Introduction to public health emergency management
- 1. Adama Hospital Medical College Department of Public Health Basic Epidemiology Introduction to Public Health Emergency management 10/5/2021 AHMC GMPH YEAR-ONE 1
- 2. Group members • Dr. Yared Adane • Mohammed Amin • Meaza Desalegn • Legesse Niguse 10/5/2021 AHMC GMPH YEAR-ONE 2
- 3. Out line • Introduction • Goal and objective of PHEM • Mandate of PHEM • Principle of PHEM • PHEM phase Early warning Preparedness Response Recovery • Priority disease • Surveillance • Communication • Reporting • Linkage with other process 10/5/2021 AHMC GMPH YEAR-ONE 3
- 4. Abbreviations • PHEM – Public health emergency management • IDSR – Integrated disease surveillance & response • IDS – Integrated disease surveillance • EOC – Emergency operation center • PPE – personal protective equipment • HEW – health extension worker • NNT – neonatal tetanus • IHR – international health regulation • DRM – disaster risk management 10/5/2021 AHMC GMPH YEAR-ONE 4
- 5. What does PHEM mean? • PHEM is the process of anticipating, preventing, preparing for, detecting, responding to and recovering from consequences of Public Health threats in order that health and economic impacts are minimized. • The process is fully integrated, adaptable, all hazards and all health approach national preparedness and response. • This core process is comprised of four sub processes which are: public health emergency preparedness, Early warning, Response and Recovery. 10/5/2021 AHMC GMPH YEAR-ONE 5
- 6. PHEM sub processes 10/5/2021 AHMC GMPH YEAR-ONE 6
- 7. Cont. • Every public health emergency management processes have a starting and ending point. • The process starts with early warning and ends with recovery. • However, in real situations the steps move forwards and backwards. • Each step repeats itself based on health risks identified. 10/5/2021 AHMC GMPH YEAR-ONE 7
- 8. IDSR Vs. PHEM IDSR • Mainly focus on Epidemic disease • Surveillance data comes monthly • Smallest reporting unit is Health Center • Week early warning system • Delayed response • No recovery • No event based surveillance • Include only some DRM Component PHEM • Multi hazard approach • Surveillance data comes weekly • Smallest reporting unit is Health post • Robust early warning system • Prompt response • Recovery activities included • Event based surveillance • Includes all DRM components 10/5/2021 AHMC GMPH YEAR-ONE 8
- 9. Goal & objectives • To markedly reduce mortality and morbidity due to epidemics and other Public Health Emergencies and minimize associated social and economic crisis • To prepare, early detection, and contain epidemics locally; respond timely to other public health emergencies and recover quickly from their impacts. 10/5/2021 AHMC GMPH YEAR-ONE 9
- 10. Mandate of PHEM • Identify, assess and monitor existing or potential threats to the public health. • Coordinate and ensure the formulation of preparedness plans for all types of public health emergencies at national, regional or woreda levels. • Strengthen the Public health emergency management capacity of the human resources of the health sector through direct training and coordination / assistance to efforts to be undertaken by the Academic Institutions, other departments of the MOH or other health actors. • Issue alerts and warning to the general public regarding potential public health emergencies or disasters. 10/5/2021 AHMC GMPH YEAR-ONE 10
- 11. Cont. • Maintain and administer a stockpile of supplies and equipment required for rapid response to public health emergencies. • Ensure that Ethiopia meets its international health security obligations in particular those under the International Health Regulations adopted in 2005. • Mobilize the government health resources to respond rapidly and effectively to the health consequences. • Coordinate and supervise the response of the Zonal and woreda Health offices in all emergencies with potential public health impact outside their respective area of responsibility. 10/5/2021 AHMC GMPH YEAR-ONE 11
- 12. Cont. • Issue bulletins and release information on the health situation, priorities and needs in all public health emergencies. • Issue technical guidelines and coordinate the humanitarian health assistance provided by partners. 10/5/2021 AHMC GMPH YEAR-ONE 12
- 13. The major public health risk identified in Ethiopian health system • Epidemics of communicable disease • Drought with malnutrition • Food contamination • Flood • Pandemic Influenza • Conflict and displaced populations • Accidents including chemical spills • Earthquake, volcano • Bioterrorism 10/5/2021 AHMC GMPH YEAR-ONE 13
- 14. Principles of PHEM Comprehensive – take into account all hazards, all phases, all stakeholders and all impacts relevant to public health problems. Progressive – anticipate future public health problem and take preventive and preparatory measures to reduce risk. Risk-driven – use sound risk management principles (hazard identification, risk analysis, and impact analysis) in assigning priorities and resources. Integrated – emergency managers ensure unity of effort among all levels of government and all elements of a community. 10/5/2021 AHMC GMPH YEAR-ONE 14
