IHR (2005):Timelines,

Core capacities,Roles &

Responsibilities

International Health: History..•1948: WHO Constitution

•1951: Adopted ISR

•1969: Revised to IHR

•1995: Call for revision

•2001: Links to Global health Security strategy

•2005: Adopted IHR 2005

•2007: IHR(2005) comes into effect

What are IHRs?

• IHR (1969): Objective: Maximum security against

international spread of diseases with minimum interference with world traffic

Scope: Only 3 diseases (Cholera, plague, yellow fever)

Limitations: Dependence on affected country to notify; Lack of mechanisms for collaboration

between WHO and affected country

An international legal instrument, legally binding on all WHO Member States who have not rejected

them

Purpose & Scope of IHR (2005)

To prevent, protect against, control & provide a public health response to the international spread of disease:

• in ways commensurate with & restricted to public health risks, and

• which avoid unnecessary interference with international traffic & trade

IHR (2005) Document• 66 Articles organized in X Parts

• 9 Annexes

• Annex 1 – Core Capacity Requirements for Surveillance & Response, and for Designated Airports, Ports and Ground Crossings

• Annex 2 – Decision Instrument for Assessment & Notification of Events that may constitute a Public Health Emergency of International Concern

• Available on Website: http://www.who.int/csr/ihr/en/

Public Health Emergency of International Concern (PHEIC)

• an extraordinary public health event whichconstitutes a public

health risk to other countries through international spread of disease

potentially requires a coordinated international response

“Disease means an illness or medical condition, irrespective of origin or source that presents or could present significant harm to humans”

Determination of PHEIC – 4 criteria

Unusual or Unexpected Event Event resulting in Serious Public Health

Impact Event with significant risk of international

spread Event with significant risk of international

travel or trade restriction

Any event irrespective of origin & source meeting any 2/more criteria shall be considered as PHEIC

& notified to WHO under IHR (2005)

Major Obligations for Member States

Assess events & notify potential

PHEIC

Core capacities to detect, report and respond

Comply with routine

provisions

Legal & administrative

framework

Designation of a

National Focal Point

Major Obligations

Key Country Obligations under IHR (1)• Designate National Focal Points, update their

details & communicate to WHO every year

• Assess ability of existing national structures and resources to meet minimum requirements under IHR (2005)

• Develop, strengthen & maintain core capacities

– for Surveillance & Response

– for Points of Entry

• Assess all urgent events irrespective of origin & source within 48 hours using ‘Decision Instrument’; notify WHO within 24 hours of assessment of events that may constitute PHEIC

Key Country Obligations under IHR (2)

• Designate Airports, Ports and Ground Crossings which have the core capacities

• Revise Legislation, Health Documents/ Forms/ Certificates & Charges in accordance with IHR (2005)

IHR (2005) provides an opportunity to strengthen readiness, surveillance & response capacities which help in dealing with PHEIC & also other prevalent diseases in the country

IHR: capacities required at each level

Local level

National level

Intermediate level

Regional & International level

- Detection of event- Reporting- Controlling

- Confirmation- Response - Assessment

- Assessment- Notification - P.H. response

- Event alert- verification- Assessment - Intl. response

Surveillance & response capacitySurveillance & response capacity

• Local levelLocal level

– Detection of events

– Reporting – Control measures

• Intermediate levelIntermediate level

– Confirmation – Assessment – Reporting

• National levelNational level – Assessment

– Notification– Pubic health

response• Control measures

• On-site assistance • Operational link• P.H. emergency

response preparedness

• At all times• Access to medical services • Transport of ill travellers• Inspection of conveyances• Control of vectors / reservoirs

• For responding to events• Emergency contingency plan• Arrangement for isolation (human,

animal)• Space for interview / quarantine• Apply specific control measures

Minimum Core Capacities at Designated Points of Entry

Alert & Response Operations

DetectionDetection

VerificationVerification

Risk assessment Risk assessment

ResponseResponse

Events that may constitute PHEIC

IHR (2005)

To prevent, protect against, control & provide a public health response to the

international spread of diseases

Entry into force

Assess national structures, resources

to meet min. req.

Develop, strengthen & maintain core capacities

reg. surveillance & response; points of entry

Further extensions possible

15th June 2007

15th June 2012

Implementation of IHR (2005) -Timeline

15th June 2009

for 2 years and exceptionally another 2 years2 + 2 years

The Stakeholders for IHR Implementation

Airports,Ports & Ground

Crossings

States, UTs &

DistrictAuthorities

National Focal PointNICD, Delhi

Other Ministries,

Dtes., & Deptts.

MOHFW

DGHS

Activities for Stakeholders

Airports,Ports & Ground

Crossings

States, UTs &

DistrictAuthorities

Other Ministries,

Dtes., & Deptts.

