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** RAND WORKING DOCUMENT FOR MBDS ** 1
Mekong Basin Disease Surveillance (MBDS) Cooperation
MBDS Monitoring within the Context of the
International Health Regulations
Human Resource Development (HRD) Indicators
Draft for discussion by MBDS HRD working group
January 24, 2011
** RAND WORKING DOCUMENT FOR MBDS ** 3
The World Health Organization (WHO) has developed assessment guidelines that
countries should use for monitoring the development of core capacities required by the
International Health Regulations (IHR). (WHO 2010) The WHO framework
encompasses three broad areas to be monitored across the full scope of the IHR:
Core capacities (n = 8): national legislation, policy and financing;
coordination and National Focal Point communications; surveillance;
response; preparedness; risk communication; human resources; laboratory
Human health hazards (n = 4): zoonotic events; food safety; chemical events;
radiological and nuclear events
Points of Entry – PoE (n = 1)
WHO convened a group of technical experts to develop specific indicators that countries
should use to monitor their capabilities in these areas. The 2010 WHO guidelines define
four distinct capability levels:
Capability level <1: Foundational or prerequisite level, representing the
critical attributes that would facilitate implementation of the IHR. Any
attribute not in place at this basic level should be addressed as a priority.
Capability level 1: Moderate level capability, reflecting that inputs and
processes needed to achieve IHR core capacities are largely in place.
Capability level 2: Strong technical capacity and high level of performance
through defined public health outputs and outcomes, typically at both national
and sub-national. This level corresponds to IHR requirements specified for
2012, i.e., the level of attainment for all core capacities expected of all
countries by 2012.
Capability level 3: Advanced technical capacity, contributions to IHR core
capacities beyond a States Party‟s own borders and a “reference model” for
other countries in terms of generating information, products and tools
reflecting standards or best practices that other countries can use.
Since 2001, countries in the Mekong Basin have been collaborating through the Mekong
Basin Disease Surveillance (MBDS) cooperation. MBDS collaboration focuses primarily
at distal levels of each country‟s health system, specifically cooperation in disease
surveillance and response at designated cross-border sites, and the provincial and national
support needed to enable this local cooperation. Not surprisingly, capacity building
within MBDS programming is consistent with the core capacities required by the IHR.
Indeed, the IHR requires that countries develop key capacities at all relevant levels, and
the 2010 WHO monitoring guidelines call for assessment at “national, intermediate and
local community/primary response levels.” As such, MBDS represents “bottom-up
[MBDS] meeting top-down [IHR].”
** RAND WORKING DOCUMENT FOR MBDS ** 4
In 2010, the MBDS Executive Board endorsed a new MBDS Master Plan for 2011-2016.
The plan is organized around the seven inter-related strategies shown in the figure below.
The new MBDS plan includes activities, indicators and outputs related to each of the
seven strategies.
The 2010 WHO IHR
monitoring guidelines
describe 30 indicators, 20
of which countries are expected to report annually to the World Health Assembly and ten
that are optional. MBDS stakeholders wish to reconcile MBDS monitoring with
monitoring related specifically to IHR and to other relevant programs, such as the Asia-
Pacific Strategy for Emerging Diseases (APSED), the U.S. CDC Field Epidemiology
Training Program (FETP) assessment matrix, and the WHO matrix for assessing FETP
capacity (see list of references). Because MBDS programming focuses on local activities
(and accompanying provincial and national support) that are consistent with IHR core
capacities, it is more efficient to link MBDS monitoring to the extent possible with
monitoring of IHR and other relevant programs, with supplemental MBDS indicators as
needed; such an approach is preferable to creation of a totally separate set of indicators
for MBDS. The latter approach could cause confusion at all levels.
The first table below maps MBDS strategies and activity-specific indicators onto the IHR
indicators. Only IHR indicators relevant to MBDS are included -- indicators related to the
two IHR core capacities and two potential human health hazards neither addressed by nor
relevant to MBDS are excluded. Required IHR indicators are shown in bold font;
optional indicators are in normal font. The second table below maps the two sets of
indicators in the opposite direction, indicating for all specific MBDS activities the
corresponding 2010 IHR indicators. Nearly all planned MBDS activities (and, by
extension, their associated indicators) map onto the IHR monitoring framework. Of the
54 distinct MBDS activities, only 12 have no clear-cut correlate on the IHR indicator list,
including all indicators for the policy research strategy. Nonetheless, examination of
those activities (1.1, 1.2, 1.5, 4.1, 4.2, 4.3, 7.1-7.6) will indicate that they, too, are
** RAND WORKING DOCUMENT FOR MBDS ** 5
consistent with IHR priorities. This further justifies tying MBDS monitoring to
monitoring of IHR indicators.
IHR indicators and corresponding MBDS strategies and activities
IHR indicator MBDS strategy (and activity number)
CORE CAPACITIES
1. National legislation, policy and financing Not addressed specifically by MBDS
2. Coordination & National Focal Point
communications Not addressed specifically by MBDS
3. Surveillance
Indicator based, routine surveillance
includes an early warning function for the
early detection of public health events.
1 – Cross-border cooperation (1.3, 1.4)
4 – Information & communications
technologies – ICT (4.4)
Event based surveillance is established 2 – Community-based surveillance (2.8
– 2.12)
A coordinated mechanism is in place for
collecting and integrating information from
sectors relevant to the IHR
1 – Cross-border cooperation (1.3, 1.4)
4 – Information & communications
technologies – ICT (4.5)
4. Response
Public health emergency response
mechanisms are established.
1 – Cross-border cooperation (1.9)
3 – Epidemiology capabilities (3.7)
Case management procedures for IHR
relevant hazards are established. 1 – Cross-border cooperation (1.8)
Infection prevention and control (IPC) is
established at national and hospital levels 1 – Cross-border cooperation (1.7)
A program for disinfection, decontamination
and vector control is established
Relevant but not addressed specifically
by MBDS
5. Preparedness
A multi-hazard national public health
emergency preparedness and response plan
has been developed
Relevant but not addressed specifically
by MBDS
Public health risks and resources are
mapped.
1 – Cross-border cooperation (1.10)
3 – Human resources (3.9)
4 – ICT (4.6)
6. Risk communication
Mechanisms for effective risk
communication during a public health
emergency are established.
6 – Risk communication (6.1-6.6)
** RAND WORKING DOCUMENT FOR MBDS ** 6
IHR indicator MBDS strategy (and activity number)
7. Human resources
Human resources are available to
implement IHR core capacity
requirements.
3 – Human resource development (3.1-
3.6, 3.8)
8. Laboratory
A coordinating mechanism for laboratory
services is established.
5 – Laboratory (5.1-5.5)
Laboratory services to test for priority
health threats are available and accessible.
Influenza surveillance is established
A system for the collection, packaging &
transport of specimens is established.
Laboratory biosafety and biosecurity
practices are in place.
