A severe pandemic would harm health, economies, and communities in all countries, but especially in poor and fragile states. Pandemic prevention requires robust public health systems (veterinary and human) that collaborate to stop contagion promptly.
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ChallengeIn April 2009, the A/H1N1 influenza virus spread rapidly around the world. In Argentina, as the virus circulated through the country, the contagion reached its peak at the end of June. By Dec... Show More +ember, the number of deaths had reached 613. The number of cases of influenza-like illness reported during 2009 was much higher than during previous epidemics. Children under five and adults between 45 and 64 years were the most seriously affected. In response to the overwhelming increase in demand for services, the country’s health system became over extended. This resulted in an excess burden on emergency and hospitalization sectors. In addition, the pandemic generated significant economic losses from work and school absenteeism, and observed declines in tourism, purchases in commercial centers, and tickets for sporting and cultural events.SolutionThe World Bank-financed Emergency Project for the Prevention and Management of Influenza-Type Illness and Strengthening of Argentina’s Epidemiological System was formulated with the objective of controlling the second wave of the A/H1N1 influenza pandemic and strengthening the Argentine health system’s capacity to respond to potential epidemiological outbreaks. The project complemented the Bank’s earlier immediate response to the first A/H1N1 outbreak with US$ 7.5 million from the emergency component of the Provincial Maternal-Child Health Investment Project.The emergency generated by the pandemic deepened the provinces’ commitment to promote the use of quality health information for decision making. The project contributed to the development of capacities at the national and provincial levels in public health policy implementation. The project helped Argentina prepare for the second wave of A/H1N1 by supporting the strengthening of the surveillance system at the central and provincial levels, the application of the necessary vaccines, provision of antiviral medication, and prevention communication campaigns. The project‘s adoption of a results-based financing mechanism provided incentives to the provincial governments to improve health outcomes by linking financing to results.ResultsThe project transformed the crisis into an opportunity with strategic and operational improvements in the monitoring and control of the A/H1N1 influenza epidemic. It also contributed significantly to improvements in public health. Some of the concrete results are:In December 2013, 36 situation rooms could generate health information at the provincial and departmental level in a systemic and timely manner.The project supported the development of local communication campaigns that increased public influenza awareness, encouraged prevention through vaccination, and promoted self-care against the transmission of infectious diseases, by focusing on prevention measures for respiratory diseases, and promotion of early doctor visits.The project supported the successful implementation of a massive anti-flu and anti-pneumococcal vaccination. At the end of the 2010 campaign, no deaths from H1N1 were reported within the prioritized at-risk groups; during 2011 no deaths from the H1N1 virus were reported from any groupsThe country’s laboratory surveillance system has actively monitored respiratory viruses since 2008. Argentina currently contributes the greatest volume of information on respiratory viruses to the CDC for the development of the southern hemisphere influenza vaccine in the region.Bank Group ContributionThe Bank provided a loan of US$ 229 million. The project helped to strengthen the epidemiological surveillance system through the funding of interdisciplinary technical teams, training, technical assistance, purchase and distribution of computer equipment, publications and communications campaigns for prevention and self-care. While the Government of Argentina funded the purchase and distribution of vaccines and antivirals, the project helped to create the necessary synergies between different levels of government to address the pandemic and outline intervention strategies in the long term.PartnersProject implementation was executed through the different technical units within the National Ministry of Health (Ministerio de Salud de la Nación), representing a new modus-operandi, which served to build up in-house capabilities and fostered greater cooperation among different health units.Moving ForwardThe sustainability and institutionalization of the health situation rooms in the provinces will depend on their continued use and transformation into strategic tools for the management of health decisions. The inclusion of the A/H1N1 vaccine for high-risk groups and pneumococcal vaccine for children into the National Vaccine Calendar schedule is expected to reduce the likelihood of a new A/H1N1 influenza epidemic and reduce pneumococcus in children.BeneficiariesBefore the A/H1N1 epidemic, the City of Santa Fe’s health situation room had not developed the capacity to integrate and provide information to support a health management strategy. With project support, the situation room began the systematic analysis of health-related information. Municipal Mayor Ana Maria Meiners said, "Our Health Room will be alive and all of the city institutions can provide useful data to start working on our problems. It will be a valuable meeting point where different stakeholders can provide available information. Let us begin creating mechanisms for data that we do not have yet," Show Less -
ChallengeFollowing the outbreak of the new A/H1N1 Human Influenza strain in Mexico, the virus quickly spread into the Central America region. Nicaragua was among the more severely affected countries i... Show More +n the region, with more than 2,152 confirmed cases of the A/H1N1 Human Influenza, and eleven official deaths, when WHO declared a worldwide pandemic in 2009. Important constraints faced by Nicaragua at the time included uneven quality of services, limited laboratory, diagnostic and surveillance capacity, poorly trained staff and inadequate supply of drugs.SolutionProject design focused on reducing the risk of illness and case fatality, particularly among high-risk groups. Thereby a substantial part of the grant was invested in relevant drugs and a smaller part in the capacitation of human resources and facilities. What made this approach so interesting was the versatility of focusing on a number of essential drugs and not only on Influenza vaccines. In the end the pandemic was far less pronounced in Nicaragua than anticipated, but the grant still benefitted a very large segment of the population. An innovative feature was the procurement of drugs through the Pan American Health Organization’s (PAHO) revolving fund mechanism, which required a waiver for certain Bank operation policies, otherwise PAHO’s UN status would have prohibited the agency to enter a standard World Bank supply contract.ResultsThe Project’s main result was to strengthen the countries health system capacity and pandemic preparedness and response (between 2009-2012) by supporting the following improvements:Nicaragua’s epidemiologic emergency preparedness and surveillance capacity improved substantially, as reflected in the availability of appropriately equipped facilities, availability of relevant medicines in 100 percent of targeted facilities and trained personnel. The capacity of the Nicaraguan Health System to effectively treat secondary infections in the case of human influenza improved, as reflected by 31 hospitals with staff certified in Human Influenza AH1N1 control, and the number of health workers with training in diagnosis, treatment and care of influenza patients. The population is increasingly aware of preventive measures against. The measure increased by 33 percentage points during one year of project implementation, surpassing the target of 80 percent by 13 percentage points. This finding is partly attributable to the rollout of the Bank supported communication and prevention strategy.The extent of the effectiveness of these inputs to increase prevention, surveillance and emergency response is not yet measurable, although there are indications of improvement.The direct beneficiaries were people at high risk for secondary infection, like pregnant women, children and elderly people, but through prevention and treatment the Project benefitted the general population. Show Less -
Bank Group ContributionThe project was financed by a grant of US$ 4.7 million from the Avian and Human Influenza Facility (AHIF), a trust fund administered by the World Bank and currently supported by... Show More + 10 donor agencies led by the European Commission.PartnersA number of international organizations such as the World Health Organization (WHO), the Food and Agriculture Organization (FAO) of the United Nations, the 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 ForwardThe 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.BeneficiariesMs. 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 eight different types of modern medical diagnostic equipments,” she said. Show Less -
The Avian Influenza virus is widespread in poultry and is a risk to human health. Infected poultry can infect humans. Once in the human body, the virus can mutate so it is easily transmitted from pers... Show More +on to person.Following a thorough assessment of Turkmenistan's laboratory services, the country's central veterinary laboratory was renovated and equipped to allow testing of this dangerous virus in a highly secure and contained environment to avoid any risk of it spreading and infecting others. To this end, staff were trained to handle and test Avian Influenza samples safely and accurately. Regional laboratories were also renovated and provided with basic equipment so that staff there could perform preliminary tests. Show Less -