SMU MBAHCS ASSIGNMENT

SEMESTER III

MH0051

HEALTH ADMINISTRATION
ASSIGNMENT SET: II

SUBMITTED BY:

J.JERALD JEYAPRAKASH
MBAHCS

ROLL NO :- 531010671

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INDEX
Q.No QUESTION Page No

Q.1

MRS. ANANDI MUTHAPPA BELONGS TO A LOW MIDDLE INCOME GROUP AND SHE LIVES IN A TIER II CITY. SHE JUST GAVE BIRTH TO A FEMALE BABY. WHAT DO YOU THINK ARE THE NURTURING PROGRAM OF THE GOVERNMENT OF INDIA FOR THE NEW BORN. EXPLAIN THOSE PROGRAMS IN DETAIL. WRITE SHORT NOTES ON: I. STRESS AND CO-OCCURRING DISEASES. II. BEHAVIOURAL HEALTH.

Q.2

9 10

Q.3

EXPLAIN ANY FIVE OCCUPATIONAL DISEASES AND THEIR PREVENTION. WHAT ARE THE STEPS IN DISASTER MANAGEMENT. EXPLAIN ABOUT THE CONCEPT OF COMBINED LIFE INSURANCE AND HEALTH INSURANCE. WITH REFERENCE TO INTERNATIONAL HEALTH REGULATION, EXPLAIN GLOBAL ALERT AND RESPONSE

11

Q.4 Q.5

15 19

Q.6

21

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Q.1 MRS. ANANDI MUTHAPPA BELONGS TO A LOW MIDDLE INCOME GROUP AND SHE LIVES IN A TIER II CITY. SHE JUST GAVE BIRTH TO A FEMALE BABY. WHAT DO YOU THINK ARE THE NURTURING PROGRAM OF THE GOVERNMENT OF INDIA FOR THE NEW BORN. EXPLAIN THOSE PROGRAMS IN DETAIL Answer Nurturing Newborns The data published in the third survey (2005-06) of National Family Health Survey (NFHS), 56.1% of ever married women aged 15-49 years are Anemic. The problem is more severe during pregnancy, with 57.8% of pregnant women (15-49 years) being anemic. A programme for prophylaxis and treatment of anemia has been under completion through out the country since 1997-98. Under this programme all pregnant and lactating women are provided with one tablet (containing 100 mg of elemental iron and 0.5 mg of Folic Acid) daily for 100 days. Those who have severe anemia are provided with double dose of these tablets. The program focuses on the following factors: Provision of 24 Hrs Delivery Services at PHC: Under RCH II, all the CHCs and 50% of the PHCs are being operationalized for providing round the clock delivery services by placing at least 3-5 Staff Nurses and 1 Medical Officer in these facilities. Post natal care for mother and newborn: Ensuring post natal care within first 24 hours of delivery and subsequent home visits on day 3 and 7 are the important components for identification and management of emergencies occurring during post natal period. The (Auxiliary Nurse Midwife) ANMs, (Lay Home Visitor) LHVs and staff nurses are being made aware of and also oriented for tackling emergencies identified during these visits.

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Skilled attendance at birth Government of India has a commitment to provide skilled attendance at every birth both at community and Institution level. New Initiatives in Skilled Attendance at Birth: To manage and handle some common obstetric emergencies at the time of birth, the Government of India has taken a policy decision to permit Staff Nurses (SNs) and ANMs to give certain injections and also perform certain interventions under specific emergency situations to save the life of the mother. Training Strategy involves a 2-3 week training of (Staff Nurses) SNs and 3-6 week training of ANMs/LHVs in Skilled Attendance at Birth. For this Curriculum and Technical Guidelines have been developed and have already been disseminated to the States. 1 Home-based new born care The Government of India has recently approved the implementation of Home Based Newborn Care (HBNC) based on the Gadchirolli model, where appreciable decline in Infant Mortality Rates has been documented on the basis of work done by SEARCH, an NGO. ASHAs will be trained in identified aspects of newborn care during the second year of their training. 2 Facility based new born care The facility based newborn care programme implanted by the Government in 140 districts with technical assistance from the National Neonatology Forum (NNF) has been evaluated and based on this feedback, a facility based newborn care programme is being set up. Level II sick newborn units have been proposed by the states in their RCH II PIPs and are being set up throughout the country in a phased manner, initially at district hospitals. 3 Promotion of Infant and Young Child Nutrition (IYCN) A Breastfeeding Partnership involving all the key partners has been formed under the auspices of the Honble MOS. Revival of the Breastfeeding Hospital Initiative (BFHI) has been approved and implementation shall be initiated.

