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Business Continuity Plan (BCP) for Emergencies like Ebola Virus Diseases for Health sectors

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Business Continuity Plan (BCP) for Emergencies like Ebola Virus Diseases for Health Sectors (public health agency)

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Business Continuity Plan (BCP) for Emergencies like Ebola Virus Diseases for Health sectors

  1. 1. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 1 | Preparedness Ebola Virus Outbreak Business Continuity Plan (BCP) Generic Presentation Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA Public Health Specialist Disclaimer: This presentation is developed with a view of advocating a need of development of Business Continuity Plan (BCP) as part of preparedness or readiness/response plan for emergencies like Ebola Virus Diseases or any other emergencies, where the response may have to compromise the essential and critical functions.
  2. 2. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 2 | Outline  Difference between Contingency Plan and Business Continuity Plan (BCP)  Impacts of Ebola (socio-economic and others)  Potential impacts on health and non –health sectors  Rationale for BCP  Planning assumptions  BCP Planning and Steps  Lack of Preparedness: Example
  3. 3. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 3 | Difference between CP and BCP BCP is part of CP A Contingency Plan Protects life safety in the event of an incident and is geographically based, meaning that your office’s plan should be specific to its location. In other words, what will you do in case of an immediate emergency- where will you go, what should go with you, how will you account for everyone, etc. A Business Continuity Plan Protects the job that you do, and should outline how you will continue do essential tasks in the event of an incident that may affect operations. For example, how will you provide the immunization if there health care workers are sick? Or how will you do your job if you can’t use your office space for a week
  4. 4. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 4 | Socio-Economic Impact EVD outbreak
  5. 5. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 5 | Potential Impact on Ebola Outbreak  Projections show a possible $32.6 billion loss to West Africa over the next two years (only in West Africa) – source: WB  Deaths, absenteeism and attempts to avoid infection have consequences for supply and demand side of economy – Markets close, utilities unreliable, telecoms break, cash in short supply – Mining and production reduces  Threats to Rule of Law and Security (recently established peace after decade long conflict
  6. 6. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 6 | Potential Impacts on Health Sectors Deaths/ Illnesses Quarantine Care Fear Absenteeism Decreased Supply Reduced Services Disrupted transportation and services Cross Sectoral Activities Increased Demand Care of Ebola/Fever Water & Sanitation Communication Banking services Mortuary & Burial Electricity/Power Routine Health Care Security Logistics Breakdown of Health Services  Changed Demands  Lack of BCP Potential Impacts on Health Sectors
  7. 7. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 7 | Potential Impacts on Non-Health Sectors Deaths/ Illnesses Quarantine Care Fear Absenteeism Decreased Supply Reduced production Disrupted transportation Trade of commodities Cross sectoral interdependencies Increased Demand Logistic support Water & Sanitation Communication Banking services Mortuary & Burial Electricity/Power Health Care Security Breakdown of Services Economic and Social Disruption  Changed Demands  Lack of BCP Decreased Demand Retail Trade Transportation Leisure Travel Gastronomy
  8. 8. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 8 | Other Risk and Impact Livelihoods Human Health Governance & Security Social & Humanitarian Needs Economic Systems • Food and income loss from loss of mining and production and other source of incomes • High illness & potentially higher death rates • Overstretched health facilities • Disproportionate impact on vulnerable • Increased demand for governance & security • Higher public anxiety • Reduced capacity due to fear, illness & death • Deterioration of coping & support mechanisms • Interruption in public services • Quarantine policies • Trade & commerce disruptions • Degraded labour force • Interruption of regular supply systems Categories of Risk
