Ebola Preparedness Assessment in Sri Lanka – … Preparedness Assessment in Sri Lanka – Mission...
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1 SEARO/WHO Ebola Preparedness Assessment in Sri Lanka – Mission Report 08-14 November 2015
Transcript of Ebola Preparedness Assessment in Sri Lanka – … Preparedness Assessment in Sri Lanka – Mission...
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SEARO/WHO
Ebola Preparedness Assessment in Sri Lanka – Mission Report 08-14 November 2015
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Contents
Executive summary ....................................................................................................................................... 3
Introduction .................................................................................................................................................. 6
Specific Objectives ........................................................................................................................................ 7
Joint Assessment Team ................................................................................................................................. 7
Assessment Methods ................................................................................................................................... 7
Activities ........................................................................................................................................................ 8
Findings ......................................................................................................................................................... 8
Conclusions ................................................................................................................................................. 14
Recommendations ...................................................................................................................................... 16
Annex 1: Agenda of activities and attendants lists ..................................................................................... 17
Annex 2: Relationship between tasks and currently functional activities -Readiness -preparedness .... 21
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Executive summary
This report summarizes the status of Sri Lanka’s alert in response to the potential introduction of Ebola
virus disease (EVD) in the country and its operating plans with respect to preparedness for EVD outbreak.
This assessment is in line with the International Health Regulations (IHR 2005) and fulfills a of World
Health Organization (WHO) requirement that was highlighted by the Executive Board in 2015.
Findings
Sri Lanka has been fortunate to have been spared by major emerging diseases that had the potential to
become a public health emergency of international concern for the past two decades (e.g., avian
influenza viruses, coronaviruses and other emerging zoonotic diseases in the region). A very high
proportion of in-patient care and approximately half of out-patient care services in the country are
offered by the state sector and the private sector is not dominant.
The overall findings indicated that evidence of operational readiness and currently functional activities is
“substantial” in Sri Lanka. Second, “some major gaps” were found in preparedness planning and surge
capacity.
The Joint Assessment Team (JAT) believes that overall, Sri Lanka is significantly prepared with respect to
the following preparedness tasks:
- Good leadership and multi-ministerial and multisectoral/multidisciplinary coordination
mechanism
- High level commitment to IHR where funds release mechanism has been eased to cover
both outbreak response and preparedness
- Close intersectoral and multisectoral coordination led by the Epidemiology Unit of the
Ministry of Health, Nutrition and Indigenous Medicine (MoH)
- Surveillance is web-based with good internet connectivity; notifiable diseases with
immediate reporting covering all districts
- Event-based surveillance appears effective in reporting unusual events in all parts of the
country
- Regular surveillance feedback through weekly and quarterly bulletins
- Effective capacity for social mobilization
- Good dissemination capacity of information or instruction via internet
- The reference hospital for infectious diseases has strong leadership and commitment to
infection prevention and control (IPC) with standard mechanism in place including
functional IPC committee, IPC training program for all level of hospital staff, surveillance of
healthcare associated infection and antimicrobial resistance
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The JAT wants to emphasize some potential vulnerability:
- Limited capacity for molecular diagnosis of major emerging viral diseases
- Pandemic Influenza Preparedness Plan and emerging infectious disease (EID) plan have not
been updated since 2012 and 2010, respectively
- A plan focusing on specificity of EVD or Middle East respiratory syndrome (MERS) has not
been formally developed
- No clear process for conducting risk assessment – no manual for guidance
- Though cost-effective approaches are in place to equip isolation rooms in IDH with the use
of locally-made equipment related to IPC (goggles, local personal Protective Equipment
(PPE), gowns, etc.), the, efficiency of these in IPC is yet to be validated
- Although there is written emergency contingency covering all PoEs (International Airport
and Sea Ports) and Standard Operating Procedures (SOPs) and training were done, no drill or
simulation were conducted to test them
Recommendations
1. The Epidemiology Unit should consider updating the preparedness and response plans for
pandemic influenza, incorporating a risk-based approach; a special addendum could be
developed for most imminent threats to the country.
2. The MoH should consider updating the risk communication plan.
3. The Medical Research Institute (MRI) should consider strengthening laboratory capacity through
developing a vision (MRI’s national roles, responsibilities using national network, information
technology support for surveillance etc.), and a short-term and long-term strategic plan for EID-
related diagnosis capacity (MRI’s national roles, responsibilities using national network, IT
support for surveillance and etc.). Collaborations for technical support could be initiated with
WHO’s support. Notably, introducing the molecular technique capacity and uplifting the
laboratory to Biosafety Level 2+ (BSL2+) should a minimum requirement for a national
reference laboratory for emerging infectious diseases including EVD and Middle East respiratory
syndrome coronavirus (MERS-CoV) infection.
