Towards Effective Emerging Infectious Diseases Surveillance: The Cases of Indonesia and Cambodia
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Transcript of Towards Effective Emerging Infectious Diseases Surveillance: The Cases of Indonesia and Cambodia
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Towards
Effective
Emerging
Infectious
Diseases
Surveillance:TheCasesof
Indonesiaand
Cambodia
SophalEar,Ph.D.AssistantProfessor
NavalPostgraduate
School
10March2011
Disclaimer:
Material
contained
herein
is
made
available
for
the
purpose
of
peer
review
and
discussion
and
does
not
necessarily
reflect
the
views
of
the
Department
of
the
Navy
or
the
Department
of
Defense.
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Contents
1.
TheProblems
2.
Timeline Context
3.
Indonesia
Case
Study
4.
CambodiaCaseStudy
5.
H1N1
6.
Conclusion
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MyriadProblems
Poortononexistent
surveillance Poordiagnostic
laboratory
capability Disincentivestoreport
Viral
sovereignty
(Indonesia)
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Page213:
In2006,
Indonesia
claimed
viral
sovereignty
oversamplesof
H5N1collectedwithinitsborders
andannouncedthatitwouldnot
sharethemuntiltheWHOand
developedcountriesestablished
anequitablemeansofsharingthe
benefits(e.g.,
vaccine)
that
could
derivefromsuchviruses.
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Page3:
inthepoorestcountries
percapitaexpenditureonall
aspectsof
health
care
[is]
3%
expenditureinhighincome
countries staffinover90%
notfamiliar
with
quality
assuranceprinciples more
than60%oflaboratory
equipment
is
outdated
or
notfunctioning
August
2001
report
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2010
[F]rommyownexperiencesincountries(
CentralAsia,
Southeast
Asia,
India,
Sub
Saharan
Africa)Ibelievethestatushasnotchanged
muchfromthedateofthe
[2001GAO]
report.
DirectorofLaboratorySystemsDevelopmentata
majorAmericanuniversity
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TimelineContextHuman
Pandemic
Flu
Timeline
Spanish(H1N1) HKfluH3N2 HPAIH5N1 H7N2 H7N3H10N7
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DownsideofGlobalization:
GlobalReach
of
Diseases
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QualityofHealthCare,2002
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H5N1:HighlyPathogenicAvianInfluenza
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AFewWordsonMethodology Qualitative
research
methodology
CambodiaandIndonesiacasescompared
~50one
on
one
semi
structured
interviews
acrossgovt(donorandhost),privatesector,
&NGOs
in
2009
and
2010
200pagesofnotes
Content
analysis/tagging Frequencyofissuesraised
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IndonesiaCaseStudy
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AfterFOUR
decades,the
NavalArea
Medical
Research
Unit2
(Namru
2)
is
kickedoutof
Indonesia
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AndallbecauseofoneMinister?AndallbecauseofoneMinister?
Maybenot.Maybe
not.
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IssuesRaisedinIndonesia
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CambodiaCaseStudy
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H5N1Animal
Outbreaks
2004
2008
2008
2007
2006
2005
2004
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2007
2006
2005
2008
H5N1Human
Victims
2005
2008
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IssuesRaisedinCambodia
l d d l h ld
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Goal:reducepandemicpotentialthatcould
strikedonorcountriesthemselves
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ButletButletsendwherewestarted,withsendwherewestarted,with
Indonesia
and
CambodiaIndonesia
and
Cambodia
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Dateline:11April2010
Namru2Jakartaisshuttingdown.Ihavebeenvery
sad.Not
only
because
I
amlosingmyjob,butmorethanthat,Indonesia
willloss
[sic]
an
establishedlaboratoryresearchcoz[sic]ofpoliticalreasons
SeniorIndonesianscientist
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Churchill
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IssuesandPossibilities
Indonesia Poorhostdonorrelationship
Differinghostanddonorpriorities
Low
salaries DeclineinMin.ofHealthquality
Namru2ismisunderstood
Problematiccompensationforculling
Locallevelsdontseereportingtranslatedintoresponse
Cambodia Lowsalaries
Donordependenceculture
Poor
staff
management/HR Patronagenetworks
Nocompensationforculling
Differinghostanddonorpriorities
Indonesia Dontlettherelationshipsour!
Alignyourprioritiesmore
This
is
a
national
problem Helpbuildcapacity(albeitlowpay)
Namru2needsbetterPR
Spendcompensationthatexists
Make
it
a
point
to
close
the
feedback
loop
Cambodia Thisisanationalproblem
Improveaideffectiveness
Helpbuildcapacity(albeitlowpay)
This
is
a
national
problem
Nocompensation=noreporting
Alignyourprioritiesmore
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The
end
or
the
beginning?
25June2010:Directorof
Namru2PhnomPenhsteps
down
FormerNamru2Jakarta
CommandingOfficer
was
to
headNamru2PhnomPenh
(butdidnotendupthere)
Awarenessofissuesbothin
IndonesiaandCambodiafor
whereverNamru
2ends
up.
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Thank
you.Thankyou.
Questions?Questions?