A power point prepared on public health emergency management with regard to Ethiopian public health emergency management protocol.

1. Adama Hospital Medical College
Department of Public Health
Basic Epidemiology
Introduction to Public Health Emergency
management
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2. Group members
• Dr. Yared Adane
• Mohammed Amin
• Meaza Desalegn
• Legesse Niguse
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3. Out line
• Introduction
• Goal and objective of PHEM
• Mandate of PHEM
• Principle of PHEM
• PHEM phase
 Early warning
 Preparedness
 Response
 Recovery
• Priority disease
• Surveillance
• Communication
• Reporting
• Linkage with other process
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4. Abbreviations
• PHEM – Public health emergency management
• IDSR – Integrated disease surveillance & response
• IDS – Integrated disease surveillance
• EOC – Emergency operation center
• PPE – personal protective equipment
• HEW – health extension worker
• NNT – neonatal tetanus
• IHR – international health regulation
• DRM – disaster risk management
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5. What does PHEM mean?
• PHEM is the process of anticipating, preventing,
preparing for, detecting, responding to and recovering
from consequences of Public Health threats in order
that health and economic impacts are minimized.
• The process is fully integrated, adaptable, all hazards
and all health approach national preparedness and
response.
• This core process is comprised of four sub processes
which are: public health emergency preparedness,
Early warning, Response and Recovery.
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6. PHEM sub processes
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7. Cont.
• Every public health emergency management
processes have a starting and ending point.
• The process starts with early warning and ends with
recovery.
• However, in real situations the steps move forwards
and backwards.
• Each step repeats itself based on health risks
identified.
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8. IDSR Vs. PHEM
IDSR
• Mainly focus on Epidemic
disease
• Surveillance data comes
monthly
• Smallest reporting unit is
Health Center
• Week early warning system
• Delayed response
• No recovery
• No event based surveillance
• Include only some DRM
Component
PHEM
• Multi hazard approach
• Surveillance data comes
weekly
• Smallest reporting unit is
Health post
• Robust early warning system
• Prompt response
• Recovery activities included
• Event based surveillance
• Includes all DRM components
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9. Goal & objectives
• To markedly reduce mortality and morbidity due to
epidemics and other Public Health Emergencies and
minimize associated social and economic crisis
• To prepare, early detection, and contain epidemics
locally; respond timely to other public health
emergencies and recover quickly from their impacts.
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10. Mandate of PHEM
• Identify, assess and monitor existing or potential threats
to the public health.
• Coordinate and ensure the formulation of preparedness
plans for all types of public health emergencies at
national, regional or woreda levels.
• Strengthen the Public health emergency management
capacity of the human resources of the health sector
through direct training and coordination / assistance to
efforts to be undertaken by the Academic Institutions,
other departments of the MOH or other health actors.
• Issue alerts and warning to the general public regarding
potential public health emergencies or disasters.
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11. Cont.
• Maintain and administer a stockpile of supplies and
equipment required for rapid response to public health
emergencies.
• Ensure that Ethiopia meets its international health
security obligations in particular those under the
International Health Regulations adopted in 2005.
• Mobilize the government health resources to respond
rapidly and effectively to the health consequences.
• Coordinate and supervise the response of the Zonal and
woreda Health offices in all emergencies with potential
public health impact outside their respective area of
responsibility.
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12. Cont.
• Issue bulletins and release information on the health
situation, priorities and needs in all public health
emergencies.
• Issue technical guidelines and coordinate the
humanitarian health assistance provided by partners.
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13. The major public health risk identified
in Ethiopian health system
• Epidemics of communicable disease
• Drought with malnutrition
• Food contamination
• Flood
• Pandemic Influenza
• Conflict and displaced populations
• Accidents including chemical spills
• Earthquake, volcano
• Bioterrorism
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14. Principles of PHEM
 Comprehensive – take into account all hazards, all
phases, all stakeholders and all impacts relevant to
public health problems.
 Progressive – anticipate future public health problem
and take preventive and preparatory measures to reduce
risk.
 Risk-driven – use sound risk management principles
(hazard identification, risk analysis, and impact
analysis) in assigning priorities and resources.
 Integrated – emergency managers ensure unity of effort
among all levels of government and all elements of a
community.
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15. Cont.