4. Infectious Diseases Hospital should consider collaborating with WHO to validate the cost-
effective infrastructure concept to handle isolation rooms and locally-made equipment (e.g. PPE)
approach for IPC. Also, SOPs for IPC could also be reviewed by an external team in detail. This
could be a project where the model could be replicated in other similar settings with limited
resources.
5. The Quarantine Unit of MoH should consider conducting drills and simulation exercises as soon
as possible to test the preparedness plan, SOPs and IPC practices or PPE donning/doffing
procedure at Ports of Entry (PoE) of the country
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Limitations The results of this assessment need to be interpreted in light of the country’s particular situation. Sri
Lanka has been fortunate not to have had major infectious diseases of Public Health Emergency of
International Concern (PHEIC) type; diseases of low likelihood of occurrence but of potentially
catastrophic impact for instance. Our review methodology did not focus on the quality aspect of the
procedures and contents of the technical materials. “High level” of preparedness only concludes that Sri
Lanka is taking steps to ensure plan is truly operational. Vigilance is always required regarding the
quality of preparedness planning including updating the preparedness plan regularly, strengthening risk
assessment and monitoring and evaluation capacities. Drills and simulation are a continuous process to
enhance preparedness capacity.
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I. Introduction
In January 2015, SEARO requested a country review of the Preparedness and Readiness for Ebola Virus
Disease to help identify gaps and ways to developing their operational readiness for Ebola Virus Disease
(EVD) to the greatest degree possible. This assessment fulfills a World Health Organization (WHO)
requirement that was highlighted by the Executive Board in 2015.
In December 2014, the Regional Office disseminated the WHO self-assessment checklist to the 11 WHO
country offices (WCO) to gauge countries’ capacity to respond to the potential occurrence of EVD
imported cases and outbreaks. With the support of their national counterparts, the 11 WCOs responded
promptly. The results have served as the basis for an interim SEARO action plan to further strengthen
countries’ capacity on Ebola preparedness.
The WHO Ebola preparedness checklist has been conceived with a primary focus on high risk countries.
Given the low risk of EVD spread in South-East Asia, SEARO recognizes that Member States (MS) and
many of their agencies cannot be in a full capacity mode to respond to an Ebola outbreak – particularly
when resources are limited. Following a risk –based approach for managing major public health events,
the assessment will focus on the readiness for a potential introduction of EVD and the capacity of surge
to respond to a wider outbreak.
SEARO proposes a rigorous and systematic yet adaptable approach to the WHO Ebola Preparedness
Checklist accounting for the level of Ebola risk the SEAR countries.
We hope the present joint assessment will serve as a significant starting point for formulating a short-
and long-term capacity development response. It can help build political support for a regional agenda
and offer a platform for dialogue among regional and international stakeholders in line with the
International Health Regulations (IHR), 2005.
The goal of the mission was to ensure that the country is as operationally ready as possible to effectively
and safely detect, investigate and report potential EVD cases and to mount an effective response that
will prevent a larger outbreak. The visit will assess the situation and identify current gaps and required
support to strengthen preparedness.
The SEARO missions, in collaboration with WCO and countries’ health authorities, have focused on the
implementation of the procedures and mechanisms with respect to the following areas, in alignment
with the 2005 IHR:
Coordination of institutions involved in detecting and responding to potential Ebola cases
Risk assessment to get prepared and epidemiological investigation, surveillance and laboratory
capacity, particularly to ensure rapid identification and isolation of cases, diagnostic confirmation,
and contact tracing to contain the spread of the virus
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Surge capacity in healthcare facilities and among various technical agencies in case of several clusters
scattered in different locations.
Communication capacity to ensure transparency and public trust in health authorities and general
compliance with public health measures
II. Specific Objectives
• Conduct assessment for readiness and preparedness for Ebola virus disease (EVD) response
• Assist MS to identify vulnerabilities, opportunities and needs to meet EVD response
requirements
III. Joint Assessment Team
Organization Name Function/Role
Mission dates
Ministry of Health, Nutrition and
Indigenous Medicine
Dr. Paba Palihawadana
Dr. Palitha Karunapema
Dr. Samitha Ginige
Dr. Iresh Dassanayake
Dr. Madhava Gunasekara
Member
Member
Member
Member
Member
N/A
WHO Country Office
Dr. Arturo Pesigan
Dr. N. Janakan
Dr. N. Gunawardena
Member
Member
Member
N/A
SEARO/WHO Staff
Dr Hammam M El Sakka Dr Sirenda Vong
Member - WCO BAN Member - SEARO
Arrival: 08/11/15 Departure: 14/11/15
IV. Assessment Methods
The assessment was performed by a joint team (see above) and consists of guided discussions between
the JAT and the senior technical leaders of the national health authorities using table-top exercise (TTX)
approach and field visits.
