REPORT OF
MULTI-DISCIPLINARY COMMITTEEONEARLY WARNINGMECHANISM FOR EPIDEMICSINNIGERIA
AUGUST, 2009.
CONTENTS
Pages
List Of Acronyms 4 - 6
1.0 Chapter One:Preamble
1.1 Time Frame 7
1.2 Membership of the Committee 7 – 8
1.3 Committee’s Meeting Days 8
2.0 Chapter Two: Terms of Reference
2.1 The Existing Early Warning mechanism for Epidemics in Nigeria. 9
2.2 Background of IDSR in Nigeria 9
2.3 Flow of Information in an IDSR in Nigeria 9 – 11
2.4 How IDSR contributes to Epidemic Preparedness 11
2.5 Flow of Information Chart for Integrated Disease Surveillance
Institution / Department. 12
2.6 Alert and Epidemic Thresholds of Epidemic prone Diseases 13
2.7 Port Health Services Early Warning Mechanism 14 - 15
2.8 Support by Partners to the implementation of the IDSR System
under the Federal Ministry of Health. 15 - 17
3.0 Chapter Three : Gaps in the Existing Early Warning Mechanisms for
Epidemics in Nigeria. 18
3.1 Generation of Early Warning Mechanisms for Epidemics 18 - 20
3.2 Analysis of Early Warning Mechanisms for Epidemics 20 - 21
3.3 Dissemination of Early Warning Information on Epidemics 21 - 22
3.4 Application of Early Warning Mechanisms for Epidemics 23
4.0 Chapter Four: Integration of the existing early warning mechanisms for
Epidemics. 24 - 26
5.0 Chapter Five: The stakeholders that will support the early warning
Mechanism for epidemics and their roles. 27 - 30
6.0 Chapter Six: Workplan on Early Warning System for Epidemics 31 - 33
7.0 Chapter Seven: Early Warning Mechanism for Epidemics
Action plan 33 - 35
8.0 Chapter Eight: Others. 36
List of Members of the Committee on early warning Mechanism for
Epidemics. 37
LIST OF ACRONYMS
FMOH Federal Ministry of Health
NEMA National Emergency Management Agency
NPHCDA National Primary Health Care Development Agency
NSCDC Nigeria Security and Civil Defence Corps
NHMIS National Health Management Information System
NMN Nigerian Merchant Navy
IDSR Integrated Disease Surveillance and Response
SMOH State Ministry of Health
SEMA State Emergency Management Agency
SPHCDA State Primary Health Care Development Agency
LGPHC Local Government Primary Health Care
LGHD Local Government Health Department
CDC Center for Disease Control and Prevention
UNICEF United Nations Children’s Fund
MSF Medecins Sans Frontieres
NRCS Nigerian Red Cross Society
WHO World Health Organization
RRT Rapid Respond Team
NGOS Non Governmental Organizations
HF Health Facility
DSN Disease Surveillance and Notification officer
DMO Disaster Management Officer
DO Divisional Officer
ZTO Zonal Technical Officer
CSM Cerebrospinal Meningitis
EWS Early Warning System
NOA National Orientation Agency
FMOIC Federal Ministry of information and Communication
SMOI State Ministry of Information
FMAWR: Federal Ministry of Agriculture and WaterResources.
SMOH-PHC/PH: State Ministry of Health-Primary Health Care/Public Health.
NIMET: Nigerian Meteorological Agency
CDCs: Community Development Committee
NAFDAC: National Agency for Food and Drug Administration and Control
NESREA: National Environmental Standards and Regulatory Enforcement Agency
NPF: Nigeria Police Force
NOSDRA: National Oil Spill Detection and Response Agency
NPS: Nigeria Prison Service
NIS: Nigeria Immigration Service
1.0 PREAMBLE
The consultative stakeholders meeting on Early warning Mechanism for Epidemics which was organized by NEMA and held at NEMA Headquarters on 23rd July, 2009, suggested for a formation of a committee to examine the existing mechanisms. The committee was given the following Terms of Reference.
- Identify the existing Early Warning Mechanisms;
- How effective are the mechanism;
- How to integrate the existing mechanism;
- Identify stakeholders that will support the system and their roles;
- Develop a work Plan for the implementation of the Early Warning System on Epidemics.
1.1Time Frame
The Committee was given three (3) Weeks to submit its Report.
1.2 Membership of the Committee.
Committee members were selected from the following organizations / Ministries /Agencies.