Laboratory data management
HUMAN HEALTH HAZARDS
1. Zoonotic events
Mechanisms for detecting and responding 2 – Animal-human interface (2.1-2.6)
2. Food safety
Mechanisms are established for detecting
and responding to foodborne disease and
food contamination
Relevant but not addressed specifically by
MBDS
3. Chemical events Not addressed specifically by MBDS
4. Radiological and nuclear events Not addressed specifically by MBDS
EVENTS AT POINTS OF ENTRY
General obligations at PoE are fulfilled.
1 – Cross-border cooperation (1.6)
Compliance with IHR (2005) for PoE and for
health and technical documents is established.
Coordination in the prevention, detection and
response to public health events at PoE is
established.
Effective surveillance is established at PoE.
Effective response is established at PoE.
** RAND WORKING DOCUMENT FOR MBDS ** 7
MBDS activities and corresponding IHR indicators
MBDS Activities
IHR indicators
Core capacities Health
risks PoE
3 4 5 6 7 8 1 2
MBDS Strategy 1: Cross-border (XB) cooperation
1.1 Identification of new XB sites
1.2 Basic package of activities for XB sites
1.3 Surveillance information exchange x
1.4 Regular meetings of XB sites
1.5 Regular supervisory visits to XB sites
1.6 Border health quarantine at check points x
1.7 Infection control in medical facilities x
1.8 Patient isolation capacity x
1.9 Outbreak response capacity (real/drill) x
1.10 Updated resource mapping x
MBDS Strategy 2: Human-animal sector interface and community-based surveillance
Animal-human interface
2.1 Identification of priority diseases x
2.2 Mechanisms for collaboration, info sharing x
2.3 Development of model tabletop exercise (TTX) x
2.4 Protocol for joint outbreak investigation x
2.5 Regular info sharing between sectors x
2.6 Sharing cross-sector info across countries x
2.7 Cross-sector outbreak investigation or TTX x
Community-based surveillance
2.8 Selection of priority diseases/events x
2.9 Development of guidelines x
2.10 Development/testing of model at XB site/s x
2.11 Training of volunteers, implementation x
2.12 Regular reporting from communities x
MBDS Strategy 3: Human resources and epidemiology
3.1 Surveillance evaluation and joint outbreak
investigation into RRT/FETP training x
3.2 Short-course epidemiology training x
3.3 Workshops on epi, scientific writing, lab, GIS x
3.4 Training of country training directors x
3.5 Long-term epidemiology training x
** RAND WORKING DOCUMENT FOR MBDS ** 8
MBDS Activities
IHR indicators
Core capacities Health
risks PoE
3 4 5 6 7 8 1 2
3.6 Scientific meetings to share experiences x
3.7 Joint outbreak investigation &/or surveillance
evaluation x
3.8 Monitoring & evaluation of activities x
3.9 Resource mapping x
MBDS Strategy 4: Information & communications (ICT)
4.1 ICT policy proposal
4.2 Capacity assessment
4.3 Plan development
4.4 Routine ICT use in surveillance & reporting x
4.5 Routine ICT use across MBDS countries x
4.6 Resource mapping x
MBDS Strategy 5: Laboratory
5.1 Filling gaps based on capacity assessment x
5.2 Capacity development for core diseases x
5.3 Proficiency testing for core diseases x
5.4 Regional protocol for specimen collection,
transport, reference testing x
5.5 Promotion of new diagnostic technologies x
MBDS Strategy 6: Risk communications (RC)
6.1 RC framework and plan x
6.2 RC curriculum x
6.3 RC training x
6.4 Message development and testing x
6.5 Implementation x
6.6 Emergency equipment x
MBDS Strategy 7: Policy research
7.1 Identification of research priorities
7.2 Study protocol
7.3 Funding
7.4 Implementation, analysis, report
7.5 Application of findings
7.6 Dissemination of results
** RAND WORKING DOCUMENT FOR MBDS ** 9
The indicator tables on the pages that follow are organized based on the 2010 WHO IHR
monitoring framework. Specifically, they describe the different capability levels for
required (bold) and optional (not bold) IHR indicators, taken directly from the 2010
WHO IHR monitoring guidelines (these items are shown in gray). The tables also
include proposed supplemental MBDS human resource development (HRD) indicators to
guide more targeted action in that area (these items are shown in white). The final section
of this document includes tables to capture summary information across all the indicators.
The supplemental MBDS indicators add value for monitoring MBDS HRD activities and
outputs and also fit nicely within the overall IHR organizing framework. Ultimately, it
may be desirable to add supplemental indicators relevant to the full range of MBDS
strategies, but that is beyond the purview of this document.
The IHR monitoring framework is timely and seems appropriate as MBDS embarks on
its new plan of action for 2011-2016. It may also be of interest to other sub-regional
surveillance networks, e.g., through the global CHORDS initiative1 in which MBDS
participates.
1 Connecting Health Care Organizations for Regional Disease Surveillance (CHORDS) is an initiative
organized by the Global Health and Security Initiative of the nonprofit Nuclear Threat Initiative,
headquartered in the United States.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 11
HRD Indicators for MBDS – Linked to both IHR and MBDS Action Plan
CORE CAPACITIES
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
IHR Core Capacity 3: Surveillance (MBDS Strategy 1 – Cross-border cooperation & Strategy 2 – Community surveillance)
Routine surveillance
Indicator based, routine,
surveillance includes the
early warning function
for the early detection of
public health events.
A list of priority diseases,
conditions and case
definitions for surveillance
is available.
There is a specific unit
designated for surveillance
of public health risks.
Surveillance data on
epidemic prone and priority
diseases are analyzed at
least weekly at national and
sub-national levels.
Baseline estimates, trends
and thresholds for alert and
action are defined for the
local public health response
level for priority diseases/
events.
Timely reporting from at
least 60% of all reporting
units takes place.
Reports or other
documentation that
deviations or values
exceeding thresholds are
detected and used for
action at the primary
public health response
level are available.
Timely, reporting from
>80% of all reporting units
takes place.
At least quarterly feedback
of surveillance results is
disseminated to all levels
and other relevant
stakeholders.
Evaluation of the early
warning function of
routine surveillance and
country experiences,
findings and lessons
shared with the global
community is performed.
Are there surveillance
units/offices in place? *1
(Foundational level –IHR)
At National level
/provincial level
Not dedicated
Inadequately equipped and
funded
Personnel are not trained
At National level:
Dedicated unit in
operation
Roles and responsibilities
clearly defined
Trained personnel can be
contacted by phone, fax
and/or email on a 24/7
At the Sub-national /
provincial level:
Dedicated unit in
operation
Roles and responsibilities
clearly defined
Trained personnel can be
contacted by phone, fax
All district level:
Dedicated unit in
operation
Roles and responsibilities
clearly defined
Trained personnel can be
contacted by phone, fax
and/or email on a 24/7
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 12
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability basis including holidays
All urgent events were
verified and assessed
within 48 hours over the
past 12 months
and/or email on a 24/7
basis including holidays
All urgent events were
verified and assessed
within 48 hours over the
past 12 months
basis including holidays
All urgent events were
verified and assessed
within 48 hours over the
past 12 months
Event-based surveillance
Event based surveillance
is established.