The Checklist contains nine major assessment components (AC): (1) Ebola emergency planning; (2) risk
assessment; (3) leadership and coordination; (4) surveillance – alert and early warning; (5) laboratory
diagnosis; (6) rapid investigation and containment; (7) infection control and clinical management; (8)
different aspects of communication and (9) points of entry. Within each AC, different aspects or tasks
will be discussed. Each task intends to address one of the three aspects of preparedness: (1) what has
been operational currently for Ebola detection? (2) Is the country ready for an introduction of an EVD
case? and (3) How prepared is the country to face a wider outbreak?
The relationship between ACs, tasks and the above three aspects of preparedness is provided in Annex 2.
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Results of the discussion are summarized in form of:
- Bullet points regarding strengths and vulnerabilities for each task and AC
- Level of preparedness or readiness
- Overall level of readiness and the overall currently functional activities can range from as follows:
“Limited, Significant or Substantial evidence”
- Level of preparedness using the following terms: “Inadequate preparedness”, “Some major
gaps” or “No major gaps”.
The present assessment requires that all activities that are reported in the table-top exercise are
documented. A particular attention was paid to documented procedures.
Assessment limitations:
• Potential biases: reports from limited number of national interviewees
• Focus on system analysis rather than assessing quality of response capabilities
– Focus on system gaps (input and process indicators) at central level
– Limited assessment of quality of activities/documents used as evidence
– Limited knowledge about compliance to instructions
– Impact of trainings or exercises difficult to assess given time constraint
• A high level for Operational Readiness emerging from this assessment should not be interpreted
as indicating that the country is truly operationally prepared. Rather, it is an indication that the
country is taking steps to ensure that its plan is truly operational and that the activities, as
addressed in the plans, are actionable and viable as written.
V. Activities
Details of the activities conducted are shown in Annex 1.
VI. Findings
The overall findings indicated that evidence of operational readiness and currently functional activities is
“substantial” in Sri Lanka. Second, “some major gaps” were found in preparedness planning and surge
capacity.
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Detailed of the findings par task are shown as follows.
Assessment components Findings
Level
1. Planning - Emergency risk management
Although there is PIIPP plan (2012) and National Preparedness Plan (2010) there is specific written Preparedness Plan for EVD.
WHO guidelines and SOPs were adapted to country prospective, validated, widely distributed and feedback mechanisms were in place.
The fund release mechanisms were well defined, tested during EVD by using fund form procurement of laboratory equipment, fund needs is discussed on monthly basis during the Epidemiology Unit meetings.
There is no bonus system for high-risk group and only available if death happened to a medical staff member during duty.
Contingency measurement took place in EVD preparedness for designated hospital (Infection Disease Hospital).
2. Risk assessment conducted and operational
Risk assessment appears to have been conducted to some extent; however, risk assessment manual or process has not been formally developed and no formal reports were released.
3. Leadership & Coordination in place and with surge capacity (multi-level & multisectoral)
Use of pre-existing committee (i.e., technical committee on influenza) to coordinate at national and subnational level EVD preparedness plan.
Membership of the committee is clearly defined and flexible to include relevant departments.
Incidence management system is clearly defined in the national pandemic influenza preparedness plan; although the plan has not been updated since 2012.
Several EOCs with different roles including one in EU and one in MOH appear to be in place and functional.
4. Surveillance – Alert – warning system
Surveillance reporting forms were updated to include EVD and MERS. Both diseases were categorized as group A (immediate reporting) together with Zero reporting.
Case definitions were revised and distributed to all reporting units and training was conducted to the medical staff.
Data flow is in place with clear feedback mechanisms from the central level AND post outbreak follow-up was conducted regularly.
The Web based Surveillance system is totally functional with rapid data analysis. Weekly and quarterly epidemiological reports are timely produced and widely distributed.
Rapid response teams from the national level were trained and participated in outbreak investigation and response.
5. Laboratory diagnosis
Medical Research Institute is designated as the national reference laboratory for EID diagnosis, however, it does not have diagnostic capacity for Ebola virus due to unavailability of BSL3 or BSL2+ capacity in MRI. Molecular technique for MERS-CoV available but not fully validated by external quality assurance..
MRI has no stand-by arrangements with WHO collaborating centres for EVD.
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MRI staff was trained in sample collection and packaging of high security agents to be shipped; however, MRI is not involved in training other lab technicians, e,. hospitals' lab technicians.
Limited planning to address needs for surge capacity; MRI's acknowledged difficulties in handling an EVD outbreak.
6. Rapid investigations, efficient contact tracing and containment
National and District level RRTs specifically trained for investigation and contact tracing but only national RRT is mainly involved in outbreak investigation. Roster mechanism is in place.
National and district RRTs specifically trained on sample collection and transportation but only national RRT collects and transports samples.