- 15. Cont. Collaborative – create good relationships among individuals and organizations to encourage trust, advocate a team atmosphere, build consensus, and facilitate communication Coordinated – all relevant stakeholders should be involved to achieve a common purpose Flexible – emergency managers use creative and innovative approaches in solving disaster challenge Professional – PHEM activities should be knowledge- based approach 10/5/2021 AHMC GMPH YEAR-ONE 15
- 16. PHEM phases and its processes 10/5/2021 AHMC GMPH YEAR-ONE 16
- 17. What is early warning • The identification of a public health threat by closely and frequently monitoring identified indicators and predicting the risk it poses on the health of the Public and the health system. • The purpose of early warning is to enable the provision of timely and effective information to the public and to responders, through identified institutions that allow preparing for effective response or taking action to avoid or reduce risk. 10/5/2021 AHMC GMPH YEAR-ONE 17
- 18. Major indicators of early warning • Increased in number of cases beyond expected /occurrence of out breaks • Unexplained morbidity and mortality • Evidence of increase in zoonotic diseases and/or related vectors • Environmental changes such as air pollution • Water quality changes contamination • Drought, flood, severe weather (metrological information) • Agricultural events such as reduced harvest, occurrence of pests • Refugees, internally displaced people, disruption of health services and infrastructure • Important industrial accidents; chemical spills etc. 10/5/2021 AHMC GMPH YEAR-ONE 18
- 19. Components of early warning 10/5/2021 AHMC GMPH YEAR-ONE 19
- 20. Public health emergency preparedness • Preparedness focuses on preparing equipment and procedures for use when a disaster occurs. • The equipment and procedures can be used to reduce vulnerability to disaster, to mitigate the impacts of a disaster, or to respond more efficiently in an emergency. 10/5/2021 AHMC GMPH YEAR-ONE 20
- 21. Cont. • Coordination and collaboration • Vulnerability assessment and risk analysis • Planning & resource mobilization • Exercise/drill – test the plan regularly • Capacity building - System and Human • Stockpile system –Drugs, Vaccines, PPE… 10/5/2021 AHMC GMPH YEAR-ONE 21
- 22. Public health emergency response • The response phase of an emergency focuses on rapid assessment of outbreaks, outbreak investigations, implementing control and prevention measures and monitoring of the interventions. • Rapid response limits the number of cases and geographical spread, shortens the duration of the outbreak and reduces fatalities. • These benefits save resources and also reduce the associated morbidity & mortality. 10/5/2021 AHMC GMPH YEAR-ONE 22
- 23. Cont. • Rapid assessment/outbreak investigation Epidemiological Laboratory (Field investigation, reference and atypical testing) Environmental • Control, preventive and supportive measures • Isolation and quarantine • Case management • Mass vaccination • Monitoring of drug sensitivity • Environmental management 10/5/2021 AHMC GMPH YEAR-ONE 23
- 24. Public health emergency response Emergency operation Center: The EOC is the physical location at which the coordination of information and resource to support incident management (on-scene operations) activities normally takes place. • Equipped with trained staff and state of the art communication and IT at the central level • Horizon scanning – e-mail, web based, News • Hotline – health personnel and to the public • Activation and deactivation process 10/5/2021 AHMC GMPH YEAR-ONE 24
- 25. Emergency operation Center Activated • When an emergency is imminent • When threshold events described in the emergency operation plan occurs • When there is predictions of hazardous weather, elevated threat level occurs etc. Deactivated • When there is no need of additional resources • The epidemic / emergency is stabilized • The response objectives are met 10/5/2021 AHMC GMPH YEAR-ONE 25
- 26. Recovery • Recovery is defined as the process of rebuilding, restoring, and rehabilitating the community following an emergency, but it is more than simply the replacement of what has been destroyed and the rehabilitation of those affected. • It is a complex social and developmental process rather than just a remedial process. • Recovery is best achieved when the affected community is able to exercise a high degree of self determination. 10/5/2021 AHMC GMPH YEAR-ONE 26
- 27. Cont. • Impact assessment • Monitoring and evaluation • Rehabilitation • Restoration of the health system Infrastructure Supplies Health Personnel • Liaison with multi sectorial committee 10/5/2021 AHMC GMPH YEAR-ONE 27
- 28. List of diseases / condition under surveillance in Ethiopia 1. Acute Flaccid Paralysis 2. Anthrax 3. Avian Human Influenza 4. Cholera 5. Dracunculiasis/ Guinea warm 6. Measles 7. Neonatal tetanus 8. Pandemic Influenza A(H1N1) 9. Rabies 10. Small pox 11. SARS 12. Viral Hemorrhagic Fever(VHF) 13. Yellow Fever 14. Maternal death 15. Perinatal Death Immediately notifiable Weekly reportable 1. Dysentery 2. Malaria 3. Meningitis 4. Relapsing 5. Typhoid Fever 6. Typhus 7. Severe Acute Malnutrition 8. Scabies 10/5/2021 AHMC GMPH YEAR-ONE 28
- 29. Priority disease & prioritization criteria • High epidemic potential (anthrax, avian human influenza, cholera, measles, meningococcal meningitis, pandemic influenza, smallpox, severe acute respiratory syndrome (SARS), viral hemorrhagic fever (VHF), and yellow fever) • Required internationally under IHR 2005 (smallpox, poliomyelitis due to wild-type poliovirus, human influenza caused by a new subtype, SARS) 10/5/2021 AHMC GMPH YEAR-ONE 29