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4 Child nutrition in the Reproductive and Child Health (RCH) programme Breastfeeding Objectives "Exclusive breastfeeding of the first six months of life" to be propagated as it would the following benefits: It is the ideal method of infant feeding, Is the single most cost effective intervention for reduction of infant mortality? Delays return to fertility in the mother and hence acts as a natural contraceptive (Lactational Amennarrhoea Method, LAM) Strategy A breastfeeding partnership of he government with all major professional bodies and various NGOs has been formed. The Infant Milk Substitute (IMS) Act is being implemented Baby Friendly Hospital Initiative Lactation Clinics Peer Counselling

Iron and folic acid supplementation

Objectives Screening of children for anaemia wherever required and appropriate treatment of those found anaemic. Strategy Iron supplementation for at least hundred days in a year for all age groups, infants above six months of age up to adolescence and beyond, for all diagnosed as anaemic, with iron Children from six months of age to five years to be supplemented with liquid iron. Improve dietary intake to meet RDA for all macro and micronutrients; Dietary diversification-inclusion of iron folate rich foods as well as food items that promote iron absorption; Food fortification, including introduction of iron and iodine-fortified salt and other iron-fortified items (e.g. atta in specific areas);

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Health and nutrition education to improve over all dietary intakes and promote consumption of iron and folate-rich foodstuffs. Infants Exclusive breast feeding for six months, and introduction of green leafy vegetables along with cereal/pulse/oilseed mix in the seventh month for the prevention of anaemia; Screening for anaemia in pre-term, low birth weight infants and those with growth faltering and repeated episodes of infection; and Appropriate treatment for anaemic infants. Coverage As per a survey carried out in 2002 by the National Nutrition Monitoring Bureau, under the ICMR, 67% of the preschool children were anaemic. 2,84,729 kits are distributed throughout the country each year under the RCH programme, each kit containing 13,000 tablets of paediatric IFA tablets. Implementation Through the health institutions under the government sector. 5 Routine immunization programme Immunization programme is one of the key interventions for protection of children from life threatening conditions, which are preventable. Immunization Programme in India was introduced in 1978 as Expanded Programme of Immunization. This gained momentum in 1985 as Universal Immunization Programme (UIP) and implemented in phased manner to cover all districts in the country by 1989-90. UIP become a part of Child Survival and Safe Motherhood Programme in 1992. Since, 1997, immunization activities have been an important component of National Reproductive and Child Health Programme. Immunization is one of the key areas under National Rural Health Mission (NRHM) launched in 2005. Under the Immunization Programme Government of India is providing vaccination to prevent six vaccine preventable diseases i.e. Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, and Measles. The vaccination schedule is as under:

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BCG (Bacillus Calmetter-Gurin) Birth DPT ( Diphtheria, Pertussis and Tetanus Toxoid ) 6,10,14 weeks and at 16-24 months of age OPV (Polio) 6,10,14 weeks & 16-24 months of age and birth dose for institutional delivery Measles 9-12 months of age DT (Diphtheria and Tetanus Toxoid) 5 years of age TT (Tetanus Toxoid ) 10 years and 16 years of age TT for pregnant woman two doses or one dose if previously vaccinated within 3 years The Immunization coverage of vaccines under Routine Immunization as per NFHS-II and NFHS-III data is enclosed. To improve the coverage in low performing NE States, Special Immunization weeks are being observed in the North East States along with EAG States from the year 2005-06 every year. To further strengthen the Routine Immunization, with the aim to improve the coverage, Government of India has taken the following initiatives as part of NRHM: Introduction of AD syringes for all immunization replacing the existing glass syringe and needles. Downsizing the BCG vial from 20 dose to 10 dose. Plans for alternate vaccine delivery from PHC to sub centre and outreach sessions. Outsourcing immunization activities in urban slums and under served areas. Strengthening supervision and monitoring. Mobility support to District Immunization officer for supportive supervision and monitoring. Review meeting at the State level with the districts on 6 monthly basis. Mobilization of children to immunization session sites by Accredited Social Health Activist. (ASHA), Link workers, Women Self Help Groups etc. All the States/UTs were asked to prepare their own State Programme Implementation Plan (PIP) for Immunization as part C of NRHM PIP from the year 2005-06 to address their specific needs.

