Community resilience in public health management of viral outbreaks

1. Community resilience in public health management of viral outbreaks Dr. Abhijeet Jadhav JTCDM- TISS, Mumbai

2. Epidemic • How to define • Region/ area (which population) • Time (point of start; sudden/ over a time) • Excess (to the background incidence)

4. Source - Principles of EPIDEMIOLOGY. CDC

5. Some commonly used descriptive terminologies • Epidemic • Common source epidemic • Single exposure/ point source • Continuous/ multiple exposure • Propagated epidemic • Person to person • Antropod/ vector born • Animal reservoir • Slow/ modern epidemic • Endemic • Pandemic • Syndemic

6. Incubation period A- Latent period B- Minimal Incubation P. C- Median Incubation P. Primary cases No. of cases C Secondary cases A B Time  Exposure

7. Outbreak is ‘an epidemic limited to a localized increase in incidence of a disease’ (Last) • Problem is unexpected • Demand for immediate response • Usually needs intensive field work- assessment, prevention, cure • Scope of investigation limited because of time constraint (Goodman and Buechler 1996) • Generally needs official sanction

8. Viral out-breaks • Frequent • Influenza virus & other • Antigenic shift • Antigenic drift • Prevention- vaccines? • Treatment- antivirals? And symptomatic • Prevention of spread- isolation, quarantine

9. TEN KEY STEPS • Determine existence of epidemic • Confirm diagnosis • Define case and estimate number • Orient data in time, place, person • Determine who is at risk • Develop explanatory hypothesis • Compare with established facts • Plan and execute systematic study • Prepare written report • Execute control and preventive measures Brownson and Petitti

10. Basic parameters for decision making • Demographic details • Annual disease incidence rate • Existing policies related to the disease • Standard definitions & protocols by international agencies • biological & Special groups with more vulnerability • Capacity of local institutions

11. Community Resilience Resilient community needs resilient system…

12. Resilience for viral outbreaks • Term “Resilience” implies a prolong activity and in disaster management “community Resilience” typically falls in the DRR component. • But for viral outbreaks it is also part of response…

13. Responding to the outbreak

14. Controlling the epidemic • Specific points to act • Decrease vulnerability • Controlling the source • Manipulate infection pathway • When treating a case is priority? • Very high infectivity or severity • New disease- no information about the treatment • That is the only option

15. Further Prevention of disease • Primordial prevention: • prevention of infection + prevention of disease • Removal of risk factor • Primary prevention: • prevention of disease • Through personal protection • Secondary prevention: • early detection + treatment/ containment • Prevention of bad outcomes of disease

16. Case management • Objectives: • Early case detection • Early treatment • Prevention of worst health outcomes

17. Case management • Activities for community resilience • Case definition • Help line • Detection • Health care centers • Partnership with privet sector • Improvising the existing facilities

18. Controlling the spread of disease • Objective- • Reducing the spread of the disease to a ‘significant’ level

19. Controlling the spread of disease • Activities for community resilience • Isolation • Quarantine • Migration • Preventive measures • Special care of vulnerable

20. Action plan Before epidemics During epidemics Confirm & delegate the responsibilities Gather latest information to improvise the plan of action Train volunteers Community awareness Provision of supplies Modification of HCS Implementation of preventive & mitigating measures • Agree upon roles & responsibilities • Establish plan of action • Training of the staff for epidemic situations • Protocols in surveillance system • Protocol for contingency arrangements of supplies & referrals

21. Health communication in viral outbreak

22. Communication with… • Community (through mass-media) • Media • Health department & pvt. health sector • Stakeholder departments • International bodies • NGOs & welfare societies

23. Massage should be • Specific • Simple, clear & meaningful • Timely • Updated • Non-ambiguous • Culturally acceptable • Based on perceived needs/ threats

24. For media communication • Ask media to trust only one portal/ agency for outbreak related information eg- website • It should be updated and checked for technical correctness as well as appropriateness • This is the most effective tool to modify community behavior • Ask media to use effective ways to change the behavior and work with them

25. Viral outbreak massage themes- for community • Don’t panic • Symptoms of the disease • What to do if one has the symptoms • How to protect ourselves and prevent the disease • Facilities available • Where to contact for further information

26. Communication with health sectors • Private medical setups • Dedicated helplines • What is the disease • How to diagnose • How to treat & treatment of complications • Referral facilities • Preventive modalities

27. Communication for help • NGOs, international bodies etc can be approached depending upon their specific areas of expertise • Be clear and specific • Make sure about upper hand of the agency • Consider all possible socio-economical & political consequences • Or many NGOs and other organizations can approach for help. You need to communicate with them very carefully.

28. Role of CBOs

29. Why there is need of helping hand • Acute & sudden appearance of problem • Huge scale of intervention • Technicality of intervention • Distribution chain to remote areas • Urgent need of many volunteers • Need of training technical and non-technical training to masses at various sites • Procurement of medical/other supplies and related logistic • Monitoring and evaluation of short term plan

30. Specific areas of contribution • Training- Health related human recourse (HW, AW, ASHA, para-medic, lab-technicians, doctors, nurses) needs specific training related to intervention and disease. • Volunteers- Some organizations have good hold on community and they can gather good manpower. • Technical knowledge- Some organizations work in community based or other related research and their specific inputs can be valuable in designing the intervention & making it simple

31. Specific areas of contribution • Regulatory work Some organizations have good experience of working in administrative work with govt in monitoring and evaluation. • Health communication & working with community Some genuine organization are deep rooted and quite experienced in doing this job. • Acquiring materials & logistics Some rich and influential organizations- specially Corporate social responsibility centers can help in funding or material arrangements

32. Some precautions… • Thorough contracts or MOUs • Same motive of community welfare • Proper understanding of the issues • Consider possible ill-motives • Strict regulation is a must • A priory plan of deliverables and responsibilities (with consequences of failure)

33. Thank you