National Emergency Management Agency (NEMA)
Federal Ministry of Health ( Epidemiology, Port Health and NHMIS Divisions);
State Ministry of Health, LagosState;
State Ministry of Health, BauchiState;
National Primary Health Care Development Agency (NPHCDA);
State Emergency Management Agency (SEMA), LagosState;
State Emergency Management Agency (SEMA), BauchiState;
Nigeria Security and Civil Defence Corps (NSCDC);
Nigerian Merchant Navy Corps (NMNC);
Centers for Disease Control and Prevention (CDC);
Nigerian Red Cross Society (NRCS);
United Nations Children’s fund (UNICEF);
Medecins Sans Frontieres (MSF);
World Health Organization (WHO).
1.3 Committee’s Meeting Days
The Committee met for deliberations on the following Days:
1st Leg: 4th – 5th August, 2009;
2nd Leg: 11th – 12th August, 2009,
3rd Leg: 18th – 19th August, 2009.
2.0 TERMS OF REFERENCE
2.1 The Existing Early Warning Mechanismfor Epidemicsin Nigeria.
The primary mechanism for early warning system on Epidemics in Nigeria is the Integrated Disease Surveillance and Response (IDSR) under the Federal Ministry of Health.
2.2 Background of Integrated Diseases Surveillance and Response (IDSR) in Nigeria
In September, 1998 in Harare, the WHO Afro Countries endorsed the introduction of Integrated Disease Surveillance and Response (IDSR) by members Countries to strengthen the Surveillance System using an integrated approach with involvement of laboratory services in Disease Surveillance and Epidemic response. Other objectives of IDSR include improving the use of information for Decision making, improving the flow of surveillance information between and within levels of the Health System, increasing the involvement of clinicians in the Surveillance System, emphasizing Community participation and detecting and responding to public health problems. Nigeria adopted and commenced the implementation of IDSR by the assessment of the existing National Surveillance System in 2001.
2.3 Flow of Information in an Integrated Disease Surveillance and Response in Nigeria.
Health facility:
Information about twenty-one priority diseases is to be collected based on the case definitions of the diseases. The sources of the data are out patient and the in patient registers. The register should as a minimum include date, name, patient number, sex, age, address, problem diagnosis, treatment and outcome.
If a disease or condition that is targeted for elimination, eradication or if a disease with high epidemic potential is suspected it is reported immediately to adesignated health authority in the health facility and at the LGA level.
The health facility should begin a response to the suspected outbreak and also obtain a laboratory confirmation through collection of laboratory specimen where applicable. The following data about the laboratory specimen should be documented: type of specimen, date obtained, date sent to the lab., condition of specimen when received in the lab.
Information on epidemic diseases is completed weekly using the weekly reporting form and forwarded to the LGA while other priority diseases are be compiled monthly and quarterly for TB and Leprosy and sent to the LGA.
Simple analyses are expected to be carried out at this level to keep trend lines of priority diseases and also to know when thresholds are reached for action.
LGA:
The completed forms from the health facilities are collated periodically as applicable and sent to the State level. Analyses are carried out at this level and logs of outbreaks reported by the healthfacilities are maintained including the
intervention activities.
State level:
Data from various LGAs are compiled by the DSN officer and forwarded to the Federal Epidemiology Division, Detailed analysis are expected to be carried out at this level. Feedbacks are also to be given to the lower level.
- Federal:
Data from all the States of the Federation are to be compiled and analysed, interpreted and used for action. Also data are to be disseminated to all the vertical programmes, partners and other stakeholders. Feedback is given via the monthly newsletter and bulletin.
2.4 How IDSR contributes to Epidemic preparedness:
Because epidemiological surveillance collects data for describing and analysing health events, it provides skills and information for early detection of outbreaks leading to enhanced preparedness for emergency situations. For example, an LGA’s epidemic management committee can define each level’s role in outbreak response in advance. Limited resources are maximised by combining resources for training, demonstration and setting aside adequate supplies of equipment, vaccines, drugs and supplies.
2.5Flow of Information Chart for Integrated Disease Surveillance Institution / Department.
1ST TIER
2ND TIER
3RD TIER
4TH TIER
2.6Alertand Epidemic Thresholdsof Epidemic Prone Diseases.
S/N / DISEASES / ALERT THRESHOLD / EPIDEMIC THRESHOLD / ACTION BY01. / CSM / 5 cases per 100,000 inhabitants per week in a pop. greater than 30,000.
2 cases per 100,000 inhabitants per week in a pop. Of 30,000 or less. / 15 cases per 100,000 inhabitants per week in a pop. greater than 30,000.
4 cases per 100,000 inhabitants per week in a pop. of 30,000 or less. / DSNOs, Record officers, Doctors, Nurses, EHOs and M&E officers at LGAs.