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6 Introduction of Hepatitis-B vaccine A pilot project for the introduction of Hepatitis-B vaccine in the National Immunization Programme was approved by the Government and launched by Honble Prime Minister on 10th June 2002. Under the pilot project 33 districts and 15 metropolitan cities implemented Hepatitis B vaccination. The current schedule includes birth dose along with earlier 3 doses. Vaccine and syringes are being made available by Global Alliance for Vaccine and Immunization (GAVI) for the expansion programme. Expenditure for IEC, training and monitoring budget is being incurred through the domestic funds. 7 Pulse polio immunization In pursuance to the World Health Assembly resolution No. 1988/41.28 Pulse Polio Immunization (PPI) Programme was started in India from 1995 to eradicate Polio from India. Following the successful pilot undertaking in Delhi in 1994, Nation-wide PPI rounds was undertaking in 1995 covering children in the age group of 0-3 years from 1996-97 the age cohort for vaccination was started to cover 0-5 years children. Till 1998-99 two rounds used to be organized in the month of December and January each year. From 1999-2000 house to house vaccination of missed children was also introduced to vaccinate children missed during the fixed booth based vaccination of children. This resulted in increasing coverage of 2-3 crore additional children.

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Q2. WRITE SHORT NOTES ON: I. Answer Stress and Co-occurring Diseases Stress is the bodys reaction to a change that requires a physical, mental or emotional adjustment or response. Symptoms of stress and anxiety often co-occur in certain diseases/disorders. In fact, major depression/stress often accompanies panic disorder and other anxiety disorders. While depression and anxiety have distinct clinical features, there is some overlap of symptoms. For example, in both stress/depression and anxiety, irritability, decreased concentration and impaired sleep are common. Effects of Stress on Well Being Depleted Physical Energy: Prolonged stress can be physically draining, causing a man to feel tired much of the time, or no longer have the energy once he did. Emotional Exhaustion: Man feel impatient, moody, inexplicably sad, or just get frustrated more easily than he normally would. He feels like he cant deal with life as easily than he once could. Lowered Immunity to Illness: When stress levels are high for a prolonged amount of time, the immune system does suffer. People who are suffering from stress usually get the message from their body that something needs to change, and that message comes in the form of increases susceptibility to colds, the flu, and other minor illnesses. Less Investment in Interpersonal Relationships: Withdrawing somewhat from interpersonal relationships is another possible sign of stress. The individual may feel like he have less to give, or less interest in having fun, or just less patience with people. But for whatever reason, people experiencing stress can generally see the effects in their relationships. STRESS AND CO-OCCURRING DISEASES.

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Increasingly Pessimistic Outlook: When experiencing stress, its harder to get excited about life, harder to expect the best, harder to let things roll off the back, and harder to look on the bright side in general. Because optimism is a great buffer for stress, those suffering from stress find it harder to pull out of their rut than they normally would. Increased Absenteeism and Inefficiency at Work: When experiencing job stress, it gets more difficult just to get out of bed and face more of whats been overwhelming for him in the first place. Q2. WRITE SHORT NOTES ON: II BEHAVIOURAL HEALTH. Answer Behavioural health can be defined as an interdisciplinary field dedicated to promoting a philosophy of health that stresses individual responsibility in the application of behavioural and biomedical science knowledge and techniques to the maintenance of health and prevention of illness and dysfunction by a variety of self-initiated individual and shared activities. Behavioural health shapes how we feel, think and act. Behavioural health problems can lead to poor health, self-injury, or even suicide. Studies show that the people with depression are more at risk for stroke. They are also more at risk for a second heart attack. Behavioural health problems can happen to anyone. They may need help from an expert. Left alone, problems can get worse. Warning signs of a possible problem: Sudden changes in behaviour Missing too much work or school Not eating. Eating too much. Not sleeping. Sleeping too much. Trouble focusing Spending a lot of time alone