National Focal PointNICD, Delhi

Activities on the part of State Governments/UTs and District Authorities

• Designation of IHR focal points – 24x7 accessibility

• IHR component in all IDSP trainings• Assessment and strengthening of disease

surveillance & response capacity as per IHR • Evaluation & strengthening of laboratory

capacities • Evaluation & strengthening of isolation

facilities & infection control practices • Mechanism for rumour verification • Awareness reg. information to be reported to

NFP

Activities on the part of State Governments/ UTs and District Authorities contd...

• Preparation and periodical updating of public health contingency plans

• Involvement of private sector and professional organizations (e.g. IMA) for disease surveillance activities

• APHOs/ PHOs be included in state surveillance committees

• Investigation findings of central/state RRT be urgently conveyed to States/Distt./ Municipal bodies

• Identification of high-risk areas near international borders and programme for cross-border control of diseases

Activities on the part of State Governments/ UTs and District Authorities contd...

• Satellite linkages of IDSP/NFP with all state/ district HQs

• Nodal members to be identified: – Designated hospitals, laboratories and various

pest/ vector control agencies– State Health Directorates, District Health

Authorities – Local municipality, cantonment board, other

relevant agencies– Ministries of Civil Aviation, Shipping, Surface

transport, Agriculture (veterinary dept.), Home Affairs, Tourism, Railways

– Customs, Immigration, AAI– AOC, Association of shipping agents – CISF

Activities related to the Airports/ Ports/ Ground Crossings

• Designation of Airports/ Ports/ Ground Crossings Designation of IHR Focal Points

• Training of technical staff on IHR• Assessment & strengthening of capacities at

designated entry/ exit points • Awareness about information to be reported to NFP • Referral system for medical care services • Creation of new public health units • Improve infrastructure of quarantine centers • District IDSP lab be designated for each APHO/ PHO• Provision of entomologist for vector surveillance &

control activities

Activities related to the Airports/ Ports/ Ground Crossings contd...

• Satellite linkages with IDSP (incld. laboratories) • Preparation of PHE Contingency plan including:

– Panel of doctors/ paramedical staff for deputation during PHE

– Identify referral laboratories and medical facilities

• Coordination amongst:• Designated hospitals & laboratories,• Department of Animal Husbandry,• Immigration contact point,• Airport/ ship management agencies,• Customs contact point

Activities required to be undertaken at National level

• Examine/ revise health certificates/ documents and charges, if necessary

• Enactment of Public Health Act 2007 (Draft) • Revise National Aircraft/Port Health Act & Rules for

effective IHR implementation• Prepare/Update Health rules for designated Ground

Crossings • Awareness about IHR among administrators &

politicians at all levels • Mechanism for emergency support services and

coordination between different sectors during PHEIC

Activities required to be undertaken at National level contd...

• Strengthen capacity incld. trained manpower & institutional support (NCDC) for disease surveillance & response at central level

• Strengthen lab. capacity; linkages with international reference labs

• Involvement of major institutions like NVBDCP, ICMR etc. in investigation of PHEs

• Disease control guidelines be updated and widely circulated

• Preparation of a National PHE Response Plan• Periodic independent evaluation of IDSP • Identification of high-risk areas near international borders

and programme for cross border control of diseases

Activities required to be undertaken at National level contd...

• Mechanism for collaboration & coordination between different Ministries/ Departments:– MOHFW – Designated hospitals, laboratories and various pest/

vector control agencies– State Health Directorates, District Health Authorities – Local municipality, cantonment board, any other

relevant agency– Ministries of Civil Aviation, Shipping, Surface

transport, Agriculture (veterinary dept.), Home Affairs, Tourism, Railways

– Customs, Immigration, AAI– AOC, Association of shipping agents – CISF

Activities required to be undertaken at National level contd...

• Health column in immigration clearance form: – Yellow fever – travel detailsduring past 6 days – Other diseases – as per need – e.g. AI, SARS etc.

• Flight disinsection as per revised Rules• Advance intimation reg. dead body clearance • During PHEIC – baggage, animal cargo clearance • Advisory during PHEIC • Other actions to be taken by different organizations,

as required from time-to-time

Main Challenges

• Building core capacities for surveillance and response at all levels – national, intermediary, local (technical challenge)

• Mobilization of resources to meet core capacities requirements (financial challenge)

• National Commitment to rapid sharing of information, materials and inter-country collaboration (political challenge)

Summary • IHR (2005) is an international legal instrument,

legally binding on all WHO Member States

• Urgent need to:• Identify Stakeholder Focal Points

• Create awareness among stakeholders, administrators & politicians

• Prepare state/ dist. health contingency plans

• Assess/ strengthen surveillance & response capacity

• Strengthen laboratories

• Coordinate with all stakeholders

• Report any unusual/ unexpected public health event to National Focal Point (NICD, Delhi)

• Respond to the request for verification & response of any reported event

Thank you