Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries

Abstract

BackgroundSince 2003, Asia-Pacific, particularly Southeast Asia, has received substantial attention because of the anticipation that it could be the epicentre of the next pandemic. There has been active investment but earlier review of pandemic preparedness plans in the region reveals that the translation of these strategic plans into operational plans is still lacking in some countries particularly those with low resources. The objective of this study is to understand the pandemic preparedness programmes, the health systems context, and challenges and constraints specific to the six Asian countries namely Cambodia, Indonesia, Lao PDR, Taiwan, Thailand, and Viet Nam in the prepandemic phase before the start of H1N1/2009.MethodsThe study relied on the Systemic Rapid Assessment (SYSRA) toolkit, which evaluates priority disease programmes by taking into account the programmes, the general health system, and the wider socio-cultural and political context. The components under review were: external context; stewardship and organisational arrangements; financing, resource generation and allocation; healthcare provision; and information systems. Qualitative and quantitative data were collected in the second half of 2008 based on a review of published data and interviews with key informants, exploring past and current patterns of health programme and pandemic response.ResultsThe study shows that health systems in the six countries varied in regard to the epidemiological context, health care financing, and health service provision patterns. For pandemic preparation, all six countries have developed national governance on pandemic preparedness as well as national pandemic influenza preparedness plans and Avian and Human Influenza (AHI) response plans. However, the governance arrangements and the nature of the plans differed. In the five developing countries, the focus was on surveillance and rapid containment of poultry related transmission while preparation for later pandemic stages was limited. The interfaces and linkages between health system contexts and pandemic preparedness programmes in these countries were explored.ConclusionHealth system context influences how the six countries have been preparing themselves for a pandemic. At the same time, investment in pandemic preparation in the six Asian countries has contributed to improvement in health system surveillance, laboratory capacity, monitoring and evaluation and public communications. A number of suggestions for improvement were presented to strengthen the pandemic preparation and mitigation as well as to overcome some of the underlying health system constraints.

An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion

“…Thus, improved distribution of resources has the potential to benefit public health outcomes beyond mitigation of pandemic influenza, and shortages or maldistribution may hinder control and mitigation efforts. But for public health to benefit effectively from improved distribution of resources, political, administrative and contextual hurdles may need to be overcome, including the mobilisation of resources across administrative boundaries [30]. Whilst drugs and ventilators may be readily re-distributed, other resources such as hospital beds and human resources may be more challenging.…”

“…A number of other contextual challenges for optimum distribution and utilisation of healthcare resources were identified in our previous qualitative analysis of pandemic preparedness programmes in relation to national health systems in our four GMS study countries (along with Indonesia and Taiwan) [30]. These include the need for: (i) greater emphasis on strategies for pandemic mitigation (since planning in the region was found to focus overwhelmingly on early detection and containment); (ii) translation of existing plans into operations, particularly at sub-national administrative levels; and, (iii) greater national ownership of preparedness activities, particularly in low resource countries where external funding is prominent, to ensure that the allocation of pandemic-related investments is aligned with national systems and priorities [30].…”

“…These include the need for: (i) greater emphasis on strategies for pandemic mitigation (since planning in the region was found to focus overwhelmingly on early detection and containment); (ii) translation of existing plans into operations, particularly at sub-national administrative levels; and, (iii) greater national ownership of preparedness activities, particularly in low resource countries where external funding is prominent, to ensure that the allocation of pandemic-related investments is aligned with national systems and priorities [30]. …”

Rapid, simple influenza RNA extraction from nasopharyngeal samples

“…To ensure appropriate use of antiviral drugs, a near-patient diagnostic test is therefore highly desirable (Barenfanger et al, 2000). In addition, there is a growing interest in deploying rapid detection methods in resource-limited settings (Ghosh and Vogt; Hanvoravongchai et al, 2010; Kubo et al, 2010; Ortiz et al, 2009; Oshitani, Kamigaki, and Suzuki, 2008) and expanding non-human influenza surveillance activities (e.g. (Antarasena et al, 2007; Samaan et al, 2011)).…”

Lessons Learned from Influenza A(H1N1)pdm09 Pandemic Response in Thailand

“…In addition, Hanvoravongchai et al and the AsiaFluCap Project ( 15 ) reported results from rapid analyses of pandemic influenza preparedness in 6 Asian countries. Similar to the situation in Thailand, many of the countries were challenged by the need for greater flexibility in pandemic planning and implementation in order to accommodate changing transmission circumstances and different pandemic scenarios.…”