Information sources for
public health events and
risks are identified.
A local community level/
primary response level
reporting strategy has
been developed.
Unit(s) designated for
event-based surveillance
that may be part of existing
routine surveillance system.
SOPs and guidelines for
event capture, reporting,
confirmation, verification,
assessment and notification
are developed and
disseminated.
System in place at national
and/or sub-national levels
for capturing and registering
public health events from a
variety of sources including
veterinary, media (print,
broadcast, community,
electronic, internet etc.).
SOPs and guidelines for
event capture, reporting,
confirmation, verification,
assessment and notification
are implemented, reviewed
and updated as needed.
Active engagement and
sensitization of community
leaders, networks, health
volunteers, and other
community members, in
the detection and reporting
of unusual health events as
required.
Local community
reporting evaluated and
results shared with the
respective communities
and stakeholders.
Country experiences and
findings on
implementation of event-
based surveillance, and the
integration with indicator
based surveillance, is
documented and can be
shared with the global
community.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 13
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
The decision instrument
in Annex 2 of the IHR
(2005) is used to notify
WHO.
100% of events that meet
criteria for notification
under Annex 2 of IHR have
been notified by NFP to
WHO (Annex 1A Art 6b)
within 24 hours of
conducting risk
assessments.
The use of the decision
instrument is reviewed and
procedures for decision
making are updated on the
basis of lessons learnt.
Country experiences and
findings in notification and
use of Annex 2 of the IHR
are documented and
shared globally.
Are there guidelines and
SOPs in place to guide the
reporting, filtering, and
verification of information
reported? 1
(Capability levels 1 and 2
– IHR)
None Draft national guidelines /
SOPs are in process of
being approved and
finalized.
National guidelines / SOPs
approved and being used
in selected pilot areas only
National guidelines/ SOPs
being used by entire
country to guide national
and local staff with event
reporting, verification and
assessment.
Guidelines are consistent
with the WHO EBS guide.
Situation awareness
A coordinated mechanism
is in place for collecting
and integrating
information from sectors
relevant to the IHR.
Roles and responsibilities
of various ministries in
contributing relevant
surveillance data on IHR
relevant hazards are
defined.
A communication
mechanism is established
for sharing surveillance
data with relevant
authorities across the
levels of the health system
and between sectors and
partners.
A mechanism is
established for
maintaining a
comprehensive
surveillance overview of
all relevant urgent health
risks.
An up to date nationwide
overview on surveillance
of all IHR relevant hazards
is available and published
annually.
IHR Core Capacity 4: Response (MBDS Strategy 3 – Epidemiologic capabilities)
Rapid response capacity
Public health emergency
response mechanisms are
established.
Resources for rapid
response during outbreaks
of national or international
concern are accessible.
Public health emergency
response management
procedures are established
for command,
communications and control
A functional, dedicated
command and control
operations centre.
Emergency response
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 14
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
during emergency response
operations.
management procedures
are evaluated after a real or
simulated public health
response.
Rapid Response Teams
(RRTs) are available.
A roster of trained RRT
members is available and
SOPs for their deployment
are available.
Multidisciplinary RRTs are
deployed within 48 hrs from
the time when the decision
to respond is made.
Preliminary written reports
on investigation and control
measures are submitted by
RRTs to relevant authorities
within one week of
investigation
RRTs are mobilized for
actual events or simulation
exercises are conducted at
least once a year at the
relevant levels.
Evaluations of response,
including for timeliness
and quality, are
systematically carried out
and response procedures
are updated as necessary.
Assistance is offered to
other States Parties for
developing their response
capacities or
implementing control
measures.
Is there a central unit
responsible for
outbreak/event response in
the country? 1
No central/ national unit or
office
There are some resources at
the national level, but they
are:
o Not dedicated
o Inadequately
equipped and limited
funds
o Inadequately staffed
(personnel not
trained)
Dedicated national unit
established
Terms of reference
identified
The equipment and
funding are sufficient for
most key activities
Personnel have some
basic training in
Dedicated national unit in
full operation:
Carrying out all activities
identified in the ToRs
Equipment and funding
are sufficient for all
activities
Personnel have had
comprehensive training in
outbreak response
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 15
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
There are frequently
difficulties in mobilizing
a rapid and appropriate
response to outbreaks
(lack of technical and
logistical support to
proper investigation)
outbreak/event response
There are sometimes
difficulties in mobilizing
rapid and appropriate
response to outbreaks
(some, but inadequate,
technical and logistical
support for proper
investigation)
There are rarely
difficulties in mobilizing
a rapid and appropriate
response to outbreaks.
Central level provides
effective support to
conduct outbreak
investigation and rapid
response
Is there a multidisciplinary
Rapid Response Team
(RRT) at national level? 1
None There is a rapid response
team at the national level
but it is not
multidisciplinary.
There is a
multidisciplinary RRT
trained at the national
level, with at least one
team member trained in:
– Epidemiology
– Clinical medicine
There is a
multidisciplinary RRT
trained at the national
level with at least one
team member trained in:
– Epidemiology
– Clinical medicine
– Laboratory
– Infection Control
– Risk communication
>80% of outbreaks were
responded to in the
previous 12 months
Are there RRTs at sub-
national (e.g., provincial)
level? 1
There is no RRT trained at
sub national level
There are RRTs at the
sub national level but
they are not
multidisciplinary and/or
are present in <50% of
sub national jurisdictions
(e.g., provinces)
There is an RRT in at least
50% of sub national
jurisdictions (e.g.
provinces)
These RRTs have at least
two sectors (e.g., human
and animal health) and/or
two disciplines (e.g.,
epidemiology and clinical
There are
multidisciplinary RRTs
in most (at least 90%)
sub national jurisdictions,
with at least one member
in each RRT trained in:
– Epidemiology
– Clinical and/or
veterinary medicine
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 16
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability medicine) represented. – Laboratory
– Infection Control
– Risk communication
>80% of outbreaks
responded to in the
previous 12 months
Do lab staff participate in
outbreak investigations, or
is laboratory training
provided for RRTs? *1
No representatives from
any lab participate in
outbreak investigation
No training for RRTs has
been conducted
Lab representatives are
occasionally invited on an
ad hoc basis to be part of
the outbreak investigation
team
National level responders
have received lab training,
and/or national level
laboratory personnel have
received training in
outbreak investigation.
Lab representatives are
usually invited to be part
of the outbreak
investigation team
Sub-national level
responders have received
lab training, and/or sub-
national level laboratory
personnel have received
training in outbreak
investigation.
It is documented policy
of the Outbreak Response
Unit within MOH, that
each outbreak
investigation team should
include a lab
representative
Local level responders
have received lab training,
and/or local level
laboratory personnel have
received training in
outbreak investigation.
