Ten Essential Public Health Services in HPAI Prevention and Control

Joann Lindenmayer

Iwan Willyanto

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History

• In 2006 the Government of Indonesia established KOMNAS-FBPI to coordinate Highly Pathogenic Avian Influenza Prevention and Control

• In 2008 KOMNAS expanded to include other zoonotic diseases

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Objective

• Describe CDC’s Essential Public Services performed by veterinarians in HPAI prevention and control efforts in Indonesia

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4http://www.cdc.gov/nphpsp/essentialservices.html

National Public Health Performance Standards Program

The Public Health System

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Public health systems are commonly defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within

a jurisdiction.” This concept ensures that all entities’ contributions to the health and well-being of the community

or state are recognized in assessing the provision of public health services

The Public Health System

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Application of the Ten EPHS in the US

• Assess public health systems in local, regional, and state health departments

• Assess specific systems within public health agencies

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Ten Essential Public Health Services (EPHS)

1. Surveillance to identify community health problems

2. Diagnose and Investigate health threats

3. Inform, educate and empower community about health problems

4. Mobilize community partnerships and action

5. Programs and Policies to support individual and community health problems

6. Enforce laws and regulations that protect health

7. Link people to needed health services and assure provision when needed

8. Assure competent personal and public health workforce

9. Evaluate effectiveness, accessibility and quality of programs and policies

10. Research for new insights and innovative solutions

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Working Group

• Understanding of veterinary medical education and services delivery system in Indonesia

• Expertise in survey methodology, development and implementation

• Experience with outcomes assessment

• Extensive knowledge of, and involvement with Participatory Disease Surveillance and Response training in Indonesia

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Survey Methods

• Approved by Director, Directorate General of Livestock Services of Ministry of Agriculture and President of Indonesian Veterinary Medical Association IVMA

• Translated into Bahasa Indonesia and back-translated into English for modification

• Distributed throughout government veterinary services and to offered to attendees at the 10th

Annual Meeting of the IVMA

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Ten EPHS Applied to HPAI Prevention and Control

In your present position, do you…

1. Conduct surveillance for new cases of HPAI in people or animals

2. Diagnose population-based health problems, including laboratory testing of HPAI

3. Investigate HPAI cases and/or outbreaks

4. Educate the community about HPAI prevention and control

5. Help communities organize to respond to HPAI

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Ten EPHS Applied to HPAI prevention and control

6. Develop programs and policies related to HPAI prevention and control

7. Enforce quarantine, culling, vaccination and animal movement control

8. Provide health services, including preventive health services (including poultry vaccinations for HPAI and Newcastle Disease Virus) and/or treatment for affected people or animals

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Ten EPHS Applied to HPAI prevention and control

9. Control quality of laboratory testing, personnel and training

10.Evaluate HPAI programs and policies

11.Conduct HPAI research

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Results

• 520 veterinarians

– 5.4% academic

– 14.1% private, corporate

– 77.6% government-employed

• All 5 veterinary medical schools (Airlangga, Gadjah Mada, IPB, Udayana, Syiah Kuala)

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Essential Public Health Services

Veterinarians, by Employer Type

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Sur

veillan

ce

Dia

gnos

e

Inve

stigat

e

Edu

cate

Mob

ilize

Policy

Enf

orce

Heal

th S

ervice

s

Ass

ure

Eva

luate

Rese

arch

Essential Public Health Service

Perc

en

t o

f R

esp

on

den

ts

Academia

Government

Other

Results

• A higher proportion of government-employed veterinarians reported conducting surveillance, diagnosis, investigation, education, mobilization, enforcement, health services and policy and program development than did other-employed veterinarians

• A higher proportion of academia-employed veterinarians reported conducting assurance, evaluation and research than did other-employed veterinarians

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Conclusions

• The 10 Essential Public Health Services can be applied to health systems in countries other than the US, particularly where zoonotic diseases are concerned

• Veterinarians (and paraveterinarians) contributed a great deal to HPAI prevention and control in all essential service areas

• Consider conducting a similar study among medical and public health professionals

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Drh. Mahdi Abrar M.Sc., PhD

Dean, Universitas Syiah Kuala

Prof. Hj. Romziah Sidik Budiono PhD, DVM

Dean, Universitas Airlangga

Dr. Drh. I. Made Damriyasa MS

Dean, Universitas Udayana

Prof. Drh. Charles Rangga Tabbu MSc, PhD and Prof. Dr. Drh. Bambang Sumiarto, SU, MSc MSc

Former Dean and Dean, respectively, Universitas Gadjah Mada

Dr. Drh. I. Wayan Teguh Wibawan DVM, MS

Dean, Institut Pertanian Bogor

Deborah T. Kochevar DVM, PhD

Dean, Cummings School of Veterinary Medicine

Tufts University

George Saperstein, DVM

Chair, Department of Environmental and Population Health

Cummings School of Veterinary Medicine

Tufts University

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