Aicp 065-66-narm


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Aicp 065-66-narm

  1. 1. Avian Influenza Control Project Department of Health Services Dr. Jeetendra Man Shrestha Deputy Coordinator
  2. 2. Risk of Avian Influenza <ul><li>Path of major migratory birds flyways </li></ul><ul><li>3 in every 5 households have poultry </li></ul><ul><li>Mixed farming – poultry mixed with pigs/wild birds </li></ul><ul><li>Poultry free-ranging – contamination of surfaces </li></ul><ul><li>Children as poultry care-taker </li></ul><ul><li>Slaughtering – no protection to butcher or buyer </li></ul><ul><li>Live chicken and unprotected meat </li></ul>
  3. 3.
  4. 4. GOALS Nepal Avian Influenza Control Project -HUMAN HEALTH COMPONENT- <ul><li>To reduce the risk of infection to humans </li></ul><ul><li>To mitigate the health and socio-economic impact of an influenza pandemic </li></ul>
  5. 5. Avian Influenza Control Project COMPONENTS & SUB-COMPONENTS Animal Health Strengthening Disease Surveillance Strengthening Quarantine Services Human Health Upgrading Laboratory Capacity Field Veterinary Services Compensation Fund Social Mobilization and Behavior Change Communication Project Management Strengthening Disease Surveillance and Laboratory Capacity Prevention and Containment Measures Health Care Delivery System Preparedness and Response Project Management
  6. 6. COORDINATION MECHANISMS Nepal Avian Influenza Control Project National Disaster Relief Central Coordination Committee Technical Subcommittee on Avian Influenza Jointly chaired by MOAC+MOHP Secretaries TSCAI secretariat at AHD MOAC Program MOHP Program DOLS Animal Health Component DOHS Human Health Component Communication Working Group Surveillance Working Group AI Coordination Committee Activities to be implemented by MOLD Activities to be implemented by MOHA Compensation Working Group
  7. 7. Surveillance: Objectives <ul><li>Strengthening the existing disease surveillance capacity at the national, regional and district level </li></ul><ul><li>Building an influenza surveillance system on existing structures </li></ul><ul><li>SARI (Pneumonia) Surveillance (IPD-ACD) </li></ul><ul><li>Suspected Outbreak Investigation (ACD) </li></ul><ul><li>- PDSR - Participatory Disease Surveillance & Response </li></ul><ul><li>Implementers: DPHO/DHOs, RHDs, EDCD, WHO/IPD </li></ul><ul><li>Supported by: WHO-CSR, WHO/VPD </li></ul>
  8. 8. Laboratory: Objectives <ul><li>To ensure the necessary laboratory network to the national influenza surveillance system </li></ul><ul><li>Molecular Diagnosis at NPHL </li></ul><ul><li>Orientation to field laboratory technicians on sample collection, storage and dispatch </li></ul><ul><li>To upgrade the NPHL to reach BSLIII </li></ul><ul><li>Implementers: PHCs, DPHO/DHOs, District Hospitals labs, Regional Referral Hospitals and National Referral Hospitals, NPHL </li></ul><ul><li>Supported by: WHO, other partners like WARUN </li></ul>
  9. 9. Prevention and Containment: Objectives <ul><li>To prevent avian and seasonal influenza transmission in high risk groups </li></ul><ul><li>To develop a modern quarantine system in the ports of entry </li></ul><ul><li>To develop a legal and regulatory framework for public health interventions during epidemics. </li></ul><ul><li>Identification of high risk groups </li></ul><ul><li>Stockpiling of PPE, AVs and Vaccine </li></ul><ul><li>Implementers: DPHO/DHO, RHDs, EDCD, AICP </li></ul><ul><li>Supported by: USAID, WHO </li></ul>