Case management
Case management
procedures are established
for IHR relevant hazards.
Case management
guidelines are available for
priority epidemic prone
diseases.
Case management
guidelines have been
developed and are available
at relevant health system
levels for priority
diseases60 and IHR relevant
hazards.
SOPs are available for the
management and transport
of potentially infectious
patients in the community
and at PoE.
Patient referral and
transportation systems are
implemented according to
national or international
guidelines.
Appropriate staff (as
defined by the country) is
trained in management of
relevant IHR related
emergencies.
Country experiences on
case management of major
biological, chemical,
radiological and nuclear
contamination events are
published and shared with
the global community.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 17
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Infection control
Infection prevention and
control (IPC) is
established at national
and hospital levels.
Responsibility is assigned
for surveillance of health-
care associated infections
and antimicrobial
resistance.
A national IPC policy, or
guidelines and operational
plan, is available.
SOPs, guidelines and
protocols for IPC are
available to all hospitals.
National coordination with
defined strategies,
objectives, priorities and
nature of data for the
surveillance of relevant
events (such as healthcare-
associated infections,
infections of potential
public health concern) is
set-up.
All tertiary hospitals have
designated area(s) and
defined procedures for the
care of patients requiring
specific isolation
precautions65 according to
national or international
guidelines.
Norms are defined or
guidelines developed for
protecting health care
workers.
Infection control plans are
implemented nationwide,
with documented review
of implementation.
Management of patients
with highly infectious
diseases meets established
IPC standards.
Surveillance in high risk
groups to promptly detect
and investigate clusters of
infectious disease patients,
as well as unexplained
illnesses in health workers
is established.
A monitoring system for
antimicrobial resistance
has been implemented and
data on magnitude and
trends are available.
Qualified IPC
professionals are at least in
place at all tertiary
hospitals.
Compliance with infection
control measures and
effectiveness is regularly
evaluated and published.
A national programme for
protecting health care
workers is implemented.
Are there trained infection
control focal points
Persons trained in the
principles of standard and In 51-75% of all hospitals In >75% but not all
hospitals
Trained IC personnel in
all hospitals
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 18
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability allocated in hospitals?
1 transmission-based
precautions, waste
management and
sterilization and disinfection
methods, and IC personnel
coordinates infection control
activities within the hospital:
In <50% of all hospitals,
or only at designated
hospitals.
Disinfection,
decontamination, vector
control
A program for
disinfection,
decontamination and
vector control is
established.
An up-to-date inventory of
essential materials for
disinfection and vector
control has been done.
Essential materials for
disinfection,
decontamination and
vector control are
available at relevant sites.
Decontamination
capabilities are established
for chemical
decontamination to
address main chemical
risks.
Decontamination
capabilities are established
for radiological and
nuclear hazards as relevant
to the country‟s situation.
Assistance is offered to
other States Parties for
developing their
disinfection and
decontamination
capacities.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 19
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
IHR Core Capacity 5: Preparedness (Applies broadly across MBDS Strategies)
Public health emergency
preparedness & response
Multi-hazard National
Public Health Emergency
Preparedness and
Response Plan is
developed.
Assessment of core
capacities for IHR
implementation has been
conducted (Annex 1A
Article 2) and the report
shared with relevant
national stakeholders.
A national plan to meet the
IHR core capacity
requirements has been
developed (Annex 1A
Article 2).
National public health
emergency response plans
for IHR related hazards
and PoE have been
developed (Annex 1A,
Article 6g).
The national public health
emergency response plan
is tested in actual
emergency or simulation
situations and updated as
needed.
Country experiences and
findings on emergency
response and mobilizing
surge capacity have been
documented and shared
with the global
community. A policy, strategy or
national plan for surge
capacity to respond to
public health emergencies
of national and
international concern is
available.
Surge capacity is tested
either by responding to a
public health event, or
during an exercise and
documentation is
adequate.
IHR risk and resource
management
Public health risks and
resources are mapped.
A directory of experts in
health and other sectors to
support a response to the
IHR related hazards is
available.
A national risk assessment
has been conducted to
identify the most likely
sources of „urgent public
health event‟ and
vulnerable populations.
National resources have
been assessed to address
priority risks.
Experts have been
mobilized from multiple
disciplines/sectors in
response to an actual
public health event or
during a simulation
exercise in the last 12
months.
The national risk profile
and resources are assessed
regularly over time (e.g.
yearly) to accommodate
emerging threats.
National plan for
management and
distribution of stockpiles is
in place.
Stockpile management
system tested through a real
or simulated exercise and
updated.
Stockpiles (critical stock
Contributes to international
stockpiles.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 20
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability levels) for responding to
priority biological, chemical
and radiological events and
other emergencies are
available and accessible at
all times.
IHR Core Capacity 6: Risk Communication (MBDS Strategy 6 – Risk communication)
Policy and procedures for
public communications
Mechanisms for effective
risk communication
during a public health
emergency are
established.
Risk communication
partners and stakeholders
are identified.
A unit responsible for
coordination of public
communications during a
public health event is
designated, with roles and
responsibilities of the
stakeholders clearly
defined.
A risk communication
plan including social
mobilization of
communities has been
developed.
Policies, SOPs or
guidelines are
disseminated on the
clearance and release of
information during a
public health event.
Policies or guidelines are
available to support
community-based risk
communication
interventions during public
health emergencies.
A risk communication plan
has been implemented in
>50% of public health
events of national or
potential international
concern in the last 12
months.
Evaluation of the public
health communication after
emergencies, including for
timeliness, transparency
and appropriateness of
communications, is carried
out and SOPs updated as
needed.
Results of evaluations of
risk communications
efforts during a public
health emergency have
been shared with the
global community.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 21
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Populations and partners
have been informed of a
real or potential risk within
24 hours following
confirmation in >30% of
public health emergencies
in the last 12 months.
A regularly updated
information source is
accessible to media and the
public for information
dissemination.
Accessible and relevant
information, education and
communications materials
tailored to the needs of the
population are available.
Populations and partners
have been informed of a
real or potential risk within
24 hours following
confirmation in >50% of
PH emergencies in the last
12 months.
Have personnel been
identified to lead
communication during
outbreaks/ crises? 1
(Foundational level – IHR)
No spokespersons
designated
No officials/ technical
staff trained as
spokespersons
Governmental officials/
technical staff trained and
act as spokespersons during
outbreaks only (HOW IS THIS
DIFFERENT FROM CAPABILITY LEVEL 2 ITEM?)
Key spokespersons
designated and trained at
national level only (HOW IS
THIS DIFFERENT FROM CAPABILITY LEVEL 1 ITEM?)
Designated person
accountable for leading
the response/ verifying
phases (IS THIS A
COMMUNICATIONS FUNCTION?)
