The document summarizes a presentation on International Health Regulations given on July 32nd, 2022. It provides an outline of the topics covered in the presentation, including an introduction to IHR, its purpose and scope, history, comparison of the 1969 and 2005 versions, Public Health Emergencies of International Concern, and challenges of implementation. The presentation also discusses the need for IHR, its benefits, COVID-19, and the way forward.
This document discusses the International Health Regulations (IHR), which provide a framework for international cooperation to control the spread of diseases. Some key points:
1. The IHR aim to prevent the international spread of diseases, encourage surveillance and capacity building, and ensure prompt notification of public health emergencies.
2. Vaccination requirements are outlined for certain diseases like smallpox, plague, cholera, and yellow fever. Smallpox vaccination is no longer recommended.
3. National IHR Focal Points have been established in countries to act as communication channels with WHO. India's focal point is the National Institute of Communicable Diseases.
4. The document outlines core surveillance and response capacities
The document discusses the International Health Regulations (IHR), which were established in 2005 to help the international community prevent and respond to public health risks and emergencies. It outlines the IHR's purpose of preventing disease spread while avoiding unnecessary interference with trade and travel. It also describes how the IHR determine Public Health Emergencies of International Concern, the role of the Global Outbreak Alert and Response Network in outbreak responses, and core capacity requirements for member states related to surveillance, notification, and response.
The International Health Regulations (IHR) provide the framework for global health security and require reforms to address new initiatives. The World Health Organization is responsible for overseeing the IHR and its leadership is critical for effective implementation. The IHR establish procedures for reporting and coordinating responses to public health emergencies of international concern. Member countries must develop capabilities for detection, assessment, reporting and response. The IHR were revised in 2005 and went into effect in 2007 to address new health risks.
The International Health Regulations originated in 1851 to promote international cooperation and limit interference with trade during disease outbreaks. The IHR have been revised multiple times to address new public health challenges, including the 2005 revision to strengthen surveillance and response systems for infectious diseases and public health emergencies. The IHR (2005) require countries to develop core surveillance and response capacities and obligate information sharing during public health events of international concern in order to rapidly detect and respond to global health threats.
The document discusses primary health care, including its conceptualization, philosophy, principles, strategies, and models. It describes the key outcomes of the 1978 Alma-Ata Conference, including its 10 declarations and 22 recommendations which established primary health care as a global health strategy focused on achieving health for all by 2000 through equitable access to comprehensive services. The document also analyzes selective and comprehensive primary health care approaches and outlines the basic components, principles, and operational aspects of primary health care delivery within national health systems.
The National Health Policy 2017 aims to raise public health expenditure to 2.5% of GDP to provide comprehensive primary health care through 'Health and Wellness Centers'. It envisions a larger package of assured primary care that includes services for non-communicable diseases, geriatrics, mental health, and palliative care. The policy also looks to improve regulatory standards for quality healthcare and reform regulatory systems to promote domestic manufacturing of drugs and devices as well as medical education.
The document summarizes the emergence and expansion of health services in Nepal from the 1950s. It describes how the Department of Health Services was established in 1953 to manage hospitals and traditional medicine. In the 1950s-60s, health plans focused on curative services and established projects to control infectious diseases like malaria, tuberculosis, and smallpox. In the late 1960s, USAID and WHO advocated for integrating vertically run programs. This led to integrated community health services projects in several districts by the 1980s. By 1987, all programs were integrated under the Ministry of Health to work toward health for all.
Prabesh Ghimire presented on the International Health Partnership (IHP). The IHP was launched in 2007 to help coordinate global health initiatives and improve health systems in developing countries. It aims to support country-led health plans, jointly assess strategies, negotiate funding agreements, and increase accountability. The IHP has grown to include 66 partner organizations and 37 countries. Country compacts outline commitments between governments and donors to align funding with national health priorities. Studies show countries engaged with IHP have seen positive results, including increased health funding and coverage. Nepal was an early adopter of IHP principles through its own health partnership compact.
This document discusses the International Health Regulations (IHR), which provide a framework for international cooperation to control the spread of diseases. Some key points:
1. The IHR aim to prevent the international spread of diseases, encourage surveillance and capacity building, and ensure prompt notification of public health emergencies.
2. Vaccination requirements are outlined for certain diseases like smallpox, plague, cholera, and yellow fever. Smallpox vaccination is no longer recommended.
3. National IHR Focal Points have been established in countries to act as communication channels with WHO. India's focal point is the National Institute of Communicable Diseases.
4. The document outlines core surveillance and response capacities
The document discusses the International Health Regulations (IHR), which were established in 2005 to help the international community prevent and respond to public health risks and emergencies. It outlines the IHR's purpose of preventing disease spread while avoiding unnecessary interference with trade and travel. It also describes how the IHR determine Public Health Emergencies of International Concern, the role of the Global Outbreak Alert and Response Network in outbreak responses, and core capacity requirements for member states related to surveillance, notification, and response.
The International Health Regulations (IHR) provide the framework for global health security and require reforms to address new initiatives. The World Health Organization is responsible for overseeing the IHR and its leadership is critical for effective implementation. The IHR establish procedures for reporting and coordinating responses to public health emergencies of international concern. Member countries must develop capabilities for detection, assessment, reporting and response. The IHR were revised in 2005 and went into effect in 2007 to address new health risks.
The International Health Regulations originated in 1851 to promote international cooperation and limit interference with trade during disease outbreaks. The IHR have been revised multiple times to address new public health challenges, including the 2005 revision to strengthen surveillance and response systems for infectious diseases and public health emergencies. The IHR (2005) require countries to develop core surveillance and response capacities and obligate information sharing during public health events of international concern in order to rapidly detect and respond to global health threats.
The document discusses primary health care, including its conceptualization, philosophy, principles, strategies, and models. It describes the key outcomes of the 1978 Alma-Ata Conference, including its 10 declarations and 22 recommendations which established primary health care as a global health strategy focused on achieving health for all by 2000 through equitable access to comprehensive services. The document also analyzes selective and comprehensive primary health care approaches and outlines the basic components, principles, and operational aspects of primary health care delivery within national health systems.
The National Health Policy 2017 aims to raise public health expenditure to 2.5% of GDP to provide comprehensive primary health care through 'Health and Wellness Centers'. It envisions a larger package of assured primary care that includes services for non-communicable diseases, geriatrics, mental health, and palliative care. The policy also looks to improve regulatory standards for quality healthcare and reform regulatory systems to promote domestic manufacturing of drugs and devices as well as medical education.
The document summarizes the emergence and expansion of health services in Nepal from the 1950s. It describes how the Department of Health Services was established in 1953 to manage hospitals and traditional medicine. In the 1950s-60s, health plans focused on curative services and established projects to control infectious diseases like malaria, tuberculosis, and smallpox. In the late 1960s, USAID and WHO advocated for integrating vertically run programs. This led to integrated community health services projects in several districts by the 1980s. By 1987, all programs were integrated under the Ministry of Health to work toward health for all.
Prabesh Ghimire presented on the International Health Partnership (IHP). The IHP was launched in 2007 to help coordinate global health initiatives and improve health systems in developing countries. It aims to support country-led health plans, jointly assess strategies, negotiate funding agreements, and increase accountability. The IHP has grown to include 66 partner organizations and 37 countries. Country compacts outline commitments between governments and donors to align funding with national health priorities. Studies show countries engaged with IHP have seen positive results, including increased health funding and coverage. Nepal was an early adopter of IHP principles through its own health partnership compact.
The International Health Regulations (IHR) are a legally binding agreement between WHO member states aimed at preventing, protecting against, and controlling the spread of disease internationally. The IHR require countries to report certain public health events and diseases to the WHO and develop minimum core public health capacities for surveillance, risk assessment, and response. Major revisions in 2005 expanded the scope of the IHR beyond specific diseases to all public health emergencies of international concern. The IHR establish procedures for WHO to verify country reports and determine whether events constitute a public health emergency of international concern.
The Nepal Health Sector Strategy (NHSS) 2015-2020 provides strategic guidance for the health sector over five years. Its goal is to improve health status through accountable and equitable health services. NHSS outlines nine outcomes, including rebuilding health systems and improving quality of care. It identifies key outputs needed to achieve each outcome, along with interventions, indicators, targets, data sources, and timelines to monitor progress in strengthening Nepal's health sector.
The document discusses international health and globalization. It introduces concepts in international health like equity, poverty, environment, culture, and urbanization. It then discusses the history of international health organizations like the First International Sanitary Conference in 1851 and the establishment of WHO, UNICEF, and other agencies. Globalization is defined and its positive and negative impacts on health are described. The roles of WHO, World Bank, and other multilateral organizations in health promotion in Nepal are also summarized.
The National Health Policy of 1991 in Nepal had the objective of extending primary health care services to rural populations. It outlined 14 areas to achieve this, including preventive services like immunization and MCH, promotive services like health education, curative services through a referral system, strengthening primary health care, and developing human resources. However, a critical review found it lacked clear strategies for equity, collaboration, and community participation. While it targeted rural areas, there was no strategy for marginalized groups' access. Collaboration and referral mechanisms were also not clearly defined. Community participation was mentioned but ignored beneficiaries' involvement in services.
1. Health system development concerns how a country organizes its health sector functions including health services, workforce, financing, and policies.
2. Nepal has developed its health system over three historical periods from ancient to modern times, establishing hospitals, clinics, and public health programs at
National digital health mission- Dr. GurmeetYogesh Arora
The National Digital Health Blueprint outlines India's vision for a digital health ecosystem to support universal health coverage through digital systems and infrastructure. Key objectives include establishing digital health records for citizens, national health registries, and adopting open standards. The federated architecture separates data storage across national, state, and local levels while citizens maintain control over their health data. Building blocks like the Unique Health ID, electronic health records, and health directories will enable sharing of health information based on citizen consent for improved healthcare access, delivery and outcomes.
Universal health coverage aims to ensure everyone has access to health services without facing financial hardship. World Health Day 2022's theme focuses on achieving universal health coverage for everyone everywhere. India's Ayushman Bharat program aims to achieve this through two pillars - providing basic health services through health centers and providing insurance coverage for serious illnesses for poor families. Realizing universal coverage requires addressing issues like inadequate resources, uneven quality of care, and high out-of-pocket costs that push people into poverty.