  10. 10. Health Care Delivery System Preparedness and Response: Objectives <ul><li>To develop and implement acute respiratory disease triage and referral system. </li></ul><ul><li>To prepare and implement contingency plans at the primary care system </li></ul><ul><li>Develop Triage and Referral System </li></ul><ul><li>Management of the cases </li></ul><ul><li>Implement Infection Control </li></ul><ul><li>Implementers: PHCs, District, Regional & National Referral Hospitals </li></ul><ul><li>Supported by: Curative Division, MOHP; Management Division, DHS </li></ul>
  11. 11. Program Management: Monitoring and Evaluation <ul><li>Monitoring </li></ul><ul><ul><ul><li>Build on existing recording and reporting system. </li></ul></ul></ul><ul><ul><ul><li>Specific separate indicators at each level </li></ul></ul></ul><ul><ul><ul><li>Each Line Ministry report to AITSC </li></ul></ul></ul><ul><ul><ul><li>Feed back by AITSC ensures two way flow of information and accountability </li></ul></ul></ul><ul><li>Evaluation </li></ul><ul><ul><ul><li>Midterm (2yrs) and final at the end of the project </li></ul></ul></ul>
  12. 12. Common Communication Strategy <ul><li>Advocacy : </li></ul><ul><li>To gain political and social commitment to address AI </li></ul><ul><li>Social Mobilization: </li></ul><ul><li>To build inter-sectoral alliances and participation in the delivery of BCC messages at the household level </li></ul><ul><li>Behavior Change Communication (BCC): </li></ul><ul><li>To design and deliver targeted communication and training materials to initiate behavior change to each of the defined target groups </li></ul><ul><li>Implementer: </li></ul><ul><li>National focal Point: NHEICC for NAICC (AH and HH) </li></ul><ul><li>UNICEF on cross cutting issues </li></ul>
  13. 13. Achievement during FY 2065/66
  14. 14. Policy Updates <ul><li>Preparedness mode switched to Emergency mode after the introduction of HPAI & PI into the country. </li></ul><ul><li>Zonal Hospitals in the border district and the Poultry hub - primary isolation facility and do primary case management. </li></ul><ul><li>New site in the existing NPHL’s building for the establishment of BSL-III facility </li></ul><ul><li>The technical specification for proposed BSL-III laboratory facility is prepared by WHO Consultant and Experts. </li></ul>
  15. 15. Surveillance and Laboratory <ul><li>The medical team (HRRT) mobilization during AI outbreaks in Jhapa </li></ul><ul><li>The PCR diagnosis from the suspected human case/s of Avian influenza will be carried out by NPHL in collobration with WARUN. For A(H1N1) through CDC and WHO </li></ul><ul><li>House to House Surveillance in the epicenter (ward No. 10, Mechi NP) and Saranamati VDC; passive surveillance around the affected area. </li></ul>
  16. 16. Prevention and Containment <ul><li>Provision of 5000 doses of trivalent seasonal vaccines to the health workers </li></ul><ul><li>16000 tablets of Tamiflu and 100 bottles of Tamiflu suspension for the culling team and suspected human case/s of AI </li></ul><ul><li>Antimicrobial, antipyretic, Antitussive, disinfectant, pumps and PPE </li></ul>
  17. 17. Health Care Delivery System Preparedness and Response <ul><li>An isolation room with 2 sets of ventilator and pulse oxymeter at BPKIHS. </li></ul><ul><li>An isolation room with a set of ventilator, mobile x-ray machine and pulse oxymeter at Mechi, Seti and Bheri Zonal Hospital. </li></ul><ul><li>2 sets of ventilator, pulse oxymeter, IBP+NIBP monitors, a mobile x-ray machine, portable dialysis machine, syringe pump, suction pump, four ICU beds and 10 Fowler beds, small equipment and consumables at TUTH </li></ul><ul><li>An Isolation Room at Amda Hospital </li></ul><ul><li>5 Isolation rooms at STIDH </li></ul>