 Collaborative – create good relationships among
individuals and organizations to encourage trust, advocate
a team atmosphere, build consensus, and facilitate
communication
 Coordinated – all relevant stakeholders should be
involved to achieve a common purpose
 Flexible – emergency managers use creative and
innovative approaches in solving disaster challenge
 Professional – PHEM activities should be knowledge-
based approach
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16. PHEM phases and its processes
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17. What is early warning
• The identification of a public health threat by closely
and frequently monitoring identified indicators and
predicting the risk it poses on the health of the Public
and the health system.
• The purpose of early warning is to enable the
provision of timely and effective information to the
public and to responders, through identified
institutions that allow preparing for effective response
or taking action to avoid or reduce risk.
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18. Major indicators of early warning
• Increased in number of cases beyond expected /occurrence of out breaks
• Unexplained morbidity and mortality
• Evidence of increase in zoonotic diseases and/or related vectors
• Environmental changes such as air pollution
• Water quality changes contamination
• Drought, flood, severe weather (metrological information)
• Agricultural events such as reduced harvest, occurrence of pests
• Refugees, internally displaced people, disruption of health services and
infrastructure
• Important industrial accidents; chemical spills etc.
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19. Components of early warning
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20. Public health emergency preparedness
• Preparedness focuses on preparing equipment and
procedures for use when a disaster occurs.
• The equipment and procedures can be used to reduce
vulnerability to disaster, to mitigate the impacts of a
disaster, or to respond more efficiently in an
emergency.
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21. Cont.
• Coordination and collaboration
• Vulnerability assessment and risk analysis
• Planning & resource mobilization
• Exercise/drill – test the plan regularly
• Capacity building - System and Human
• Stockpile system –Drugs, Vaccines, PPE…
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22. Public health emergency response
• The response phase of an emergency focuses on rapid
assessment of outbreaks, outbreak investigations,
implementing control and prevention measures and
monitoring of the interventions.
• Rapid response limits the number of cases and
geographical spread, shortens the duration of the
outbreak and reduces fatalities.
• These benefits save resources and also reduce the
associated morbidity & mortality.
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23. Cont.
• Rapid assessment/outbreak investigation
 Epidemiological
 Laboratory (Field investigation, reference and atypical
testing)
 Environmental
• Control, preventive and supportive measures
• Isolation and quarantine
• Case management
• Mass vaccination
• Monitoring of drug sensitivity
• Environmental management
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24. Public health emergency response
 Emergency operation Center:
 The EOC is the physical location at which the
coordination of information and resource to support
incident management (on-scene operations) activities
normally takes place.
• Equipped with trained staff and state of the art
communication and IT at the central level
• Horizon scanning – e-mail, web based, News
• Hotline – health personnel and to the public
• Activation and deactivation process
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25. Emergency operation Center
Activated
• When an emergency is
imminent
• When threshold events
described in the emergency
operation plan occurs
• When there is predictions of
hazardous weather, elevated
threat level occurs etc.
Deactivated
• When there is no need of
additional resources
• The epidemic / emergency is
stabilized
• The response objectives are
met
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26. Recovery
• Recovery is defined as the process of rebuilding,
restoring, and rehabilitating the community
following an emergency, but it is more than
simply the replacement of what has been
destroyed and the rehabilitation of those affected.
• It is a complex social and developmental process
rather than just a remedial process.
• Recovery is best achieved when the affected
community is able to exercise a high degree of
self determination.
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27. Cont.
• Impact assessment
• Monitoring and evaluation
• Rehabilitation
• Restoration of the health system
 Infrastructure
 Supplies
 Health Personnel
• Liaison with multi sectorial committee
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28. List of diseases / condition under
surveillance in Ethiopia
1. Acute Flaccid Paralysis
2. Anthrax
3. Avian Human Influenza
4. Cholera
5. Dracunculiasis/ Guinea warm
6. Measles
7. Neonatal tetanus
8. Pandemic Influenza A(H1N1)
9. Rabies
10. Small pox
11. SARS
12. Viral Hemorrhagic Fever(VHF)
13. Yellow Fever
14. Maternal death
15. Perinatal Death
Immediately notifiable Weekly reportable
1. Dysentery
2. Malaria
3. Meningitis
4. Relapsing
5. Typhoid Fever
6. Typhus
7. Severe Acute
Malnutrition
8. Scabies
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29. Priority disease & prioritization criteria
• High epidemic potential (anthrax, avian human
influenza, cholera, measles, meningococcal
meningitis, pandemic influenza, smallpox, severe
acute respiratory syndrome (SARS), viral
hemorrhagic fever (VHF), and yellow fever)
• Required internationally under IHR 2005 (smallpox,
poliomyelitis due to wild-type poliovirus, human
influenza caused by a new subtype, SARS)
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30. Priority disease & prioritization criteria
• Targeted for eradication or elimination (poliomyelitis,
Dracunculiasis, NNT
• Have a significant public health importance (rabies,
dysentery, malaria, RF, typhoid fever, typhus and
SAM
• Diseases that have available effective control and
prevention measures for addressing the public health
problem they pose.
