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Food fortification, including introduction of iron and iodine-fortified salt and other iron-fortified items (e.g. atta in specific areas);

Health and nutrition education to improve over all dietary intakes and promoteconsumption of iron and folate-rich foodstuffs.Infants Excl usive 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 childrenfrom life threatening conditions, which are preventable. Immunization Programme in Indiawas introduced in 1978 as Expanded Programme of Immunization. This gained momentum

in 1985 as Universal Immunization Programme (UIP) and implemented in phasedmanner to cover all districts in the country by 1989-90. UIP become a part of Child Survivaland 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:

BCG (Bacillus Calmetter-Gurin) BirthDPT ( Diphtheria, Pertussis and Tetanus Toxoi d ) 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 deliveryMeasles 9-12 months of age

DT (Diphtheria and Tetanus Toxoid) 5 years of ageTT (Tetanus Toxoid ) 10 years and 16 years of age

TT for pregnant woman two doses or one dose if previously vaccinated within 3 yearsThe 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, SpecialImmunization weeks are being observed in the North East States along with EAG Statesfrom 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:6 Introduction of Hepatitis-B vaccine

A pilot project for the introduction of Hepatiti s-B vaccine in the National ImmunizationProgramme 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 i mplementedHepatitis B vaccination. The current schedule includes birth dose along with earlier 3 doses.7 Pulse polio immunization

In pursuance to the World Health Assembly resolution No. 1988/41.28 Pulse PolioImmunization (PPI) Programme was started in India from 1995 to eradicate Polio from India.

Q2. WRITE SHORT NOTES ON:

I. STRESS AND CO-OCCURRING DISEASES.Stress and Co-occurring Diseases

Stress is the bodys reaction to a change that requires a physical, mental or emotionaladjustment or response. Symptoms of stress and anxi ety often co-occur in certain

diseases/disorders. In fact, major depression/stress often accompanies panic disorder andother 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 Ex haustion: 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 themessage 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

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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.

Increasingly Pessimistic Outlook: When experiencing stress, its harder to get excitedabout 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, thosesuffering 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.Behavioural health can be defined as an interdisciplinary field dedicated to promoting a

philosophy of health that stresses individual responsibility in the application of behaviouraland 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 withdepression 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 anexpert. 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 aloneBeing angry with everything and everyone

Depression, drug and alcohol abuse are the types of behavioural probl emsMany 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.

Occupational Diseases and their PreventionIn 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 aslead poisoning and pneumoconiosis and an increase in what are now called work -relateddiseases, 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 polysymptomaticand the symptoms tend to be chronic. The most common type of occupationaldiseases are given in the Table 3.1.

Table 3.1: Common Health Conditions Associated with Occupational Exposure

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Q4. WHAT ARE THE STEPS IN DISASTER MANAGEMENT.The number of natural disasters i s increasing worldwide due to climatic changes.

Still, disasters fascinate people. They bring on feelings of amazement and fear, and provideinstances 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, unplannedgrowth proliferation non-engineered constructions which make the disaster-proneareas 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. Thesenatural 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,Building collapse, Toxicological accidents (e.g. release of hazardous substances),

Nuclear accidents, Explosions Civil disturbances, Water contamination andExisting or anticipated food shortages.

Despite the fact that it may not be feasible to control nature and to stop the developmentof natural phenomena but the efforts could be made to avoid di sasters and lightentheir 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 tolessen 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 and4) 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:

Define disasters and their typeExplain the basics of di saster management and mass casualties Name the components of disaster planRecognize the necessity of disaster alertness in hospitals

State the steps in disaster management planning and implementationDiscuss the severity of illness amongst disaster victims and risk assessment

Basics of Disaster Management and Mass CasualtiesMass 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 militaryaircraft accident, hurricane, flood, earthquake, or armed attack that exceeds local logisticalsupport capabilities. Mass casualty incidents may occur in a variety of forms.

Disaster management is the discipline of dealing with and avoiding risks. It is a disciplinethat involves preparing for disaster before it occurs, disaster response (e.g., emergencyevacuation, quarantine, mass decontamination, etc.), and supporting, and rebuilding

society after natural or human-made di sasters have occurred.Steps in disaster management

Mainly there are four steps in disaster management: mitigation, preparedness, responseand recovery. The meanings of the terms used in the disaster management are as follows:

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

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prevent flooding, or nonstructural solutions such as connecting wi th local andgovernment 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 managementfocuses 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 resourcemobilization. Large-scale disaster training exercises are often conducted to test

preparedness and look for weaknesses in disaster response. Corporations might also haveemergency response teams consisting the volunteers that undergo drills meant for disaster preparedness.

Response: First responders to a disaster are generally law enforcement, firefighters andemergency 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 thestate and, finally, to the local level. Volunteer organizations such as the Red Cross areoften pivotal to the response effort as well. Response timing is very important as mostdisaster 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 asdetermined by the National Response Plan, which is managed by the Department

responsible for the management and rescue of the disaster victims. As the recovery phasecomes to a close, a thorough assessment of what failed or succeeded should be taken and

used to improve all phases of disaster management.