  9. 9. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 9 | Rationale for BCP  During emergencies our health system will be overwhelmed and challenged by various factors: – Demand of Outbreak Response is High • 30% of required ETC beds are only available (1188 available vs requirement 4167) • INSERT: Number of health Care required for the effective response – Absenteeism • More than 600 health care workers are affected • More than half of them died • Sickness of Health Care workers • Fear Factors (we don’t know the exact number)
  10. 10. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 10 | Rationale for BCP – Absenteeism e.g. Liberia  46 percent of those working at the start of the Ebola crisis are no longer working as of early November 2014  Self-employed and wage workers have been the hardest hit, while agriculture is beginning to see returns to work as the harvest approaches  Food insecurity is worsening, especially for the poorest, due to rising rice prices, falling incomes, and transportation restrictions Source: World Bank Group: The Socio-Economic Impacts of Ebola in Liberia
  11. 11. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 11 | Rationale for BCP…Contd  During emergencies our health system will be overwhelmed and challenged by various factors: – Other requirements • Safe burial team and trained manpower in place • Logistic Demands for the outbreak response  To over come the demands of response – Other sectors will be compromised by mobilizing • Health Care workforce • Logistics • Facilities • Finance (Money)
  12. 12. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 12 | Rationale for BCP…Contd  During emergencies our health system has to operate other essential functions in absence of that for instance may lead to following situation – immunization rates have been dropping with loss of health care workers and reluctance of the population to visit health facilities. – The long planned measles campaign in one of the country has been postponed until after the Ebola epidemic is over. – Some evidence has shown collapse of routine health care as both patients and providers have avoided clinics for fear of infection. – It has also highlighted that the malaria control effort has been impacted and likely to linger long after the outbreak ends. – Achievements so far made (malaria deaths have fallen by about 30% in African countries since 2000) are at stake in these countries.
  13. 13. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 13 | Rationale for BCP…Contd  During emergencies our health system has to operate other essential functions in absence of that for instance may lead to following situation – Locally endemic disease surveillance and laboratory confirmation have been challenged and case reporting is already going down. – Similar situation prevails in the area of maternal health services, where pregnant women cannot get assistance delivering babies. In some places due to ignorance, some of the pregnant mothers are visiting Ebola treatment center with a view of receiving better services. – Patients who need lifesaving emergency surgeries like appendectomy, C- sections and others are at risk due to limitation of surgical capacity as well as the risk of being turned away if they have signs of vomiting or fever.
  14. 14. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 14 | Rationale for BCP…Cont  In absence of BCP may lead to: – Disruption of essential services like immunization, maternal and child health care; – Disruption of control of locally endemic diseases and other emergency care and services.  Inability to provide these services not only impacts health of people but also impact on overall development of the country, – Can compromise achievements made for MDGs; – Other goals of sustainable development and – Put these countries at stake, where peace has established after decade long conflict and this kind of situation may lead to newer form or revival of the conflict.
  15. 15. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 15 | Plan and Planning  Plans alone are nothing; planning is everything.  Vital element is to involve stakeholders in the planning process and identify their roles and responsibilities
  16. 16. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 16 | Planning assumptions  EVD outbreak can overwhelm the health services  Health Care Workers’ Absenteeism due to one of the four causes  Saving life, reducing morbidity and mortality and decreasing impact on socio-economy are high priorities.  Maintaining critical and essential services during EVD outbreak is a priority  Adequate training is delivered and is made aware of its existence and their and responsibilities during outbreak.  During outbreak, health care workers are considered essential staff and can be mobilized to EVD response and to other essential services.  Sharing the resources between departments, hospitals, and other partners are essential on the success of responding the EVD outbreak.