The document discusses the history and structure of international health organizations and the World Health Organization (WHO). It describes how early international health efforts focused on quarantine measures for diseases like plague and cholera. Over time, organizations were established to promote cooperation and standards between countries on international health issues, culminating in the formation of WHO in 1945. WHO aims to coordinate global health initiatives and works on priorities like disease prevention, health systems, and environmental health. It has six regional offices and is overseen by the World Health Assembly and Executive Board.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
Globalization and its effects on public health were discussed. Key points included:
1. Globalization refers to the increasing integration and interdependence of economies, technologies, and cultures worldwide. It impacts public health through factors like population mobility, social changes, and environmental changes.
2. Public health aims to prevent disease and promote community health through organized efforts. It has evolved from a focus on disease control to health promotion and addressing social determinants of health.
3. Globalization influences public health through various pathways like health policies, economic development, social interactions, and environmental changes. It presents both opportunities and challenges for improving population health outcomes worldwide.
The National Health Policy 2017 sets ambitious targets for reducing infant and maternal mortality rates, and eliminating diseases. However, many of these targets are the same as those set in 2002 which were not achieved. The 2017 policy has now pushed the deadlines to 2019 or later. It aims to achieve universal health coverage through increasing access, quality and lowering costs. A key focus is preventive healthcare and increasing public health spending to 2.5% of GDP. Fact-checking found the 2017 policy recycled many 2002 targets that were already missed.
Current Policy, Strategies and Program of Preventing, Protecting and Control ...Mohammad Aslam Shaiekh
The document summarizes the history and development of tuberculosis control policies and programs in Nepal over several decades. It begins with the establishment of the first sanatorium in 1937 and traces the establishment of additional clinics, hospitals, and tuberculosis control initiatives through partnerships with international organizations. It describes Nepal adopting the DOTS strategy in 1995 and details the current goals, strategies and components of Nepal's National Tuberculosis Control Program, including the adoption of the End TB Strategy.
The emergence of the concept of "International Health." Traces back to the pre/post world war period and how it impacted the formation of various international health organization for various strata of the society.
This document provides an overview of international health and the history of international health organizations. It discusses how diseases know no borders and early international efforts focused on quarantine practices to control disease spread. The first international health conferences in the 1850s aimed to standardize quarantine measures but had little success. Over time, organizations like the Pan American Health Bureau in 1902 and the Office International d'Hygiene Publique in 1907 were formed to promote cooperation on international health issues. Major milestones included the founding of the World Health Organization in 1948 to coordinate global health initiatives and address both communicable and non-communicable diseases.
The document discusses Nepal's family planning program. The main points are:
1) Family planning is a priority in Nepal to improve health outcomes and economic development. It aims to ensure individuals can fulfill reproductive needs through informed choice of contraceptive methods.
2) The government, NGOs, and private sector provide a range of temporary and permanent family planning methods through health facilities. Community health volunteers also provide information and some methods.
3) National policies emphasize increasing access, integrating services, and engaging both males and females in planning their families to improve their quality of life.
The document provides an outline for a seminar on the International Health Regulations (IHR). It discusses the purpose and scope of the IHR, which is to prevent and respond to the spread of disease across borders in a way that balances public health risks with trade and travel. The document outlines the history of the IHR, comparing the 1969 and 2005 versions. It discusses events that demonstrated the need for revisions, like SARS in 2003. Key aspects of the updated IHR include applying to all health threats rather than specific diseases and emphasizing containment at the source of outbreaks.
The International Health Regulations (IHR) are a legally binding agreement between WHO member states aimed at preventing, protecting against, and controlling the spread of disease internationally. The IHR require countries to report certain public health events and diseases to the WHO and develop minimum core public health capacities for surveillance, risk assessment, and response. Major revisions in 2005 expanded the scope of the IHR beyond specific diseases to all public health emergencies of international concern. The IHR establish procedures for WHO to verify country reports and determine whether events constitute a public health emergency of international concern.
The Nepal Health Sector Strategy (NHSS) 2015-2020 provides strategic guidance for the health sector over five years. Its goal is to improve health status through accountable and equitable health services. NHSS outlines nine outcomes, including rebuilding health systems and improving quality of care. It identifies key outputs needed to achieve each outcome, along with interventions, indicators, targets, data sources, and timelines to monitor progress in strengthening Nepal's health sector.
The document discusses international health and globalization. It introduces concepts in international health like equity, poverty, environment, culture, and urbanization. It then discusses the history of international health organizations like the First International Sanitary Conference in 1851 and the establishment of WHO, UNICEF, and other agencies. Globalization is defined and its positive and negative impacts on health are described. The roles of WHO, World Bank, and other multilateral organizations in health promotion in Nepal are also summarized.
The National Health Policy of 1991 in Nepal had the objective of extending primary health care services to rural populations. It outlined 14 areas to achieve this, including preventive services like immunization and MCH, promotive services like health education, curative services through a referral system, strengthening primary health care, and developing human resources. However, a critical review found it lacked clear strategies for equity, collaboration, and community participation. While it targeted rural areas, there was no strategy for marginalized groups' access. Collaboration and referral mechanisms were also not clearly defined. Community participation was mentioned but ignored beneficiaries' involvement in services.
1. Health system development concerns how a country organizes its health sector functions including health services, workforce, financing, and policies.
2. Nepal has developed its health system over three historical periods from ancient to modern times, establishing hospitals, clinics, and public health programs at
National digital health mission- Dr. GurmeetYogesh Arora
The National Digital Health Blueprint outlines India's vision for a digital health ecosystem to support universal health coverage through digital systems and infrastructure. Key objectives include establishing digital health records for citizens, national health registries, and adopting open standards. The federated architecture separates data storage across national, state, and local levels while citizens maintain control over their health data. Building blocks like the Unique Health ID, electronic health records, and health directories will enable sharing of health information based on citizen consent for improved healthcare access, delivery and outcomes.
Universal health coverage aims to ensure everyone has access to health services without facing financial hardship. World Health Day 2022's theme focuses on achieving universal health coverage for everyone everywhere. India's Ayushman Bharat program aims to achieve this through two pillars - providing basic health services through health centers and providing insurance coverage for serious illnesses for poor families. Realizing universal coverage requires addressing issues like inadequate resources, uneven quality of care, and high out-of-pocket costs that push people into poverty.
The document discusses the history and structure of international health organizations and the World Health Organization (WHO). It describes how early international health efforts focused on quarantine measures for diseases like plague and cholera. Over time, organizations were established to promote cooperation and standards between countries on international health issues, culminating in the formation of WHO in 1945. WHO aims to coordinate global health initiatives and works on priorities like disease prevention, health systems, and environmental health. It has six regional offices and is overseen by the World Health Assembly and Executive Board.
The current five year plan in Nepal's health services aims to increase rural access to basic primary health services and doctors. It focuses on effective implementation of population control through mother and child health and family planning services. The plan also seeks to develop specialized health services within the country. Key targets include establishing more health posts, primary health care centers, and Ayurvedic dispensaries. It also aims to reduce the total fertility rate and cases of leprosy.
Globalization and its effects on public health were discussed. Key points included:
1. Globalization refers to the increasing integration and interdependence of economies, technologies, and cultures worldwide. It impacts public health through factors like population mobility, social changes, and environmental changes.
2. Public health aims to prevent disease and promote community health through organized efforts. It has evolved from a focus on disease control to health promotion and addressing social determinants of health.
3. Globalization influences public health through various pathways like health policies, economic development, social interactions, and environmental changes. It presents both opportunities and challenges for improving population health outcomes worldwide.
The National Health Policy 2017 sets ambitious targets for reducing infant and maternal mortality rates, and eliminating diseases. However, many of these targets are the same as those set in 2002 which were not achieved. The 2017 policy has now pushed the deadlines to 2019 or later. It aims to achieve universal health coverage through increasing access, quality and lowering costs. A key focus is preventive healthcare and increasing public health spending to 2.5% of GDP. Fact-checking found the 2017 policy recycled many 2002 targets that were already missed.
Current Policy, Strategies and Program of Preventing, Protecting and Control ...Mohammad Aslam Shaiekh
The document summarizes the history and development of tuberculosis control policies and programs in Nepal over several decades. It begins with the establishment of the first sanatorium in 1937 and traces the establishment of additional clinics, hospitals, and tuberculosis control initiatives through partnerships with international organizations. It describes Nepal adopting the DOTS strategy in 1995 and details the current goals, strategies and components of Nepal's National Tuberculosis Control Program, including the adoption of the End TB Strategy.
The emergence of the concept of "International Health." Traces back to the pre/post world war period and how it impacted the formation of various international health organization for various strata of the society.
This document provides an overview of international health and the history of international health organizations. It discusses how diseases know no borders and early international efforts focused on quarantine practices to control disease spread. The first international health conferences in the 1850s aimed to standardize quarantine measures but had little success. Over time, organizations like the Pan American Health Bureau in 1902 and the Office International d'Hygiene Publique in 1907 were formed to promote cooperation on international health issues. Major milestones included the founding of the World Health Organization in 1948 to coordinate global health initiatives and address both communicable and non-communicable diseases.
The document discusses Nepal's family planning program. The main points are:
1) Family planning is a priority in Nepal to improve health outcomes and economic development. It aims to ensure individuals can fulfill reproductive needs through informed choice of contraceptive methods.
2) The government, NGOs, and private sector provide a range of temporary and permanent family planning methods through health facilities. Community health volunteers also provide information and some methods.
3) National policies emphasize increasing access, integrating services, and engaging both males and females in planning their families to improve their quality of life.
The document provides an outline for a seminar on the International Health Regulations (IHR). It discusses the purpose and scope of the IHR, which is to prevent and respond to the spread of disease across borders in a way that balances public health risks with trade and travel. The document outlines the history of the IHR, comparing the 1969 and 2005 versions. It discusses events that demonstrated the need for revisions, like SARS in 2003. Key aspects of the updated IHR include applying to all health threats rather than specific diseases and emphasizing containment at the source of outbreaks.
international health regulation
RULES AND GUIDELINES OF INTERNATIONAL HEALTH REGULATIONS:
International health regulations evolution:
The IHR originated with ISR adapted at the international sanitary conference in Paris in 1851
Cholera epidemic 🡪 Europe 🡪1830 & 1847
Need international cooperation
22nd World Health Assembly (1969) adopted, revised and consolidated the international sanitary regulations, renames as IHR in 1969
26th World Health Assembly 1973🡪amendment in IHR
Thirty-fourth World Health Assembly amended the IHR (1969) to exclude smallpox in the list of notifiable diseases.