Q5. EXPLAIN ABOUT THE CONCEPT OF COMBINED LIFE INSURANCE AND HEALTH INSURANCE

Concept of Combined Life Insurance and Health InsuranceCombined 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, suchas 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 i nsurance but it combi nes 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 tounderstand so you can make the right deci sions about your coverage.It has benefit that the policy holder doesnt have to pay the premiums for di fferent policiesat different dates and i n different companies. And in case of any happening he need

not go to different companies for hi s claim.Different Health Insurance Policies Analysis and ManagementThe New India Assurance and Mediclaim 2007: The National Insurance, New India

Assurance, United India and Oriental Insurance, which were earl ier subsidiaries of the

General Insurance Company (GIC), have become autonomous and their mediclaim policiesare more or less the same with slight variations.Though the premium of mediclaim policy has almost doubled in the last five years; themiddle 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 thetreatment 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 thenumber of policyholders.

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 domiciliaryhospitalization 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 inthe 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 premi um either ininstallments or as single premium.

Amount: The sum insured ranges from Rs. 50,000 onwards and the premium depends onthe 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 an d 5 years can be covered provided

one or both parents are also covered.

Coverage: Insures against any hospitalization expenses that may arise in future. Thescheme reimburses hospitalization expenses for illness, di seases or injury sustained,excludes any disease existing before taking the policy.

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Cost: Sum insured can be anywhere between Rs. 15,000 Rs. 500,000. Rate of premiumranges 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 shadeep Provides insurance against four major critical ailments cancer(malignant), paralytic stroke

resulting in permanent di sability, renal failure of both kidneys or coronary arterydiseases 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).

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, EXPLAINGLOBAL ALERT AND RESP ONSE

The International Health Regulations (IHR) are an international legalinstrument that is binding on 194 countries across the globe, including all theMember States of (World Health Organization) WHO. Their aim is to help the

international community prevent and respond to acute public health risks that havethe potential to cross borders and threaten people worldwide.

Global Alert and ResponseHistory has demonstrated the capacity of outbreak-prone diseases to spread

rapidly and overwhelm national resources causing acute emergencies. At the presenttime, 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 andtransmission 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 thiscan and does happen.

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 pastcrossed 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 significanthuman disease

Diseases such as cholera, dengue, influenza, measles, meningitis, shigellosis, yellowfever and food-borne diseases present a constant threat to human populations. Theyare 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 ofteneffective control measures are available. In many countries these diseases havecome 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 atnational and international levels.Many countries have recognised the renewed threat of outbreaks and have soughtto strengthen their national surveillance and response capacities. In many other countries similar developments have been very slow due to lack of funds andcompeting 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 upsmall numbers of imported disease cases. There is an increasing realisation that thisapproach often is not the most effective response.

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World Health Organization has also been involved in combating outbreaks since itsinception in 1950. Outbreak alert and response requires a non-partisan approach and

the capacity to facilitate collaborations between diverse partners. World HealthOrganization has a unique health mandate from 191 member states and has, with existing partners,

already established mechanisms for global outbreak alert and response. Currentmechanisms function in the areas of outbreak alert and outbreak response.

Outbreak Alert: Accurate and timely information about important diseaseoutbreaks is delivered systematically and rapidly to key professionals in international

public health through:

Specialised Surveillance Networks: World Health Organization has established anumber 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 globaldisease 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. OVrelies on a broad range of information sources including the Global Public Health

Information Network (GPHIN) which is a web-based electronic system developed by HealthCanada in collaboration with World Health Organization which scans the web to

identify suspected outbreaks. Suspected outbreaks are actively followed up with affectedcountries 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 isdisseminated via the Outbreak Verification List (OVL) to over 900 institutions and keydecision-makers in international public health (e.g. World Health Organization

networks, collaborating centres, national institutes of public health, major NGOs). As of January2000, 512 outbreak reports have been investigated and disseminated if found to beof 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 inKenya 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 andMarburg virus infection in the Democratic Republic of the Congo.

Active World Health Organization involvement in co-ordinating epidemic responseallows not only provision for immediate needs, but also allows initiation of measures

which result in permanent benefit, such as the development of laboratory networksand 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

Creating networks of partners for preparedness and rapid response (e.g.

sub-regional preparedness and response teams in the African Region)Strengthening laboratory capacity and laboratory networksTraining in field epidemiology

Assessment and strengthening of national surveillance systemsGaps, constraints, and challenges in global alert and response

To date the responses by the international community and World HealthOrganization have helped to increase awareness and develop systems to detect andcontain 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 thesenetworks have a strong rationale and have been devised in response to particular

needs.