02. / Yellow fever / If a single case is suspected. / If a single case is confirmed. / As above.
03. / Measles / 5 or more suspected cases reported from a district/ health facility in a month. / 3 or more measles lgM+ confirmed cases in a district / health facility in a month. / As above.
04. / Viral Hemorrhagic / If a single case is suspected. / If a single case is confirmed. / As above.
05. / Cholera / Doubling of cases per week. / As above.
2.7 PortHealth Services Early Warning Mechanism.
The division is presently at all the international Airports, seaports, and ground crossing where they are involved in the following activities:
- International Airports
The international Airlines submit General Declaration of Health which shows the following information:
(i) Persons on board with signs and symptoms of communicable disease.
(ii) Any other condition on board that may lead to the spread of disease.
(iii) Details of each disinfecting or sanitary treatment (place/date/time/method)
during the flight.
- Boarding and inspection of Aircraft to detect nuisances such as insects and rodents and to ensure that the aircraft is in sanitary condition.
- Disease surveillance
- Food handlers’ medical examination to prevent food borne disease: This involves all the food handlers within the Airport and flight catering services.
- Issuance of disease alert to the port community.
- Screening of refugees and deportees.
- SEAPORTS
- Maritime declaration of Health.
- Ship sanitation certificate: Any ship not in possession of this must produce an exemption certificate or sanitary measures must be applied to the ship.
- Boarding and inspection of ship.
- Granting of Free Pratique: When a ship is declared healthyby Port Health services, a free Pratique is granted and then people are allowed in and out of the ship.
- Disease surveillance
- Issuance of disease alert to the port community.
- Screening of refugees and deportees
- Food handlers’ medical examination to prevent food borne disease
LANDBOARDERS / GROUND CROSSING
- Inspection of vehicles.
- Issuance of disease alert to the port community.
- Screening of refugees and deportees.
- Disease surveillance.
2.8 Supports by Partners to the Implementation of the IDSR System under the Federal Ministry of Health.
(a) Centers for Disease Control and Prevention (CDC) Nigeria.
National Influenza Sentinel Surveillance (NISS).
As one of the strategies for Early Warning detection and prompt response to Avian influenza as well as other influenza viruses with pandemic potential, a sentinel surveillance system has been established by the Federal Ministry of Health with financial support from the US Centers for Disease Control and prevention (CDC). Seven sentinel sites, covering all the six Geo-political Zones of the Country have been identified. Currently, four (4) of the Sites (Aminu Kano Teaching hospital, Kano, Asokoro District Hospital, Abuja, Lagos State Teaching Hospital, Ikeja, Lagos and the Nnamdi Azikiwe Teaching Hospital, Nnewi) are operational. In each sentinel site, Surveillance Staff collect daily, epidemiologic data as well as nasal and throat swabs from three (3) out-patient cases presenting with influenza-like illnesses (ILI) and from all SARI in-patients. The swabs are tested for influenza viruses using r-RT PCR technique. Data on total out-patient consultants and admissions are also collected. The results are submitted to the State Epidemiologists and to the Federal Ministry of Health, Epidemiology Division.
(b)Nigerian Red Cross Society (NRCS)
The Nigerian Red Cross Society (NRCS) support the Federal Ministry of Health IDSR system. NRCS help raise local awareness of the hazards that communities are exposed to and most times Community Based volunteers alert Health Authorities. Also the Society assists local organizations and vulnerable populations with interpreting early warning information and taking appropriate and timely action to minimize mortality and morbidity. Efforts in building these capacities complements local indigenous capacities and knowledge related to disaster early warning and alert. (How is information gathered by, or available to Red Cross shared with relevant authorities?
(c). Medecins Sans Frontieres (MSF)
The Emergency preparedness unit of MSF has an ongoing surveillance system that is always active. The surveillance system is in line with that of the Federal Ministry of health system where they obtain data from the FMOH, SMOH and other stakeholders and act on such information given in conjunction with and the permission of the Federal and State Ministries of Health. The organization communicates with authorities in the area they cover on a weekly basis for the purpose of surveillance by phone and physically go to the fields as often as possible. They also have an informal system that comprises of people in States and LGA’s where they have worked or are currently working and in this way are alerted very early when any epidemic is suspected or occurring.
3.0GAPS IN THE EXISTING EARLY WARNING MECHANISMS FOR EPIDEMICS IN NIGERIA.
The gaps were categorized into four broad groups /Stages:
- Gaps at the stage of generation of the Early Warning System
- Gaps at the stage of the Analysis of the Early warning Mechanism for Epidemics
- Gaps at the Stage of dissemination of Early Warning information on Epidemics
- Gaps at the stage of application of Early warning Mechanisms for Epidemics.