During the Forty-Eighth World Health Assembly in 1995, WHO and Member States agreed on the need to revise the IHR (1969) most notably:
narrow scope of notifiable diseases (cholera, plague, yellow fever),
The past few decades have seen the emergence and re-emergence of infectious diseases.
The emergence of “new” infectious agents Ebola, Hemorrhagic Fever and the re-emergence of cholera and plague in South America and India, respectively;
dependence on official country notification; and
lack of a formal internationally coordinated mechanism to prevent the international spread of disease.
These challenges were placed against the backdrop of the increased travel and trade characteristic of the 20th century.
The IHR (2005) entered into force, generally, on 15 June 2007, and are currently binding on 194 countries (States Parties) across the globe, including all 193 Member States of WHO.
summary:
The International Health Regulations (IHR) are an international legal instrument that covers measures for preventing the transnational spread of infectious diseases.
IHR is an instrument of international law that is legally binding on countries.
IHR is a set of regulations that is legally binding upon 196 state parties.
This legal binding is adopted by 196 countries, including all (194) WHO member states.
IHR is a benchmark to state the rights and obligations of countries to report public health actions.
The objective of IHR is to work together to protect global health security.
IHR are the international agreements with the objective of preventing the spread of public health threats without unnecessary impairment of international travel and trade.
The IHR was adopted by the 58th World Health Assembly in 2005 through Resolution WHA 58.3.
International Health was in action since 15 June 2007
The International Health Regulations (IHR 2005) are a set of regulations legally binding on 196 States Parties, including all WHO Member States. They contribute to global public health security by providing a new framework for the coordination of the management of events that may constitute a public health emergency of international concern, and improve the capacity of all countries to detect, assess, notify and respond to public health threats.
The IHR were adopted at the Fifty-eighth World Health Assembly on 23 May 2005 and entered into force on 15 June 2007.
The document summarizes the International Health Regulations (IHR), which were revised in 2005 and entered into force in 2007. The IHR aim to help countries work together to detect and respond to public health threats, and minimize interference with international trade and travel. Key points of the revised IHR include expanding their scope to cover all public health emergencies instead of just three diseases, promoting rapid response at the source of outbreaks, and strengthening national and global surveillance and response capabilities. The IHR also establish procedures for international collaboration and information sharing during public health events.
IHR_Overview.ppt unicef international health agencyAkshayaKiran2
The document summarizes the International Health Regulations (IHR), which were revised in 2005 and entered into force in 2007. The IHR aim to help countries work together to detect and respond to public health threats, and minimize interference with international trade and travel. Key points of the revised IHR include expanding their scope to cover all public health emergencies instead of just three diseases, promoting rapid response at the source of outbreaks, and strengthening national and global surveillance and response capabilities. The IHR also establish procedures for international collaboration and information sharing during public health events.
This document outlines a unit on international public health. It discusses the need for a global perspective on health and defines key concepts like international health, public health, and global health. Important forces affecting international health are noncommunicable diseases, communicable diseases, food security and nutrition, environmental health, and health inequity. Current issues requiring global action include long COVID, mental health, climate change impacts, and strengthening health systems. International public health actions involve health promotion, disease prevention, health protection like immunization, and pandemic control. Globalization can impact health through issues like nutrition, emerging diseases, pharmaceutical industries, and effects on underdeveloped nations.
The International Health Regulations (IHR) are a legally binding agreement between 196 countries that aims to help prevent and respond to public health emergencies internationally. The IHR requires countries to strengthen disease detection and response capacities, and to notify the WHO of health threats. It also calls for global cooperation in verifying and responding to outbreaks in an effort to limit international disease spread. Implementation of the IHR remains challenging for many countries due to resource and infrastructure limitations, but the framework provides an important mechanism for collective global health security.
The document discusses international health regulations, specifically the International Health Regulations (IHR) from 2005. It provides background on the evolution of international health regulations from 1830 to 2005. It describes key aspects of IHR 2005, including its scope, objectives, structure with 10 parts and 9 annexures. Some important features of IHR 2005 are notification requirements, national IHR focal points, requirements for national core public health capacities, recommended measures, and procedures for determining public health emergencies of international concern.
The Applicability of the IHR;
With the signing of the revised International Health Regulations (IHR) in 2005, the international community agreed to improve the detection and reporting of potential public health emergencies worldwide. IHR (2005) better addresses today’s global health security concerns and are a critical part of protecting global health. The regulations require that all countries have the ability to detect, assess, report and respond to public health events.
In response to the exponential increase in international travel and trade, and emergence and reemergence of international disease threats and other health risks, 196 countries across the globe agreed to implement the International Health Regulations (2005) (IHR). This binding instrument of international law entered into force on 15 June 2007.
The stated purpose and scope of the IHR are; "to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade." Because the IHR are not limited to specific diseases, but are applicable to health risks, irrespective of their origin or source, they will follow the evolution of diseases and the factors affecting their emergence and transmission. The IHR also require States to strengthen core surveillance and response capacities at the primary, intermediate and national level, as well as at designated international ports, airports and ground crossings.
The International Health Regulations (IHR), a legally binding agreement between 196 States Parties, whose aim is to prevent, protect against, control, and provide a public health response to the international spread of disease, deserve critical examination with regard to their applicability. The emergence and spread of the new mysterious hemorrhagic fever may constitute a public health emergency of international concern (PHEIC) and is therefore notifiable to the World Health Organization under the IHR notification requirement.
IHR (2005) is coordinated by the World Health Organization (WHO) and aims to keep the world informed about public health risks and events. As an international treaty, the IHR (2005) is legally binding; all countries must report events of international public health importance. Countries reference IHR (2005) to determine how to prevent and control global health threats while keeping international travel and trade as open as possible.
IHR (2005) requires that all countries have the ability to do the following:
· Detect: Make sure surveillance systems and laboratories can detect potential threats
· Assess: Work together with other countries to make decisions in public health emergencies
· Report: Report specific diseases, plus any potential international public health emergencies, through participation in a network of National Focal Points
· Respond: Respond to public healt.
The international health regulations (IHR) is an agreement among 194 countries, including all WHO member countries ,to work together for healthy security of the world. Under the IHR, all countries need to report all events of international public health impact
This document is a report from The Independent Panel for Pandemic Preparedness & Response that makes recommendations to improve pandemic preparedness and response in the future. It summarizes that COVID-19 has caused over 3 million deaths globally, trillions in economic losses, and widespread disruption to education, healthcare and more. It finds failures in countries' early responses and stresses the need for urgent action now to curb the pandemic, including consistent use of public health measures, scaled up equitable global vaccine rollout, and addressing uneven international access to vaccines. The Panel calls the current situation intolerable and recommends immediate, ambitious transformation of the global health system to prevent future pandemics.
Lancet thougths on ebola crisis, @xemide, @jiwitmanuel, @fminigeriaXEMIDE
@xemide, @jiwitmanuel, @fminigeria
In summary Lancet is saying more resources to ihr because countries failed to back WHO, with enough money to prevent global pandemic.
US is implementing is independent strategy and should be welcomed in the affected countries.
The WHO played both positive and controversial roles in responding to the COVID-19 pandemic:
- Positively, the WHO helped countries prepare and respond, provided accurate information to counter myths, ensured supplies reached health workers, trained health workers, and coordinated vaccine research. However, the pandemic was still preventable.
- Controversially, the WHO was slow to declare a global emergency and was accused of turning a blind eye to China's initial response. Early recommendations on face masks also caused confusion.
- An independent review found the WHO and countries' combined response was inadequate and the world remains vulnerable to future pandemics without changes to strengthen global health cooperation.
This document discusses strengthening health emergency preparedness and response capacities in the Republic of Moldova. It notes that the European Region faces health threats from infectious diseases, natural disasters, and other emergencies. A Joint External Evaluation found that Moldova has some strengths in public health legislation but needs to strengthen specific capacities like surveillance systems, multisectoral coordination, and long-term preparedness planning. The WHO supports Moldova's response to health emergencies and recommends developing a national action plan to build sustainable emergency capacities as part of achieving universal health coverage.
This document discusses international health organizations and the International Health Regulations (IHR). It provides background on the IHR, stating that they are binding on 194 countries and are intended to help prevent disease spread across borders and ensure countries have response systems. The IHR require countries to quickly notify the WHO of severe disease events that could spread internationally. The WHO then guides a coordinated global response. Four diseases always require reporting. The role of countries is to assess risk while the WHO determines if an event is an emergency of international concern.
The document summarizes the internship of Jill Scott at the World Health Organization International Health Regulations Secretariat from June to August 2008. Some key points:
1) The IHR (2005) are legally binding international regulations that help countries respond to public health risks while limiting interference with trade and travel.
2) During the internship, Scott helped update guidance documents for legislative implementation of the IHR and created a tool to help WHO respond efficiently to health emergencies.
3) An example response coordinated by WHO under the IHR involved a case of Marburg virus reported between the Netherlands and Uganda within 5 hours.
The document summarizes the history and development of international public health from the mid-1800s to the present. It discusses the establishment of early international health organizations to coordinate disease prevention and control efforts between European nations and their colonies. It then outlines the creation of the World Health Organization in 1948 and its role in promoting universal health coverage through the "Health for All" movement beginning in the 1970s. The movement advocated for primary healthcare as a practical approach for low and middle income countries to improve population health and reduce health inequities globally by the year 2000. While progress was made in many areas, implementation challenges remained due to lack of coordination, community involvement, and health system strengthening in some nations.
Climate change poses significant risks to human health that require urgent action. The document outlines the health impacts of climate change such as increased deaths from heat waves, spread of diseases, food and water insecurity. It discusses what has been done through international agreements and WHO efforts in raising awareness, building partnerships and evidence. However, more still needs to be done including strengthening health systems, scaling up proven interventions and increasing funding to protect populations from climate change health impacts.
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
1. Seminar on International Health Regulations
7/32/2022
Presentation on International Health
Regulations
Presented By:
Govinda Poudel (505)
MPH 5Th Batch
School of Public Health
Patan Academy of Health Sciences
1
2. Seminar on International Health Regulations
7/32/2022
Outline of Seminar:
❖ Introduction to International Health Regulation (IHR)
❖ Purpose and Scope
❖ Need for IHR
❖ History of IHR
❖ Comparison between IHR 1969 and 2005
❖ Public Health Emergency of International Concern (PHEIC)
❖ Focal Point for IHR
❖ Point of Entry (POE)
❖ COVID-19 and IHR
❖ Benefit of IHR Implementation
❖ Challenges of IHR implementation
❖ Conclusion
❖ Way Forward
2
3. Seminar on International Health Regulations
7/32/2022
International Health Regulations (IHR)-Introduction
❏ The International Health Regulations (IHR) are an international
legal instrument that is binding on 196 countries across the globe,
including all member states of the World Health Organization
(WHO) to work together for global health security.
