MPDSR training for SNNP regional experts:

Introduction to Public Health Emergency

Management (PHEM) System – Ethiopia

Ethiopian MPDSR Training

 Outline:
• Background
• Introduction
• What is PHEM and its sub-process?
• Goal and objectives of PHEM
• Mandate of PHEM
• Early warning and communication
– Preparedness and capacity building
– Response
– Response
– Recovery
Ethiopian MPDSR Training
 Background:
Diseases Surveillance In Ethiopia
Between 1998-2009
• It includes:
– Integrated diseases surveillance
– Emergency response
– Focus on containment of an outbreaks
• Weak early warning system
– Surveillance data received monthly
• Late detection and delayed response

Ethiopian MPDSR Training

 Background …
Diseases Surveillance In Ethiopia…
• Limited to Health Centers and Hospitals
– Lack of representativeness
• Focused on epidemic diseases only
– No nutritional surveillance
– Weak laboratory surveillance
– Event based surveillance
• Lack of appropriate preparedness
• No recovery activities after disaster

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 Introduction
• Since 2009
– Public Health Emergency Management (PHEM)
– Designed by BPR
– It is one of the Eight core processes of MOH
– Located in Ethiopian Public Health Institute

Ethiopian MPDSR Training

 Introduction:
IDSR PHEM
• Mainly focus on Epidemic • Multi hazard approach
disease
• Surveillance Data comes
• Surveillance data comes weekly
monthly
• Smallest reporting unit is
• Smallest reporting unit is
Health post
Health Center
• Robust early warning system
• Week early warning system
• Prompt response
• Delayed response
• Recovery activities included
• No recovery
• No event based surveillance • Event based surveillance

• Include only some DRM • Includes all DRM

Component components
Ethiopian MPDSR Training
 What is PHEM?
• PHEM is the process of
– Anticipating
– Preventing
– Preparing for
– Detecting
– Responding to
– Controlling and
– Recovering from consequences of Public Health
threats in order that health and economic
impacts are minimized
Ethiopian MPDSR Training
 What is PHEM?
• Public health emergencies are events or
disasters that threaten the health of communities
or groups of people
• Some examples are:
– Disease outbreaks
– Natural disasters such as earthquakes, floods
droughts, Volcanoes……
– Pandemic flu
– Biological terrorist attacks such as an anthrax release
– Chemical spills etc.

Ethiopian MPDSR Training

 Sub Process of PHEM:

To strengthen capacity in recognizing and responding to public health

emergencies through (1). Conducting regular risk identification and analysis,
(2). Establishing partnership and collaboration, (3). Strategic communication
during the pre emergency phase and (4). Ensuring their monitoring and
evaluation
Ethiopian MPDSR Training
 PHEM Process
Institutional
framework

Vulnerability Assessment Public Health

and Risk Mapping Intelligence

Public Health
Planning Emergency Early Warning Communication
Preparedness

Capacity Monitor and Evaluate

Building

Monitor and
Rehearse
Public Health Emergency
Management

Outbreak investigation/Rapid
Assessment

Public Health Rehabilitation

Control and Prevention Emergency
measures Recovery
Response
Evaluation

Monitor and Contain

10
Major Health Hazards by order of Priority
1. Epidemics of communicable disease
2. Drought with malnutrition
3. Food contamination
4. Flood
5. Pandemic Influenza
6. Conflict and displaced populations
7. Accidents incl. chemical spills
8. Earthquake, volcano
9. Bioterrorism
11
 Goal of PHEM
• Overall goal of PHEM is
– To markedly reduce mortality and morbidity
due to epidemics and other Public Health
Emergencies
– To minimize associated social and economic
crisis

Ethiopian MPDSR Training

 General objective of PHEM
• General objective of PHEM is to
– Prepare for
– Detect early
– Contain epidemics locally
– Respond timely to other public health
emergencies
– Recover quickly from their impacts

Ethiopian MPDSR Training

 Objectives of PHEM ….
Desired Outcome Stretch Objective
1. Timely Risk profile with recommended
Identification of aversion/minimizing action will be
Risks communicated to all concerned within 45 days
of assessment

2. Prompt Preventive and control measures will be

aversion or initiated within 48 hours of identification of risk
minimization of and characterization of threat
risks
3. Response to Initiation of response within 3 hours
any type of public Deployment will made within 24 hours from
health threats will central level
be made timely

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 Objectives of PHEM …
Desired Stretch Objective
Outcome
4. Threats/ Reporting cycle will be every 8th days at the
epidemics will source
be promptly Timeliness and completeness of reporting will
detected be 100% at all levels
(Timeliness and completeness shall be
analyzed by reporting units)
Notification will be made in time to 2 hours at
central level
100% outbreaks will be detected within 48
hours