- 30. Priority disease & prioritization criteria • Targeted for eradication or elimination (poliomyelitis, Dracunculiasis, NNT • Have a significant public health importance (rabies, dysentery, malaria, RF, typhoid fever, typhus and SAM • Diseases that have available effective control and prevention measures for addressing the public health problem they pose. 10/5/2021 AHMC GMPH YEAR-ONE 30
- 31. Threshold for outbreak 10/5/2021 AHMC GMPH YEAR-ONE 31
- 32. Cont. Reportable disease Number of cases Measles 5 suspected cases or 3 confirmed cases malaria Crossing the norm line or doubling of cases compared to the same week of the previous year Meningitis 5/<30,000 population or 10/10000 population Dysentery Unusual increases of cases or doubling of cases on subsequent weeks Typhoid fever Unusual increases of cases or doubling of cases on subsequent weeks Typhus Unusual increases of cases or doubling of cases on subsequent weeks Relapsing fever Unusual increases of cases or doubling of cases on subsequent weeks scabies SAM To be determined locally at kebele level 10/5/2021 AHMC GMPH YEAR-ONE 32
- 33. Case definition • A case definition: is a set of criteria used to decide if a person has a particular disease, or if the case can be considered for reporting and investigation • Standard case definition: is a case definition that is agreed upon to be used by everyone within the country. • Standard case definition can be classified as confirmed, probable, and possible or suspected 10/5/2021 AHMC GMPH YEAR-ONE 33
- 34. Surveillance • Surveillance – It is surveillance derived from two French words “ Sur”(watch or look) and “veller” (Over). • Surveillance is the ongoing systematic collection, analysis, and interpretation of health and health related data. • Surveillance is information for action. • It is the main activities of PHEM. 10/5/2021 AHMC GMPH YEAR-ONE 34
- 35. Types of surveillance • Based on intervention A. Active Surveillance B. Passive Surveillance C. Sentinel Surveillance • Based on location A. Community based Surveillance B. Facility based Surveillance 10/5/2021 AHMC GMPH YEAR-ONE 35
- 36. Communicate information • Communicate with the public in ways that build, maintain or restore trust, and encourage participate in the early warning activities. • Routinely translate scientific and health information for communities and policy makers. • Risk communication: activities for sharing information and ideas about risks and actions to deal with real and potential dangers that could lead to an indiscriminate demand that is impossible to meet. • Communicate information to other stake holders that may help you to achieve objectives 10/5/2021 AHMC GMPH YEAR-ONE 36
- 37. Cont. • Alert/warning • Provision of feedback (written / oral) • Reinforce efforts of the health staff to participate in the surveillance system. • Raise awareness about certain diseases and any achievements of disease control and prevention activities in the area. 10/5/2021 AHMC GMPH YEAR-ONE 37
- 38. Reporting tools • Weekly reporting format for health post / HEW • Weekly reporting format for other levels • Daily epidemic reporting format for Woreda(DERF- W) • Daily epidemic reporting format for Region(DERF- R) • Integrated case based reporting format • Case based reporting format (CRF) for many diseases • Line list 10/5/2021 AHMC GMPH YEAR-ONE 38
- 39. Cont. • Rumor log book • Case based laboratory reporting form (CLRF) • Maternal death identification and notification • Verbal autopsy • Maternal death reporting format (MDRF) 10/5/2021 AHMC GMPH YEAR-ONE 39
- 40. Surveillance flow chart 10/5/2021 AHMC GMPH YEAR-ONE 40
- 41. Time line for immediately notifiable disease or conditions 10/5/2021 AHMC GMPH YEAR-ONE 41
- 42. Time line for weekly reportable diseases / conditions 10/5/2021 AHMC GMPH YEAR-ONE 42
- 43. Surveillance data reporting methods 10/5/2021 AHMC GMPH YEAR-ONE 43
- 44. Surveillance data analysis & interpretation • Provides key information for taking prompt public health actions. • Should be done daily and weekly at each level where data are collected (starting from health facility level to national level). • Major steps Creating database or filed paper data Data cleaning Check completeness Data analyzing and interpretation 10/5/2021 AHMC GMPH YEAR-ONE 44
- 45. Cont. • Simple data analysis is done to find information Related to person, place, and time. Trends over time(line graph, bar graph or histogram) Geographic distribution of the disease or the outbreak (dot map) Frequency of cases, deaths (table) Case fatality rate (CFR) Attack rate (AR) 10/5/2021 AHMC GMPH YEAR-ONE 45
- 46. Cont. • An action threshold triggers a definite response • Possible actions include Communicating laboratory confirmation results to concerned health centers, Implementing an emergency response such as immunization, community awareness campaign, or improved infection control practices in the health care setting etc. 10/5/2021 AHMC GMPH YEAR-ONE 46
- 47. Linkage with other process 10/5/2021 AHMC GMPH YEAR-ONE 47
- 48. References • National public health emergency guideline, February, 2012 10/5/2021 AHMC GMPH YEAR-ONE 48
- 49. Thank you! 10/5/2021 AHMC GMPH YEAR-ONE 49