Nepal is one of the member state.
❏ It is a legally- binding agreement.
❏ It significantly contributes to the global public health security.
❏ It improves the capacity of all countries to detect, assess, notify
and response to all public health threats.
Source: IHR 2005
3
4. Seminar on International Health Regulations
7/32/2022
❏ While disease outbreaks and other acute public health risks are often
unpredictable and require a range of responses, the International
Health Regulations (IHR) provide a complete legal framework that
defines countries’ rights and obligations in handling public health
events and emergencies that have the potential to cross borders.
❏ Providing a new framework for the coordination of the management
of events that may constitute a public health emergency of
international concern.
❏ help prevent the spread of disease across borders.
Contd…..
Source: IHR 2005
4
5. Seminar on International Health Regulations
7/32/2022
Purpose and scope of IHR
❏ The purpose and scope of IHR is to prevent, protect against, control
and provide a public health response to the international spread of
disease in ways that are commensurate with and restricted to public
health risks, and which avoid unnecessary interference with
international traffic and trade.
❏ Because the IHR are not limited to specific diseases but apply to
new and ever- changing public health risks, they are intended to
have long-lasting relevance in the international response to the
emergence and spread of disease.
❏ The IHR also provide the legal basis for important health documents
applicable to international travel and transport and sanitary
protections for the users of international airports, ports, and ground
crossings.
Source: IHR 2005
5
6. Seminar on International Health Regulations
7/32/2022
Need for IHR
“A threat anywhere is
a threat everywhere”
6
7. Seminar on International Health Regulations
7/32/2022
Need for IHR:
❏ According to statistics of the World Tourism Organization,
international tourist arrivals in the year 2005 exceeded 800 million.
❏ International travel can pose various risks to health as travellers may
encounter sudden and significant changes in
➔ altitude
➔ Humidity
➔ microbes and
➔ temperature
❏ Additional health risks arise when:
➔ accommodation is of poor quality
➔ hygiene and sanitation are inadequate
➔ medical services are not well developed
➔ clean water is unavailable
7
8. Seminar on International Health Regulations
7/32/2022
Need for IHR
❏ It is estimated that 2.1 billion airline passengers travelled in
2004.
❏ The infectious diseases are now spreading faster by emerging and
re-emerging more quickly, than ever before.
❏ There are now more than 40 diseases that were unknown a
generation ago.
❏ During the last five years, WHO has verified more than 1100
epidemic events worldwide.
❏ Consequently the need for international co-operation in order to
safeguard global health has become increasingly important.
❏ About half of the people on Earth live in urban areas ( Wilcox
et al.;2008)
8
9. Seminar on International Health Regulations
7/32/2022
Need for IHR
❏ Most of the population and projected growth are in low- latitude
urban and many surrounded by vast slum areas that lack clean
water and sanitary facilities.
❏ Animals such as dogs,chickens,cows,rats and many others live in
and near human living quarters,which have been assembled from
whatever materials can be found.
❏ Animals have been the origin of many of the identified emerging
infectious diseases.
❏ HIV/AIDS
❏ H5N1 avian influenza
❏ Severe acute respiratory syndrome (SARS)
❏ Swine -origin H1N1 influenza A
9
11. Seminar on International Health Regulations
7/32/2022
History of IHR
WHO issued
first set of
legally
binding
international
sanitary
regulation.
1951
WHO adopted
international
sanitary
regulation and
renamed as
international
health
regulation.
1969
Minor
modifications
in IHR,
amended
world wide.
1973,1981
World
health
assembly
adopted
revised IHR
2005
1830,1847
Cholera
epidemics in
Europe were
catalyst for
intense infectious
disease
diplomacy and
multilateral
cooperation.
Came in
to force
revised
IHR.
2007
11
12. Seminar on International Health Regulations
7/32/2022
History of IHR
❏ The cholera epidemics that overran Europe between 1830 and
1847 were catalysts for intensive infectious disease diplomacy and
multilateral corporation in public health.
❏ This led to the first international sanitary conference in Paris in
1851.
❏ In 1948, the WHO constitution entered into the force.
❏ In 1951 WHO member states adopted the International Sanitary
Regulations.
❏ Replaced and renamed the International Health regulations in 1969,
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13. Seminar on International Health Regulations
7/32/2022
History of IHR
❏ The 1969 IHR were primarily intended to monitor and control six
infectious diseases:
❏ Cholera
❏ Plague
❏ Yellow fever
❏ Smallpox
❏ Relapsing fever and typhus
❏ The Regulations were amended in 1973, and then in 1981, to
focus on three diseases: cholera, yellow fever and plague. With the
increase in international travel and trade, and the emergence, re-
emergence and international spread of disease and other threats, the
World Health Assembly called for a substantial revision in 1995.
13
14. Seminar on International Health Regulations
7/32/2022
History of IHR
❏ In May 2001, the World Health Assembly adopted resolution
WHA 54.14.
❏ Global Health Security: epidemic alert and response, in which
WHO was called upon to support its member states in strengthening
their capacity to detect and respond rapidly to communicable disease
threats and emergencies.
❏ The World Health Assembly adopted the IHR 2005 on May 23
by way of resolution WHA 58.3.
❏ The IHR 2005 entered into force on June 15 2007.
14
15. Seminar on International Health Regulations
7/32/2022
WHY A NEW IHR?
● IHR (1969)- smallpox, yellow fever, cholera, and plague.
● Eradication of smallpox- requirement for international notification
was reduced to the remaining three diseases.
● Increasing international travel and trade and globalization.
● Early warning is essential and depends on collaboration and
guarantees to notifying member state against misuse of
information.
● Measures should be coordinated internationally - WHO may take
this role.
● Recent experiences -Anthrax attacks (2001) ; SARS (2003) and
Chernobyl disaster
15
16. Seminar on International Health Regulations
7/32/2022
Why revised International Health
Regulations?
● In today’s world, diseases travel fast and no
single country can protect itself on its own.
● Acknowledging this, the 194 WHO Member
States unanimously adopted a new version
of the International Health Regulations (IHR).
● The revised IHR enter into force in June 2007.
It will now be up to the world to translate the
new code of the Regulations into the reality of
greater international public health security.
Dr Margaret Chan, WHO Director-General-2006
16
17. Seminar on International Health Regulations
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Our world is changing as never before
Populations grow, age, and move
Diseases travel fast
Microbes adapt
Chemical, radiation, food risks
increase
Health security is at
stake
17
18. Seminar on International Health Regulations
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cont…
18
● The unique conditions of the 21st century have amplified
the invasive and disruptive power of epidemics and other
public health emergencies.
● The dynamics of disease spread worldwide have changed
greatly.
● We living in a global “village” where diseases can travel at
the speed of jetliners on the wings of international travel and
trade, and can jump from one continent to another in a
matter of hours.
● This has made all nations vulnerable – not just to invasion
of their territories by pathogens, but also to the economic,
political and social shocks of public health
events elsewhere.
19. Seminar on International Health Regulations
7/32/2022
cont…
19
● They have the power to disrupt the entire global system in
ways that cannot be controlled by one nation acting alone.
● SARS was the first disease of the 21st century to expose the
world’s vulnerabilities. It will not be the last.
● hared vulnerabilities imply shared responsibilities and create
a need for strong collective action to protect lives and
livelihoods from disease spread.
To address these public health risks, the world's
countries, through WHO, initiated an intensive process to
revise the IHR, eventually adopted by the World Health
Assembly in May 2005.
20. 30 years of international health insecurity
● HIV/AIDS
● CHERNOBYL
● PLAGUE
● EBOLA
● NIPAH
● YELLOW FEVER
● …….
● ANTHRAX
● SARS
● MENINGITIS
● CHOLERA
● CHEMICAL
● AVIAN INFLUENZA
● XDR-TB
● ...
20
21. Chernobyl Disaster, 1986
21
The Chernobyl disaster was a nuclear accident that occurred on
26 April 1986 in the Chernobyl Nuclear Power Plant, near the city of
Pripyat in the north of the Ukrainian SSR in the Soviet Union.
The accident results of a flamed reactor design that was operated
with inadequately trained persons. Fire released at 5% of
radioactive materials in many parts.
❖ 2 died on that night and 28 within 1 month later due to acute
radiation syndrome.
❖ 1000 people with highest radiation
❖ 600000 people contaminated.
❖ >5 million exposed
❖ >400 thyroid cancer by 2002.
22. Seminar on International Health Regulations
7/32/2022
H5N1: Avian influenza, a pandemic threat
22
23. Seminar on International Health Regulations
7/32/2022
H5N1: Avian influenza, a pandemic threat
● In 1997 a high-pathogenicity H5N1 avian influenza virus caused
serious disease in both man and poultry in Hong Kong, China.
● Eighteen human cases of disease were recorded, six of which were
fatal. This unique virus was eliminated through total depopulation
of all poultry markets and chicken farms in December 1997. Other
outbreaks of high-pathogenicity avian influenza (HPAI) caused by
H5N1 viruses occurred in poultry in 2001 and 2002.
● No new cases of infection or disease in man due to these or other
H5N1 viruses have been reported. Prior to the human outbreak, the
H5N1 virus was found to cause extensive death in chickens in three
farms in Hong Kong.
● The significance of this outbreak raised worldwide concern on the
possibilities that such an influenza virus may become the next
influenza pandemic strain.