15
 Mandate of the PHEM Center
• Identify, assess and monitor existing or potential threats to
the public health
• Coordinate and ensure the formulation of preparedness
plans for all types of public health emergencies at national,
regional or Woreda levels
• Strengthen the Public Health Emergency Management
capacity of the human resources of the health sector
through
– Direct training
– Coordination/ assistance to efforts to be undertaken by the Academic
Institutions, other departments of the MoH or other health actors.
• Issue alerts and warning to the general public regarding
potential public health emergencies or disasters
16
 Mandate of the PHEM Center
• Maintain and administer a stockpile of supplies and
equipment required for rapid response to public health
emergencies
• Ensure that Ethiopia meets its international health
security obligations in particular those under the
International Health Regulations adopted in 2005.
• Mobilize the government health resources to respond
rapidly and effectively to the health consequences
• Coordinate and supervise the response of the
Regional, Zonal and Woreda Health Offices in all
emergencies with potential public health impact outside
their respective area of responsibility

17
 Mandate of the PHEM Center
• Support and assist Regional, Zonal and Woreda
Health Offices to respond to and coordinate public
health emergencies of local significance
• Issue bulletins and release information on the
health situation, priorities and needs in all public
health emergencies
• Issue technical guidelines and coordinate the
humanitarian health assistance provided by
partners.

18
Preparedness and Capacity Building
• Vulnerability Assessment and Risk
Mapping
– All elements clearly identified
– Clearly included in the PHEM Guideline
– Priority hazards identified
– Process of DRM are included

19
 Capacity Building
1. Community case
definitions
– Prepared and distributed
– In different language
– Used at health post level

20
 Reporting Formats
No. Types of Reporting Formats Distributed
(pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for Region 114
5 Case based Report format 4,638
6 Case Based Laboratory reporting format 4,598
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288

21
 Reporting Formats
No. Types of Reporting Formats Distributed
(pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for Region 114
5 Case based Report format 4,638
6 Case Based Laboratory reporting format 4,598
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288

22
 Reporting Formats
No Types of Reporting Formats Distributed
. (pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for 114
Region
5 Case based Report format 4,638
6 Case Based Laboratory reporting 4,598
format
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288
23
 Reporting Formats
No. Types of Reporting Formats Distributed
(pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for Region 114
5 Case based Report format 4,638
6 Case Based Laboratory reporting format 4,598
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288

24
 Reporting Formats
No Types of Reporting Formats Distributed
. (pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for 114
Region
5 Case based Report format 4,638
6 Case Based Laboratory reporting 4,598
format
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288
25
 Reporting Formats
No. Types of Reporting Formats Distributed
(pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for Region 114
5 Case based Report format 4,638
6 Case Based Laboratory reporting format 4,598
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288

26
 Reporting Formats
No. Types of Reporting Formats Distributed
(pad)
1 Weekly Reporting format 4,302
2 Weekly Reporting format for HEWs 16,023
3 Daily Epidemic Report format for 4,038
Woreda
4 Daily Epidemic Report format for Region 114
5 Case based Report format 4,638
6 Case Based Laboratory reporting format 4,598
7 Line list 4,262
8 Case Investigation Form for Guinea 16,000
Worm Disease
9 Case based reporting format for AFP 4,288
10 Influenza case based reporting format 1,057
11 Case based reporting format for NNT 4,288

27
Community Case Definition
• Sensitive
• Used at the community
level

28
 Capacity Building…

2. Standard case
Definitions
– Customized from WHO case
definitions

– Printed and distributed to all

health facility

– Used at health center and

above

29
 Capacity Building…
4. Guidelines already printed and
distributed • y
– PHEM guideline
– Cholera guideline
– Measles guideline
– Malaria guideline
– Influenza Surveillance
implementation guideline
– Meningitis Guideline
– AFP Guideline
– NNT Guideline

• Guideline under Preparation

– Yellow Fever
– Rabies
– Anthrax 30
 Training Modules
• Facilitators
• Participants