  18. 18. Others <ul><li>Partnership with CDC, Atlanta in order to strengthen surveillance of ILI in collaboration with Patan Academy of Health Sciences including other public and private hospitals </li></ul><ul><li>Partnership with H2P Project - CARE, NRCS, SCF and AED (AI.COMM) with the objective of Pandemic Preparedness (Non-pharmaceutical intervention) at the district and community level. </li></ul><ul><li>Integrated HH+AH Outbreak Preparedness and Response Centre at the regional level </li></ul>
  19. 19. Communication <ul><li>HE Messages from National Daily newspapers. </li></ul><ul><li>HE Messages production and aired through TV and radio. </li></ul><ul><li>Regular briefing to the Media personnel </li></ul><ul><li>Awareness in affected area through miking. </li></ul><ul><li>Different types of HE Messages (During low/high risk and after introduction of disease) prepared disseminated jointly by HH, AH and UNICEF. </li></ul><ul><li>A joint press release by DOHS and WHO. </li></ul><ul><li>A joint press release by MOHP and MOAC. </li></ul>
  20. 20. Pandemic Influenza A(H1N1)2009
  21. 21. Chronology of Events <ul><li>25 April - EC decided situation constitutes Public Health Emergency of International Concern </li></ul><ul><li>28 May - EC recommended Director General to declare Phase 4 </li></ul><ul><li>29 May - EC recommended DG (WHO) to raise to Phase 5 </li></ul><ul><li>11 June - EC recommended DG (WHO) to raise to Phase 6 </li></ul><ul><li>Surveillance- Case definitions adapted and shared </li></ul><ul><ul><li>Suspected/probable/confirmed </li></ul></ul><ul><ul><li>Reporting frequency and channel </li></ul></ul><ul><li>Monitoring - daily video/teleconferences- HQ/ROs </li></ul>
  22. 22. Situation of A (H1N1)2009 in Nepal <ul><li>Popularly known as “Swine Flu” </li></ul><ul><li>Introduction of Disease to the country was declared on 15 Ashad 2066 </li></ul><ul><li>Total number of confirmed cases: 63 </li></ul><ul><li>Nepalese Citizen: 29 ( Residing/working abroad) </li></ul><ul><li>Foreigner: 2 </li></ul><ul><li>Close Contact Transmission: 5 </li></ul><ul><li>Community Transmission: 27 (15 Oct onwards) </li></ul>
  23. 23. Surveillance <ul><li>Case definition </li></ul><ul><ul><li>75 RRTs, 40 Sentinel Hospitals, 80 WHO/VPD sites </li></ul></ul><ul><li>Laboratory diagnosis: RT-PCR (NPHL) </li></ul><ul><li>Coordination with WHO Collaborating Center </li></ul><ul><li>11 points of entry – 1 TIA, 10 land crossings </li></ul><ul><li>Health care facilities: </li></ul><ul><ul><li>All zonal + Amda – Primary referral facilities. </li></ul></ul><ul><ul><li>BPKIHS, NSRH, LZH, BHZH and SEZH – Secondary </li></ul></ul><ul><ul><li>Central- STIDH, TUTH, PAHS – Tertiary </li></ul></ul>
  24. 24. CRITERIA FOR SAMPLE TESTING <ul><li>Any person matching the case definition + </li></ul><ul><ul><li>develop shortness of breath or </li></ul></ul><ul><ul><li>required hospital admission. </li></ul></ul><ul><li>In case of community outbreak or cluster of cases, samples are collected by random sampling. </li></ul><ul><li>Confirming infection in new geographical areas or communities </li></ul>
  25. 25. Criteria for Hospitalization <ul><li>Signs of severe illness </li></ul><ul><ul><li>Shortness of breath, difficulty breathing, weakness/unable to stand, unconsciousness, convulsions, inability to drink fluids and dehydration, high fever. </li></ul></ul><ul><ul><li>If you are pregnant (especially in the 2 nd and 3 rd trimester) and become ill with fever, cough and/or sore throat, visit the health facility. </li></ul></ul>