23
24. Seminar on International Health Regulations
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0
20000
40000
60000
80000
100000
120000
3/16
3/19
3/22
3/25
3/28
3/31
4/3
4/6
4/9
4/12
4/15
4/18
4/21
4/24
4/27
4/30
5/3
5/6
5/9
5/12
5/15
5/18
5/21
5/24
5/27
5/30
6/2
6/5
6/8
6/11
6/14
6/17
Number
of
passenger
WHO travel recommendations removed
36 116
WHO travel recommendations
2 April
14 670
13 May
102 165
25 May
27 March 23 June
Screening of exit passengers
SARS: an unknown coronavirus
• 8098 cases
• 774 deaths
• 26 countries affected
• trends in airline passenger
movement drop
• economic loss: US$ 60 billion
2003: SARS changes the world
24
25. Seminar on International Health Regulations
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The 58th World Health Assembly adopts the revised
International Health Regulations, “IHR”
25
27. Seminar on International Health Regulations
7/32/2022
IHR 1969 VERSUS IHR 2005
From three diseases to all public health threats
From preset measures to tailored response
From control of borders to also include containment at source
From reactive to proactive
PARADIGM SHIFT
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28. Seminar on International Health Regulations
7/32/2022
All public health threats
❏ The revised IHR recognize that
international disease threats have
increased
❏ Scope has been expanded from cholera,
plague and yellow fever to all public
health emergencies of international
concern
❏ They include those caused by infectious
diseases, chemical agents, radioactive
materials and contaminated food
28
29. Containment at source
❏ Rapid response at the source is:
❏ the most effective way to secure
maximum protection against
international spread of diseases
❏ key to limiting unnecessary health-
based restrictions on trade and travel
29
30. Seminar on International Health Regulations
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KEY FEATURES OF IHR 1969
❏ Notification to WHO of cases of cholera,
plague,smallpox and yellow fever
❏ Certain health related rules for international
travel and trade
❏ Prescription of maximum border measures
against cholera, plague and yellow fever
(deratting, disinsection…)
❏ Health documents for people, aircraft and ships.
30
31. Seminar on International Health Regulations
7/32/2022
LIMITATIONS OF IHR 1969
❏Concerns only cholera, plague and yellow fever
❏The old paradigm of case-based surveillance
❏Difficult to revise disease list
❏Dependent on official notification from the member state
❏No incentives to notification
❏Very few notifications
❏Notifications seemed as a very serious act by states
❏No formal mechanisms for collaboration between member state
and WHO
❏No dynamic in the response for stopping international spread
31
32. Seminar on International Health Regulations
7/32/2022
What is IHR 2005?
❏ The International Health Regulations are a formal code of conduct
for public health emergencies of international concern.
❏ They're a matter of responsible citizenship and collective
protection.
❏ They involve all 194 World Health Organization member
countries.
❏ They focus on serious public health threats with potential to spread
beyond a country's border to other parts of the world.
❏ Such events are defined as public health emergencies of
international concern, or PHEIC.
❏ The revised International Health Regulations outline the
assessment, the management and the information sharing for
PHEICs.
32
33. Seminar on International Health Regulations
7/32/2022
● A legal tool: describes procedures, rights
and legal obligations for 195 States Parties
and WHO.
● Legal framework requested, developed
and negotiated by WHO Member States
based on dialogue, transparency and trust.
● State’s commitment - beyond the health
sector.
● 10 Parts, 66 Articles, and 9 Annexes
International public health security is the goal
➔ Ensuring maximum public health security while minimizing interference
with international transport and trade.
➔ Legally binding for WHO and the world’s countries that have agreed to play
by the same rules to secure international health.
33
34. Seminar on International Health Regulations
7/32/2022
Objectives of IHR 2005
❏ To ensure the appropriate application of routine preventive
measures (e.g. at ports and airports) and the use by all countries of
internationally approved documents (e.g. Vaccination certificate).
❏ To ensure the notification to WHO of all events that may constitute
a public health emergency of international concern.
❏ The implementation of any temporary recommendations should the
WHO Director General have determined that such an emergency is
occurring.
❏ The revised IHR also focus on the provision of support for
affected states and the avoidance of stigma and unnecessary
negative impact on international travel and trade.
34
35. Seminar on International Health Regulations
7/32/2022
Obligation of the Member States Under IHR 2005
❏ Designating a national IHR focal point
❏ Strengthening core capacity to detect, report and respond rapidly to
public health events
❏ Assessing events that may constitute a PHEIC within 48 hours and
notifying WHO within 24 hours of assessment
❏ Providing routine inspection and control activities at international
airports, ports and some ground crossings
❏ Examining national laws, revising health documents/forms and
certificates, and building a legal and administrative framework in
line with the IHR requirements
35
36. Seminar on International Health Regulations
7/32/2022
Parts in the IHR (2005)
Part I. Definitions, purpose and scope, principles and responsible
authorities.
Part II. Information and public health response
Part III. Recommendations
Part IV. Points of entry
Part V. Public health measures
Part VI. Health documents
Part VII. Charges
Part VIII. General provisions
Part IX. The IHR Roster of Experts, the Emergency Committee and
the Review Committee
Part X. Final provisions
36
37. Seminar on International Health Regulations
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Some important definitions under IHR 2005 (Article I)
“affected” means persons, baggage, cargo, containers, goods, postal
parcels or human remains that are infected or contaminated, or carry
sources of infection or contamination, so as to constitute a public
health risk;
“affected area” means a geographical location specifically for
which health measures have been recommended by WHO under
these Regulations;
“decontamination” means a procedure whereby health measures are
taken to eliminate an infectious or toxic agent or matter on a human
or animal body surface, in or on a product prepared for consumption
or on other inanimate objects that may constitute a public health risk;
37
38. Seminar on International Health Regulations
7/32/2022
“deratting” means the procedure whereby health measures are taken
to control or kill rodent vectors of human disease present in baggage,
cargo, containers, facilities, goods and postal parcels at the point of
entry;
“departure” means, for persons, baggage, cargo or goods, the act of
leaving a territory;
“disinfection” means the procedure whereby health measures are
taken to control or kill infectious agents on a human or animal body
surface or in or on baggage, cargo, containers, goods and postal
parcels by direct exposure to chemical or physical agents;
38
39. Seminar on International Health Regulations
7/32/2022
“disinsection” means the procedure whereby health measures are
taken to control or kill the insect vectors of human diseases present in
baggage, cargo, containers, goods and postal parcels;
“free pratique” means permission for a ship to enter a port, embark
or disembark, discharge or load cargo or stores; permission for an
aircraft, after landing, discharge or load cargo or stores; and
permission for a ground transport vehicle, upon arrival, to embark or
disembark, discharge or load cargo or stores;
“health measure” means procedures applied to prevent the spread of
disease or contamination; a health measure does not include law
enforcement or security measures;
39
40. Seminar on International Health Regulations
7/32/2022
“inspection” means the examination, by the competent authority or
under its supervision, of areas, baggage, containers,facilities, goods
or postal parcels, including relevant data and documentation, to
determine if a public health risk exists;
“international traffic” means the movement of persons, baggage,
cargo, containers, goods or postal parcels across an international
border, including international trade;
“point of entry” means a passage for international entry or exit of
travellers, baggage, cargo, containers, conveyances, goods and
postal parcels as well as agencies and areas providing services to
them on entry or exit;
“public health observation” means the monitoring of the health
status of a traveller over time for the purpose of determining the risk
of disease transmission;
40
41. Seminar on International Health Regulations
7/32/2022
“public health risk” means a likelihood of an event that may affect
adversely the health of human populations, with an emphasis on one
which may spread internationally or may present a serious and direct
danger;
“surveillance” means the systematic ongoing collection, collation
and analysis of data for public health purposes and the timely
dissemination of public health information for assessment and public
health response as necessary;
“verification” means the provision of information by a State Party to
WHO confirming the status of an event within the territory or
territories of that State Party;
“WHO IHR Contact Point” means the unit within WHO which
shall be accessible at all times for communications with the National
IHR Focal Point.
41
42. Seminar on International Health Regulations
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“National IHR Focal Point” means the national centre, designated
by each State Party, which shall be accessible at all times for
communications with WHO IHR Contact Points under Regulations.
“public health emergency of international concern” A PHEIC is
defined as an: extraordinary event that constitutes a public health risk
to other states through international spread and requires a coordinated
international response:
➢ serious, sudden, unusual or unexpected;
➢ carries implications for public health beyond the
affected State's national border; and
➢ may require immediate international action.
“isolation” means separation of ill or contaminated persons or
affected baggage, containers, conveyances, goods or postal parcels
from others in such a manner as to prevent the spread of infection or
contamination.
42
43. Seminar on International Health Regulations
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“quarantine” means the restriction of activities and/or separation
from others of suspect persons who are not ill or of suspect baggage,
containers, conveyances or goods in such a manner as to prevent the
possible spread of infection or contamination;
“temporary recommendation” means non-binding advice issued by
WHO pursuant to Article 15 for application on a time-limited, risk-
specific basis, in response to a public health emergency of
international concern, so as to prevent or reduce the international
spread of disease and minimize interference with international traffic.
“standing recommendation” means non-binding advice issued by
WHO for specific ongoing public health risks pursuant to Article 16
regarding appropriate health measures for routine or periodic
application needed to prevent or reduce the international spread of
disease and minimize interference with international traffic.
43
44. Seminar on International Health Regulations
7/32/2022
Article-2:Purpose and Scope:
❖ To prevent, protect against, control and provide a public health
response to the international spread of disease in ways that are
commensurate with and restricted to public health risks, and
which avoid unnecessary interference with international traffic
and trade.
Article-3: Relates to Principles of the IHR
❖ The implementation of these Regulations shall be with full
respect for the dignity, human rights and fundamental freedoms
of persons.
❖ Guided by the Charter of the UN and the Constitution of the
World Health Organization.
❖ Guided by the goal of their universal application for the
protection of all people of the world from the international spread
of disease.
❖ States have, in accordance with the Charter of the UN and the
principles of international law, the sovereign right to legislate and
to implement legislation in pursuance of their health policies
44
45. Seminar on International Health Regulations
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Article-4:Relates to responsible authorities:
1. All State Parties should establish a National IHR Focal Point
and responsible authorities for the implementation of health
measures under these Regulations.
1. National IHR Focal Points to be accessible all times for
communications with the WHO IHR Contact Points.
1. WHO should generate IHR Contact Points at headquarters or at
the regional level and accessible at all times with National IHR
Focal Points and send urgent communication on implementation
of the Regulations under Articles 6 to 12 to National IHR Focal
Point.
1. States should provide WHO the details of their National IHR
Focal Point and WHO also provide with details of WHO IHR
Contact Points and it should be updated continuously and
annually.
45
46. Seminar on International Health Regulations
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Article-5:Surveillance-
develop, strengthen and maintain strong surveillance system not later
than 5 years of IHR Implementation.
Article-6:Notification
shall notify WHO by way of the National IHR Focal Point within 24
hours of assessment of public health information, of all events which
may constitute a public health emergency of international concern within
territory and health measures implemented in response.
