Multisectoral involvement in IHR 2005

1. Multisectoral involvement in IHR 2005 Prof. Dr. Be-Nazir Ahmed Director, Disease Control National IHR Focal Point dbenazirahmed@yahoo.com

2. IHR 2005: Background • The International Health Regulations (IHR) administered by WHO were in force since 1969 and revised in 1981 • Member States were required to notify only cholera, plague and yellow fever • Again revised and adopted by member countries on 21 May 2005 is now referred to as “International Health Regulations (2005)”

3. IHR 2005: Goal and responsibilities • The goal is to prevent international spread of diseases • Member states be able to timely detect, assess, notify and report events and respond to public health risks and Public Health Emergency of International Concern (PHEIC)

4. IHR Core Capacities • National legislation, policy and financing • Coordination and NFP Communication • Surveillance • Response • Preparedness • Risk communication • Human resources • Laboratory services

5. Disease Reporting Any event • Small Pox • Poliomyelitis • Influenza • SARS • Diseases • Cholera • Pneumonic • Plague • Yellow Fever • V. H. Fevers • Dengue, • Rift Valley Fever • Meningococcal diseases 1. Serious public health impact of the event 2. Unusual or unexpected event3. Significant risk for international spread4. Significant risk for international Travel or trade restrictions? EVENT SHAL BE NOTIFIED TO THE WHO UNDER IHR 2005

6. HEALTH RELATED EVENTS DETECTION Local Community Level or Primary Public Health Response Level REPORTING Intermediate Public Health Response Level REPORTING National Level National IHR Focal Point WHO IHR Contact Point Preliminary Control Measures Country Level Investigation and additional Control Measures Formal assessment. Containment and Control Measures NOTIFICATION OR REPORTING InternationalLevel Recommendations and other Control Measures Public health surveillance structures and processes specified in International Health Regulations (IHR) 2005.

7. Environment Animal Health Social Psychological Human Health Food Radiation

8. Good Example of Multisectoral Involvement • Rabies elimination: DBM, MDV, DPM • MHFW, MLGD, MFL, WHO, OIE, FAO, WSPA, HIS • Avian influenza prevention and control • MFL, MHFW, MFE, FAO, OIE, WHO, USAID, UNICEF • Anthrax management • MFL, MHFW, FAO, OIE, WHO • Nipah infection control • MHFW, MFL, MFE, ICDDRB, CDC,USA, FAO, OIE, WHO, USAID, UNICEF • Filariasis elimination • MHFW, MPME, WHO, USAID, UNICEF, CWW, J&J,

9. Event notification and determination under IHR (2005) at WHO

10. Collaboration for IHR at all levels • UN and development agencies • Stakeholders in government, private sectors and NGOs • Bangladesh and neighboring countries • Among laboratories

11. IHR Committees and Institutes • National Coordination Committee • National Technical Committee • Core Committee at DGHS • National IHR Focal point • National IHR Technical Focal Institute • Designated Point of Entry (PoE) • Coordination Committee at Ports (Hazrat Shahjalal International Airport, Dhaka, Chittagong Sea port, Chittagong, Benapole Land Port, Jessore) • IHR Focal Hospitals: Infectious Disease hospital (IDH), Kurmitola General Hospital

12. National IHR Coordination Committee • President: • Senior Secretary, Ministry of Health and Family Welfare • Member Secretary: • Director, Disease Control and Line Director, CDC. DGHS. National Focal Point-IHR 2005, Bangladesh Members: • Members : 27 • TOR • Approval of Strategy, Action Plan and Policy for IHR 2005 • Provides decision on proposals sent by IHR national technical committee • Monitoring and evaluation IHR Implementation • Meet every once a year or before when necessary • Co-opt member (s) when necessary

13. National IHR Focal Point • President: Director, Disease Control and Line Director, CDC, • Member Secretary: DPM, Avian and Pandemic Influenza • Members : 04 • TOR • Draft Strategy, Action Plan and Policy for IHR • Draft budget for IHR • Spokes person on behalf of DG on PHEIC • Manage and coordinate outbreak investigation • Contact with WHO IHR focal point and other relevant persons • Collect information on zoonotic, chemical, radio nuclear and food related diseases and events • Arrange workshop, seminar and round table discussion

14. National IHR Technical Focal Institute • National IHR Technical Focal Institute: IEDCR • TOR • Conduct surveillance • Investigate outbreak • Send update to control room of DGHS • Do lab tests for Influenza, Nipah and ERD • Draft , implement and coordinate implementation of IHR 2005 • Inform PHEIC to National IHR Focal Point • Organize training for improving capacity for surveillance • Conduct IHR related research • Conduct above activities in coordination with National IHR Focal

15. Coordination Committees for PoEs Hazrat Shahjalal International Airport, Dhaka : • Coordinator: Airport health officer • Member Secretary: Assistant Airport Health Officer • Members: 13 Chittagong Port: • Coordinator: Port Health Officer • Member Secretary: Assistant Port Health Officer • Members: 8 Benapoe Land Port: • Coordinator: Upazila Health Family Officer, Sharsha , Jessore • Member Secretary: In charge Port Medical Officer • Members: 7

16. TOR for Coordination Committees of Ports • According to article 22 of IHR, they will act as appropriate authority • Apply and implement IHR related health activities in POE • Inform national IHR focal point on activities taken • According to article 57 take measures through bilateral or multilateral agreement for prevention and control of diseases

17. Referral Hospitals • Infectious Disease hospital • Kurmitola General hospital TOR of Referral Hospitals • Isolation and quarantine • Inform national IHR focal point

18. Issues and challenges • Administrative, Collaborative, and legal issues • Development of specific National Plan for Multisectoral Public Health Emergency Preparedness and Response • Approval of draft law for implementation of IHR (2005) • Some funds are allocated for some activities under different heads but no separate head as such for IHR has been created. • Laboratory capacities • Lack of capacity of detecting AI/H5N1, A/H1N1 (2009), Nipah, Polio or Anthrax at district level • No laboratory networking between human and animal health or inter-country agreement for laboratory networking • Infection Control and Prevention • Lack of National Infection Control Committee nor National Focal Point for Infection Control.

19. Issues and challenges • Core Capacities of Points of Entry (PoE) • Building of minimum core capacity at designated PoEs as per IHR (2005) guideline within the timeframe of 2014 • No agreement between Bangladesh and neighboring countries concerning prevention and control of disease at PoE • Very few trained personnel for the control of vectors and reservoirs in and near points of entry: • Majority of the PoEs had no Entry/exit control tools. • Veterinary facilities for assessing potentially contaminated/ infected animals are absent at all PoEs. • No practice for submission of Health part of Aircraft General Declaration by the Captain/crew member to the airport authority in case aircraft coming from an infected area.

20. Thanks