3.1Generation of Early Warning Mechanisms for Epidemics:
S/N / GAPS / RECOMMENDATIONS / ACTION BY01. / Inadequate skills of designated officers. Designated officers at the lower level do not have the necessary skill. / Training / Capacity building at all levels with more emphasis at the lower level. / FMOH, SMOH-PHC/PH Dept., LGPHC, NPHCDA, Development partners and NGOs.
02. / Lack of ownership of data by State and LGAs / Sensitization and enlightenment.
Analysis and interpretation at the State level. / FMOH & SMOH
03. / Complexity of data collection forms / Simplification and standardization of Data forms / FMOH and other stakeholders
04. / Insufficient data collection forms. / Provision of sufficient Data Collection Forms. / FMOH, SMOH-PHC/PH Dept., LGPHC, NPHCDA.
05. / Inadequate feed back at all levels. / Forward and backward flow of information at all levels. / FMOH, SMOH-PHC/PH Dept., LGPHC, NPHCDA
06. / Poor flow of information at all levels. / Provision of adequate ICT facilities at all levels. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA and Development partners
07. / Shortage of Skilled manpower / Recruit and train qualified Manpower / FMOH, Port Health, NMN, SMOH-PHC/PH Dept., NESREA, LGPHC, NPHCDA, NESREA, Development partners & NGOs.
08. / Frequent transfer of technical staff / Succession plan should be in place. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA
09. / No budgetary allocation for Early Warning / Disease Surveillance at all levels, where it exist either fund are not being release or it is inadequate / Adequate budgetary allocation and timely release of funds for Disease Surveillance / Early Warning. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA.
10. / Inadequate community involvement in data generation. / Sensitization of the community on need for reporting priority diseases and unusual health events through Community Development Committee(CDCs) where available. Development and dissemination of simplifying case definition of priority disease. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA,NESREA and Development partners.
11. / Limited involvement f Private health facilities. / Sensitization of private health practitioners and provision of data collection forms to private health facilities. / FMOH, SMOH-PHC/PH Dept., LGA PHC Dept.
12. / Lack of Monitoring and supervision / Effective Monitoring and Evaluation mechanism should be put in place. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA and Development partners.
3.2Analysis of Early Warning Mechanisms for Epidemics:
S/N / GAPS / RECOMMENDATIONS / ACTION BY01. / Lack of centralized database at all tiers. / Strengthen the capacity of the personnel and provision of necessary tools and equipments. / FMOH, NEMA, SMOH.
02. / Lack of skill of designated officers. / Training and retraining of designated officers. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA and Development partners.
03. / Inadequate public health laboratory services. / Each State should have at least a functional Health laboratory. / FMOH, SMOH, SPHCDA, LGPHC, NPHCDA and Development partners.
04. / Inadequate feed back at all levels / Forward and backward flow of information at all levels. / FMOH, SMOH, SPHCDA, LGPHC,NPHCDA
05 / Inadequate Monitoring and supervision / Effective Monitoring and Evaluation mechanism should be put in place. / FMOH, SMOH, SPHCDA, LGPHC, and NPHCDA and Development partners.
3.3Dissemination of Early Warning Information on Epidemics:
S/NO / GAPS / RECOMMENDATIONS / ACTION BY01. / Insufficient financial support for free flow of information. / Adequate Budgetary allocation for surveillance and Early Warning System.
EWS Budgetary allocation should not be subjected to unnecessary bureaucracy. / FMOH, SMOH, SPHCDA, LGPHC, NPHCDA and Development partners.
02. / Weak linkage with the communities. / Revitalization of Village Health committees vis a vis their roles in Early Warning. / LGPHC, NPHCDA and Development partners.
03. / Poor state of preparedness in terms of Epidemics control. / Establish EPR and RRT
Strengthen of EPR Committee / FMOH, NEMA and SMOH.
SEMAand all Partners
.
04. / Inadequate feed back at all levels / Ensure effective forward and backward flow of information at all levels. / FMOH, SMOH-PHC/PH Dept., LGPHC, NPHCDA
05 / Lack of Monitoring and supervision / Establish effective Monitoring and Evaluation mechanism at all levels. / FMOH, SMOH-PHC/PH Dept., LGPHC, and NPHCDA and Development partners.
06 / Inadequate involvement of the Media in dissemination of Early Warning. / Relevant stakeholders should partner with the Media in disseminating Early Warning signals to the public. / FMOH, FMOIC,NOA NEMA, SMOH,SMOI SEMA,
3.4Application of Early Warning Mechanisms for Epidemics: