Global Health Risk Framework Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks: Workshop Summary (2016) / Chapter Skim
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5 Strengthening Outbreak Management and Emergency Response Systems
5 Strengthening Outbreak Management and Emergency Response Systems
Pages 75-92
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From page 75... ...
This center would be responsible for monitoring indicators and triggers of infec tious disease outbreaks and other emergencies while also maintaining awareness to identify potential unknown threats. (Campbell, Hanfling)
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From page 76... ...
Chapter 5 gives an overview of the role of strengthening countries' day-to-day health systems and public health infrastructures in preparing for effective outbreak management and emergency response, also highlighted in Chapter 3. Speakers and participants in this chapter discuss how to best augment existing systems for surge capacity needs during an emergency response.
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From page 77... ...
) • A skilled public health workforce • A functional and networked laboratory • Inter-sectoral collaboration • A strengthened public health system • Public health funding and leadership • Effective coordination OUTBREAK RESPONSE: PRINCIPLES AND STRATEGIES Perl defined five key elements of health care outbreak response that other speakers commented on throughout this section: outbreak management; care of large numbers of critically ill patients; protection of health care workers, patients, and volunteers; communication with health care workers, patients, families, community members, and public health authori
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From page 78... ...
Outbreak Investigation Perl outlined the key components of outbreak investigation. To explain the fundamentals of outbreak investigation and how investigation informs disease transmission prevention, she described her experience as part of a team investigating a 2013 nosocomial, or intrahospital, outbreak of iddle M East respiratory syndrome coronavirus (MERS-CoV)
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From page 79... ...
Infection Control and Prevention Perl stated that the outbreak at Al Hasa hospital was ultimately terminated when appropriate infection control practices were actually put in place, positing that the outbreak likely resulted from failure to adequately implement isolation and infection control measures. Isolation precautions 1 Therehas been at least one bat in which the MERS-CoV sequence has been identical to a patient MERS-CoV sequence.
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From page 80... ...
Campbell urged for protecting health care workers more effectively by providing them with better education and training regarding infection control and prevention. Rubinson similarly highlighted the importance of health care workers' safety and called for a commitment to disease transmission assessment that drives appropriate protection in terms of procedures, equipment, and training.
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. Fowler remarked that the sphere of infection control and preven tion extends beyond clinical practice to the domains of social mobilization, community engagement, and dispelling myths and misconceptions.
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Further services include offering psychosocial support to patients and relatives, as well as to health workers to help them avoid burnout and depression. EMERGENCY WORKFORCE CAPACITY: PREPARING FOR SURGES Norton's presentation focused on strategies and principles for incorporating global health reserve teams on the ground in times of need.
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From page 83... ...
He described the unified emergency response program as seeking to build energy by strengthening health systems' resilience and surveillance capacities, developing research and development "blueprints," and offering field support by delivering district teams using logistics arms. Strengthening Countries' Ability to Receive Support Enhancing a country's ability to receive international support teams was another topic of discussion.
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From page 84... ...
. Strategies for Incorporating Clinicians Effectively in Outbreak Response Rubinson offered a set of strategies for more effectively incorporating clinicians in outbreak response: "Clinical response is not just about bedside providers." He argued for the utility of attempting supportive care, remarking that many diseases are survivable with adequate supportive care, so it is crucial to give clinicians an accurate picture of what they will be doing and any information available about whether their care may be helping.
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From page 85... ...
Norton suggested the benefits of "twinning" Western clinicians so that when they are ready to deploy to the twinned country they are familiar with the available resources and setting-specific needs and can be as effective as possible.5 Engaging Community Health Workers in Outbreak Response Panjabi of Last Mile Health recommended professionalizing community health care workers not only for primary care delivery but also for disease response, branding it as particularly critical in the aforementioned 4 He advised never turning away pediatricians, because of the impact of disease outbreaks on children in affected communities. 5 As Norton explained, "twinning" is a process by which doctors in two or more countries train in each other's country to prepare for effective foreign deployment as necessary.
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From page 86... ...
By training them to identify suspected cases, community health workers can then iso late the patient, contact the relevant facility, educate the patient's caregiver, and keep the community calm. Regarding surveillance and preparedness, he suggested identifying the potential role of community health workers in reserve teams, risk stratification, and decentralizing surveillance from the facility to village level in remote areas (Kenny et al., 2015; Tanser et al., 2006)
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From page 87... ...
Strategic Planning of Operations Around Infectious Disease Outbreaks Strategic planning of operations around disease outbreaks was a topic of dialogue among participants in the focus area on incorporating global reserve teams on the ground. Campbell reported that participants discussed the importance of the strategic plan being multisectoral, suggesting the integration of clinical care, public health capacity, logistics, information technology (IT)
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From page 88... ...
Campbell noted that within a country, sufficient national operational capacity and a national emergency operations center are vital resources for constructing the planning of operations. Campbell emphasized that reinstating national ownership and national decision making in implementing these strategic plans will make a crucial difference in the future in determining when regional or international support is required.
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From page 89... ...
"Indicators" should go through a process of analysis or vetting to develop into scripted triggers and tactics that produce outcomes. "Triggers" are decision points that are based on changes in the availability of resources; they need to be adapted to health care services delivery all along the care continuum.6 According to Hanfling, this requires considering what information about demand and resources is available across the health system, understanding how this information is shared and integrated across stakeholders, determining how this information drives actions, and ultimately 6 Perlsuggested that when dealing with certain pathogens, there can be an element of security that necessitates developing triggers when the good of the people outweighs sovereignty.
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From page 90... ...
He referred to the Infectious Disease Emergency Response Plan in San Francisco7 and CDC's modified Liberia model (Pillai et al., 2014) as examples of models that are based on the ICS structure; however, he noted as of now, there is no high-level evidence to support or to compare effectiveness and efficiency of different management models for pandemics.
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From page 91... ...
Norton noted that neighboring countries can make a huge difference in terms of timely response and providing the appropriate context and skills; Myers noted similarly that if medical teams are available and on standby, and if a government can trust that the neighboring assistance will actually arrive, then perhaps countries would not need to build up that capacity themselves, and can focus on endemic issues. Another participant remarked that countries with existing services, such as an established training system, could provide a place for countries without existing services to train.
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