Health systems in control of outbreaks epidemics and
Health systems in control of outbreaks, epidemics, and pandemics ANDREW KITUA DIRECTOR USAID P&R PROJECT CENTRAL AND EAST AFRICA, KAMPALA, UGANDA.
Health system definition Health System: organization of people, institutions, and resources that deliver disease prevention and health care services and Interventions to meet the health needs of target populations. It encompasses: health service delivery systems (Prevention and Curative), the health workforce, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms, governance and legislation.
Outbreaks and Epidemics: Vulnerability of the EAC member states ØGeographical location within or close to the Rift Valley and the Congo Basin ØRich ecological systems offering close interactions between environment, wild animals, domesticated animals and humans. ØWeak health systems, yet to invest adequately on disease prevention ie. safe water, sanitation and hygiene. ØPublic ignorance of risks and how to avoid them ØIndividual and community risky customs and practices ØNatural and man-made disasters.
Figure 1. Maps of all zoonotic emerging infectious disease events (n = 202) stratified by origin. source: ILRI –Grace D. et al. 2012 https: //cgspace. cgiar. org/bitstream/handle/10568/21161/Zoo. Map_July 2012_final. pdf? sequence=4
Recent outbreaks in EAC Member states Disease outbreaks in EAC member states Year Type of outbreak Countries affected Source 2017 H 5 N 8 Uganda World Organization for Animal Health (OIE) 2017. MINISTRY OF Agriculture, Animal Industry and Fisheries (MAAIF) 2013 Ebola Virus Disease DRC Congo, Uganda MOH 2013 Yellow fever Angola, Congo, Uganda Onyango D 2013, Ochieng, Ahenda et al. 2015 206 -2007 Rift Valley Fever Ethiopia, Kenya, Tanzania Nanyingi, Munyua et al. 2015
FACTS: CHAIN OF EVENTS LEADING TO OUTBREAK Public health events of initially unknown etiology: A Animal Amplification framework for preparedness and response in the African Domestic Animal Human Region SPI L SPIL LL O VER R OVE C A SE S Wildlife SPI LL O VER TIME Source: Dennis Carroll
FACTS: Delays in response increase impact and costs Cost of outbreak control Human exposure Animal clinical signs Human disease & medical care Animal exposure Adapted from IOM (2009) Source: People, Pathogens and Our Planet. The Economic of One Health. Page 27, Volume 2, June 2012, World Bank.
Before, During and After Event periods BEFORE DURING AFTER
OH Preparedness &Response activities: OUR THEORY OF CHANGE FOCUS Public health events of initially One Health Preparedness activities TIME ACTIVITY unknown etiology: A framework for preparedness and response in the African Wildlife Domestic Animal Human Region One Health Response activities C A SE S TIME Adapted from Dennis Carroll
Targeting activities and funding to prevention: being ahead of outbreaks One Health Preparedness activities ACTIVITY Wildlife Domestic Animal Human One Health Response activities Max FUND Min Public Health, socioeconomic impacts TIME Adapted from Dennis Carroll C A SE S
Health systems strengthening: addressing major gaps in the control of outbreaks, epidemics, and pandemics 1. Inadequate policies and regulations supporting disease prevention and disease intelligence. 2. Weak coordination across sectors at all times (pre event, during event and post event) 3. Poor investment in disease intelligence (integrated disease surveillance mechanisms and their linkages) 4. Inadequate joint disease prevention research and interventions (hygiene, water sanitation 5. Unhealthy customs and practices, food safety and vaccinations)
Tools at our disposal to guide actions §THE AU ABUJA DECLARATION 2001 - (increasing health budget to 15% of their annual budget to improve the health sector) §THE WORLD HEALTH ORGANIZATION INTERNATIONAL HEALTH REGULATIONS (IHR) §THE WORLD ORGANIZATION FOR ANIMAL HEALTH PERFORMANCE OF VETERINARY SERVICES PATHWAY (APVS) §THE GLOBAL HEALTH SECURITY AGENDA (GHSA)
Public measures: Political q INVESTING IN DISEASE PREVENTION AND HEALTH PROMOTION. Educating and convincing our government on the value of investing in prevention, and hence strengthening regional and national capacities for infectious disease intelligence that allows effective prevention, detection and responding to public health events at source. Strategy : Enshrining health as a fundamental human right in member states national constitutions q Establishing regional one and eco health competitive fund to support research and innovations to strengthen targeted health systems prevention capacities. In this respect, emphasize strengthening health economics research as a tool to motivate policy decisions to invest in prevention.
Public measures: Interventions v STRENGTHENING CAPACITIES FOR INFECTIOUS DISEASE INTELLIGENCE: PREVENT, DETECT, RESPOND TO PUBLIC HEALTH EVENTS AT SOURCE v. STRENGTHEN CROSS SECTORAL COOPERATION, COLLABORATION AND COORDINATION IN DESIGNING AND IMPLEMENTING DISEASE PREVENTION AND CONTROL PROGRAMMES v. STRENGTHEN CROSS SECTOR ROUTINE COMMUNICATION AND DATA SHARING MECHANISMS v CONDUCT ROUTINELY JOINT SIMULATION EXERCISES
Public measures: Research ØJOINT RISK ASSESSMENT ØJOINT AND COMPLEMENTING RESEARCH FOR STRENGTHENING HEALTH SYSTEMS ASPECTS TARGETING PREVENTION, DETECTION AND RESPONDING TO PUBLIC HEALTH EVENTS ØSTRENGTHEN HEALTH ECONOMICS RESEARCH AS A TOOL TO MOTIVATE POLICY DECISIONS TO INVEST IN PREVENTION (DEMONSTRATE THE COST OF EPIDEMICS AGAINST THE SAVINGS OF IMPLEMENTING EFFECTIVE PREVENTIVE STRATEGIES). ”Limited resources can be best investing in preventing our populations from ill health and disease outbreaks. Doing so will make our governments save money and address better development issues to get us out of poverty. Neglecting this makes us spin around the circle of poverty where we are forced to spend our limited resources to address frequent outbreaks instead of attending development issues”
One and eco health initiative: linking human, animal and environmental health In order to bring about and maintain the status of health of our populations we must 1. strengthen our capacities and efforts to identifying the cause of the incidence and stemming it at source 2. Agree that health of humans is not divorced from the health of the animals we domesticate, wild animals and the environment. 3. Encourage initiatives that endeavor to bring about stronger collaboration between physicians, veterinarians, environmental professionals and other health related sectors. 4. We recommend establishing strong working consortia in the areas of - Research to determine the cause of incidence of outbreaks - Devise preventative strategies and test Interventions and innovations to prevent and respond adequately to outbreaks - Provide evidence for Social economic costs and burden of epidemics and savings to be made by investing in prevention.
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