Designated person
responsible for
implementing various
communications activities
Designated, trained
spokespersons at both
national, regional, local
level with authority to
verify, clear and release
information
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 22
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Is there training on risk
communication? 1
None. Developing a plan for risk
communication training to
include public health staff
Some training conducted
Risk communication
officers and spokespersons
trained
Relevant officials and
technical staff trained
Risk communication
officers and spokespersons
trained annually
Relevant officials and
technical staff trained
every year
Communications team that
can implement a national
emergency plan during an
outbreak, is trained
IHR Core Capacity 7: Human Resources (MBDS Strategy 3 – Human resource development)
Human resource capacity
Human resources are
available to implement
IHR core capacity
requirements.
A responsible unit has
been identified to assess
human resource capacity
to meet country IHR
requirements.
Critical gaps in existing
human resources
(numbers and
competencies) to meet
IHR requirements are
identified.
A training needs
assessment has been
carried out and plan to
meet IHR requirements
has been developed.
Workforce development
plans and funding for the
implementation of the IHR
approved by responsible
authorities.
Targets are achieved for
meeting workforce
numbers and skills
consistent with milestones
set in the training
development plan.
A strategy is developed for
the country to access field
epidemiology training (one
year or more) in-country,
regionally or
internationally.
A specific program and
budget is allocated to train
workforce for IHR
relevant hazards.
Training opportunities or
resources are used for
training staff from other
countries.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 23
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Strengthening of the
workforce is documented
when tested by an urgent
public health event or
simulation exercise.
Practitioners of PH
Epidemiology 3
<1 practitioner of PH
Epidemiology per 1
million population in
MOH, with relevant
roles & responsibilities
>1 practitioner of PH
epidemiology per
million population, as
previously described
>3 practitioners of PH
epidemiology per
million population
>1 practitioners per
province in >75% of
provinces
>10 practitioners of PH
epidemiology per 1
million population
<25% vacancies of
epidemiology
practitioners
Training indicators (especially field epidemiology training)
Long-term field
epidemiology training
programme in place 1
No type of field
epidemiology training has
been conducted or exists
Current situation not
meeting national needs:
Utilizes training
programme in another
country
Currently preparing for
program in country
(national planning
underway for field
epidemiology training,
including FETP)
Informal training
embedded in another
program
Short-course training only
RRT trained for avian
influenza response
Some form of
epidemiological training
program established in
country, duration of
training less than 1yr,
meets some national needs
No national coordinator
identified and trained for
coordinating all FETP
Meets national needs and
sustainable:
Established, long-term
(e.g., 2-year), ongoing,
accredited in-country
training program with
dedicated resources,
annual cohorts or
graduates.
A national coordinator
identified to coordinate
field epidemiology
training.
A mechanism in place to
ensure that most staff
trained continue to work
in the country surveillance
and response system.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 24
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
MOH support for training
program (Sustainability) 2
MOH authorities are
actively subverting
program or not visibly
supporting.
There is no line budget
item for Program.
No per diem support for
transport for outbreak
investigations.
MOH authorities visibly
supporting program
and/or active in
identifying partner
program.
There is line item for
Program in government
budget or from external
partner(s). (HOW IS THIS
DIFFERENT FROM CAPABILITY LEVEL 3 2ND BULLET ITEM?)
Program receives
sustainable financial and
administrative support
from MOH.
Per diem support and
transport are provided for
outbreak investigations. (HOW IS THIS DIFFERENT FROM CAPABILITY LEVEL 3 6TH BULLET ITEM?)
Program sits within MOH
organogram, MOH
provides leadership and
ownership.
There is a line in the
MOH budget for the
program and/or MOH
assists in identifying
partner support. (HOW IS
THIS DIFFERENT FROM CAPABILITY LEVEL 2 1ST BULLET ITEM?)
Program receives
substantial financial and
administrative support
from MOH.
Training staff are MOH
employees
Trainees are salaried by
MOH during training.
MOH provides per diem
and transport for outbreak
investigations. (HOW IS
THIS DIFFERENT FROM CAPABILITY LEVEL 2 3RD BULLET ITEM?)
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 25
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Training Program Staff
(Management) 2
There is no full-time
training director/
coordinator.
There is a director/
coordinator who is
assigned a majority of
his/her time (but not full
time) to FETP.
There is a director/
coordinator who is
assigned full-time (>90%)
to FETP.
There are important gaps
in the number and
qualifications of
administrative and
technical staff.
Full-time program
director/coordinator has
visibility and credibility in
MOH.
Administrative and
technical staffs are
sufficient in terms of
numbers & qualifications.
Structured curriculum with
regular review (Training) 2
Curriculum is created by
different groups, without
oversight.
Curriculum is not
reviewed.
Curriculum is structured to
achieve some of the
desired competencies.
Curriculum includes
outbreak case studies.
Curriculum is structured to
achieve all core
competencies and includes
clear objectives and
appropriate training
methods.
Occasional review and
revision of curriculum is
carried out.
Curriculum also includes
clear objectives and
appropriate training
methods. (e.g., exercises,
facilitator‟s guide,
references quizzes, etc)
Yearly review and revision
of curriculum is carried
out.
Field Sites (Training) 2 Limited orientation of host
field sites
Limited access by trainees
to data at field sites.
Field supervisors receive
orientation to program. (HOW IS THIS DIFFERENT FROM CAPABILITY LEVEL 2 1ST BULLET ITEM?)
Field sites provide trainees
with access to surveillance
data.
Field sites allow trainees
to accompany outbreak
investigations.
Field supervisors receive
some orientation and
training. (HOW IS THIS
DIFFERENT FROM CAPABILITY LEVEL 1 1ST BULLET ITEM?)
Review and use of
surveillance data by
trainees is expected. (HOW
IS THIS DIFFERENT FROM CAPABILITY LEVEL 3 2ND BULLET ITEM?)
Trainees are considered
Field supervisors are
trained or are program
graduates and have
sufficient time to work
with and mentor trainees
and document their
achievements.
Field sites/MOH provides
access to and allows
routine review and use of
surveillance data by
trainees. (HOW IS THIS
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 26
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability integral to outbreak
investigation teams.
DIFFERENT FROM CAPABILITY LEVEL2 2ND BULLET ITEM?)
Field sites/MOH provides
access to outbreak
investigation response
teams. (is this specifically
an element of training?)
Field sites provide support
for relevant public health
research by trainees.
Trainee (officer) is
considered to be doing the
necessary epidemiologic
work of the unit- not
academic assignments.
MOH retention
(Strengthened Workforce) 2
<30% of graduates enter
MOH
30-70% of graduates enter
MOH positions on
completion of training
>70% of graduates enter
MOH positions
>50% of graduates in
MOH positions remain
after 5 year.
>90% of graduates enter
MOH positions after
graduation.
> 80% remain with MOH
after 5 years.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 27
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
IHR Core Capacity 8: Laboratory (MBDS Strategy 5 – Laboratory)
Laboratory diagnostic and
confirmation capacity
Laboratory services are
available and accessible
to test for priority health
threats.
Policy to ensure quality of
laboratory diagnostic
capacity (e.g., licensing,
accreditation etc.).