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Being angry with everything and everyone Depression, drug and alcohol abuse are the types of behavioural problems Many behavioural health problems are medical problems just like cancer or heart disease. They can be treated.. Q3. EXPLAIN ANY FIVE OCCUPATIONAL DISEASES AND THEIR PREVENTION. Answer Occupational Diseases and their Prevention In many industrialized countries there is a change in work pattern now a days, a change that has resulted in a decrease in the old traditional occupational diseases, such as lead poisoning and pneumoconiosis and an increase in what are now called work-related diseases, that is, diseases that can occur regardless of any occupational exposure, e.g. musculoskeletal disorders, asthma and cardiovascular diseases. Moreover, the occupational physician or nurse, these days sees an increasing number of patients who show different symptoms without any sign of disease. The complaints are often polysymptomatic and the symptoms tend to be chronic. The most common type of occupational diseases are given in the Table 3.1. Table 3.1: Common Health Conditions Associated with Occupational Exposure

SMU- MBA Semester III

Reg. No: 531010671

HEALTH ADMINISTRATION-MH0051

SMU- MBA Semester III

Reg. No: 531010671

HEALTH ADMINISTRATION-MH0051

SMU- MBA Semester III

Reg. No: 531010671

HEALTH ADMINISTRATION-MH0051

SMU- MBA Semester III

Reg. No: 531010671

HEALTH ADMINISTRATION-MH0051

Q4. WHAT ARE THE STEPS IN DISASTER MANAGEMENT. Answer The number of natural disasters is increasing worldwide due to climatic changes. Still, disasters fascinate people. They bring on feelings of amazement and fear, and provide instances of courage, folly, and tragedy in a sense, all the aspects of a great drama. With the tropical climate and unsound land forms, matched with deforestation, unplanned growth proliferation non-engineered constructions which make the disaster-prone areas mere vulnerable, sluggish communication, poor or no budgetary allocation for disaster prevention, developing countries suffer more or less constantly by natural disasters. The Asian region tops the list of fatalities due to natural disaster. Among a variety of natural hazards, earthquakes, landslides, floods and cyclones are the major disasters negatively disturbing very large areas and population in the Indian sub-continent. These natural disasters are of (i) geophysical origin such as earthquakes, volcanic eruptions, land slides and (ii) climatic origin such as drought, flood, cyclone, locust, forest fire etc. World Health Organization (WHO) defines Disaster as "any occurrence, that causes damage, ecological disruption, loss of human life, deterioration of health and health services, on a scale sufficient to warrant an extraordinary response from outside the affected community or area." Disasters can by of many types like: Tornadoes, Fires, Hurricanes, Floods/Sea Surges/Tsunamis Snow storms, Earthquakes, Landslides, Severe air pollution (smog) Heat waves, Epidemics,

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Building collapse, Toxicological accidents (e.g. release of hazardous substances), Nuclear accidents, Explosions Civil disturbances, Water contamination and Existing or anticipated food shortages.

Despite the fact that it may not be feasible to control nature and to stop the development of natural phenomena but the efforts could be made to avoid disasters and lighten their influences on human lives, infrastructure and property. It is almost unfeasible to prevent the event of natural disasters and their damages. Nevertheless it is possible to lessen the impact of disasters by adopting appropriate disaster lessening strategies. The disaster mitigation works mainly address the following: 1) Minimize the potential risks by developing disaster early warning strategies, 2) Prepare and put into practice developmental plans to provide flexibility to such disasters, 3) Mobilize resources together with communication and tele-medicinal services and 4) To help in rehabilitation and post-disaster reduction. 5) Disaster management on the other hand comprises: i) Pre-disaster planning, preparedness, monitoring including relief management capability. ii) Prediction and early warning. iii) Damage assessment and relief management. 6) Disaster reduction is a systematic work which comprises with different regions, different professions and different scientific fields, and has become a significant measure for 7) human, society and sustainable development of the nature. Objectives: After studying this unit, you will be able to: o Define disasters and their type o Explain the basics of disaster management and mass casualties o Name the components of disaster plan