  17. 17. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 17 | Core Business Continuity Actions  Identify the critical functions  Identify the personnel, supplies and equipment vital to maintain essential functions  Consider how to deal with the anticipated level of staff absenteeism  Provide clear command structures, delegations of authority and orders of succession  Stockpile strategic reserves of supplies and equipment  Determine the ability of the organisation to continue operations if critical infrastructure services and/or supplies become unavailable
  18. 18. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 18 | Core Business Continuity Actions….Contd  Agree on a system of communication with staff, partners, HQs, suppliers and customers  Identify units/departments that could be downsized or closed to reallocate resources  Assign and train alternates for critical posts  Plan for security risks to operations and supply chains  Consider alternative methods of working, e.g. changes to shift patterns, working from home  Consider the implications of travel restrictions and develop procedures to follow if such restrictions are imposed
  19. 19. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 19 | Core Business Continuity Actions CONTD  Train staff on infection control and communicate essential safety messages  Consider ways of reducing social mixing (e.g. working from home, reducing meetings and travel) and test these in advance  Consider the need for family and childcare support for essential workers  Consider the need for psychosocial support services to help staff remain effective  Consider and plan for the recovery phase
  20. 20. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 20 | Business Continuity Planning (Organizations, facilities, departments) Step 2 Business Impact Analysis (Identifying Essential Services/Functions) Step 1 Governance and Leadership and establishment of BCP Committee Step 3 Identifying required skills sets and staff allocation and reallocation. Step 4 Step 5 Documentation for each Essential Service/Function Step 6 Compare to the “preparedness checklist” Maintain essential services Business Continuity Identifying relevant issues and/or Implications for Implementation Step 7 Review,Test the Plan and Revise
  21. 21. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 21 | Step 1: Governance and Leadership Establishment of BCP Committee  Public Health Agency/institute’ senior management team is responsible for overseeing BCP process. – Having policy by determining how the agency/institute will manage and control EVD outbreak and its risk – Resourcing qualified personals and sufficient resources to apply BCP. – Ensure the BCP is tested and reviewed; staff are trained and are aware of their roles and responsibilities. – Monitor and evaluate the application of BCP and make adjustment accordingly
  22. 22. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 22 | Step 2: Business Impact Analysis (Identifying Essential Services/Functions)  Business Impact Analysis: The process lead on identifying and prioritization of essential functions.  Essential Services is defined as follows: – A service and/or function that when not delivered creates an impact on the health and safety of individuals. – A service and/or function that may lead to the failure of a business unit if activities are not performed in a specified time period.
  23. 23. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 23 | Step 3: Identify Required Skill Sets and Staff Allocation  Identify the number of staff (by classification) required to maintain the essential services/functions. Include essential services/functions created or increased by the “surge activity”.  Mapping of Human Resource Capacity of the agency/institute.  Identify any special requirements necessary to perform the essential services/functions.
  24. 24. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 24 | Step 4: Identify any Relevant Issues and Implications for Implementation  Recognizing vital issues and implications that may have consequences in any essential service reduction, modification, and/or elimination is an important procedure.  Each should be discussed and any relevant comments/solution should be documented.  It is recommended that part of this process include documentation and a planned response for each essential service/function. – Activation of Plan – Planning – Policies and Procedures – Surveillance and Attendance – Delivery of Services – Human Resources – Communications – Testing of Plan
  25. 25. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 25 | Step 5: Documentation for Each Essential Service/Function  Identified essential services/functions  Identified any relevant issues/implications that may arise when the level of service/function is modified and/or reduced  This part of the plan explains how each of the essential service/function is maintained, reduced, modified and/or eliminated, who makes the decision, what are the solutions are in place, any other necessary actions to follow and any communication strategy.
  26. 26. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 26 | Step 6: Compare to the “Preparedness Checklist”  Review the Emergency Preparedness of your agency/institute to safeguard that all issues have been addressed such as the decision- making process and authority for implementing service modification, reduction and/or elimination.  To review, additional documentation may be necessary to ensure that all critical elements have been addressed.  Compare the checklist with preparedness checklist of agency/institute;
  27. 27. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 27 | Step 7: Review, Test the Plan and Revise  Circulate the plan for information and training purposes within the agency/institute once the Business Continuity Plan is ready.  Conduct annual review, test the plan and revise the Business Continuity Plan as necessary. .  Finally, conducting an emergency exercise to test the plan will help staff understand the Business Continuity Plan, how and when it’s activated, who is responsible for what, and how it fits with agency/institute strategy to deal with a EVD outbreak. Plans alone are nothing; planning is everything; however, if we don’t use and test it then planning alone is nothing too.
