Overview of International Health Regulaiton - IHR 2005, Afghanistan
-
Upload
islam-saeed -
Category
Health & Medicine
-
view
129 -
download
1
Transcript of Overview of International Health Regulaiton - IHR 2005, Afghanistan
International Health: History..•1948: WHO Constitution
•1951: Adopted ISR
•1969: Revised to IHR
•1995: Call for revision
•2001: Links to Global health Security strategy
•2005: Adopted IHR 2005
•2007: IHR(2005) comes into effect
What are IHRs?
• IHR (1969): Objective: Maximum security against
international spread of diseases with minimum interference with world traffic
Scope: Only 3 diseases (Cholera, plague, yellow fever)
Limitations: Dependence on affected country to notify; Lack of mechanisms for collaboration
between WHO and affected country
An international legal instrument, legally binding on all WHO Member States who have not rejected
them
Purpose & Scope of IHR (2005)
To prevent, protect against, control & provide a public health response to the international spread of disease:
• in ways commensurate with & restricted to public health risks, and
• which avoid unnecessary interference with international traffic & trade
IHR (2005) Document• 66 Articles organized in X Parts
• 9 Annexes
• Annex 1 – Core Capacity Requirements for Surveillance & Response, and for Designated Airports, Ports and Ground Crossings
• Annex 2 – Decision Instrument for Assessment & Notification of Events that may constitute a Public Health Emergency of International Concern
• Available on Website: http://www.who.int/csr/ihr/en/
Public Health Emergency of International Concern (PHEIC)
• an extraordinary public health event whichconstitutes a public
health risk to other countries through international spread of disease
potentially requires a coordinated international response
“Disease means an illness or medical condition, irrespective of origin or source that presents or could present significant harm to humans”
Determination of PHEIC – 4 criteria
Unusual or Unexpected Event Event resulting in Serious Public Health
Impact Event with significant risk of international
spread Event with significant risk of international
travel or trade restriction
Any event irrespective of origin & source meeting any 2/more criteria shall be considered as PHEIC
& notified to WHO under IHR (2005)
Major Obligations for Member States
Assess events & notify potential
PHEIC
Core capacities to detect, report and respond
Comply with routine
provisions
Legal & administrative
framework
Designation of a
National Focal Point
Major Obligations
Key Country Obligations under IHR (1)• Designate National Focal Points, update their
details & communicate to WHO every year
• Assess ability of existing national structures and resources to meet minimum requirements under IHR (2005)
• Develop, strengthen & maintain core capacities
– for Surveillance & Response
– for Points of Entry
• Assess all urgent events irrespective of origin & source within 48 hours using ‘Decision Instrument’; notify WHO within 24 hours of assessment of events that may constitute PHEIC
Key Country Obligations under IHR (2)
• Designate Airports, Ports and Ground Crossings which have the core capacities
• Revise Legislation, Health Documents/ Forms/ Certificates & Charges in accordance with IHR (2005)
IHR (2005) provides an opportunity to strengthen readiness, surveillance & response capacities which help in dealing with PHEIC & also other prevalent diseases in the country
IHR: capacities required at each level
Local level
National level
Intermediate level
Regional & International level
- Detection of event- Reporting- Controlling
- Confirmation- Response - Assessment
- Assessment- Notification - P.H. response
- Event alert- verification- Assessment - Intl. response
Surveillance & response capacitySurveillance & response capacity
• Local levelLocal level
– Detection of events
– Reporting – Control measures
• Intermediate levelIntermediate level
– Confirmation – Assessment – Reporting
• National levelNational level – Assessment
– Notification– Pubic health
response• Control measures
• On-site assistance • Operational link• P.H. emergency
response preparedness
• At all times• Access to medical services • Transport of ill travellers• Inspection of conveyances• Control of vectors / reservoirs
• For responding to events• Emergency contingency plan• Arrangement for isolation (human,
animal)• Space for interview / quarantine• Apply specific control measures
Minimum Core Capacities at Designated Points of Entry
Alert & Response Operations
DetectionDetection
VerificationVerification
Risk assessment Risk assessment
ResponseResponse
Events that may constitute PHEIC
IHR (2005)
To prevent, protect against, control & provide a public health response to the
international spread of diseases
Entry into force
Assess national structures, resources
to meet min. req.
Develop, strengthen & maintain core capacities
reg. surveillance & response; points of entry
Further extensions possible
15th June 2007
15th June 2012
Implementation of IHR (2005) -Timeline
15th June 2009
for 2 years and exceptionally another 2 years2 + 2 years
The Stakeholders for IHR Implementation
Airports,Ports & Ground
Crossings
States, UTs &
DistrictAuthorities
National Focal PointNICD, Delhi
Other Ministries,
Dtes., & Deptts.
MOHFW
DGHS
Activities for Stakeholders
Airports,Ports & Ground
Crossings
States, UTs &
DistrictAuthorities
Other Ministries,
Dtes., & Deptts.