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o Recognize the necessity of disaster alertness in hospitals o State the steps in disaster management planning and implementation o Discuss the severity of illness amongst disaster victims and risk assessment Basics of Disaster Management and Mass Casualties Mass Causality can be defined as any large number of casualties produced in a relatively short period of time, usually as the result of a single incident such as a military aircraft accident, hurricane, flood, earthquake, or armed attack that exceeds local logistical support capabilities. Mass casualty incidents may occur in a variety of forms. Transportation systems (road traffic, aircraft, shipping, railroads) account for many such incidents, as does industry (chemical spills, factory fires), buildings collapse or burn. Poisonings can result from sources such as restaurants or water supplies. Outbreaks of disease can quickly exceed the ability of local health care facilities to control and treat them. Generally the most intense in the public imagination are natural disasters events of a scale that they put in danger both populations and environments such as floods, windstorms, and earthquakes. As per an estimate, since 1900 the number of recorded natural disasters have increased, as have the number of people struck. At the same time, man-made events are growing in frequency and affect. In fact, the mass casualty incidents that most countries go through on a regular basis are major accidents road traffic, industrial, as well as other incidents with tens of victims, rather than larger numbers. Disaster management is the discipline of dealing with and avoiding risks. It is a discipline that involves preparing for disaster before it occurs, disaster response (e.g., emergency evacuation, quarantine, mass decontamination, etc.), and supporting, and rebuilding society after natural or human-made disasters have occurred. Steps in disaster management Mainly there are four steps in disaster management: mitigation, preparedness, response and recovery. Every disaster is different and response is decided by the events at hand. Disasters might be natural or unnatural in origin. The type of emergency determines the response. Some disasters might require evacuation or relocation. Others might demand quarantine or decontamination. The meanings of the terms used in the disaster management are as follows:

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Mitigation: The mitigation phase of disaster management focuses on long-term preparation or avoidance of disaster completely. The accurate identification of risks is very significant at this point. Risks are ranked through catastrophic modeling, which uses mathematical formulas and computer calculations to weigh risk. Mitigation also comprises preventive actions categorized as either structural solutions, such as shoring up levees, to prevent flooding, or nonstructural solutions such as connecting with local and government agencies to work out the flow of emergency process. Preparedness: Preparedness comprises collecting supplies in anticipation of disaster scenarios as well as training of emergency and non-emergency staff. Disaster management focuses on ensuring the availability of shelter for displaced citizens as well as maintenance and storage of equipment, training of staff and volunteers, and preparing for resource mobilization. Large-scale disaster training exercises are often conducted to test preparedness and look for weaknesses in disaster response. Corporations might also have emergency response teams consisting the volunteers that undergo drills meant for disaster preparedness. Response: First responders to a disaster are generally law enforcement, firefighters and emergency medical technicians. After that, if a disaster warrants a large-scale response, the chain of command and resource utilization moves to the county, then to the state and, finally, to the local level. Volunteer organizations such as the Red Cross are often pivotal to the response effort as well. Response timing is very important as most disaster victims die within the first two days of a catastrophic event. Recovery: Once the initial crisis has passed, it is time to rebuild and restore what was lost. This is known as the recovery phase of disaster management. The central government coordinates and provides the majority of post-disaster assistance as determined by the National Response Plan, which is managed by the Department responsible for the management and rescue of the disaster victims. As the recovery phase comes to a close, a thorough assessment of what failed or succeeded should be taken and used to improve all phases of disaster management.

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Q5. EXPLAIN ABOUT THE CONCEPT OF COMBINED LIFE INSURANCE AND HEALTH INSURANCE Answer Concept of Combined Life Insurance and Health Insurance Combined insurance, as its name suggests, provides the policy holder with another layer of protection, on top of existing policies the policy holder probably already have, such as health and life insurance. It can help the policy holder pay for the things existing policies may not cover. Combined insurance is similar to other lines of insurance but it combines two types of insurances in a single policy such as life or health insurance. With major medical insurance, specifically, insurance company pays the medical provider directly for services provided to policy holder. Combined Insurance specifically offers a number of insurance products designed to help meet your needs, including disability insurance, accident insurance, health insurance and life insurance. Each is clearly written and easy to understand so you can make the right decisions about your coverage. It has benefit that the policy holder doesnt have to pay the premiums for different policies at different dates and in different companies. And in case of any happening he need not go to different companies for his claim. Different Health Insurance Policies Analysis and Management The New India Assurance and Mediclaim 2007: The National Insurance, New India Assurance, United India and Oriental Insurance, which were earlier subsidiaries of the General Insurance Company (GIC), have become autonomous and their mediclaim policies are more or less the same with slight variations. Though the premium of mediclaim policy has almost doubled in the last five years; the middle class is forced to opt for this policy due to various reasons the decline in medical cover by employers, increase in income and the growing number of diseases. Also the treatment costs have increased manifold. Group Mediclaim New India: The employer can also take group mediclaim scheme to provide medical cover to the employees. He added that under the group policy, the company would give a discount of 2.5 to 30 per cent in premium depending upon the number of policyholders.

