Strengthening Epidemiological Surveillance and Response for Communicable Diseases in Indonesia, Malaysia and the Philippines (ADB TA No. 6305-REG)

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Project Description

The goal of the TA is to help support the three countries in their efforts to comply with WHO’s international health regulations and, at the same time, reduce mortality and morbidity due to communicable and infectious diseases and minimize the vulnerability of their populations at risk. The Project specifically aims to (i) strengthen disease surveillance systems for early diseases detection and response, (ii) help develop national capacity to respond to an outbreak, and (iii) harmonize national efforts to promote a subregional collaboration mechanism for communicable disease control and the monitoring, containment, and prevention of outbreaks. Aside from aiming to strengthen epidemiological surveillance and response (ESR) systems, the Project will promote subregional cooperation in communicable disease control and the monitoring, containment, and prevention of outbreaks through networking, information and experience sharing, and the establishment or strengthening of mechanisms that will enable the three countries to support each other in ESR. The Project will consist of three components, namely:

Component A: ESR System Assessment and Plan Formulation. WHO has published several key guidelines related to ESR systems for integrated communicable disease prevention and control programs. These include (i) a set of ESR Performance Standards; (ii) the first international edition of the Control of Communicable Diseases Manual (CCDM) in collaboration with the American Public Health Association (APHA); and (iii) detailed guidelines and protocols for the evaluation of national and sub-national ESR systems. The WHO ESR evaluation guidelines were adapted for use in a joint WHO-Ministry of Health (MOH) national evaluation of the ESR systems for selected high-priority communicable diseases in Indonesia in 2004. Under Component A, the WHO ESR Evaluation Guidelines, WHO ESR Performance Standards, the WHO Laboratory Assessment Tool, the WHO Outbreak Communications Guidelines, and the CCDM will be used to carry out evaluations and make recommendations for strengthening ESR systems in collaboration with the ESR Units of the respective health ministries and WHO Country and Regional Offices. For Indonesia and Malaysia, in collaboration with the respective MOH ESR Units and WHO, an assessment will be made of actions taken, and further assessment or action required, to strengthen the ESR systems in response to the findings of the joint WHO-MOH evaluations of the Indonesia and Malaysia ESR systems that were carried out in 2003-2004. In carrying out the tasks and activities under this component, the Consultant Team will cover a number of key elements, as described below.

Component B: Systems Development. Drawing on the information generated by the country assessments and with the technical guidance provided by WHO and other experts, the Project will assist the health ministries of the three countries in setting up systems that will strengthen their capacity to conduct epidemiological surveillance and response and comply with the requirements of IHR. Examples of activities that could be supported under this Component are: i) review and development of policies, pieces of legislation, and or administrative issuances that articulate the government’s support for ESR and IHR; ii) development of ESR standards, operational guidelines, protocols and manuals; iii) development of ESR and IHR training strategies and approaches, training modules, tools, and instruments; iv) review and development of ESR and IHR supervisory guidelines and procedures as well as ESR and IHR reporting and feedback mechanisms; and v) assistance to the three health ministries in setting up their National Focal Point for IHR implementation. It is expected that the degree and magnitude of the systems development work will depend largely on the level of development of the country’s ESR system. The country-specific ESR assessment should serve as the basic guide and reference in undertaking activities under this component.

Component C:  Capacity Building to Enhance ESR Systems. This Component will consist of specific activities that address weaknesses in the ESR system or constraints that impede the country’s ability to support IHR. These will be relatively small-scale interventions such as operations research, training and related capacity-building activities. Examples of activities that will be supported under this Component are:   a) measures to integrate or link fragmented ESR systems, such as IT and communications-related interventions; b) measures to improve case detection and case confirmation including interventions to strengthen the role of laboratories in supporting ESR and IHR; c) measures to improve timeliness, accuracy, and completeness of ESR and IHR reports; d) measures that strengthen the capacity of health staff to process, analyze, interpret and use epidemiological data; e) measures designed to strengthen the capacity of health workers to conduct outbreak investigation, introduce outbreak control measures, and help health managers prepare and plan for epidemiological disasters; f) measures to strengthen community involvement and participation in ESR activities; and g) measures to strengthen the capacity of the National Focal Point to manage and coordinate IHR-related activities.

Before these activities can be carried out, the concerned MOH officials will prepare proposals, with assistance of the Consultant Team, for review and approval by ADB. Such proposals should be in line with the government’s overall plan for implementing ESR and supporting IHR 2005. In view of the limited funding to support these activities, the Project will utilize a set of criteria to set priorities, including the following:

1. Relevance: the proposals should address major gaps and issues in the ESR system;
2. Efficiency: the proposals should be able to produce the desired results at a minimum cost;
3. Effectiveness: the proposals should show that the proposed interventions and measures have been proven to work under similar situations; and
4. Sustainability: the proposed measures and interventions do not require extensive external support and can be carried out using local resources.

PRIMEX Role in the Project Implementation

PRIMEX has provided the services of Technical Specialists/Core Consultants, namely: (i) Epidemiological Surveillance Specialist/Team Leader (ESS/TL), (ii) ESS/Co-Team Leader (CTL), (iii) three Health Surveillance Specialists/Deputy Team Leaders (HSSs/DTLs), and (iv) an IT Specialist (ITS) for the following Project activities:

• Preparation of a comprehensive  assessment of their country epidemiological surveillance and response systems (ESR);
• Testing of the ESR systems and selected health subsystems in each country through simulated field exercises, inter-country secondment, joint research, subregional workshops and an international conference; and
• Development of specific activities or small-scale interventions to address ESR weaknesses identified through Components A and B, such as research and case studies, local pilot operations, training, and community/NGO-led HIV/AIDS initiatives.

PRIMEX Consultants Involved

The entire Consultant Team is composed of the following specialists: Dr. Robert S. Bernstein, Epidemiological Surveillance Specialist/ Team Leader, SingHealth; Dr. Florante S. Magboo, Epidemiological Surveillance Specialist/ Co-Team Leader; Mr. Jay Lowell H. Payuyo, Information Technology Specialist; and three Health Surveillance Specialists/Deputy Team Leaders: Dr. Hudoyo Hupodio, Indonesia, TIA;  Dr. Teong Wah Lim ,  Malaysia, HS; and Dr. Aguedo Troy D. Gepte IV, Philippines. Oversight supervision  of Project activities is being provided by the Project Director (PD), Ms. Elvira C. Ablaza, through Dr. Jose Rodriguez, Project Administration Coordinator (PAC), and three Deputy Project Directors (DPDs), namely: Mr. Noor Arief Muzadi, Indonesia, TIA; Ms. Shwu Fang Long, Malaysia, HS; and Ms. Ma. LourdesA.Sumilang, Philippines.

PRIMEX provides the services of Dr Magboo, Dr Gepte and Mr Payuyo. The company's Technical Services Unit also provides backstopping assistance to the Project.

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