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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 andresponded to efficiently and effectively by the international community, and thelevel 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 possibleTravel and Trade may be interrupted

Functions of the network The network will focus on three major functional areas:

Outbreak alertCo-ordination of outbreak response

Outbreak preparedness (National and International)These will be achieved through the processes of:

Offering assistance to outbreak affected statesCombating the international spread of outbreaks

Ensuring follow-up activities to prevent recurrence or further spread of the diseaseIdentifying and encouraging essential research to strengthen future prevention and control capabilities.Evaluation of international efforts to contain outbreaks

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SMU- MBA SemesterIII

HEALTH ADMINISTRATION-MH0051

To date the responses by the international community and World HealthOrganization have helped to increase awareness and develop systems to detect andcontain outbreak threats. A series of networks have been established which seek toestablish 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 thesenetworks 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 thatoutbreaks of potential international importance are detected, verified andresponded to efficiently and effectively by the international community, and thelevel of preparedness of individual states is increased. The criteria for activation of the network to respond to emergent and well-characterised disease threats should




oOutbreak alertoCo-ordination of outbreak responseoOutbreak preparedness (National and International)

These will be achieved through the processes of:

oOffering assistance to outbreak affected statesoCombating the international spread of outbreaksoEnsuring follow-up activities to prevent recurrence or further spread of

the diseaseoIdentifying and encouraging essential research to strengthen future

prevention and control capabilities.

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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 manynations.Other pathogens, such as influenza and measles, have at some time in the pastcrossed over from animal species and now regularly cause major outbreaksassociated with high mortality and morbidity.The recurrence of outbreaks of diseases that are recognised to cause significanthuman disease

Diseases such as cholera, dengue, influenza, measles, meningitis, shigellosis, yellowfever and food-borne diseases present a constant threat to human populations. Theyare well adapted to transmission in the human populations either directly from

person to person, through vector transmission, or via contamination of theenvironment or food. In general the diseases are well understood and very ofteneffective control measures are available. In many countries these diseases havecome under control by the systematic application of control measures such asvaccination or water treatment.

Action by the international community to contain outbreaks

The threats presented by outbreaks have not gone without a series of responses atnational and international levels.Many countries have recognised the renewed threat of outbreaks and have soughtto strengthen their national surveillance and response capacities. In many other countries similar developments have been very slow due to lack of funds andcompeting priorities. The reaction of some countries has been to devise a brick

wall defence and concentrate on reducing the threat of disease introduction atnational borders or by increasing the sensitivity of surveillance systems to pick upsmall numbers of imported disease cases. There is an increasing realisation that thisapproach often is not the most effective response.

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World Health Organization has also been involved in combating outbreaks since itsinception in 1950. Outbreak alert and response requires a non-partisan approach andthe capacity to facilitate collaborations between diverse partners. World HealthOrganization has a unique health mandate from 191 member states and has, withexisting partners,already established mechanisms for global outbreak alert and response. Currentmechanisms 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 healththrough: Specialised Surveillance Networks: World Health Organization has established anumber 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 activelycollecting andverifying information on reported outbreaks and informing key public health

professionals about outbreaks, which are of potential international public healthimportance. OVrelies on a broad range of information sources including the Global Public HealthInformation Network (GPHIN) which is a web-based electronic system developed byHealthCanada in collaboration with World Health Organization which scans the web to

identify suspected outbreaks. Suspected outbreaks are actively followed up withaffectedcountries 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 isdisseminated 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 Organizationnetworks, collaborating centres, national institutes of public health, major NGOs). Asof January2000, 512 outbreak reports have been investigated and disseminated if found to beof 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 inKenya and Somalia, monkeypox in the Democratic Republic of the Congo, avianinfluenza (H5N1) in Hong Kong, Ebola haemorrhagic fever in Gabon, relapsing fever in southern Sudan, influenza in Afghanistan, epidemic dysentery in Sierra Leone andMarburg virus infection in the Democratic Republic of the Congo.Active World Health Organization involvement in co-ordinating epidemic responseallows not only provision for immediate needs, but also allows initiation of measureswhich result in permanent benefit, such as the development of laboratory networksand active surveillance systems. An epidemic represents one of many entry points for

World Health Organization to become more deeply involved with an affected countryin the areas of epidemic preparedness and the development of improved epidemicresponse capacity.

World Health Organization is working with its partners to improve global, regionaland national preparedness for epidemics through: Establishing global surveillance and response standards

oCreating networks of partners for preparedness and rapid response (e.g.

sub-regional preparedness and response teams in the African Region)oStrengthening laboratory capacity and laboratory networksoTraining in field epidemiologyoAssessment 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 HealthOrganization have helped to increase awareness and develop systems to detect andcontain outbreak threats. A series of networks have been established which seek toestablish 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 thesenetworks 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 thatoutbreaks of potential international importance are detected, verified andresponded to efficiently and effectively by the international community, and thelevel of preparedness of individual states is increased. The criteria for activation of the network to respond to emergent and well-characterised disease threats should




oOutbreak alertoCo-ordination of outbreak responseoOutbreak preparedness (National and International)

These will be achieved through the processes of:

oOffering assistance to outbreak affected statesoCombating the international spread of outbreaksoEnsuring follow-up activities to prevent recurrence or further spread of

the diseaseoIdentifying and encouraging essential research to strengthen future

prevention and control capabilities.

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oEvaluation of international efforts to contain outbreaks

Global outbreak alert and response network functions are described in pictorial formin Figure 6.1 for your easy learning.

6.1 Global Alert and Response Network Functions

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