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Bhavishya Arogya: Bhavishya Arogya is essentially to take care of medical expenses needs of persons in their old age. Coverage The policy provides for expenses in respect of hospitalization and domiciliary hospitalization during the period commencing from the Policy Retirement Age selected till survival. This is selected by the insured for the purpose of commencement of benefits in the policy. The pre-retirement period incepts from the date of acceptance of the proposal and ends with the policy retirement age during which the insured pays premium either in installments or as single premium. Amount: The sum insured ranges from Rs. 50,000 onwards and the premium depends on the sum insured and the policy retirement age selected and mode of payment (single/installment). Mediclaim insurance Age: Between 5-80 years. Children between 3 months and 5 years can be covered provided one or both parents are also covered. Coverage: Insures against any hospitalization expenses that may arise in future. The scheme reimburses hospitalization expenses for illness, diseases or injury sustained, excludes any disease existing before taking the policy. Cost: Sum insured can be anywhere between Rs. 15,000 Rs. 500,000. Rate of premium ranges between Rs. 175 per year to Rs. 2,500 per year depending on the age and capital sum insured. Amount: Compensation up to the extent of sum insured. LICs Ashadeep Provides insurance against four major critical ailments cancer(malignant), paralytic stroke resulting in permanent disability, renal failure of both kidneys or coronary artery diseases where by-pass surgery has been done. Age: Between 18-65 years. Maximum age at entry is 50 years. Cost: Premium ranging from Rs. 70.95 to 99 Rs. per Rs. of the sum assured depending on the age of the claimant and the policy term (15, 20 or 25 years).

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Amount: Insurance can be taken for a sum ranging from Rs. 50,000 to Rs. 300,000. Immediate payment of 50 per cent of sum assured and payment of an amount equal to 10 per cent of the sum assured every year from the establishment of affliction to the date of maturity or death, whichever is earlier. Q6. WITH REFERENCE TO INTERNATIONAL HEALTH REGULATION, EXPLAIN GLOBAL ALERT AND RESPONSE Answer

The International Health Regulations (IHR) are an international legal instrument that is binding on 194 countries across the globe, including all the Member States of (World Health Organization) WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. Global Alert and Response History has demonstrated the capacity of outbreak-prone diseases to spread rapidly and overwhelm national resources causing acute emergencies. At the present time, the world faces outbreak threats in three contexts: The emergence of new or newly recognised pathogens These novel pathogens are usually poorly understood in terms of source and transmission and many have the potential to cause large outbreaks. Fortunately, some of these pathogens are not well adapted to human populations and lack the potential for sustained, epidemic spread. However, history has educated us that this can and does happen.

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HIV/AIDS is the most recent example of a pathogen that has emerged in the recent past is causing a major epidemic that now threatens the economic future of many nations. Other pathogens, such as influenza and measles, have at some time in the past crossed over from animal species and now regularly cause major outbreaks associated with high mortality and morbidity. The recurrence of outbreaks of diseases that are recognised to cause significant human disease Diseases such as cholera, dengue, influenza, measles, meningitis, shigellosis, yellow fever and food-borne diseases present a constant threat to human populations. They are well adapted to transmission in the human populations either directly from person to person, through vector transmission, or via contamination of the environment or food. In general the diseases are well understood and very often effective control measures are available. In many countries these diseases have come under control by the systematic application of control measures such as vaccination or water treatment. Action by the international community to contain outbreaks The threats presented by outbreaks have not gone without a series of responses at national and international levels. Many countries have recognised the renewed threat of outbreaks and have sought to strengthen their national surveillance and response capacities. In many other countries similar developments have been very slow due to lack of funds and competing priorities. The reaction of some countries has been to devise a brick wall defence and concentrate on reducing the threat of disease introduction at national borders or by increasing the sensitivity of surveillance systems to pick up small numbers of imported disease cases. There is an increasing realisation that this approach often is not the most effective response.