National and district RRTs trained on PPE.
National and District RRTs trained and tested on contact tracing.
National and District RRTs appear ready for contact tracing.
7. Infection control and
clinical management
Extensive and repeated training organized by the Infection Disease Hospital's infection control committee with drills on EVD and MERS.
Cost-effective approach to develop over 20 well-equipped isolation beds for dangerous infectious diseases.
Detailed plan documented and described by the Director to rapidly increase the number of isolation rooms if need be.
ID hospital staff is well trained and prepared; and included the best ID specialists of the country. They also served as reference ID specialists and can be joined thru a well-established system by phone by medical doctors across the country.
8. Communication: (1) Dissemination mechanism; (2) Public information and social mobilization; (3) Risk communication
Communication coordination mechanism is in place and appears functional.
Some participants recognized that risk communication plan needs to be strengthened.
Mechanism in place to communicate with community leaders and IEC materials appear readily available.
High internet connectivity which allows good dissemination of information and instructions to districts.
Advice to travelers to affected areas are planned but not developed.
IHR channel of communications clearly established between WHO country office and MoH/Epidemiology Unit.
EU leaders recognized strong capacity for social mobilization.
9. Port of Entry
Emergency contingency covering all PoEs (International Airport and Sea Ports) and Standard Operating Procedures (SOPs) in place and training were done but no drill or simulation were conducted to test them.
The health office at the international airport is equipped and fully functional with enough Personal Protective equipment (PPE) available 24 hours.
Staff were trained PPE twice but refreshment training is required. No holding area is attached to the health office.
Stand-by arrangement exits with the designated hospital for EID, ie, Infection Disease Hospital. Although there is a patients’ transfer mechanism, there’s no dedicated ambulance service at the airport.
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Good communication channels between Airport Authority, Epidemiology Unit at MoH and infection disease hospital.
Information and advice for at-risk passengers travelling from at-risk areas for EVD and MERS appears in place; information on these passengers are shared with the Epidemiology Unit for follow-up; however, it is possible that information for follow-up is not complete
Complete response. Discussion indicates functionality or actionable intervention
MS has largely addressed activity, but response is not complete or actionable.
Discussion indicates only intention or beginning of planning for activity, or only a part of the activity has been addressed.
Strengths and vulnerabilities
Assessment Components
Strengths Vulnerabilities
Planning - Emergency risk management
EVD guidelines and SOPs were timely produced and widely disseminated to all health staff at different levels. Clear administrative mechanism for quick release of funds for preparedness is in place and tested.
National Influenza Preparedness Plan and National Preparedness Plan not updated since 2012 and 2010 respectively EVD preparedness and response plan was not developed in a timely manner. MERS preparedness and response plan is not formally developed. Contingency plan was developed only for Infection Disease Hospital and PoE Limited danger/risk allowance or motivation system exists to support staff in the public health system
Risk assessment capacity
Epidemiology Unit (EU) assigned to monitor daily the EVD situation in West Africa or MERS-CoV situation Good capacity to conduct risk assessment and there is evidence that the results have been used to develop preparedness strategy
Risk assessment was informally conducted where process, risk questions and conclusions are unclear. No clear process for conducting risk assessment – no manual
Leadership and Coordination
The pre-existing and well-structured National Influenza Technical Committee assigned to prepare for EVD or MERS outbreaks The above committee is led by DG and meetings are held systematically on monthly basis. Decisions are made immediately and implemented by EU.
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The committee is multidisciplinary and multisectoral, and sufficiently flexible to include relevant departments or ministries. EOCs in place at EU and MoH; they appear to be frequently used Centralized and central function of EU to prepare, detect and respond to infectious disease outbreaks
Surveillance – Alert – warning system
Strong commitment from the Epidemiology Unit, MoH leadership to strengthening detection and response to potential EVD or MERS outbreaks. Robust event based surveillance (EBS) to detect unusual events in the community. Indicator Based Surveillance (web-based) surveillance) included EVD and MERS in the list of group A immediate reporting diseases Significant experience in detecting and managing Influenza Outbreaks.
Laboratory diagnosis Numerous formally trained microbiologists (MBBS-MD level) Functional National Influenza Center in MRI with international collaborations MRI works closely with SEARO to collaborate with reference laboratories in the region (eg, Pune Institute of Virology, India) BSL3 capacity exists in SRL, ie, TB diagnosis; however, MRI reckons there are difficulties to use the BSL3 lab for TB for emerging infectious diseases (EID). MRI has had experience in packaging and shipment and handling infectious substances when dealing with few suspected cases
MRI’s role has focused on preparing/packing the samples collected from health facilities to transport the samples to the WHO reference laboratory. Issues with timely molecular diagnosis capacity to improve patient’s management have not been addressed. Limited MRI roles in training lab staff of other institutions (eg, hospitals) Both BSL2+ and BSL3 level laboratories are not functional (BSL2+ expected to be functional within 3-6 months; not clear when the BSL3 lab will be operational). As a result, MRI has limited capacity for virus inactivation of potentially dangerous viruses. Limited plan in strengthening laboratory capacity to handle diagnosis for EVD, MERS-CoV in terms of surge capacity: human resources, molecular techniques, etc The MRI receives about 30-40 Influenza samples per month from 19 sentinel sites across the country.
