceptibility. The matrix also considers biological and socio-cultural factors, so as to provide as thorough an analysis as possible. Under APSED (2010) countries are encouraged to conduct such analyses on a regular basis, and to use the results to guide evidence-based public health interventions.
Special consideration for pacific island countries and areas Given the regional diversity Pacific island countries have many shared issues that need to be considered different approaches for different countries and areas at times. Different Island countries are at different stages of development with regard to their capabilities for implementing the IHR (2005) and APSED, necessitating tailored approaches . It is also identified the need to shift from support that is ‘resource-based’ to support that is ‘need-based’ which is driven by the country’s expressed needs. Special consideration under APSED (2010)
27
Some strategic approaches for supporting Pacific are1, 1. Addressing human resource development as a priority. (Distance learning, In-country training and formal educational training focused on public health) 2. Allowing flexibility to adapt regional strategy to meet Pacific Island countries’ needs (Sub regional approaches to share resources such as grouping of countries with similar needs, streamlining surveillance systems/Adoption of standardized syndromic surveillance system etc) 3. Strengthen regional coordination among WHO, SPC and nations with Pacific island countries’ territories (strengthening international laboratory network and improvement of interagency technical consultations)
Confronting the threat of emerging diseases •
APSED (2010) should be used to build upon and maximize the benefits that have already been achieved, and as a platform to reach for new heights.
•
The international community cannot rely on chance when it comes to emerging infectious diseases, and all things considered we are only as strong as our weakest link. Infectious diseases are a matter of global concern, and so we must collaborate in order to tackle the issue.
•
The active engagement of different stakeholders will be crucial to enhance national and regional health security.
Member States have a responsibility to improve internal communication, and to thereby ensure that the various ministries and agencies involved in public health are attuned to the same priorities and goals.
SEARO and WPRO are responsible for supporting countries in their needs, monitoring outbreaks and pandemics from a regional perspective, and to facilitate information-sharing and response coordination between Member States.
WHO Country Offices must support capacity development initiatives and guide progress at the national level, taking care not to distort local health priorities or impose undue external pressure.
The role of donors and partnerships cannot be understated: without sufficient and reliable funding the vision of APSED (2010) cannot materialize. Without partnerships we cannot achieve intended objectives for health securtity
•
Given the expanded scope of IHR (2005), to which all parties are bound, the successful implementation of APSED (2010) becomes even more pressing.
•
APSED (2010) gives structure to the process of capacity-building at country level and regional level, and is an effective roadmap towards meeting regional and global health security.
APSED Technical papers, WHO 2010
28
IMPLEMENTING APSED 2010: Securing the health of future generations