Article-7 :Information-sharing during unexpected or unusual public
health events
If a State Party has evidence of an unexpected or unusual public health
event within its territory, irrespective of origin or source, which may
constitute a public health emergency of international concern, it shall
provide to WHO all relevant public health information. In such a case,
the provisions of Article 6 shall apply in full.
46
47. Seminar on International Health Regulations
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Article-8:Consultation:
The State Party in whose territory the event has occurred may
request WHO assistance to assess any epidemiological evidence
obtained by that State Party.
Article-9: Other reports
● States Parties shall, as far as practicable, inform WHO within 24
hours of receipt of evidence of a public health risk identified
outside their territory that may cause international disease spread,
as manifested by exported or imported:
(a) human cases;
b) vectors which carry infection or contamination; or
(c) goods that are contaminated.
47
48. Seminar on International Health Regulations
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Article-10 :Verification
(a) within 24 hours, an initial reply to, or acknowledgement of, the
request from WHO;
(b) within 24 hours, available public health information on the status
of events referred to in WHO’s request; and
(c) information to WHO in the context of an assessment under Article
6, including relevant information as described in that Article.
Article-11: Provision of information by WHO
WHO shall send to all States the information as soon as possible that
it has received under Articles 5 to 10 necessary to enable States to
respond to a public health risk.
WHO shall consult with the State Party in whose territory the event is
occurring as to its intent to make information available under this
Article.
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Article-12: Determination of a public health emergency of
international concern on the basis of:
1. information provided by the State Party;
2. the decision instrument contained in Annex 2;
3. the advice of the Emergency Committee;
4. scientific principles and available scientific evidence and information
5. an assessment of the risk to human health, of the risk of international
spread of disease and of the risk of interference with international traffic.
Article-13: Public health response
Article-14: Cooperation of WHO with intergovernmental
organizations and international bodies.
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Article:15-18 :Recommendations
❖ Temporary recommendations
❖ Standing recommendations
❖ Criteria for recommendations
❖ Recommendations with respect to persons, baggage,
cargo, containers, conveyances, goods and postal parcels
Article:19-22: Point of Entry:
❖ General obligations
❖ Airports and ports
❖ Ground crossings
❖ Role of competent authorities
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Article:23-34: Public Health Measures:
❖ Health measures on arrival and departure
❖ Conveyance operators
❖ Ships and aircraft in transit
❖ Civilian lorries, trains and coaches in transit
❖ Affected conveyances
❖ Ships and aircraft at points of entry
❖ Civilian lorries, trains and coaches at points of entry
❖ Travellers under public health observation
❖ Health measures relating to entry of travellers
❖ Treatment of travellers
❖ Goods in transit
❖ Container and container loading areas
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Article:35-39:Health documents:
❖ General rule (Health Documents)
❖ Certificates of vaccination or other prophylaxis
❖ Maritime Declaration of Health (MDH)
❖ Health Part of the Aircraft General Declaration
❖ Ship sanitation certificates
Article:40-41:Charges:
❖ Charges for health measures regarding travellers
❖ Charges for baggage, cargo, containers, conveyances,
goods or postal parcels
Article:42-46: General provisions:
❖ Implementation of health measures
❖ Additional health measures
❖ Collaboration and assistance
❖ Treatment of personal data
❖ Transport and handling of biological substances, reagents
and materials for diagnostic purposes
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Maritime Declaration of Health (MDH) (Article-37)
★ The MDH according to IHR (2005) is a document containing data
related to the state of health on board a ship during passage and on
arrival at port.
★ It is a useful tool for early detection of public health risks in ships.
★ According to Article 37 ‘the master of a ship, before arrival at its
first port of call in the territory of a State Party, shall ascertain the
state of health on board.
★ The state party may decide whether it requires all arriving ships to
submit a MDH, which should conform to the model provided in
Annex 8 of the IHR.
★ The International Maritime Organization (IMO) is a specialised
agency of the UN that is responsible for measures to improve the
safety and security of international shipping, and to prevent
pollution from ships.
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Collaboration and assistance (Article-44)
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Article:47-53:The IHR Roster of Experts, The Emergency
Committee and The Review Committee:
❖ Composition of IHR Roster of Experts
❖ Terms of reference and composition of Emergency
Committee
❖ Procedure in conducting PHEIC
❖ Terms of reference and composition of Review Committee
❖ Conduct of business (WHA)
❖ Procedures for standing recommendations
Article:54-66: Final Provision:
❖ Reporting and review ( To WHA by State and DG)
❖ Amendments (by WHA)
❖ Settlement of disputes
❖ Relationship with other international agreements
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cont…..
❖ International sanitary agreements and regulations
❖ Entry into force; period for rejection or reservation
❖ New Member States of WHO (Provision)
❖ Rejection
❖ Reservations
❖ Withdrawal of rejection and reservation
❖ States not Members of WHO
❖ Notifications by the Director-General
❖ Authentic texts (language of article)
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Annexes in the IHR:
The IHR (2005) includes provisions for the use of various health
documents that can be presented, if requested, to health authorities.
Annex-1:
A. Core capacity requirements for surveillance and response
B. Core capacity requirements for designated airports, ports and
ground crossings.
Annex-2:
A. Decision instrument for the assessment and notification of events
that may constitute a public health emergency of international
concern
B. Examples for the application of the decision instrument for the
assessment and notification of events that may constitute a public
health emergency of international concern
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Annex-3:Ship Sanitation Control Certificate
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Annex-4:Technical requirements pertaining to conveyances and
conveyance operators
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Annex-5: Specific measures for vector-borne diseases
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ANNEX 6:VACCINATION, PROPHYLAXIS AND RELATED CERTIFICATES
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Annex-7-Requirements concerning vaccination or prophylaxis for specific
diseases
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Annex-8: Model of Maritime Declaration of Health
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Annex-9:Health Part of the Aircraft General Declaration
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Public Health Emergency of International Concern
Defined as “an extraordinary event which is determined to constitute a
public health risk to other states through the international spread of
disease and to potentially require a coordinated international response.
These events of potential international concern, which require states
parties to notify WHO, can extend beyond communicable diseases and
arse from any origin or source.
Example:
Recently on July 23, the WHO Director-General declared the escalating global
monkeypox outbreak a Public Health Emergency of International Concern
(PHEIC). Currently, the vast majority of reported cases are in the WHO
European Region. WHO/Europe remains committed to partnering with
countries and communities to address the outbreak with the required urgency.
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PHEIC
This implies a situation that is:
❖ serious, sudden, unusual or unexpected;
❖ carries implications for public health beyond the affected State's
national border; and
❖ may require immediate international action.
Since 2007, the WHO Director-General has declared public health
emergencies of international concern in response to the following:
● 2009 H1N1 swine flu pandemic
● 2014 Setbacks in global polio eradication efforts
● 2013–2016 Western African Ebola virus epidemic
● 2016 Zika virus outbreak
● 2018–19 Kivu Ebola epidemic
● 2019–21 COVID-19 pandemic
● 2022 Monkeypox outbreak
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DECISION INSTRUMENT (ANNEX 2) OF IHR (2005)
FOR ASSESSMENT AND NOTIFICATION
4 diseases that shall be notified polio
(wild-type polio virus), smallpox, human
influenza new subtype, SARS.
Disease that shall always lead to utilization of
the algorithm: cholera, pneumonic plague,
yellow fever, VHF (Ebola, Lassa, Marburg),
others….
Q1: public health impact serious?
Q2: unusual or unexpected?
Q3: risk of international spread?
Q4: risk of travel/trade restriction?
Insufficient information: reassess
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Events detected by national surveillance system or reported by
media or any non-governmental organization
UNUSUAL DISEASES
⮚Smallpox
⮚Human influenzae
(new subtype)
⮚Wild poliovirus
⮚Severe acute
respiratory syndrome
⮚KNOWN EPIDEMIC
PRONE DISEASES
⮚Cholera
⮚Pneumonic plague
⮚Viral haemorrhagic
fevers
⮚Yellow fever
⮚West nile fever
⮚Other locally or
regionally important
diseases
Any event of
potential
international
public health
concern
▪Is the public health impact of the event serious?
▪Is the event unusual or unexpected?
▪Is there significant risk of international spread?
▪Is there significant risk of travel or trade restriction?
National IHR focal point to notify WHO
If yes to any two of these questions
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71. If 2 of the 4 criteria are met, countries are required to notify WHO
within 24 hours.
4 decision criteria are used to assess public health events:
❏ Is the public health impact of this event potentially serious?
❏ Is this event unusual or unexpected?
❏ Is there the potential for international spread?
❏ Is there the potential for travel and trade restrictions?
4 diseases always need to be reported to WHO:
❏ Severe acute respiratory syndrome or SARS
❏ Smallpox
❏ New influenza viruses
❏ Wild-type polio
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72. Public health emergency of international concern (cont.)
❑ The Director-General of WHO declares if the event is a public
health emergency of international concern from the decision made
by the International Health Regulation Emergency Committee and
circulates the suggestion and recommendation to the WHO and state
parties.
❑ The role of countries is to assess the magnitude and potential risk
involved with an event, and WHO’s role is to make the decision.
72
73. Public health emergency of international concern (cont.)
❑ With this design, WHO, as our global public health authority, can
quickly assess the global risk of an event and, if needed, convene
countries to mount a coordinated international response.
❑ Countries don’t need to know what the cause or the source of an
outbreak is to report it to WHO.
❑ The focus is on early detection and reporting to allow for a public
health response before international spread occurs, or at least
minimize the global impact of an outbreak.
73
74. Public health emergency of international concern (cont.)
❑ An example of SARS:
▪ The outbreak of SARS started in China in 2002.
▪ Early on, we didn’t know that the illness was caused by a
coronavirus or that it had likely jumped from animals to human.
▪ The event met 2 of assessment criteria of a public health
emergency of international concern:
• Serious impact of public health: the disease could kill people,
but we didn’t know what it was, how it was transmitted, how
we could prevent or treat it, and who could get sick from it.
• Potential for international spread: we knew that the disease
affected travelers, who could ‘export’ the disease to other
countries.
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75. ❑ An example of SARS (cont.):
▪ This event would have been a prime event to report to WHO under
the IHR and to benefit from a coordinated international response.
▪ If we had had the current IHR already in place during the SARS
outbreak, it is possible that WHO would have learned sooner about
the event.
• This could have enabled scientists to potentially identify the
cause of this illness sooner.
• Some of the significant economic impact on China because of
travel warnings by many countries against travel to China
might have been prevented through modified global
recommendations.
▪ It is because of SARS that the global public health community got
together to revise an older set of the international health
regulations and adopt the current set.
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DISEASES REPORTABLE UNDER IHR 2005
● New diseases are emerging at the historically unprecedented rate of
one per year.
● The infectious diseases reportable under the IHR (2005) include:
UNUSUAL
DISEASES
⮚Smallpox
⮚Human
influenzae (new
subtype)
⮚Wild poliovirus
⮚Severe acute
respiratory
syndrome
KNOWN EPIDEMIC
PRONE DISEASES
⮚Cholera
⮚Pneumonic plague
⮚Viral haemorrhagic
fevers
⮚Yellow fever
⮚West nile fever
OTHER
LOCALLY OR
REGIONALLY
IMPORTANT
DISEASES
⮚Dengue fever
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❏ Once a WHO member country identifies an event of concern, the
country must assess the public health risk of the event within 48 hours.
❏ If the event is determined to be notifiable under IHR the country must
report the information to WHO within 24 hours.
❏ Some diseases always require reporting under the IHR, no matter when
or where they occur, while others become notifiable when they represent
an unusual risk or situation.
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CATEGORIES OF THESE REPORTABLE DISEASES
❑ Epidemic prone diseases
Cholera, yellow fever, meningococcal disease, SARS, avian
influenza, ebola, marburg haemorrhagic fever, nipah virus
infection, drug resistant diarrhoeal diseases, hospital acquired
infections, malaria, meningitis, respiratory tract infections and
sexually transmitted infections and HIV infections.
❑ Food borne diseases
Microbial contamination chemicals and toxins. The emergence of
new food borne diseases i.e. new variant of Creutzfeldt Jakob
disease associated with bovine spongiform encephalopathy (BSE).
❑ Accidental and deliberate outbreaks
Breaches in biosafety measures are often responsible for
outbreaks associated with the accidental release of infectious
agents for example anthrax in USA in 2001.
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❑ Toxic chemical accidents
Dumping of 500 tons of petrochemical waste in at least 15 sites
led to the deaths of 8 people, and 90000 were seeking medical help
in West Africa in the year 2006.
❑ Radio nuclear Accidents
Chernobyl disaster in 1986 resulted in the evacuation and
resettlement of over 3,36,000 people.
❑ Environmental disasters
■ Heatwave in Europe 2003, the lives of 35,000 persons were
linked to extremes in weather.
■ Bhopal gas tragedy in December 1984
■ 1700 people died in Carbon dioxide poisoning in Central
Africa in 1986
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What do the IHR call for?
❏ Strengthened national capacity for surveillance
and control, including in travel and transport
❏ Prevention, alert and response to international
public health emergencies
❏ Global partnership and international
collaboration
❏ Rights, obligations and procedures,
and progress monitoring
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Why should countries implement the IHR?
Countries will receive:
❏ WHO assistance in building core
capacities
❏ WHO’s guidance during outbreak
investigation, risk assessment, and
response
❏ WHO’s advice and logistical support
❏ information gathered by WHO about
public health risks worldwide
❏ assistance to mobilize funding
support
To detect and contain public health threats faster, to contribute to
international public health security, and to enjoy the benefits of
being a respected partner.
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WHO to help countries managing events
❏ New WHO global Event Management
System
❏ WHO Regional Alert and Response
teams
❏ Train countries’ NFPs and WHO
contact points for event management
❏ Expand GOARN and other
specialized and regional support
networks
❏ Develop new tools and standard
operating procedures
❏ Carry out IHR exercises
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Adapted response
❏ International public health security is
based on strong national public
health infrastructure connected to a
global alert and response system.
❏ This is at the core of the IHR.
❏ It interlinks in real time 120 networks
and institutes.
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86. Acute public health threats are collectively managed
The key functions of this global system, for
States and WHO, are to:
❏ detect-(has to be time bound)
❏ verify-(definition of cases and fulfillment of criteria
-if exists-)
❏ assess-(assessment of conditions, situations,
process, and surveillance)
❏ inform-(local and international authorities)
❏ Assist-(for development of national and
international plans)
The IHR define a risk management process where States Parties work
together, coordinated by WHO, to collectively manage acute public
health risks.
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As each country builds its capacity, the entire world
wins
The greatest assurance of public health security will come when all
countries have in place the capacities for effective surveillance and
response, for:
● infectious diseases ● radiological-related diseases
● chemical-related diseases ● food-related diseases
Timeline
15 June 2007 2009 2012 2014 2016
Planning Implementation
2 years + 3 + (2) + (up to 2)
"As soon as possible but no later than five years from entry into force"
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National IHR Focal Point
Each State Party will designate or establish a National Focal Point
(NFP), accessible at all times to communicate with WHO IHR contact
points (Article 4)
❏ The designation of National IHR Focal Points has made an
important contribution to the process of developing the IHR (2005).
❏ Under the Regulations National IHR Focal Points are to play an
equally important role in implementing the Regulations at the
national level.
❏ The National IHR Focal Point is charged with maintaining a
continuous official communication channel between WHO and
States Parties.
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In addition to this legal requirement, the National IHR Focal Point will
need
❏ to ensure the analysis of national public health risks in terms of
international impact,
❏ participate in collaborative risk assessment with WHO,
❏ advise senior health and other government officials regarding
notification to WHO and implementation of WHO
recommendations,
❏ and distribute information to and coordinate input from several
national sectors and government departments.
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❏ Epidemiology and Disease Control Division was established as a
Division of Statistics in 2030 BS and reorganized as Epidemiology
and Statistical Division in 2035.
❏ According to new organizational structure developed in 2050 BS,
this Division is named as Epidemiology and Disease Control
Division.
❏ With the guidance of Ministry of Health, DoHS and co-ordination of
central level organizations, hospitals, regional health directorate and
medical colleges, along with technical assistance of WHO activities
are being performed.
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❏ Technical as well as financial support is provided by WHO, USAID,
DFID, NHSSP, UNFPA, UNICEF, RTI, CNTD, Save The Children
and Global Fund for EDCD to achieve the objective of this division.
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This division is responsible for following areas:
❏ Epidemic/outbreak preparedness and control programme,
❏ Malaria pre-elimination programme,
❏ Kalazar elimination programme,
❏ Lymphatic filaria elimination programme,
❏ Dengue control programme,
❏ Disaster management programme,
❏ Control of zoonotic disease specially snake bites and dog
bites, avian influenza control programme and
❏ Surveillance and communicable disease research programme.
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Importance of national capacity
The best way to prevent international spread of diseases is to detect
public health events early and implement effective response actions
when the problem is small.
❏ Early detection of unusual disease events by effective national
surveillance (both disease and event based)
❏ Systems to ensure response (investigation, control measures) at all
levels (local, regional, and national)
❏ Routine measures and emergency response at ports, airports and
ground crossings.
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Point of Entry (POE):
PART IV – POINTS OF ENTRY-“point of entry” means a passage for
international entry or exit of travellers, baggage, cargo, containers,
conveyances, goods and postal parcels as well as agencies and areas
providing services to them on entry or exit;
❏ Article 19 General obligations
❏ Article 20 Airports and ports
❏ Article 21 Ground crossings
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POE
❏ Protect the health of travellers and population and avoid/reduce
spread of disease.
❏ Keep airports, ports and ground crossings terminals running and
aircrafts, ships and ground vehicles operating in a sanitary condition
and free of sources of infection and contamination, as far as
practicable.
❏ Capacity in place for detection, containment at source and to
respond to emergency and implement public health
recommendations, limiting unnecessary health-based restrictions on
trade and travel.
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POE
Designation of points of entry –
❏ States Parties shall designate Airports, seaports, landports and Ports
for developing capacities.
❏ States Parties where justified for PH reasons, may designate ground
crossings for developing capacities, taking into consideration
volume and frequency of international traffic and public health risks
of the areas in which international traffic originates.
❏ States Parties sharing common borders should consider: Bilateral
and multilateral agreements Joint designation of adjacent ground
crossing for capacities
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Point of Entry:
Name of PoE
Province
By Air:
TIA POE Kathmandu Bagmati
Province
GBIA POE Rupendehi Lumbini
Province
By Land
Rani PoE, Morang
Province No. 1
Kakadbhitta PoE, Jhapa Province No. 1
Pashupatinagar PoE, Ilam Province No. 1
Maadar PoE, Siraha Province No. 2
Thadi PoE, Siraha
Province No. 2
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Bhittamode PoE, Mohattari
Province No. 2
Birgunj PoE, Parsa
Province No. 2
Maheshpur PoE, Nawalparasi West Lumbini
Province
Belahiya PoE, Rupandehi
Lumbini Province Taulihawa PoE, Kapilvastu
Lumbini Province Krishnanagar PoE,
Kapilvastu Lumbini Province
Gulariya PoE, Bardiya
Lumbini Province
Jamunaha PoE, Banke
Lumbini Province Gaddachauki PoE, Kanchanpur
Sudurpashchim Province Gauriphanta PoE,
Kailali Sudurpashchim Province
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SCREENING OF PERSONS AT ENTRY AND EXIT
❏ No specific health measures are advised
❏ Review travel history in affected areas
❏ Review proof of medical examination
and any laboratory analysis
❏ Require medical examinations
❏ Review proof of vaccination or other
prophylaxis
❏ Require vaccination or other prophylaxis
❏ Place suspect persons under public health
observation
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❏ Implement quarantine or other health measures for suspect persons
❏ Implement isolation and treatment where necessary of affected
persons
❏ Implement tracing of contacts of suspect or affected persons
❏ Refuse entry of suspect and affected persons
❏ Refuse entry of unaffected persons to affected areas
❏ Implement exit screening and/or restrictions on persons from
affected areas
Contd
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POINT OF ENTRY : CORE CAPACITY REQUIREMENTS (ROUTINE)
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108. a
Public Health
Emergency
Contingency plan:
coordinator, contact
points for relevant
PoE, PH & other
agencies
Provide assessment &
care for affected
travellers, animals:
arrangements with
medical, veterinary
facilities for isolation,
treatment & other
services
b c
Provide space,
separate from other
travellers to
interview suspect
or affected persons
d
Provide for
assessment,
quarantine of
suspect or affected
travellers
e
To apply
recommended
measures,
disinsect, disinfect,
decontaminate,
baggage, cargo,
containers,
conveyances,
goods, postal
parcels etc
f
To apply entry/exit
control for departing &
arriving passengers
g
Provide access to
required
equipment,
personnel with
protection gear for
transfer of
travellers with
infection/
contamination
POINT OF ENTRY : CAPACITY REQUIREMENTS DURING PHEIC (EMERGENCY)
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VACCINATION FOR TRAVELLERS
CATEGORY VACCINES
ROUTINE
IMMUNIZATION
Diphtheria, Tetanus, and Pertussis
Hepatitis B
Haemophilus influenzae type b
Human papillomavirus
Influenza
Measles, mumps and rubella
Pneumococcal disease
Poliomyelitis
Rotavirus
Tuberculosis (BCG)
Varicella
SELECTIVE USE FOR
TRAVELLERS
Cholera
Hepatitis A
Japanese encephalitis
Meningococcal disease
Rabies
Tick- borne encephalitis
Typhoid fever
Yellow fever
MANDATORY
VACCINATION
Yellow fever (according to
vaccination country list)
Meningococcal disease and polio
(required by Saudi Arabia for pilgrims)
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EWARS and International Health Regulation (IHR)
❏ One of the most important aspects of IHR 2005 is the establishment
of a global surveillance system for public health emergencies of
international concern.