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Limited capacity to use lab data for surveillance and analysis without proper IT and databases: >60,000 results per year are manually recorded in a register
Rapid investigations, efficient contact tracing and containment
RRTs at national and District levels identified and trained on PPE National RRT has been tested through management of events related to identification of suspected cases. Sufficient training and logistics for National RRTs for patient and sample transportation.
District RRT has limited role in contact tracing, sample collection, and transportation of suspected patients. Minor gaps in detecting incubating travelers for follow-ups
Infection control and clinical management
Infectious Diseases hospital (IDH) is the designated reference hospital for EID Extensive training program on IPC that contains exercises and drills on Ebola and other EID response – M&E mechanism in place to address system gaps. As a result, IDH staff was confident in handling a previous suspected EVD case. All hospital staff are trained from cleaners/drivers to consultants in IPC and preparedness Solid and structured IPC program at the Infection Disease Hospital pital Well-trained infectious disease specialists and microbiologists on IPC, AMR resistance Surveillance for AMR and healthcare associated infection using WHOnet is in place and appears functional. A Hotline 24/7 system in place with best ID specialists available to address technical questions
The lab result on an EVD suspected case returned from India’s Institute of Virology in Pune one week after sample collection. Before this timeliness issue, IDH is taking step to scale –up the lab to BSL2+ to handle virological samples. Cost-effective approach to equip isolation rooms in IDH – opportunities for collaboration with WHO to assess efficiency of locally-made equipment related to IPC (goggles, local PPE, gowns, etc.).
Communication: (1) Dissemination mechanism; (2) Public information
Good internet connectivity where information can be disseminated rapidly. Rapid dissemination of national circulars
No formally trained risk communication officers; EU and MOH rely on few experienced senior epidemiologists. EU has not been yet put into test to deal with a large EID
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VII. Conclusions
The overall findings indicated that evidence of operational readiness and currently functional activities is
“substantial” in Sri Lanka. Secondly “some major gaps” were found in preparedness planning and surge
capacity.
The Joint Assessment Team (JAT) believes that overall, Sri Lanka is significantly prepared with respect to
the following preparedness tasks:
- Good leadership and multi-ministerial and multisectoral/multidisciplinary coordination
mechanism
- High level commitment to IHR where funds release mechanism has been eased to cover both
outbreak response and preparedness
- Close intersectoral and multisectoral coordination led by the Epidemiology Unit of the Ministry
of Health, Nutrition and Indigenous Medicine (MoH)
- Surveillance is web-based with good internet connectivity; notifiable diseases with immediate
reporting covering all districts
and social mobilization; (3) Risk communication
from BOE with district health offices Capacity for social mobilization and to reach out to all communities appears efficient. No major challenges have been identified by participants.
outbreak. Risk communication plan may need to be structured and strengthened, particularly for EVD or MERS
Ports of Entry The health office is equipped and fully functional with enough Personal Protective equipment (PPE) available 24 hours. The isolation hospital is designated (Infection Disease Hospital) and good communication channels between Airport Authority, Epidemiology Unit at MoH and infection disease hospital. Forms and registration books are in place to collect basic information about travels from affected countries but there were some missing information for some passengers such as contact phone number or complete address in the country.
Although there is written emergency contingency covering all PoEs (International Airport and Sea Ports) and Standard Operating Procedures (SOPs) and training were done but no Drill or simulation were conducted to test them. Staff were trained PPE twice but refreshment training is required. No holding area is attached to the health office. Although there is a patients’ transfer mechanism, there’s no dedicated Ambulance Service at the airport. Limited technical staff at central level (1 Director and 1 public health consultant) to supervise and coordinate 4 international seaports and 2 international airports) IT equipment to support communication the airport health office is limited.