  28. 28. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 28 | Lack of Preparedness: Maternal Health Services Pregnant mother goes to health care facility for delivery Health Care workers absent and some mobilized to ETC Complication of Pregnancy and delivery Increased in MMR and IMR
  29. 29. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 29 | Lack of Preparedness: Logistic or Energy Department
  30. 30. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 30 | Operational Status Human Resources - Operation and maintenance of Wards/Departments. E.g ICUs Full Operational Capacity, 24 hours services No. of available qualified health care workers: 11-13 people (Full Human Resources Reserve) No. of available qualified health care workers: < 8 people Reduced Operational Capacity, 24 hours services no longer possible No. of available qualified health care workers: 9-10 people (Limited Human Resources Reserve) No. of available qualified health care workers: 8 people (Minimum Required Human Resources – No Reserve) Health Care Workers:All types of workers from doctors, nurses, technicians, cleaning team and other ICU operational staff.
  31. 31. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 31 | Human resources: Qualified Health Care workers 24 hours service capacity 13 – 10 Full capacity with sufficient reserve 10 - 9 Operation possible with limited reserve 8 (Minimum to run 24 - hour operation) Critical – Unable to maintain operation if one more staff is absent < 8 Continuity of operation impacted Operational Status Coding
  32. 32. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 32 | Institutional body (Ministry / Specific Team or Committee) to monitor operational status of all facilities “Network Planning and Management Facility A Facility B Facility C
  33. 33. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 33 | Role of Ministry of Health  MoH should provide advice to businesses on business continuity planning and maintaining essential services despite worker absenteeism  MoH should work with the private sector to ensure business continuity planning is coordinated and integrated
  34. 34. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 34 | Business continuity plans  Be specific  Identify who is going to do what when and how  Identify what actions need to be undertaken in each phase of pandemic  List emergency contacts  Plan around 2 scenarios: rapid onset pandemic with wide impact and slow onset pandemic with moderate localised impact  Discuss plans with staff, suppliers and banks
  35. 35. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 35 | Test  Test contingency plans  Simulation exercises  Scenario planning  Tabletop exercises  Learn lessons from tests  Identify areas that need improvement
  36. 36. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 36 | References and Acknowledgement  Nirmal Kandel. Presentation on Whole of Society Approach for Pandemic Preparedness in National Training of Trainers on WHOLE-OF-SOCIETY APPROACH on Pandemic Preparedness, Dhulikhel, Nepal, 29-30th June 2010  WHO. Whole of Society of Pandemic Readiness. WHO Guidelines for pandemic preparedness and response in the non health sector. Geneva, July 2009  UN. Socio economic impact of Pandemic Influenza. United National System for Influenza Coordination, 2009  World Bank. The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for West Africa. Accessed on 29th November 2014 (http://www.worldbank.org/en/region/afr/publication/the- economic-impact-of-the-2014-ebola-epidemic-short-and-medium-term-estimates-for-west-africa  World Health Organization: Ebola Response Roadmap Situation Report. Geneva: WHO 7 Nov 2014. 11 p (Accessed on 11 Nov 2014 http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141107)
  37. 37. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 37 | References and Acknowledgement  Nirmal Kandel. Draft Business Continuity Planning Tool Kit for Ebola Virus Disease Outbreak. Unpublished. 2014  World Health Organization. Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation. Interim version 1.2. Geneva: WHO/HSE/PED/CED/2014.05. 2014  Loose VW, Vargas VN, Warren DE, Starks SJ, Brown TJ, Smith BJ: Economic and Policy Implications of Pandemic Influenza. USA: Sandia National Laboratories; Mar 2010. 28 p. Sandia Report SAND2010-1910.  ACAPS Briefing Note. Ebola Impact on Health. Geneva: ACAPS; 26 Sep 2014. 10 p. Accessed on 18 Nov 2014 http://acaps.org/img/documents/b-acaps_briefing_note_ebola_impact_health_26_sept_2014.pdf)  Hayden EC. Ebola obstructs malaria control. Nature; 2 October 2014. Vol 14; Pg 15  Images used in the presentations are downloaded from Google Image search option using best available title for the image topic. Access in 29th November, 2014: https://www.google.com/imghp?gws_rd=ssl (these images are used for orienting purpose only and not for commercial any use)
  38. 38. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 38 | Thank You

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