National Focal PointNICD, Delhi
Activities on the part of State Governments/UTs and District Authorities
• Designation of IHR focal points – 24x7 accessibility
• IHR component in all IDSP trainings• Assessment and strengthening of disease
surveillance & response capacity as per IHR • Evaluation & strengthening of laboratory
capacities • Evaluation & strengthening of isolation
facilities & infection control practices • Mechanism for rumour verification • Awareness reg. information to be reported to
NFP
Activities on the part of State Governments/ UTs and District Authorities contd...
• Preparation and periodical updating of public health contingency plans
• Involvement of private sector and professional organizations (e.g. IMA) for disease surveillance activities
• APHOs/ PHOs be included in state surveillance committees
• Investigation findings of central/state RRT be urgently conveyed to States/Distt./ Municipal bodies
• Identification of high-risk areas near international borders and programme for cross-border control of diseases
Activities on the part of State Governments/ UTs and District Authorities contd...
• Satellite linkages of IDSP/NFP with all state/ district HQs
• Nodal members to be identified: – Designated hospitals, laboratories and various
pest/ vector control agencies– State Health Directorates, District Health
Authorities – Local municipality, cantonment board, other
relevant agencies– Ministries of Civil Aviation, Shipping, Surface
transport, Agriculture (veterinary dept.), Home Affairs, Tourism, Railways
– Customs, Immigration, AAI– AOC, Association of shipping agents – CISF
Activities related to the Airports/ Ports/ Ground Crossings
• Designation of Airports/ Ports/ Ground Crossings Designation of IHR Focal Points
• Training of technical staff on IHR• Assessment & strengthening of capacities at
designated entry/ exit points • Awareness about information to be reported to NFP • Referral system for medical care services • Creation of new public health units • Improve infrastructure of quarantine centers • District IDSP lab be designated for each APHO/ PHO• Provision of entomologist for vector surveillance &
control activities
Activities related to the Airports/ Ports/ Ground Crossings contd...
• Satellite linkages with IDSP (incld. laboratories) • Preparation of PHE Contingency plan including:
– Panel of doctors/ paramedical staff for deputation during PHE
– Identify referral laboratories and medical facilities
• Coordination amongst:• Designated hospitals & laboratories,• Department of Animal Husbandry,• Immigration contact point,• Airport/ ship management agencies,• Customs contact point
Activities required to be undertaken at National level
• Examine/ revise health certificates/ documents and charges, if necessary
• Enactment of Public Health Act 2007 (Draft) • Revise National Aircraft/Port Health Act & Rules for
effective IHR implementation• Prepare/Update Health rules for designated Ground
Crossings • Awareness about IHR among administrators &
politicians at all levels • Mechanism for emergency support services and
coordination between different sectors during PHEIC
Activities required to be undertaken at National level contd...
• Strengthen capacity incld. trained manpower & institutional support (NCDC) for disease surveillance & response at central level
• Strengthen lab. capacity; linkages with international reference labs
• Involvement of major institutions like NVBDCP, ICMR etc. in investigation of PHEs
• Disease control guidelines be updated and widely circulated
• Preparation of a National PHE Response Plan• Periodic independent evaluation of IDSP • Identification of high-risk areas near international borders
and programme for cross border control of diseases
Activities required to be undertaken at National level contd...
• Mechanism for collaboration & coordination between different Ministries/ Departments:– MOHFW – Designated hospitals, laboratories and various pest/
vector control agencies– State Health Directorates, District Health Authorities – Local municipality, cantonment board, any other
relevant agency– Ministries of Civil Aviation, Shipping, Surface
transport, Agriculture (veterinary dept.), Home Affairs, Tourism, Railways
– Customs, Immigration, AAI– AOC, Association of shipping agents – CISF
Activities required to be undertaken at National level contd...
• Health column in immigration clearance form: – Yellow fever – travel detailsduring past 6 days – Other diseases – as per need – e.g. AI, SARS etc.
• Flight disinsection as per revised Rules• Advance intimation reg. dead body clearance • During PHEIC – baggage, animal cargo clearance • Advisory during PHEIC • Other actions to be taken by different organizations,
as required from time-to-time
Main Challenges
• Building core capacities for surveillance and response at all levels – national, intermediary, local (technical challenge)
• Mobilization of resources to meet core capacities requirements (financial challenge)
• National Commitment to rapid sharing of information, materials and inter-country collaboration (political challenge)
Summary • IHR (2005) is an international legal instrument,
legally binding on all WHO Member States
• Urgent need to:• Identify Stakeholder Focal Points
• Create awareness among stakeholders, administrators & politicians
• Prepare state/ dist. health contingency plans
• Assess/ strengthen surveillance & response capacity
• Strengthen laboratories
• Coordinate with all stakeholders
• Report any unusual/ unexpected public health event to National Focal Point (NICD, Delhi)
• Respond to the request for verification & response of any reported event