An updated and accessible
inventory of public and
private laboratories88 and
their relevant diagnostic
capacity is available.
National reference
laboratory(ies) (NRL)
designated and list of NRL
disseminated to relevant
stakeholders.
Access to diagnostic
services for priority
diseases, for pathogens
listed in Annex 2 of the IHR
(2005), and for public
health threats including
hazardous substances.
National or international
external quality assessment
schemes are implemented
for diagnostic laboratories
in the country for major
public health discipline
Network of national and
international laboratories
established to meet
diagnostic and
confirmatory laboratory
requirements and support
outbreak investigations for
events specified in Annex 2
of IHR (2005).
Greater than 10 non-AFP
hazardous specimens per
year referred to national or
international reference
laboratories for
examination.
Laboratory test results are
received from the
diagnostic laboratory in a
timely manner to inform
decision-making and
actions.
All diagnostic laboratories
are certified or accredited
according to international
standards93, or to national
standards adapted from
international standards.
A national system is in place
for reliable and safe
detection of MDR and XDR
M. tuberculosis, with quality
assurance results available
for peer review and
dissemination.
Country has one or more
National Reference
Laboratory contributing to
diagnostic services in
another country.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 28
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Influenza surveillance is
established
Access to influenza
testing, nationally or
internationally
Procedures are in place for
rapid virological
assessment of clusters of
cases with severe acute
respiratory illness of
unknown cause, or
individual cases when
epidemiologic risk is high.
Participates in Global
Influenza Surveillance
Program, with regular
submission of viral
isolates for analysis.
National data/maps of
circulating strains of
influenza are available and
shared with the global
community.
Specimen collection and
transport
System for collection,
packaging and transport of
clinical specimens.
Sample collection and
transportation kits are
available.
National SOPs compatible
with international
guidelines are available for
the collection and
transport, of clinical
specimens.
Viable clinical specimens
from investigation of
urgent public health events
are delivered to
appropriate laboratory
within 48 hours of
collection for testing or
transport to international
reference laboratory.
At least one hazardous
specimen per year is
shipped internationally to
a collaborating laboratory
as part of an investigation
or exercise.
Sample collection and
transport kits are
prepositioned at appropriate
levels for immediate
mobilization during a public
health event.
Staff (including RRT
members) are trained in
specimen collection and
transport.
Staff at national level are
trained for the safe
shipment of infectious
substances according to
international standards
(ICAO/IATA97).
Documentation the
processes used when
investigating an urgent
public health event for
shipment of infectious
substances meet
IATA/ICAO standards.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 29
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Are there National SOPs
for specimen collection,
storage and transport? 1
(Capability level 1 – IHR)
No SOPs exist SOPs have been written
but have not been widely
distributed
There have been no (or
only minimal) training of
staff
SOPs have been written
Staff have been adequately
trained in their use
There has been no
evaluation or review
SOPs have been written
and are reviewed
regularly
SOPs are widely
distributed
Relevant staff are trained
in the use of SOPs
Laboratory biosafety and
biosecurity
Laboratory biosafety and
biosecurity practices are
in place.
Biosafety guidelines are
accessible to Individual
laboratories
Regulations, policies or
strategies for laboratory
biosafety have been
developed.
A responsible entity is
designated for laboratory
biosafety and biosecurity.
Biosafety guidelines,
manuals or SOPs are
disseminated to
laboratories.
Relevant staff are trained
on biosafety guidelines.
National classification of
microorganisms by risk
group is completed.
An institution or person
responsible for inspection
(includes certification of
biosafety equipment) of
laboratories for
compliance with biosafety
requirements is identified.
Biosafety procedures are
implemented and regularly
monitored.
Biorisk assessment is
conducted in laboratories
to guide and update
biosafety regulations,
procedures and practices,
including for
decontamination and
management of infectious
waste.
Diagnostic laboratories are
designated and authorized
or certified as BSL 2 or
above for relevant levels
of the health care system.
Country experience and
findings related to
biosafety have been
evaluated and reports
shared with the global
community.
Core Capacities
** RAND WORKING DOCUMENT FOR MBDS ** 30
Core capacity component
Country level indicator
Status of development of IHR capacities, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Laboratory based
surveillance
Laboratory data
management and reporting
is established.
Priority pathogens for
laboratory based
surveillance are identified.
Standard reporting
procedures between
laboratory services and the
surveillance department,
including timeliness
requirements by class of
pathogen, are established.
SOPs for data
management, data security
and data quality exist at all
diagnostic laboratories.
Analysis of laboratory data
with reports disseminated
to relevant stakeholders.
Country experience and
findings regarding
laboratory based
surveillance are published
and disseminated to the
global community.
Gray rows: Taken directly from WHO 2010
Reference1: APSED implementation monitoring tool with measurement notes (*Modified)
Reference2: CDC Matrix tool for FETP Assessment and Monitoring
Reference3: WHO quantitative Matrix (communication regarding FETP capacity)
Human Health Hazards
** RAND WORKING DOCUMENT FOR MBDS ** 31
IHR POTENTIAL HUMAN HEALTH HAZARDS
Component of hazard
Country level indicator
Status of development of IHR core capacities for hazard detection & response, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
IHR Potential hazard 1: Zoonotic events (MBDS Strategy 2: Animal-human interface)
Capacity to detect and
respond to zoonotic events
of national or
international concern
Mechanisms for
detecting and responding
to zoonoses and potential
zoonoses are established.
A regularly updated roster
(list) of experts that can
respond to zoonotic events
is available.
A mechanism for response
to outbreaks of zoonotic
diseases by human and
animal health sectors is
established.
Animal health (domestic
and wild life) is part of the
national emergency
response committee agenda.
An operational, inter-
sectoral public health plan
for responding to zoonotic
events is tested and
updated as needed.
Timely (as defined by
national standards)
response to more than 80%
of zoonotic events of
potential national and
international concern.
Is there a cross-sector
policy / mechanism in
place to coordinate
between animal and human
health sectors? 1
(Capability level 1 – IHR)
No policy and mechanism
in place for joint or
coordinated response.
Agreement/policy between
animal and human health
sectors and mechanism
established at national
level. (Mechanism has
been formalized and in
place with regular joint
risk assessment/ decision
making on joint response) (HOW IS THIS DIFFERENT FROM CAPABILITY LEVEL 2 1ST BULLET?)
Agreement/policy between
animal and human health
sectors and mechanism
established at national
level. (Mechanism has
been formalized and in
place with regular joint risk
assessment/ decision
making on joint response) (HOW IS THIS DIFFERENT FROM CAP LEVEL 1 1ST BULLET?)
Mechanism established at
sub national level for
coordinated/joint response
Mechanism established at
national level
(Mechanism has been
formalized and in place
with regular joint risk
assessment/decision
making on coordinated
response, etc)
Mechanism established at
sub national and local
levels for coordinated/joint
response
Human Health Hazards
** RAND WORKING DOCUMENT FOR MBDS ** 32
Component of hazard
Country level indicator
Status of development of IHR core capacities for hazard detection & response, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Is there training for
coordinated/ joint response
between animal and human
health sectors? 1
No joint response training
conducted.