  26. 26. Criteria for administrating antiviral <ul><li>Seriously ill  </li></ul><ul><li>Fever goes away; comes back after 2-3 days  </li></ul><ul><li>Underlying condition such as </li></ul><ul><ul><li>asthma, COPD, cardiac disease, diabetes mellitus; chronic renal diseases; immunosuppressant (cancers, HIV/AIDS infection, drugs) </li></ul></ul><ul><li>Should visit health facility for advice on antiviral medications: </li></ul><ul><ul><li>Above 60 years of age </li></ul></ul><ul><ul><li>has an ill child under 5 years old   </li></ul></ul>
  27. 27. <ul><li>Antivirals – 36,000 courses </li></ul><ul><li>200 courses at each Referral/zonal hospitals and above </li></ul><ul><li>Antibiotics and other medical supplies – 35,000 courses </li></ul><ul><li>Disposable masks – 100,000 </li></ul><ul><li>Surgical gloves – 20,000 </li></ul><ul><li>N95 Respirators - 3000 </li></ul><ul><li>Disinfectants </li></ul><ul><li>Soaps </li></ul>Stock-piling
  28. 28. <ul><li>Cover Coughs and Sneezes (with elbow/tissue/cloth/mask) </li></ul><ul><li>Wash Your Hands (frequently, in the recommended manner) </li></ul><ul><li>Keep Your Distance (stay at least 1 meter away from others who are coughing or sneezing) </li></ul><ul><li>Separate Sick People (keep them away from others) </li></ul><ul><li>Avoid crowds </li></ul><ul><li>No trade and travel restriction </li></ul>Communication
  29. 29. Dos and Don’ts
  30. 30. Communication <ul><li>TV spots </li></ul><ul><li>Radio Spots </li></ul><ul><li>FM radio spots </li></ul><ul><li>Leaflets </li></ul><ul><li>Posters </li></ul><ul><li>Flex Chart </li></ul><ul><li>Pamphlets </li></ul><ul><li>Banner (under preparation) </li></ul><ul><li>Hoarding Board (under preparation) </li></ul><ul><li>NPI training guide for trainer </li></ul><ul><li>NPI handbook for HCW </li></ul><ul><li>NPI handbook for volunteer </li></ul>
  31. 31. Last 3 Years’ Performance/Indicators During 2006-07, the approved programme was there but no transfer of funds, only remaining balance NRs.799,000 in the special account (ADB) was spent Programme Name FY 2006-07 FY 2007-08 FY 2008-09 Surveillance and Laboratory Strengthening AICP was launched on 5 May 2007, so the FY 2007-08 is regarded as the first year of the programme 50% of sentinel sites submit reports timely >80% of sentinel sites submit reports on time - QC tests couldn’t be done at NPHL. Prevention and Containment 4500 sets of PPE, 1000 antiviral (30% of the targeted high risk) 6000 sets of PPE, 5000 seasonal Flu vaccine, 38,000 course antiviral (>100% of the targeted high risk) - Quarantine check posts (Health Desk) at TIA and 10 land crossing points
  32. 32. Last 3 Years’ Performance/Indicators Programme Name FY 2006-07 FY 2007-08 FY 2008-09 Health Care Delivery System Preparedness and Response AICP was launched on 5 May 2007, so the FY 2007-08 is regarded as the first year of the programme 30% of HCWs (RRTs) at public HCF have adequate knowledge on HPAI 50% of HCWs (RRTs) at public HCF have adequate knowledge on HPAI - 1 primary, 5 Regional and 1 National referral hospitals are equipped Program Management Timely Conduct of Planned activities (50%) Timely conduct of planned activities (achieved 50% instead of 70%)
  33. 33. Last 3 Years’ Performance/Indicators Programme Name FY 2006-07 FY 2007-08 FY 2008-09 Communication Comprehensive Communication program launched Comprehensive Communication program launched High level (50%) awareness of Program message High level (70%) awareness of Program message
  34. 34. This Years’ Performance/Indicators Sub-Components Output Indicators Targeted FY 2065/66 (2008/2009) Annual Output Cumulative Output 1 Surveillance and Laboratory Strengthening Reporting by sentinel surveillance sites (Immediate, Weekly, Monthly) 80% 86% Consistency of laboratory results to WHO Reference laboratory 90% 100% 2 Prevention and Containment Seasonal Influenza vaccine for high risk occupational groups 90% 90% PPE and antiviral for high risk occupational groups 100% 100% Quarantine facilites functional at TIA and border entry points 1/5 1/10 (Temporary)