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31. Threshold for outbreak
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32. Cont.
Reportable disease Number of cases
Measles 5 suspected cases or 3 confirmed cases
malaria Crossing the norm line or doubling of cases compared to the same week
of the previous year
Meningitis 5/<30,000 population or 10/10000 population
Dysentery Unusual increases of cases or doubling of cases on subsequent weeks
Typhoid fever Unusual increases of cases or doubling of cases on subsequent weeks
Typhus Unusual increases of cases or doubling of cases on subsequent weeks
Relapsing fever Unusual increases of cases or doubling of cases on subsequent weeks
scabies
SAM To be determined locally at kebele level
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33. Case definition
• A case definition: is a set of criteria used to decide if
a person has a particular disease, or if the case can be
considered for reporting and investigation
• Standard case definition: is a case definition that is
agreed upon to be used by everyone within the
country.
• Standard case definition can be classified as
confirmed, probable, and possible or suspected
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34. Surveillance
• Surveillance – It is surveillance derived from two
French words “ Sur”(watch or look) and “veller”
(Over).
• Surveillance is the ongoing systematic collection,
analysis, and interpretation of health and health
related data.
• Surveillance is information for action.
• It is the main activities of PHEM.
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35. Types of surveillance
• Based on intervention
A. Active Surveillance
B. Passive Surveillance
C. Sentinel Surveillance
• Based on location
A. Community based Surveillance
B. Facility based Surveillance
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36. Communicate information
• Communicate with the public in ways that build,
maintain or restore trust, and encourage participate in
the early warning activities.
• Routinely translate scientific and health information
for communities and policy makers.
• Risk communication: activities for sharing
information and ideas about risks and actions to deal
with real and potential dangers that could lead to an
indiscriminate demand that is impossible to meet.
• Communicate information to other stake holders that
may help you to achieve objectives
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37. Cont.
• Alert/warning
• Provision of feedback (written / oral)
• Reinforce efforts of the health staff to participate in
the surveillance system.
• Raise awareness about certain diseases and any
achievements of disease control and prevention
activities in the area.
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38. Reporting tools
• Weekly reporting format for health post / HEW
• Weekly reporting format for other levels
• Daily epidemic reporting format for Woreda(DERF-
W)
• Daily epidemic reporting format for Region(DERF-
R)
• Integrated case based reporting format
• Case based reporting format (CRF) for many diseases
• Line list
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39. Cont.
• Rumor log book
• Case based laboratory reporting form (CLRF)
• Maternal death identification and notification
• Verbal autopsy
• Maternal death reporting format (MDRF)
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40. Surveillance flow chart
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41. Time line for immediately notifiable
disease or conditions
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42. Time line for weekly reportable
diseases / conditions
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43. Surveillance data reporting methods
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44. Surveillance data analysis &
interpretation
• Provides key information for taking prompt
public health actions.
• Should be done daily and weekly at each level
where data are collected (starting from health
facility level to national level).
• Major steps
 Creating database or filed paper data
 Data cleaning
 Check completeness
 Data analyzing and interpretation
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45. Cont.
• Simple data analysis is done to find information
Related to person, place, and time.
Trends over time(line graph, bar graph or
histogram)
Geographic distribution of the disease or the
outbreak (dot map)
Frequency of cases, deaths (table)
Case fatality rate (CFR)
Attack rate (AR)
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46. Cont.
• An action threshold triggers a definite response
• Possible actions include
 Communicating laboratory confirmation results to
concerned health centers,
 Implementing an emergency response such as
immunization, community awareness campaign, or
improved infection control practices in the health care
setting etc.
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47. Linkage with other process
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48. References
• National public health emergency guideline,
February, 2012
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49. Thank you!
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