Joint response training
carried out to relevant
stakeholders at national
level
Joint response training
carried out to relevant
stakeholders at national
and sub national level (HOW MANY PROVINCES?)
Joint response training
carried out to relevant
stakeholders at national,
sub national, and local
levels (HOW MANY
PROVINCES?)
IHR Potential hazard 2: Food safety (Not addressed directly by MBDS, but probably relevant)
Capacity to detect and
respond to food safety
events that may constitute
a public health emergency
of national or
international concern
Mechanisms are
established for detecting
and responding to
foodborne disease and
food contamination.
National or international
food safety standards are
available.
National food laws,
regulations or policy to
facilitate food safety control
are in place.
An operational national
multi-sectoral mechanism
for food safety events is in
place.
A functioning coordination
mechanism is established
between the food safety
authorities, specifically the
INFOSAN Emergency
Contact Point (if member)
and the IHR NFP.
Decisions of the food
safety multi-sectoral body
are implemented and the
outcomes documented.
The country is an active
member of the INFOSAN
network.
Human Health Hazards
** RAND WORKING DOCUMENT FOR MBDS ** 33
Component of hazard
Country level indicator
Status of development of IHR core capacities for hazard detection & response, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
A list of priority food
safety risks is available. Guidelines or manuals on
the surveillance,
assessment & management
of priority food safety
risks are available.
Epidemiological data
related to food
contamination are
systematically collected
and analyzed.
Food safety authorities
systematically report food
safety events of national or
international concern to
the surveillance unit
Food inspection services
(risk-based) are in place.
Access to laboratory
capacity to confirm
priority food safety events
of national or international
concern including
molecular techniques.
A roster of food safety
experts is available for
assessment and response
to food safety events.
Food safety events are
investigated by teams that
include food safety
experts.
Mechanisms are
established for tracing,
recall and disposal of
contaminated products.
Communication
mechanisms and materials
are in place to deliver
information, education and
advice to stakeholders
across the farm-to-fork
continuum.
An operational plan for
responding to food safety
events is tested and
updated as needed
Food safety control
management systems
(including for imported
food) are implemented
Information from
foodborne outbreaks and
food contamination has
been used to strengthen
food management systems,
safety standards and
regulations.
Published analysis of food
safety events, foodborne
illness trends and
outbreaks which integrates
data from across the food
chain.
Gray rows: Taken directly from WHO 2010 Reference1: APSED implementation monitoring tool with measurement notes (*Modified)
Points of Entry
** RAND WORKING DOCUMENT FOR MBDS ** 34
POINTS OF ENTRY
PoE component
Country level indicator
Status of development of IHR core capacity requirements at PoE, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
(These relate most to MBDS Strategy 1 – Cross-border cooperation)
General obligations at PoE
General obligations at
PoE are fulfilled.
A review meeting (or
other method as
appropriate) conducted on
designating PoE has been
held.
A „competent authority‟ is
designated for each PoE as
specified in Article 19B of
the IHR (2005); its
functions are specified in
Article 22 No.1.
Ports/airports are designated
for development of
capacities specified in
Annex 1 (i.e. as specified in
Article 20, No.1).
A list of Ports authorized to
offer certificates relating to
ship sanitation has been sent
to WHO (as specified in
Article 20, No.3).
>50% of designated
Airports have a competent
authority.
>50% of designated
Airports have been
assessed.
>50% of designated Ports
have a competent authority.
>50% of designated Ports have been assessed.
100% of designated
Airports have a competent
authority.
100% of designated
Airports have been
assessed.
100% of designated Ports
have a competent authority.
100% of designated Ports
have been assessed.
Country experiences and
findings on the process of
meeting PoE general
obligations are
documented.
Points of Entry
** RAND WORKING DOCUMENT FOR MBDS ** 35
PoE component
Country level indicator
Status of development of IHR core capacity requirements at PoE, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Legislation and policy
technical guidance &
procedures
Compliance with the IHR
(2005) for PoE and for
health and technical
documents
Updated health documents
as specified in the IHR
(2005).
Documentation that relevant
legislation, regulations,
administrative requirements,
and other governmental
instruments have been
assessed for PoE is
available.
Technical and operational guidance for PoE is available and disseminated to relevant stakeholders.
Recommendations are
implemented following
assessment of relevant
legislation, regulations and
administrative
requirements for PoE.
Updated IHR (2005) health
documents are
implemented.
Procedures, and technical
guidelines and SOPs are
implemented and updated
as needed.
Country experiences and
findings on
implementation of
legislation, regulation,
administrative
requirements, and other
governmental instruments
is documented.
Coordination
Coordination in the
prevention, detection, and
response to public health
events at PoE is
established.
A list of sectors and
agencies for coordination
at PoE is available.
Procedures for coordination and communication between the IHR NFP and the PoE competent authority, and with all relevant sectors, are established.
Procedures for
coordination and
communication between
the IHR NFP and the PoE
competent authority, and
with all relevant sectors are
tested and updated.
Procedures for
communication between
the PoE competent
authority and other
countries' PoE competent
authorities are tested and
updated as needed.
Effectiveness of
coordination between
relevant stakeholders for
PoE evaluated and
experiences are shared
with the global
community.
Surveillance at PoE
Effective surveillance is
established at PoE.
Priority conditions for
surveillance at designated
PoE are identified.
Surveillance information at designated PoE is shared with surveillance department/ unit.
Designated PoE have the
capacity to safely dispose
of potentially
contaminated products
A review of surveillance
of health threats at PoE
has been carried out in the
last 12 months and the
Points of Entry
** RAND WORKING DOCUMENT FOR MBDS ** 36
PoE component
Country level indicator
Status of development of IHR core capacity requirements at PoE, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Mechanisms for the exchange of information between designated PoE and medical facilities are in place.
Designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travellers, with adequate staff, equipment and premises (Annex 1b, Art.1a).
Surveillance of conveyances for the presence of vectors and reservoirs at designated PoE is established (Annex 1B, Art. 2e).
Designated PoE with trained personnel for the inspection of conveyances is available (Annex 1b, Art. 1c).
A functioning programme
for the surveillance and
control of vectors and
reservoirs in and near PoE
exists (Annex 1A, Art. 6a
Annex 1b, Art. 1e).
results published.
Points of Entry
** RAND WORKING DOCUMENT FOR MBDS ** 37
PoE component
Country level indicator
Status of development of IHR core capacity requirements at PoE, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
Response at PoE
Effective response at PoE
is established.
SOPs for response at PoE
are available.
A public health emergency
contingency response plan
at designated PoE has
been developed and
disseminated to key
stakeholders.
Designated PoE have
appropriate space, separate
from other travellers, to
interview suspect or
affected persons (Annex
1B, Art. 2c).