31
 Field Epidemiology Training Program
• EFETP Resident Manual
• EFETP Manual for Field
Supervisors and Mentors

32
 Capacity Building…
4. Communication facility and channel
– PHEM center equipped with:
• Telephone,
• Broad band internet communication
• Fax machine,
• satellite phone,
• GPS
– Roster of experts and institutions were kept in data base
– Electronic reporting system is on implementation phase
• Soft ware developed
• Computer and CDMA distributed to some regions
• Training provided
• Pilate phase finished
33
 Capacity Building…
5. Training
Short training
• GIS training
• Incidence command training
• Multi Agency Coordination Training
• PHEM training to regions, zoned and woreda officers
Basic Level Training
• Concept of pyramid model
• Training Module prepared and printed
• Training will be started this year
Long Term Training
• A two year competence based master program in Field
epidemiology established
34
 Capacity Building…
6. Logistic and supplies
– Drugs and medical supplies
• Stockpiled at central and prepositioned to regions
– Personnel protective equipment
– Vaccine
• Meningococcal Meningitis
• Yellow Fever
– Stand by car

35
 Early Warning and Communication
• Early warning Includes:
1. Indicator based surveillance
– Structured data collection through routine
Surveillance
– It includes:
• Integrated diseases surveillance
• Laboratory surveillance
• Nutritional surveillance
2. Event based surveillances
• Media scanning (website and news paper}
• Rumor (patient report, community concern, clinician
concern)
• Sectoral information 36
 Indicator based surveillance
Immediately Reportable Weekly Reportable
1. Acute Flaccid Paralysis
1. Dysentery
2. Anthrax
2. Malaria
3. Avian Human Influenza
4. Cholera 3. Meningitis
5. Dracunculiasis/Guinea worm 4. Relapsing
6. Measles
5. Typhoid Fever
7. Neonatal tetanus
6. Typhus
8. Pandemic Influenza A(H1N1)
9. Rabies 7. Severe Acute Malnutrition
Criteria for selection of priority
10. Small pox diseases
11. SARS 1. Diseases under eradication and
elimination
12. Viral Hemorrhagic Fever(VHF)
2. Disease of public health
13. Yellow Fever importance
14. Maternal Death 3. Diseases of international concern
15. Perinatal deaths 37
 Anything else to report ?
•In addition to the above reportable diseases and conditions

 Clusters of respiratory illness (including upper or lower respiratory

tract infections, difficulty breathing and Adult Respiratory Distress
Syndrome);

 Clusters of gastrointestinal illness (including vomiting, diarrhea,

abdominal pain, or any other gastrointestinal distress);

 Influenza-like constitutional symptoms and signs

 Clusters neurologic symptoms or signs indicating the possibility of

meningitis, encephalitis, or unexplained acute encephalopathy or
delirium;
11/28/2024
38
 Anything else to report ?
• Cluster of rash illness;
• Hemorrhagic illness;
• Botulism-like syndrome;
• Sepsis or unexplained shock;
• Febrile illness (illness with fever, chills or rigors);
• Disease caused by antimicrobial resistant organism;
• Non traumatic coma or sudden death; etc

REPORT THESE CONDITIONS IMMEDIATLY !

11/28/2024
39
 Timeline for immediately Reportable
Diseases

Health Woreda Zone Region EHNRI

Facility

Within 30 Within 30
Within 30 Within 30
Minutes Minutes
Minutes Minutes

Event
0:30 1:00 1:30 2:00
Time

40
Timeline for Weekly Reportable Diseases

HF to Woreda Zone to Region to

woreda to zone Region EPHI

Treatment at health facility

Mon Tue Wed Thu Fri Sat Sun

Event Monday Tuesday Wednesday Thursday

The following Week

41
 Reporting Chanel
EHNRI

E-mail
Fax
Rumor-Phone
Region

Telephone
E-mail
Zone Fax

Telephone
Woreda Fax

Health Facility • Paper

• Telephone

Papers Telephone 42 E-mail

 Indicator based surveillance…
 Type of surveillance operating
 Government health Facilities
 Private health facilities
 NGO health facilities

100.0
90.0
80.0
70.0
60.0
50.0
40.0 National Completeness
30.0 Minimum requariment
20.0
10.0
0.0
week 07 week 14 week 21 week 28 week 35 week 42 week 49 week 04 week 11 week 18 week 25 week 32 week 39 week 46 week 01 week 08
2011 GC 2012 GC 2013 GC

43
 Indicator based surveillance…
• Data analysis and
interpretation
• Feedback to the regions
– Upsurge of cases
– Unusual cases for
verification
– Completeness
– Data Quality

