Report of the WHO training on ship sanitation inspection and issuance of ship sanitation certificates. 27-30 November 2023, Istanbul, Türkiye

Report of the WHO training on ship sanitation inspection and issuance of ship sanitation certificates 27–30 November 2023 Istanbul, Türkiye Report of the WHO training on ship sanitation inspection and issuance of ship sanitation certificates 27–30 November 2023 Istanbul, Türkiye Abstract Points of entry, including ports, are on the front line in helping to prevent, detect and respond to public health events arising via international traffic. To further improve public health capacities at ports and on ships, the WHO Regional Office for Europe organized an in- person training on ship sanitation inspection and issuance of ship sanitation certificates, which focused on the implementation of the International Health Regulation (2005) core capacity requirements at ports to strengthen workforce development for States Parties in the European Region. Keywords COMMUNICABLE DISEASES, PUBLIC HEALTH, EPIDEMICS Document number: WHO/EURO: 2024-9520-49292-73673 © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY- NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). 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All photos: ©WHO Table of Contents Abbreviations ................................................................................................................................................. v Background ................................................................................................................................................... 1 Objectives ..................................................................................................................................................... 1 Training methodology ................................................................................................................................... 2 Proceedings ................................................................................................................................................... 2 Key Highlights ............................................................................................................................................... 3 Test results and evaluation of the training ..................................................................................................... 4 Discussion ..................................................................................................................................................... 4 References .................................................................................................................................................... 5 Annex 1. Agenda ........................................................................................................................................... 6 Annex 2. List of participants ........................................................................................................................ 10 Annex 3: Evaluation forms ........................................................................................................................... 14 Abbreviations IHR (2005) International Health Regulations (2005) PoE Points of entry SSC ship sanitation certificates VR virtual reality 1 Background Points of entry (PoE), including ports, are at the front line of prevention, detection and response to public health events that may arise via international travel and trade. Historically, ships have played a significant role in the global transmission of infectious diseases (1), and, as enshrined in Annex 1B of the International Health Regulations (2005) (IHR (2005)) (2), ports must be equipped with routine core capacity requirements as well as the core capacity requirements for responding to a public health emergency of international concern. The Action plan to improve public health preparedness and response in the WHO European Region 2018– 2023 (3), introduced at the 68th session of the WHO Regional Committee for Europe in September 2018, highlights PoE as one of the critical areas of its first Strategic Pillar and calls on all Member States to “develop and maintain routine and emergency capacities at designated points of entry and ensure regular evaluation”. To provide guidance on the implementation of health measures on board ships and at ports, WHO developed the Handbook for the management of public health events on board ships (4), the Handbook for inspection of ships and issuance of ship sanitation certificates (5), the Guide to ship sanitation (1) and the online training course on Ship Sanitation Inspection and Issuance of Ship Sanitation Certificate (SSCs) (6). To further improve public health capacities at ports and on ships, the WHO Regional Office for Europe, with support from the WHO Country Office in Kazakhstan, organized an in-person training on ship sanitation inspection and issuance of SSCs, which focused on the implementation of the IHR (2005) core capacity requirements at ports to strengthen workforce development for States Parties in the European Region. Objectives The four-day training brought together participants from Azerbaijan, Kazakhstan and Turkmenistan to learn and share experiences on ship sanitation inspection and issuance of SSCs with delegates from the General Directorate of Health for Borders and Coasts of Türkiye. The specific objectives of the workshop were to: • familiarize participants with the WHO guidance on ship sanitation inspection and the issuance of SSCs; • provide good practice examples from the Turkish experience on ship sanitation inspection from the General Directorate of Health for Borders and Coasts of Türkiye; • provide participants with practical experience through site visits to ports and ships in Istanbul, Türkiye; and • introduce the new virtual reality project on ship sanitation inspection and issuance of SSCs developed by WHO. 2 Training methodology In preparation for the training, the participants were asked to complete the Ship Sanitation Inspection and Issuance of Ship Sanitation Certificate eLearning course (6). A test was administered pre- and post-training to evaluate the level of knowledge of each participant and to subsequently determine knowledge improvement after four days of theoretical and practical learning. Proceedings Thirty-one participants attended the training with representation from four participating countries namely Azerbaijan, Kazakhstan, Turkmenistan and Türkiye. Representatives from the participating countries included officials from the ministries of health, port health officers and other professionals working at ports and PoE. The opening was facilitated by Bibigul Aubakirova, National Professional Officer, WHO Country Office in Kazakhstan, with opening speeches from Fulya Kahraman Aydogan, Deputy Director-General of The General Directorate of Health for Borders and Coasts of Türkiye and Nurtugan Yerubayev, Head of the Department for Coordination of Sanitary Protection Activities at the State Border of the Committee for Sanitary and Epidemiological Control, Ministry of Health, Kazakhstan. The agenda of the training is provided in Annex 1 and a full list of all participants is provided in Annex 2. 3 Key Highlights Day 1. After the opening session, participants from Azerbaijan and Turkmenistan presented their national experiences on ship sanitation and issuances of SSCs. An overview of the ship sanitation inspection programme in Canada was also provided by a facilitator of the training. A test consisting of 25 questions was then administered to participants. The day proceeded with presentations by facilitators from WHO and Türkiye on technical areas under the Ship Sanitation Inspection and Issuance of SSC programme, including areas such as pre-inspection planning, food safety and ship inspection equipment. Day 2. To start the day, a representative from Kazakhstan presented on their country experience with ship sanitation inspection and issuance of SSCs. Technical presentations on areas such as cargo holds, portable water and management of sewage and solid waste were given by facilitators from WHO and Türkiye throughout the rest of the day. Day 3. All participants and facilitators visited the Galataport in Istanbul and were given a tour of the port’s areas and facilities. Participants and facilitators proceeded to visit a cruise ship to conduct an inspection. Subsequently, a visit was paid to the General Directorate of Health for Borders and Coasts of Türkiye for discussions and experience-sharing with delegates from Türkiye, followed by presentations and dialogue on the Turkish ship sanitation inspection programme. Day 4. The day began with a repeat of the test administered on day 1, followed by an introduction to a new virtual reality (VR) training developed by the Learning Solutions and Training unit at the WHO Office in Lyon, France. The VR experience allowed participants to inspect every area of a virtual ship, from engine rooms, to cabins, dining areas and locker rooms. This virtual journey through the ship's corridors and decks, offering over 20 meticulously recreated visiting areas, allowed trainees to feel fully present. After the VR training session, the answers to the test were presented to participants, followed by presentation of certificates of attendance. The training concluded with a course evaluation (Annex 3). 4 Test results and evaluation of the training As described above, the same test consisting of 25 questions was administered pre- and post-training to participants. After comparison of the scores of the two tests, there was a two-point increase in the average scores, indicating an uptake in knowledge during the four-day training. Participants also provided overwhelmingly positive feedback in the course evaluation. They indicated that the training was well-organized, the technical content was comprehensive and well-understood, and requested for more national trainings on ship sanitation inspection and issuance of SSC to be organized. Discussion Throughout the training, participants highlighted some challenges, such as the lack of legislative support at the national level for the mechanisms to issue SSCs, and the need for national trainings for port health officers. They also mentioned the need to create awareness for shipowners’ associations on the importance of ship inspections and the issuance of SSCs. Some recommendations for improving this area of work included the establishment of a unified form for the sanitary documentation of ships from Caspian Sea countries, the transition of documents to electronic formats, regular exchanges of experience between countries bordering the Caspian Sea and the establishment of an interstate warning system in the event of an outbreak of particularly dangerous infections. WHO reiterated its commitment to support countries in developing capacities for ship sanitation inspections and issuance of SSCs, especially with the new VR tool that can be used to remotely train port health officers and other professionals working at ports. 5 References1 1. Guide to Ship Sanitation, 3rd Edition. Geneva: World Health Organization; 2011 (https://iris.who.int/handle/10665/43193). 2. International Health Regulations (2005) – Third edition. Geneva: WHO Regional Office for Europe; 2016 (https://iris.who.int/handle/10665/246107). 3. Action plan to improve public health preparedness and response in the WHO European Region 2018–2023. Copenhagen: WHO Regional Office for Europe; 2019 (https://iris.who.int/handle/10665/312235). 4. Handbook for the management of public health events on board ships. Geneva: World Health Organization; 2016 (https://iris.who.int/handle/10665/205796). 5. Handbook for inspection of ships and issuance of ship sanitation certificates. Geneva: World Health Organization; 2011(https://iris.who.int/handle/10665/44594). 6. Ship Sanitation Inspection and Issuance of Ship Sanitation Certificate Training course. Geneva: World Health Organization; 2016 (https://extranet.who.int/hslp/training/course/index.php?categoryid=24). 1 All weblinks were accessed 26 February 2024 6 Annex 1. Agenda WHO training on ship sanitation inspection and issuance of ship sanitation certificates Istanbul, Türkiye. 27 November 2023–30 November 2023 Provisional Programme Day 1: Monday, 27 November Time (local time) Topic Facilitators 8:30–9:00 Registration WHO Country office in Kazakhstan 9:00–9:45 Opening session 1. Welcome address 2. Introduction of participants 3. Expectation of the training course 4. Learning package overview and objectives 5. Logistics 6. Group photo Kevin Carlisle, Consultant WHO Health Emergencies Programme WHO headquarters; Yahya Alameşe, Unit Head/Director for Health Services for Seas and Straits, The General Directorate of Health for Borders and Coasts of Türkiye. 9:45–10:15 National experience on ship sanitation Azerbaijan, Kazakhstan and Turkmenistan 10:15–10:30 Participants experience and comments on ship sanitation inspection eLearning Group discussion: Kevin Carlisle 10:30–10:45 Pre-test Kevin Carlisle 10:45–11:15 Coffee Break 11:15–11:45 International Health Regulations (2005) (IHR (2005)), the IHR (2005) monitoring and evaluation framework, and point of entry capacities Jennifer Addo, Consultant WHO Health Emergencies Programme, WHO Regional Office for Europe. 11:45–12:15 Ship sanitation legal framework Yahya Alameşe 12:15–13:15 Lunch break 13:15–13:45 Types of ship Yahya Alameşe 13:45–14:15 Pre-inspection planning Yahya Alameşe 14:15–14:45 Ship inspection equipment Kevin Carlisle 7 14:45–15:15 Coffee break 15:15–15:30 Indoor air quality and air conditioning Kevin Carlisle 15:30–15:45 Childcare facilities Kevin Carlisle 15:45–16:30 Food safety (galley and stores) Kevin Carlisle 16:30–16:45 Daily evaluation Kevin Carlisle /Yahya Alameşe Day 2: Tuesday, 28 November 9:00–9:15 Ice breaking activity Kevin Carlisle /Yahya Alameşe 9:15–10:00 Medical facilities and medical waste Kevin Carlisle 10:00–10:15 Cargo holds Kevin Carlisle 10:15–10:30 Engine room Kevin Carlisle 10:30–11:00 Coffee break 11:00–11:45 Potable water Yahya Alameşe 11:45–12:30 Swimming pools and spas Yahya Alameşe 12:30–13:30 Lunch 13:30–14:00 Quarters Kevin Carlisle 14:00–14:30 Ballast water Kevin Carlisle 14:30–15:00 Vector control on ships Kevin Carlisle 15:00–15:30 Coffee break 15:30–16:00 Sewage and solid waste Yahya Alameşe 16:00–16:45 Issuance of ship sanitation certificates Yahya Alameşe 16:45–17:00 Daily evaluation and instructions for ship visit Kevin Carlisle /Yahya Alameşe Day 3: Wednesday, 29 November 9:00 Departure to conduct inspection on designated training vessel Arrival at port (15–30 minutes) Rules and procedures for ship inspection Port Safety Port representative (2–3 hours on board) Ship inspection All participants and two facilitators visit the ship Kevin Carlisle /Yahya Alameşe Departure back to training classroom 13:00–14:00 Lunch 14:00–16:00 Site visit: Turkey Health Directorate and national experience from Turkiye Yahya Alameşe (10 minutes) Evaluation Day 4: Thursday, 30 November Participants will be divided into two groups. 9:00–11:00 Group 1: Maritime incidents of public health concern Kevin Carlisle /Jennifer Addo 8 Areas to discuss using case studies include: • contingency planning • notification alerting • response/recovery Group 2: Guided through virtual reality vessel to re-visit inspection principles and practices 11:00–11:30 Coffee break 11:30–13:30 Group 1: Guided through virtual reality vessel to re-visit inspection principles and practices Group 2: Maritime incidents of public health concern Areas to discuss using case studies include: • contingency planning • notification alerting • response/recovery Will be discussed using case studies Kevin Carlisle /Jennifer Addo 13:30—14:00 Answers and discussion of pre-test Kevin Carlisle 14:00—14:30 Group evaluation and closing ceremony Certificates of completion 14:30-15:30 Lunch 9 10 Annex 2. List of participants2 Azerbaijan Huseyn Qasimov Chief Inspector, Sanitary and quarantine service of the Medical Services Department Kazakhstan Galymzhan Mamirov Head Sanitary and Quarantine Control, Seaport of Aktau Department of sanitary and epidemiological control in transport of the Committee for Sanitary epidemiological control Nurtugan Yerubayev Head Coordination Department of Sanitary protection activities in state border of the Committee for Sanitary epidemiological control, Ministry of Health Zhanar Urazalina Head Department of Sanitary epidemiological control in transport of the Committee for Sanitary epidemiological control, Ministry of Health Zhanat Nukibayev Head of the Occupational Safety and Industrial Safety Service of the Joint Stock Company National Company, Aktau Sea Commercial Port. Gulya Kembayeva Deputy Head Department of sanitary and epidemiological control in transport of the Committee for Sanitary epidemiological control Ainagul Kuatbayeva Deputy Chairman of the Board of the Republican State Enterprise on the Right of Economic Management “National Center for Public Health” of the Ministry of Healthcare of the Republic of Kazakhstan. Dinara Alibekova Chief Specialist of the Department of Sanitary and Quarantine Control of the Kuryk seaport 2 Affiliations are given based on the level of detail provided by the participants themselves. 11 Department of Sanitary and Epidemiological Control in Transport of the Sanitary and Epidemiological Control Committee Ministry of Health of The Republic of Kazakhstan Aigul Manasbay Chief Expert of the Water Transport Department of the Transport Committee of the Ministry of Transport of the Republic of Kazakhstan Baurzhan Utepov Head of the loading and unloading complex of the "National Company "Aktau Sea Commercial Port" Joint-Stock Company Talgat Ospanov Deputy Director General for Port Operations Kuryk. Turkmenistan Gurbangul Ovliyagulova Head of high dangerous diseases control department, State Sanitary and Epidemiological Service, Ministry of Health and Medical Industry of Turkmenistan Vadim Strelsov Head of sanitary-quarantine point, Turkmenbashy Sanitary and Epidemiological Service, State Sanitary and Epidemiological Service, Ministry of Health and Medical Industry of Turkmenistan General Directorate of Health for Borders and Coasts of Türkiye. Fulya Kahraman Aydogan Deputy Director-General The General Directorate of Health for Borders and Coasts of Türkiye Yahya Alameşe Unit Head/Director for Health Services for Seas and Straits The General Directorate of Health for Borders and Coasts of Türkiye Murat Ayyıldız Unit Head/Director for Health Services for Air and Lands The General Directorate of Health for Borders and Coasts of Türkiye Aysegul Kanat Deputy expert The General Directorate of Health for Borders and Coasts of Türkiye Derman Gosterit Deputy expert 12 The General Directorate of Health for Borders and Coasts of Türkiye Samil Ucak Deputy expert The General Directorate of Health for Borders and Coasts of Türkiye Yeliz Alacahan Deputy expert The General Directorate of Health for Borders and Coasts of Türkiye Nil Toksoy Deputy expert The General Directorate of Health for Borders and Coasts of Türkiye Zuleyha Tekin Deputy expert The General Directorate of Health for Borders and Coasts of Türkiye World Health Organization Kevin Carlisle Consultant WHO Health Emergencies Programme WHO headquarters Jennifer Oderkie Addo Consultant WHO Health Emergencies Programme WHO Regional Office for Europe Bibigul Aubakirova National Professional Officer WHO Country Office in Kazakhstan Samal Danbayeva Programme Assistant WHO Country Office in Kazakhstan Jean-Paul Gressard Technical officer WHO Health Emergencies Programme WHO headquarters 13 Others Andrei Romanenko Photographer Aliya Seitkanova Translator Maria Beat-Ponomarenko Translator Fırat İslam Translator 14 Annex 3: Evaluation forms You have recently taken part of our Learning Programme. Now, do you find that you have achieved the following learning objectives? Satisfaction survey In order to improve our events, we would like you to complete the following questionnaire. It takes just few minutes. Thank you. A. General organization Concerning the organization of this workshop, how much are you satisfied about each item below? Fully achieved Partially achieved Not achieved Not relevant for me Have a better knowledge and understanding of the Inspection scope, processes and framework (legal aspects of the ship Inspection) Have the competencies and skills to coordinate/interact with stakeholders involved in ship inspection Have the competencies and skills to carry out effective risk assessment about ships calling at ports Have a better understanding of steps for effective management of public health emergencies Assess risk based on relevant findings during ship inspection Communicate results of inspection to other professionals and crew Perform ship inspection according to technical and ethical standards Collect relevant documents and data in each technical areas of the ship Perform on-site measurements Recommend health measures Issue ship sanitation certificates and evidence report forms 15 B. Classroom activities Concerning the classroom learning activities you have been a part of, how much are you satisfied about each item below? Satisfied Partially satisfied Not satisfied at all Not relevant Theoretical contents? Interactivity among trainers and trainees during theoretical sessions? Satisfied Partially satisfied Not satisfied at all Not relevant Welcome and registration Objectives of the event Agenda Course materials Administrative support availability Travel arrangements Location of the course Transport from the airport to the hotel Transfers between the hotel and the port (inspection activities) Hotel facilities Meals Yes No Was the time for each activity enough? Did you find teachers reachable (to ask question, discuss particular problems, etc…)? Did you find that the teachers were competent in their fields? 16 C. On board activities Concerning the on board activities you have been a part of, how much are you satisfied about each item below? D. Final considerations Overall comments Satisfied Partially satisfied Not satisfied at all Not relevant Safety information before boarding Security clearance for access to the port Appropriateness of ship for the exercise Facilitation of the inspection by crew Availability of personal protective equipment Demonstration on board Interactivity among trainers and trainees on board ship Yes No Was the time for each activity sufficient? Did you find teachers reachable (to ask question, discuss particular problems…)? Did you find that the teachers were competent in their fields? Satisfied Partially satisfied Not satisfied at all Not relevant Have you been satisfied by the sharing of best practices with other trainees? Is the course relevant to your job role? 17 The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands (Kingdom of the) North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Türkiye Turkmenistan Ukraine United Kingdom Uzbekistan Document number: WHO/EURO: 2024-9520-49292-73673 World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eurocontact@who.int Website: www.who.int/europe