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- Event-based surveillance appears effective in reporting unusual events in all parts of the country
- Regular surveillance feedback through weekly and quarterly bulletins
- Effective capacity for social mobilization
- Good dissemination capacity of information or instruction via internet
- The reference hospital for infectious diseases has strong leadership and commitment to
infection prevention and control (IPC) with standard mechanism in place including functional IPC
committee, IPC training program for all level of hospital staff, surveillance of healthcare
associated infection and antimicrobial resistance
The JAT wants to emphasize some potential vulnerability:
- Limited capacity for molecular diagnosis of major emerging viral diseases
- Pandemic Influenza Preparedness Plan and emerging infectious disease (EID) plan have not been
updated since 2012 and 2010, respectively
- A plan focusing on specificity of EVD or Middle East respiratory syndrome (MERS) has not been
formally developed
- No clear process for conducting risk assessment – no manual for guidance
- Though cost-effective approaches are in place to equip isolation rooms in IDH with the use of
locally-made equipment related to IPC (goggles, local personal Protective Equipment (PPE),
gowns, etc.), the, efficiency of these in IPC is yet to be validated
- Although there is written emergency contingency covering all PoEs (International Airport and
Sea Ports) and Standard Operating Procedures (SOPs) and training were done, no drill or
simulation were conducted to test them
Limitations
The results of this assessment need to be interpreted in light of the country’s particular situation. Sri
Lanka has been fortunate not to have had major infectious diseases of Public Health Emergency of
International Concern (PHEIC) type; diseases of low likelihood of occurrence but of potentially
catastrophic impact for instance. Our review methodology did not focus on the quality aspect of the
procedures and contents of the technical materials. “High level” of preparedness only concludes that Sri
Lanka is taking steps to ensure plan is truly operational. Vigilance is always required regarding the
quality of preparedness planning including updating the preparedness plan regularly, strengthening risk
assessment and monitoring and evaluation capacities. Drills and simulation are a continuous process to
enhance preparedness capacity.
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VIII. Recommendations
1. The Epidemiology Unit should consider updating the preparedness and response plans for
pandemic influenza, incorporating a risk-based approach; a special addendum could be
developed for most imminent threats to the country.
2. The MoH should consider updating the risk communication plan.
3. The Medical Research Institute (MRI) should consider strengthening laboratory capacity through
developing a vision (MRI’s national roles, responsibilities using national network, information
technology support for surveillance etc.), and a short-term and long-term strategic plan for EID-
related diagnosis capacity (MRI’s national roles, responsibilities using national network, IT
support for surveillance and etc.). Collaborations for technical support could be initiated with
WHO’s support. Notably, introducing the molecular technique capacity and uplifting the
laboratory to Biosafety Level 2+ (BSL2+) should a minimum requirement for a national
reference laboratory for emerging infectious diseases including EVD and Middle East respiratory
syndrome coronavirus (MERS-CoV) infection.
4. Infectious Diseases Hospital should consider collaborating with WHO to validate the cost-
effective infrastructure concept to handle isolation rooms and locally-made equipment (e.g. PPE)
approach for IPC. Also, SOPs for IPC could also be reviewed by an external team in detail. This
could be a project where the model could be replicated in other similar settings with limited
resources.
5. The Quarantine Unit of MoH should consider conducting drills and simulation exercises as soon
as possible to test the preparedness plan, SOPs and IPC practices or PPE donning/doffing
procedure at Ports of Entry (PoE) of the country
Acknowledgments
SEARO acknowledges with gratitude the support of the Sri Lanka Ministry of Health and the WHO
Representative's Office in Sri Lanka.
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Annex 1: Agenda of activities and attendants lists
Date Name of Participants Designation/ Organization
e-mails
Day-1
9/11/2015 Briefing/orientation of the assessment methodology to Assessment team.
Visit to the Medical Research Institute (MRI) - Reference Laboratory
Dr. Samitha Ginige Consultant Epidemiologist, Epidemiology Unit (EU), Ministry of Health (MoH)
Dr. Palitha Karunapema
Director/ Quarantine,MoH
Dr. Madhava Gunasekara
Senior Registrar, EU, MoH
Dr. Iresh Dassanayaka Consultant Community Physician, Quarantine Unit, MoH
Dr. Alinda Perera Registrar, EU, MoH [email protected]
Dr. Arturo Pesigan Technical Officer, WHO Country Office, Sri Lanka
Dr. N. Janakan. NPO (Communicable diseases), WHO Country Office, Sri Lanka
Dr. N. Gunawardena National Consultant, WHO Country Office, Sri Lanka
Dr. Hammam El Sakka Senior Public Health Epidemiologist/EHA- WHO, Bangladesh
Dr. Sirenda Vong MO/SEARO [email protected]
Dr. Sunethra Gunasena
Consultant Virologist, MRI
Dr. Janaki Abeynayake
Consultant Virologist [email protected]
Dr. Jude Jayalath Consultant Virologist [email protected]
Dr. Priyanka Herath Consultant Haematologist, MRI
Dr. Malika Karunarathne
Consultant Microbiologist, MRI
Dr. Gaya Katulanda Consultant Pathologist, MRI
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Day-2
10/11/2015 [Tuesday] Field visits • Infectious Disease Hospital (IDH)
• International Air Port, Katunayake
Dr. Mahendra Arnold Director, IDH [email protected]
Dr. Ananda Wijewickrame
Consultant Physician, IDH
Dr. PD Idampitiya Consultant Physician, IDH
Dr. Rohini Wadinamby
Consultant Microbiologist, IDH
Dr. Fonseka MO Disaster Preparedness , IDH
Dr. Iresh Dassanayaka Consultant Community Physician, Quarantine Unit, MoH
Dr. Shaminda Salgado Chief Medical Officer, Airport Health Office
Dr. LDLP Liyanage Medical Officer, Airport Health Office
Mr. RS Jayarathne Public Health Inspector, Air Port Health Office
Day-3
11/11/2015 [Wednesday] Guided discussion/table top exercise with technical leaders
Dr. Paba Palihawadana
Chief Epidemiologist, MoH
Dr. Palitha Karunapema
Director Quarantine. MoH
Dr. Sumith Ananda
Director, MRI [email protected]
Dr. Mahendra Arnold Director, IDH [email protected]
Dr. Ananada Amarasinghe
Consultant Epidemiologist, EU, MoH
Dr. Samitha Ginige Consultant Epidemiologist, EU, MoH
Dr. Deepa Gamage Consultant Epidemiologist, EU, MoH
Dr. Jagath Amarasekara
Consultant Epidemiologist, EU, MoH
Dr. Madhava Gunasekara
Senior Registrar, EU, MoH
Dr. Iresh Dassanayaka Consultant Community [email protected]
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Physician, Quarantine Unit, MoH
Dr. Alinda Perera Registrar, EU, MoH [email protected]
Dr. Upendra Sirisena Chief Port Health Officer, Colombo
Dr. JMDSP Jayamanne Port Health Officer, Colombo
Dr. Bimal Dias Medical Officer, Civil Aviation Authority
Dr. CPH Semasinghe Medical Officer, Sri Lanka Ports Authority
Dr. Shaminda Salgado Chief Medical Officer, Airport Health Office
Dr. LDLP Liyanage Medical Officer, Airport Health Office
Mr. RS Jayarathne Public Health Inspector, Air Port Health Office
Dr. PD Idampitiya Consultant Physician, IDH
Dr. Rohini Wadanamby
Consultant Microbiologist, IDH
Dr. S. Gunasena Consultant Virologist, MRI
Dr. Lilani Karunanayake
Consultant Microbiologist, MRI
Dr. J. Abeynayake Consultant Virologist, MRI
Dr. Priyanka Herath Consultant Haematologist, MRI
Dr Jude Jayamaha Consultant Virologist, MRI
Dr. Gaya Katulanada Consultant Pathologist, MRI
Dr. BKR Batuwanthudawe
Consultant Community Physician, Health education Bureau
Dr. PJ Arumapperuma Medical Officer, EU, MoH [email protected]
Dr. NWANY Wijesekara
Medical Officer, Disaster Preparedness and Management Unit, MoH
Dr. Arturo Pesigan Technical Office, WHO Country Office Sri Lanka
Dr. N. Janakan. NPO (CDC), WHO Country Office Sri Lanka
Day-3
12/11/2015 Wrap-up meeting between JAT members Presentation on EID for WCO staff Debriefing to DGHS/MOH –Sri-Lanka on the findings and recommendations from the assessment.
Dr. Paba Palihawadana
Chief Epidemiologist, MoH
Dr. Palitha Karunapema
Director/ Quarantine. MoH
Dr. Samitha Ginige Consultant Epidemiologist, EU, MoH
Dr. Iresh Dassanayaka Consultant Community Physician, Quarantine Unit, MoH
20
Day-4
13/11/2015 Debriefing to Ag WR, 2 Deputy DGs and participants on the findings and recommendations from the assessment. Presentation of the main findings and recommendations to technical leaders of the Ministry of Health
Dr. Sarath Amunugama
Deputy Director General (Public Health Services I)
Dr. Sunil De Alwis Deputy Director General (Education Research and Training)
Dr. Paba Palihawadana
Chief Epidemiologist, MoH
Dr. Palitha Karunapema
Director Quarantine. MoH
Dr. Sumith Ananda
Director, MRI [email protected]
Dr. Samitha Ginige Consultant Epidemiologist, EU, MoH
Dr. Deepa Gamage Consultant Epidemiologist, EU, MoH
Dr. Jagath Amarasekara
Consultant Epidemiologist, EU, MoH
Dr. Madhava Gunasekara
Senior Registrar, EU, MoH
Dr. Iresh Dassanayaka Consultant Community Physician, Quarantine Unit, MoH
Dr. Alinda Perera Registrar, EU, MoH [email protected]
Dr. Upendra Sirisena Chief Port Health Officer, Colombo
Dr. JMDSP Jayamanne Port Health Officer, Colombo
Dr. CPH Semasinghe Medical Officer, Sri Lanka Ports Authority
Dr. Shaminda Salgado Chief Medical Officer, Airport Health Office
Dr. LDLP Liyanage Medical Officer, Airport Health Office
Mr. RS Jayarathne Public Health Inspector, Air Port Health Office
Dr. Rohini Wadanamby
Consultant Microbiologist, IDH
Dr. S. Gunasena Consultant Virologist, MRI
Dr. J. Abeynayake Consultant Virologist, MRI
Dr. BKR Batuwanthudawe
Consultant Community Physician, Health education Bureau
Dr. PJ Arumapperuma Medical Officer, EU, MoH [email protected]
Dr. Arturo Pesigan Technical Officer, WHO Country Office, Sri Lanka
Dr. N. Janankan. NPO (CDC), WHO Country Office, Sri Lanka
Mr. Hiran Thilakaratne
Assist. Director, Disaster Managament Centre
Dr. G.R. Rajapaksha Chief Animal Health Officer
21
Annex 2: Relationship between AC - tasks and currently functional activities (CFA)-Readiness
(Ready)-preparedness (prep.) Assessment Components (AC) Tasks
CF
A?
read
y?
pre
p?
1. Planning - Emergency risk management
1.1. EVD plan developed X
1.2. Guidance, guidelines instructions disseminated X
1.3. Funds release mechanism established X
1.4. Bonus system for high-risk assignments and compensation in case of infection or
death.
X
1.5 Contingency planning encouraged when appropriate x
2. Risk assessment conducted and operational
Risk assessment conducted x
3. Leadership & Coordination in place and with surge capacity (multi-level & multisectoral)
3.1. Ebola Task Force (ETF) at the national and subnational / district levels mentioned
in EVD plan
x
3.2. Membership to the Committee / ETF at national and in “at risk” districts level
reviewed and updated
x
3.3. Contingency or emergency plans exist and are fully costed for fund identification X
3.4. EOC or IMS (incidence management structure) x
3.5. Readiness of EOC x
4. Surveillance – Alert – warning system
4.1. Early warning for hemorrhagic fever cases in place and enhanced x
4.2. Indicator-based Surveillance (IBS) enhanced x
4.3. Event-Based Surveillance enhanced x
4.4. Early warning is timely reported and complete x
4.5. Rumors ready to operate (hotline, internet search.. etc) x
5. Laboratory diagnosis
5.1. Reference laboratories identified x
5.2. Stand-by arrangements (MoUs) and agreements to ship samples from suspected
cases for confirmatory testing in place
x
5.3. Instructions on procedures for specimen collection, packaging, labelling, referral
& shipment, including handling of infectious substances
x
5.4. Surge the capacity of public health and clinical laboratories to meet the needs is X
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planned
6.1. Several RRTs for investigation and contact tracing identified x
6. Rapid investigations, efficient contact tracing and containment
6.2. Several RRTs on sampling procedures (suspect cases) and on transport (cat. A
pathogens)
identified at national and subnational levels
x
6.3. Several RRTs on PPE identified x
6.4. Several RRTs on case management and patients referral to ETC identified x
6.5. RRT ready for contact tracing x
6.1. Several RRTs for investigation and contact tracing identified x
7. Infection control and clinical management
7.1. General awareness about hygiene and how to implement infection prevention and
control in hospitals enhanced due to EVD
X
7.2. Isolation units (used as ETC) + triage system for suspected cases in all major
hospitals and all border points (ideally regional and district hospitals) identified.
x
7.3. Establish a compensation and benefits package for health care workers (HCWs)
for: remuneration and motivation for high-risk assignment; in case of infection and
death.
X
7.4. Surge capacity to increase treatment centers planned X
7.5 Adequate capacity for clinical management of cases with hemorrhagic fever x
8. Communication: (1) Dissemination mechanism; (2) Public information and
social mobilization; (3) Risk communication
8.1. Communication coordination mechanism involving all government sectors and
other stakeholders functional
x
8.2. Risk communication plan in MOH in place x
8.3. Communication with public and community and feedback readily established X
8.4. Procedures for information dissemination to all levels planned x
8.5. Advice to travelers to affected areas provided x
8.6. Procedures with communication with WHO x
8.7 Social mobilization planned X
9. Port of Entry
9.1. Health emergency contingency plan is in place at high risk PoE (ports, airports,
and ground crossings) ensured
x
9.2.PoE adequately equipped x
9.3. PoE teams to cover24/7, to assist travelers and ensure correct isolation if required,
including through a “holding” center/area for any suspect cases
x
9.4. Stand-by agreement (MoU) with referral hospitals in place x
9.5 Communication procedures in place between MoH and PoE authorities x
9.6 Follow-up of at-risk travelers from affected countries in place x
