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FEATURE STORY

Mongolia: Better Prepared for Avian and Human Influenza

August 29, 2012

Overview

The “Avian and Human Influenza Control, Preparedness and Response Project” (Sept. 2008 – Nov. 2011) strengthened the capacity of Mongolia’s emergency departments, public health system and veterinary services to detect and respond to potential outbreaks of infectious diseases such as an avian and human pandemic influenza.

For the first time, the concept of “One Health” was put into practice in the country – different sectors such as emergency management, health, agriculture, inspection, at both national and local levels, worked together in joint planning, training and exercise for disease prevention and control.

Challenge

Mongolia is a land-locked country bordered by China and Russia. Both countries have reported outbreaks of highly pathogenic avian influenza that could be transmitted to humans. Mongolia became vulnerable to this serious disease.

Mongolia also plays a unique role in global response to avian influenza. Every year, millions of birds migrate through Mongolia between their Arctic breeding ground and the wintering ground in the south. Monitoring those birds is an essential task for Mongolia.

In response to the threat posed by the disease, the Government of Mongolia prepared a three-year National Strategy and Action Plan for Avian and Human Pandemic Influenza and requested the World Bank to carry out an independent evaluation of the strategy, which the Bank conducted in 2007. The assessment noted the country’s progress in disease preparedness but also pointed out the existing gaps, such as lack of technical and financial resources and low personnel capacity in Mongolia to fight diseases.

Approach

The project focused on strengthening the capacity of key agencies involved in the Avian and Human Influenza preparedness and response: the National Emergency Management Agency (NEMA), the Department of Veterinary Services (DVS) of the Ministry of Food, the Agriculture and Light Industry of the Ministry of Health (MOH), and their counterparts at the aimag (province) level. It aimed to raise awareness among senior policy makers and officials, review and improve the existing policy and regulatory framework related to the disease, improve the existing command and control structures with international best practices, and develop standard operational procedures. 

The project also helped establish computer-based early warning and surveillance systems across the country, equipped response teams in different sectors with better technical skills, and upgraded infection control and intensive care facilities in provincial hospitals that could be most exposed to such diseases.

Open Quotes

Before, we used to screen and treat our patients using only a stethoscope. Today the in-patient department in my hospital has 8 different types of modern medical diagnostic equipment. Close Quotes

Ms. Myagmar
a doctor at the Darkhan Uul Central Health Center

Results

  • The project conducted risk assessments on Highly Pathogenic Avian Influenza, vulnerability to and preparedness for human influenza pandemic, and hospital infection control. A manual on zoonotic disease risk assessment has also been developed.
  • The project initiated Avian Influenza surveillance among poultry in the country, expanded coverage of early warning and response system for human diseases and sustained surveillance among wild birds. 
  • A number of national policies and strategies were developed or revised. The project also helped develop working tools and technical guidelines, including:
    • Incidence Response Information System (IRIS);
    • Standard Operating Protocols for rapid response, command and control, surge capacity;
    • guideline for exercise and drills, guideline for hospital infection control;
    • risk communication plan for influenza.
  • 22 joint response teams (including health, agriculture, emergency management, professional inspection) have been set up across the country.
  • Capacity for intensive care for severe respiratory infectious diseases has been built at 6 aimags (provinces) and the National Center for Communicable Diseases.
  • 3 provincial veterinary laboratories have been accredited for avian influenza outbreak detection.
  • The project started building monitoring and evaluation (M&E) capacity in the country by developing manuals for it and establishing technical working groups.
  • Significant progress has been made in the scale and speed with which test results are processed. This has enabled authorities to treat animals and human patients faster and more effectively:

 

Before

After

Percentage of Poultry Mortality Events Investigated Annually

75%

100%

Average Number of Days between Taking Suspected Influenza Specimen in the Field and Arrival at Reference Labs

<3 days

1-1.4 days

Average Number of Days between Receipt of Biological Specimen in Lab and Lab Sending the Testing Results to the Requestor

 

 

         Avian Influenza

7 days

1 day

         Human Influenza

8.7 days

<1 day

Time from Start of AHI Investigation to Completion of File in National Information System

 

 

         Avian Influenza

1 month

5 days

         Human Influenza

1 month

4-4.5 days

Bank Contribution and Partners

The project was financed by a grant of US$ 4,656,463 from the Avian and Human Influenza Facility (AHIF), a trust fund administered by the World Bank and currently supported by 10 donor agencies led by the European Commission.

A number of international organizations such as the World Health Organization (WHO), the United Nation’s Food and Agriculture Organization (FAO), Wildlife Conservation Society, the United Nations Children's Fund (UNICEF) and the United Nations Development Programme (UNDP) provided technical assistance to the project, or supervised the project implementation. 

Moving Forward

Mongolia is an ideal place for ongoing Avian Influenza surveillance among wild birds. At least three migratory routes cross at the country. Many lakes are the summer habitats for migratory birds. This makes findings from the Avian Influenza surveillance among wild birds in Mongolia, which are imperative for the understanding of evolution of avian influenza virus, valuable to the global community.

The project outcomes are highly sustainable since the One Health Approach is now set firmly in place in the country. Capacity to respond to other emerging infectious disease has been also improved and further improvement can be expected.

Beneficiaries

Ms. Myagmar is a doctor at the Darkhan Uul Central Health Center. “Before, we used to screen and treat our patients using only a stethoscope. Today the in-patient department in my hospital has 8 different types of modern medical diagnostic equipment,” she said.