❏ The IHR requires the rapid detection of public health risks, as well
as the prompt risk assessment, notification, and response to these
risks.
❏ EWARS in Nepal works as an indicator-based surveillance in line
with the requirement of IHR 2005.
❏ The data received by EWARS are assessed at EDCD by the National
Focal point for IHR. The identified public health risks and events are
communicated within the country, with WHO and with other
countries as needed
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COVID 19 and IHR
COVID-19 IHR Emergency Committee
The IHR Emergency Committee for COVID-19 held its first meeting on
22 and 23 January 2020. On 30 January 2020, following its second
meeting, the Director-General declared that the outbreak constituted a
Public Health Emergency of International Concern, accepted the
Committee’s advice and issued it as IHR Temporary Recommendations.
The Committee continues to meet on a regular basis.
Temporary recommendations to State Parties
❏ Share best practices, including from intra-action reviews, with
WHO; apply lessons learned from countries that are successfully re-
opening their societies (including businesses, schools, and other
services) and mitigating resurgence of COVID-19.
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❏ Support multilateral regional and global organizations and
encourage global solidarity in COVID-19 response.
❏ Enhance and sustain political commitment and leadership for
national strategies and localized response activities driven by
science, data, and experience; engage all sectors in addressing the
impacts of the pandemic.
❏ Continue to enhance capacity for public health surveillance, testing,
and contact tracing.
❏ Share timely information and data with WHO on COVID-19
epidemiology and severity, response measures, and on concurrent
disease outbreaks through platforms such as the Global Influenza
Surveillance and Response System.
❏ Strengthen community engagement, empower individuals, and build
trust by addressing mis/disinformation and providing clear guidance,
rationales, and resources for public health and social measures to be
accepted and implemented.
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❏ Engage in the Access to COVID-19 Tools (ACT) Accelerator,
participate in relevant trials, and prepare for safe and effective
therapeutic and vaccine introduction.
❏ Implement, regularly update, and share information with WHO on
appropriate and proportionate travel measures and advice, based on
risk assessments; implement necessary capacities, including at points
of entry, to mitigate the potential risks of international transmission
of COVID-19 and to facilitate international contact tracing.
❏ Maintain essential health services with sufficient funding, supplies,
and human resources; prepare health systems to cope with seasonal
influenza, other concurrent disease outbreaks, and natural disasters.
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❏ Nepal announced a nationwide lockdown after second case of
COVID-19
❏ Suspension of public transport
❏ Suspension of international flights
❏ Closure of schools, colleges and universities
❏ Closure of government services and private institutions
❏ No gathering of more than 25 people
❏ Nepal established health desks at Tribhuvan International Airport
as well as on other border checkpoints with India.
❏ Quarantine centers and temporary hospitals being set up
❏ Designated COVID-19 hospitals
❏ Setting up of ICU units and isolation at hospitals
❏ Expanding and upgrading laboratory services
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❏ To support the Government
of Nepal in preparing and
responding to an outbreak of
COVID-19 of a scale that
necessitates an international
humanitarian response
(including mitigation of
social and economic
impacts).
❏ To ensure that affected
people are protected and have
equal access to assistance and
services without
discrimination, in line with
humanitarian principles and
best practise.
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COVID-19 Response Plan
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❏ This plan intends to prepare and
strengthen the health system
response that is capable to
minimise the adverse impact of
COVID-19 pandemic.
❏ Provide clear policy guidance for
timely health system preparedness
and readiness to respond to the
pandemic.
❏ Provide a guiding framework for
timely, efficient and effective
response to the pandemic. Provide
official guidance
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Health Sector Emergency Response Plan
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Activities undertaken by government were guided by this plan.
It includes:
❏ Public health and social measures
❏ Quarantine management
❏ Community engagement and risk communication
❏ Case investigation and contact tracing
❏ Surveillance
❏ Screening at Point of Entries(POE)
❏ Community level screening and testing
❏ Emergency response teams
❏ Other Socio-administrative measure
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❏ Hospital Based Interventions:
❏ Hospital care and referral
❏ Laboratory services and other areas of hospital intervention
❏ Management and Oversight
❏ Safety and security of the frontline staff
❏ Human resource management and capacity building
❏ Logistics and supply chain management
❏ Collaboration and partnership
❏ Monitoring, evaluation and reporting
❏ Research
❏ Budget and financial arrangements
❏ Budget estimation
❏ Financing mechanism and funding
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What happens When state do not want to follow IHR?
143
❏ If a State notifies the Director-General of its rejection of these
Regulations or of an amendment thereto within the period
provided in paragraph 1 of Article 59 (The period provided in
execution of Article 22 of the Constitution of WHO for rejection
of, or reservation to, these Regulations or an amendment thereto,
shall be 18 months from the date of the notification by the
Director-General of the adoption of these Regulations or of an
amendment to these Regulations by the Health Assembly.
❏ Any rejection or reservation received by the Director-General
after the expiry of that period shall have no effect), these
Regulations or the amendment concerned shall not enter into
force with respect to that State.
❏ Any international sanitary agreement or regulations listed in
Article 58 to which such State is already a party shall remain in
force as far as such State is concerned.
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❏ The Chinese government was responsible for collecting data
about its spread and promptly informing the World Health
Organization (WHO), governments and scientists around the
world.
❏ Instead, China suppressed, falsified and obfuscated data and
repressed advanced warnings about the contagion as early as
December, well before the start of the global pandemic.
❏ The Chinese government also joined Moscow in exploiting
confusion around the pandemic by engaging in information
warfare through blatant disinformation on the origins of the virus,
suggesting it was developed as a tool for U.S. biological warfare.
❏ Last week, the Canadian government announced that one million
face masks recently purchased from China failed to meet
standards and would be returned.
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IHR and NCDs
146
In 2005, the World Health Organization introduced the International
Health Regulations (IHR) 2005 a diverse set of approaches to reduce the
impact of international public health emergencies through improved
country capacity to detect, assess, report, and respond to health security
threats. In 2014, the Global Health Security Agenda (GHSA) emerged
as a joint initiative among multiple countries to further support
implementation of the IHR.However, despite the syndemic relationship
between communicable and noncommunicable conditions worldwide
and despite growing recognition that integrated health systems are
important to health security objectives, NCD aspects of health
security are not part of IHR- or GHSA-related preparedness
approaches.
In a world of overlapping disease risks, where NCDs can no longer be
siloed away as an independent circumstance from pandemic outcomes,
pandemic prevention strategies might benefit from incorporating select
NCD elements as part of an integrated approach to health systems.
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IHR implementation and effects on routine services
147
Example from Nepal at the time of COVID-19 Pandemic
A qualitative study among community members and stakeholders at
Province-2 on impact of COVID-19 on health service utilization presented
that:
❏ Maternity services, immunization, and supply of essential medicine
were found to be the most affected areas of healthcare delivery during
the lockdown.
❏ Participants reported that the interruptions in health services were
mostly due to the closure of health services at local health care facilities,
limited affordability, and involvement of private health sectors during
the pandemic, fears of COVID-19 transmission among health care
workers and within health centers, and disruption of transportation
services.
❏ In addition, the participants expressed frustrations on poor testing,
isolation, and quarantine services related to COVID-19, and poor
accountability from the government at all levels towards health services
continuation/management during the COVID-19 pandemic.
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Major Achievements
❏ IHR national focal points
❏ Assessment and plans
❏ Training and capacity buildings
❏ IHR 2005 advocacy and provincial distribution
❏ Surveillance and response
❏ Laboratory support
❏ Collaboration with international community
❏ Reporting to WHO
❏ Asking for extension
❏ Still long way to go
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❏ Lives saved
❏ Good international image
❏ No unilateral travel and trade restrictions
❏ Public trust
❏ No political and social turmoil
Benefit from IHR implementation
149
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Challenges for IHR implementation in Nepal
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❏ Lack of infrastructure to respond at the time of emergencies.
❏ Difficult to mobilize resources
❏ Difficult to develop and implement national action plans
❏ Lack of skilled manpower
❏ Challenges to strengthen capacity at airports, and ground
crossings
❏ No proper reporting mechanisms
❏ Lack of supervision and monitoring
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Countries’ challenges for IHR implementation
❏ Mobilize resources and develop national action plans
❏ Strengthen national capacities in alert and response
❏ Strengthen capacity at ports, airports, and ground crossings
❏ Maintaining strong threat-specific readiness for known
diseases/risks
❏ Rapidly notify WHO of acute public health risks
❏ Sustain international and intersectoral collaboration
❏ Monitor progress of IHR implementation
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Conclusion
❏ IHR implementation is the responsibility of all sectors of the
government.
❏ Coordination is the must
❏ Capacities should be established
❏ Proper implementation ensure saving lives and resources
❏ Good international image
❏ Capacity building and human resources
❏ National and global health security
❏ Collaboration across countries
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Way Forward
❏ Capacity development
❏ Contingency planning
❏ Cross-border coordination
❏ Disease surveillance
❏ Infrastructure, equipment, and supplies (including ICT)
❏ Immigration and visa consular process
❏ IPC including WASH services
❏ Protection
❏ Risk communication
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This is all for health security.
Are we prepared for the next pandemic?
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