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World Health Organization has also been involved in combating outbreaks since its inception in 1950. Outbreak alert and response requires a non-partisan approach and the capacity to facilitate collaborations between diverse partners. World Health Organization has a unique health mandate from 191 member states and has, with existing partners, already established mechanisms for global outbreak alert and response. Current mechanisms function in the areas of outbreak alert and outbreak response. Outbreak Alert: Accurate and timely information about important disease outbreaks is delivered systematically and rapidly to key professionals in international public health through: Specialised Surveillance Networks: World Health Organization has established a number of international networks for specific disease threats (e.g. FluNet for influenza, RabNet for rabies, Global SalmSurv for salmonellosis and DengueNet for Dengue). Outbreak Verification: Outbreak verification (OV) is a new approach to global disease surveillance. Its aim is to improve epidemic disease control by actively collecting and verifying information on reported outbreaks and informing key public health professionals about outbreaks, which are of potential international public health importance. OV relies on a broad range of information sources including the Global Public Health Information Network (GPHIN) which is a web-based electronic system developed by Health Canada in collaboration with World Health Organization which scans the web to identify suspected outbreaks. Suspected outbreaks are actively followed up with affected countries to verify the existence of the epidemic, its cause and the response being put in place. World Health Organization offers assistance in all cases: The information then is disseminated via the Outbreak Verification List (OVL) to over 900 institutions and key

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decision-makers in international public health (e.g. World Health Organization networks, collaborating centres, national institutes of public health, major NGOs). As of January 2000, 512 outbreak reports have been investigated and disseminated if found to be of international public health importance. Outbreak Response: World Health Organization responds to requests from member states for assistance with outbreak management. Recent examples of outbreaks with direct World Health Organization participation in the field are: Rift Valley fever in Kenya and Somalia, monkeypox in the Democratic Republic of the Congo, avian influenza (H5N1) in Hong Kong, Ebola haemorrhagic fever in Gabon, relapsing fever in southern Sudan, influenza in Afghanistan, epidemic dysentery in Sierra Leone and Marburg virus infection in the Democratic Republic of the Congo. Active World Health Organization involvement in co-ordinating epidemic response allows not only provision for immediate needs, but also allows initiation of measures which result in permanent benefit, such as the development of laboratory networks and active surveillance systems. An epidemic represents one of many entry points for World Health Organization to become more deeply involved with an affected country in the areas of epidemic preparedness and the development of improved epidemic response capacity. World Health Organization is working with its partners to improve global, regional and national preparedness for epidemics through: Establishing global surveillance and response standards o Creating networks of partners for preparedness and rapid response (e.g. sub-regional preparedness and response teams in the African Region) o Strengthening laboratory capacity and laboratory networks o Training in field epidemiology o Assessment and strengthening of national surveillance systems Gaps, constraints, and challenges in global alert and response

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To date the responses by the international community and World Health Organization have helped to increase awareness and develop systems to detect and contain outbreak threats. A series of networks have been established which seek to establish communication or diagnostic partnerships. These may be disease specific or regional, and focus on sharing surveillance data on outbreak-prone diseases. However, most lack a response component or are highly specialised. All these networks have a strong rationale and have been devised in response to particular needs. Objectives of a global outbreak alert and response network The network will bring together key institutional and human resources so that outbreaks of potential international importance are detected, verified and responded to efficiently and effectively by the international community, and the level of preparedness of individual states is increased. The criteria for activation of the network to respond to emergent and well-characterised disease threats should be based on the following criteria: Humanitarian need International Spread is possible Travel and Trade may be interrupted Functions of the network The network will focus on three major functional areas: o Outbreak alert o Co-ordination of outbreak response o Outbreak preparedness (National and International) These will be achieved through the processes of: o Offering assistance to outbreak affected states o Combating the international spread of outbreaks o Ensuring follow-up activities to prevent recurrence or further spread of the disease o Identifying and encouraging essential research to strengthen future prevention and control capabilities.

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o Evaluation of international efforts to contain outbreaks Global outbreak alert and response network functions are described in pictorial form in Figure 6.1 for your easy learning.

6.1 Global Alert and Response Network Functions

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