Designated PoE can
provide assessment of and
quarantine of suspect
travellers and care for
affected travellers or
animals (Annex 1B, Art.
2b and 2d).
Designated PoE referral
system and transport for
the safe transfer of ill
travellers to appropriate
medical facilities and
access to equipment, in
place (Annex 1b, art 1b
and 2g).
A public health emergency
contingency plan at
designated PoE has been
integrated with other
response plans, and is
tested and updated as
needed.
Designated PoE can apply
recommended public
health measures (Art. 1B,
Art 2e and 2f).
Results of the evaluation
of the effectiveness of
response to public health
events at PoE are
published.
Have contact points for
points of entry been
nominated? 1
No unit/person identified Person/unit identified but
has minimal input and is
inadequately resourced
Person/unit identified and
has some input but is not
supported by senior
officials (WHAT IS THE
DIFFERENCE BETWEEN
Person/unit identified.
Terms of reference
defined.
Staff/unit are trained to
Points of Entry
** RAND WORKING DOCUMENT FOR MBDS ** 38
PoE component
Country level indicator
Status of development of IHR core capacity requirements at PoE, by capability level
<1
Foundational
1
Moderate capability
2
Strong capability
3
Advanced capability
“MINIMAL” AND “SOME”?) perform their duties.
They have a significant
input into policy
development.
They are fully supported
by senior officials in the
MOH
They are adequately
resourced to carry out
their terms of reference.
Gray rows: Taken directly from WHO 2010
Country Summary
39
Country Level Summary Tables
CORE CAPACITIES
Core capacity component
Country level indicator
Status of development of
IHR capacities, by
capability level
<1 1 2 3
IHR Core Capacity 3: Surveillance
(MBDS Strategy 1 – Cross-border cooperation & Strategy 2 – Community surveillance)
Routine surveillance - Indicator based, routine, surveillance includes the early warning function
for the early detection of public health events.
Are there surveillance units/offices in place? *1 (Foundational level –IHR)
Event-based surveillance - Event based surveillance is established.
Are there guidelines and SOPs in place to guide the reporting, filtering, and verification of information
reported? 1
(Capability levels 1 and 2 – IHR)
Situation awareness - A coordinated mechanism is in place for collecting and integrating information
from sectors relevant to the IHR.
IHR Core Capacity 4: Response (MBDS Strategy 3 – Epidemiologic capabilities)
Rapid response capacity - Public health emergency response mechanisms are established.
Is there a central unit responsible for outbreak/event response in the country? 1
Is there a multidisciplinary Rapid Response Team (RRT) at national level? 1
Are there RRTs at sub-national (e.g., provincial) level? 1
Do lab staff participate in outbreak investigations, or is laboratory training provided to RRTs? *1
Case management - Case management procedures are established for IHR relevant hazards.
Country Summary
40
Core capacity component
Country level indicator
Status of development of
IHR capacities, by
capability level
<1 1 2 3
Infection control - Infection prevention and control is established at national and hospital levels.
Are there trained infection control focal points allocated in hospitals? 1
Disinfection, decontamination, vector control- A program for disinfection, decontamination and vector
control is established.
IHR Core Capacity 5: Preparedness (Applies broadly across MBDS Strategies)
Public health emergency preparedness & response - Multi-hazard National Public Health
Emergency Preparedness and Response Plan is developed.
IHR risk and resource management - Public health risks and resources are mapped.
IHR Core Capacity 6: Risk Communication (MBDS Strategy 6 – Risk communication)
Policy and procedures for public communications - Mechanisms for effective risk communication
during a public health emergency are established.
Have personnel been identified to lead communication during outbreaks/crises? 1 (Foundational level –
IHR)
Is there training on risk communication? 1
IHR Core Capacity 7: Human Resources (MBDS Strategy 3 – Human resource development)
Human resource capacity - Human resources are available to implement IHR core capacity
requirements.
Practitioners of PH Epidemiology 3
Country Summary
41
Core capacity component
Country level indicator
Status of development of
IHR capacities, by
capability level
<1 1 2 3
Training indicators (especially field epidemiology training)
Field Epidemiology training programme in place 1
MOH support for training program (Sustainability) 2
Training Program Staff (Management) 2
Structured curriculum with regular review (Training) 2
Field Sites (Training) 2
MOH retention (Strengthened Workforce) 2
IHR Core Capacity 8: Laboratory (MBDS Strategy 5 – Laboratory)
Laboratory diagnostic and confirmation capacity - Laboratory services are available and accessible
to test for priority health threats.
Influenza surveillance is established
Specimen collection and transport - System for clinical specimen collection, packaging and transport.
Are there National SOPs for specimen collection, storage and transport? 1
(Capability level 1 – IHR)
Laboratory biosafety and biosecurity - Laboratory biosafety and biosecurity practices are in place.
Laboratory based surveillance - Laboratory data management and reporting is established.
Gray rows: Taken directly from WHO 2010
Country Summary
42
HUMAN HEALTH HAZARDS
Component of hazard
Country level indicator
Status of development of
IHR core capacities for
hazard detection &
response, by capability
level
<1 1 2 3
IHR Potential hazard 1: Zoonotic events (MBDS Strategy 2: Animal-human interface)
Capacity to detect and respond to zoonotic events of national or international concern
Mechanisms for detecting and responding to zoonoses and potential zoonoses are established.
Is there a cross-sector policy / mechanism in place to coordinate between animal and human health
sectors? 1
(Capability level 1 – IHR)
Is there training for coordinated/ joint response between animal and human health sectors? 1
IHR Potential hazard 2: Food safety (Not addressed directly by MBDS, but probably relevant)
Capacity to detect and respond to food safety events that may constitute a public health emergency of
national or international concern
Mechanisms are established for detecting and responding to foodborne disease and food
contamination.
Gray rows: Taken directly from WHO 2010
Country Summary
43
POINTS OF ENTRY
PoE component
Country level indicator
Status of development of
IHR core capacity
requirements at PoE, by
capability level
<1 1 2 3
(These relate most to MBDS Strategy 1 – Cross-border cooperation)
General obligations at PoE
General obligations at PoE are fulfilled.
Legislation and policy technical guidance & procedures
Compliance with the IHR (2005) for PoE and for health and technical documents
Coordination
Coordination in the prevention, detection, and response to public health events at PoE is established.
Surveillance at PoE
Effective surveillance is established at PoE.
Response at PoE
Effective response at PoE is established.
Have contact points for points of entry been nominated? 1
Gray rows: Taken directly from WHO 2010
45
References
WHO 2010. “IHR monitoring framework: Checklist and indicators for monitoring
progress in the development of IHR core capacities in States Parties”. Geneva, 2010.
Available online at http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf,
as of January 3, 2011.
(PLEASE ADD FULL REFERENCE CITATIONS FOR THE 3 REFERENCES NOTED
AT THE BOTTOM OF LONG “CORE CAPACITIES” TABLE)