  35. 35. Overall Physical Progress: 84% Overall Financial Progress: 82% Sub-Components Output Indicators Targeted FY 2065/66 (2008/2009) Annual Output Cumulative Output 3 Health Care Delivery System Preparedness and Response Adequate knowledge of HAI among public health care workers 50% 50% District PHOs have Influenza epidemic prepaedness and reponse plan 50% 0% Establishment of a national referral hospital feasibility study at STIDH 0% 4 Program Management Timely implementation of procurement (% not beyond 1 month) 80% 30% Submission of project reports every four month to TSCAI 100% 66% 5 Communication Component (Human Health) Comprehensive Communication Program launched yes yes Target group population showing high level of awareness (survey) 60% 70%
  36. 36. Last 3 Years’ Budget and Expenditure Amount in ‘000 Programme Name FY 2006-07 FY 2007-08 FY 2008-09 NRs. NRs. NRs. Surveillance and Laboratory Strengthening Budget AICP was launched on 5 May 2007, so the FY 2007-08 is regarded as the first year of the programme 155,403 84,560 Exp. 50,108 75,476 Exp. % 32% 89% Prevention and Containment Budget 32,696 34,036 Exp. 229 20,410 Exp. % 1% 60% Health Care Delivery System Preparedness and Response Budget 56,764 53,661 Exp. 20,547 49,100 Exp. % 36% 91%
  37. 37. Last 3 Years’ Budget and Expenditure Amount in ‘000 Programme Name FY 2006-07 FY 2007-08 FY 2008-09 NRs. NRs. NRs. Program Management Budget AICP was launched on 5 May 2007, so the FY 2007-08 is regarded as the first year of the programme 11,804 25,298 Exp. 7,338 11,884 Exp. % 62% 47% Communication Budget 22,503 13,063 Exp. 17,174 14,802 Exp. % 76% 113% Overall Exp% 35% 82% * Direct Payment to WHO and Custom and duties of the vehicles are included ** Annual Budget was reduced by NRs. 50 M to NRs. 210.618 M by the decision of MoF
  38. 38. Problems/Issues/Challenges <ul><li>No leadership at the Project since Ashad 2066 </li></ul><ul><li>BSL-III laboratory establishment – WB cancelled funding </li></ul><ul><li>Hospitals – Not admitting the patients if suspected H1N1 </li></ul><ul><li>Lab. Diagnosis – demanded </li></ul><ul><li>Health care absorption capacity is low </li></ul><ul><ul><li>16,000 non-obstetric beds in 84 Public hospitals </li></ul></ul><ul><ul><li>4015 peripheral health facilities with HA or AHWs </li></ul></ul><ul><li>Advocacy for Political Commitment </li></ul><ul><li>Coordination Among different Stakeholders </li></ul><ul><li>Establishment of timely and effective coordination and communication mechanism </li></ul>
  39. 39. Problems/Issues/Challenges <ul><li>Contingency Plan – being prepared </li></ul><ul><li>Case Management Module at Community </li></ul><ul><li>Quarantine check points – possibility? </li></ul><ul><li>Risk Assessment on the introduction of AI </li></ul><ul><li>Development of Risk Communication Strategy based on local situation </li></ul><ul><li>Mobilization of social workers/Volunteers </li></ul><ul><li>Social Research </li></ul>
  40. 40. Problems/Issues/Challenges Issues Reset Target Original Target Surveillance Core Capacities at all levels 2011 IHR-2012 Establishment of BSL-III Laboratory 2011 2010 Establishment of Border Health Check Posts 2009 2009 Regional Referral Hospital Strengthening (Initial facility upgrading has been accomplished) 2009 2009 Additional referral hospital at the Poultry Hub (Bharatpur Hospital, Kanti Children etc.) 2009 2009 Assessment and cost estimation for the strengthening of Central Referral Hospital (Sukraraj Infectious and Tropical Disease Hospital) 2009 2009
  41. 41. Thank You