44
 Indicator based surveillance…

• Weekly PHEM bulletin

– Weekly data analysis

– Weekly bulletin has been

producing

– Shared with decision

makers and concerned
body

45
 Indicator based surveillance…r the
c h u re fo s)
Bro in g iti
b lic (Men
• Early Warning information to the pu
public
– To protect them selves
– To seek medical treatment
– Knows where to treated
– To report to health facility
• Early Warning could be through
– Public media
• Television
• Radio
• Magazine
– Brochures Press gitis)
e (Menin
lea s
Re
46
 Event Based Surveillance
The websites that should be visited are
1. Media Scanning •http://www.promedmail.org
•http://www.who.int
– Websites identified •http://www.vadscorner.com/latest.html
•http://www.asean-disease-surveillance.net
•http://www.bbc.co.uk
– One officer recruited •http://www.cnn.com
•http://www.canada.com
•http://www. abc.net.au/news
– Daily website •http://news.com.au
•http://www.cdc.gov
•http://news.yahoo.com
scanning initiated •http://news.googles.com
•http://ecdc.europa.eu/en/
and started •http://www.moh.gov.et
•http://www.moard.gov.et
•http://www.mowr.gov.et
•http://www.moinf.gov.et

47
 Event Based Surveillance….
1. Media Scanning… Information from Websites
• Daily website scanning finding
shared with all PHEM officers
• Based in the information
feedback and alert letter has
been giving to regions
• E.g.
– Hepatitis E-outbreak in Sudan
– Cholera outbreak in Somalia
– Novel influenza (H7N9) in
China
– Polio

48
 Event Based Surveillance…
2. Rumor
• Rumor logbook prepared and
distributed to all levels
• Rumors have been registering
and verifying
• Tall free phone under
procurement

49
 Electronic PHEM reporting:
Soft Ware Activities

• Software was developed

• Computers were
distributed to health
facility
• Training is underway
• Implementation has
started
• Will solve the challenges
of public health
surveillance
50
 Outbreak Response
• Outbreak Investigation
– Epidemiological
– Laboratory
• Prevention and control Measures
– Case management
– Training
– Vaccination
– Quarantine and isolation
– Environmental management
• Post outbreak assessment
– Lesson Learnt

51
Emergency Operation Center (EOC)

52
 The Purpose of the EOC

• The EOC’s purpose is to coordinate incident

information and resources for management.

– The EOC must receive, analyze, and display

information about the incident to enable CEO decision-
making.

– The EOC must find, prioritize, deploy, and track critical

resources.

– The EOC must enhance decision making,

communication, collaboration, and coordination.
53
 Response Operation
• Emergency operation Center
– Equipped with trained staff and state of the art
communication and IT at the central level
– Functional - 24/7/365
– Horizon scanning – e-mail, web based, News
– Hotline – health personnel and to the public
– Activation and deactivation process
– Permanent staff and guest experts – Pooled

• Rapid Assessment/Response Team

– Pool of experts – various institution/organization/level/
54
 Recovery and Rehabilitation
• Health impact assessment
• Psychosocial support
• Rehabilitation of affected health facility
– Temporary health facility
– Mobilization of health workers
– Replacement of drugs and medical supplies

55
Maternal and Perinatal Death Surveillance
and Responses (MPDSR)
• Immediately reportable events / conditions

• A single maternal or perinatal death is

treated as an outbreak

• A single maternal or perinatal death review

informs a lot to prevent many similar deaths
in the future

Ethiopian MPDSR Training

 Case Definitions of Maternal Death
Community case definition Standard case definition (confirmed
(probable maternal deaths) maternal death)

• “Death of a woman of • “The death of a woman while

reproductive age group
(between 15-49 years of age.)” pregnant or within 42 days of the

end of pregnancy (irrespective of

Suspected maternal death duration and site of pregnancy),

• “Community case definition from any cause related to or
plus at least one of the
aggravated by the pregnancy or its
following:”
– Died while pregnant, management but not from
– Died within 42 days of accidental or incidental causes “
termination of pregnancy or
– Missed her menses before she (Source: ICD-10)
died Ethiopian MPDSR Training
 Case Definitions of Perinatal Death
Probable perinatal death Standard Case Definition
• “The birth of a dead fetus or death of a (Confirmed Perinatal Death -
new-born” extended):
• ``A death of a fetus born after 28
Suspected perinatal death:
completed weeks of gestation or
• “Probable perinatal death” plus the neonatal deaths through the first
following”
28 completed days after birth``
– Birth after 7 months of pregnancy and
– New-born dead at the time of birth OR
• Gestational age of 28 weeks as
– Death within 28 days of delivery
determined by:
– LNMP:GA of 28 weeks or
– Seven months of pregnancy is to be 196 days starting from the
determined by: first date of the last
• Maternal report or Anyone who knows menstrual period (LNMP) or
her duration of pregnancy or
• GA of 28 weeks or 196 days starting – Fundal height of 28 cm
from the first date of the last normal
menstrual period (LNMP)
Ethiopian MPDSR Training
Ethiopian MPDSR Training
Thanks!!!

Ethiopian MPDSR Training