MDSC presentation

WORLD HEALTH ORGAI\IZATION REGIONAL OFFICE FOR AT'RICA ORGANISATION MOI\DIALE DE LA SAIITE BUREAU REGTONAL POUR L',AFRTQITE WHO/AFRO - MULTI DISEASE SURVEILLANCE CENTRE (MDSC) OMS/AFRO - CENTRE DE SURVEILLANCE PLLruPATHOLOGIQUE Avenue Naba Zombre N'1473 - 0l BP 549 OUAGADOUGOU 0l - Burkina Faso Tel.:(226)50342953159160 - Fax: (226) 50342875 -50343647-Email:mdsc@oncho.oms.bf MULTI DISEA,SE SUR\mILI,AI ICE CE},[TRE OFOUAGADOUGOU WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR ATRICA DTYISION OF PRVENTION AND CONTROL OF COMMUMCABI,E DISEASES MDSC PRE,SEIYTHTION OMS/WHO BURKINA FASO < Amenet tous les peuples au nive.u de sant6 le plus 6levd possrble r June 2005 TABLE OF CONTENTS Executive summary Background and Justifi cation Mission Objectives Expected Results Strategic Orientation Areas of Intervention Strategy for Implementation Monitoring and Evaluation Budget Page I. il. m. IV. V. VI. vII. VIII. x. K. 2 3 4 4 4 4 6 7 8 9 I I. EXECUTIVE SUMMARY The Multi Disease Surveillance Centre (MDSC) is created to serve as a centre of excellence for disease surveillance in the WHO Africa Region. Established in the premises of the Onchocerciasis Control Programme (OCP), the MDSC inherited the facilities of OCP, including the buildings, the laboratories, the library, and telecommunication equipment. The MDSC will support the WHO African Region countries in the surveillance of onchocerciasis and other communicable diseases such as HIV/AIDS, malaria, and meningococcal meningitis. As the Centre is strengthened, the range of targeted diseases will be expanded and further include Non Communicable Diseases. The core activities of the MDSC includes compilation and in depth analysis of surveillance data, using the information generated to establish disease trends and to predict epidemics. Particular emphasis is laid on integration of laboratory into disease surveillance. The Centre will offer to WHO Member States of the region, facilities and mechanisms for training of epidemiologists, entomologists and laboratorians, laboratory quality assurance and quality control, and exchange of key epidemiolo gical information. The project for strengthening the MDSC covers a span of three phases. Phase I (2001-2003) was the creation and establishment of the MDSC as a unit of the World Health Organization, Regional Office for Africa (WHO/AFRO). During Phase 2 (2004-2005), the activities of the MDSC were to cover surveillance of onchocerciasis, malaria, HIV/AIDS and epidemic meningitis. However due to lack of funding surveillance was established for only two diseases namely Onchocerciasis and epidemic meningitis. Resources permitting the Phase 2 will now be extende d to a 2"d biennial planning periods, 2006 - 2007 during which surveillance on Malaria and HIV/AIDS will be initiated and entomological based surveillance on vector borne diseases consolidated. During the third phase (2008-2009 and 2010-2011) the MDSC will expand the range of diseases under surveillance to include other communicable and non- communicable diseases of public health importance. Resources permitting strengthen its laboratory capacity with a P2 Laboratory and engage in the surveillance of virulent diseases of the region including Lassa fever, Ebola, HIV and other viruses. By the end of 2012 MDSC should be fully operational, thus exerting the role of a centre of excellence in the area of disease surveillance that Member States can rely on for support. The MDSC is establishing linkages with the countries of the region, and with partners involved in disease surveillance. The World Health organization will contribute significantly to the resources of the MDSC in terms of facilities, staffing, and operational costs and would welcome the support of partners. The WHO contributions will need to be complemented with extra-budgetary funds. The estimated budget for phases 2 and 3 amounts to 20,063,500USD. The purpose of this document is to present the objectives and interventions capacity of the MDSC and to provide an estimate of the resources needed for the second and third phases of operation. 2 III. BACKGROUND The African region is still confronted with a high burden of communicable diseases while non-communicable diseases are also on the increase. The estimated burden of communicable diseases in the region represented 60 oh of the total disability-adjusted life years (DALYS) in 2000. HIV/AIDS alone accounted for nearly 23 oh of all deaths in the region and malaria for 9.1 yot . Epidemic-prone diseases cause frequent disruption in social and economic life and perturbations in the functioning of already weak health systems. West Africa is particularly subjected to deadly outbreaks of meningococcal meningitis, yellow fever and cholera affecting mainly children. During the year 2000, 45,529 cases and 5,264 deaths attributed to meningococcal meningitis were reported to the World Health Organization. In the same year, cholera caused 98,620 cases and 3,908 deaths. Yellow fever outbreaks were reported from Liberia, Benin, Guinea Conakry and Sierra Leone.2 A key component of disease prevention and control is an effective surveillance system able to provide timely information on disease trends for action. Operational National Disease Surveillance systems therefore constitute the cornerstone to effective disease control. Such systems provide basic data for planning, resource allocation, resource mobilization, early epidemic detection and response, and evaluation of results and impact of health interventions. Taking into account that the surveillance system in the African Region is still not contributing efficiently to communicable diseases control, the Regional Committee for Africa in 1998 decided to implement the Integrated Disease Surveillance (IDS) strategy in the region, (Resolution AFRO/RC58/R2). In this line MDSC was created and installed in the OCP premises in Ouagadougou. The Centre will serve as a centre of excellence and a reference point for surveillance with the capacity to forecast epidemics, monitor the occurrence and spread of resistant strains of disease through its well-equipped laboratory and perform research activities as well. The MDSC will preserve the gains achieved by OCP in Onchocerciasis control. Today, onchocerciasis is no longer a major public health problem, nor it is an obstacle to socio-economic development in West Africa. Maintaining the gains achieved by OCP will require sustaining onchocerciasis surveillance and integrating it into national disease surveillance systems. MDSC will build on the effective epidemiological and entomological surveillance developed by OCP. It will provide continuing surveillance support to countries where onchocerciasis has been controlled in order to detect early recrudescence of the disease. The Centre could also continue to follow up and support Onchocerciasis research activities that are not completed at the closure of the programme in December 2002. The quality of laboratory diagnosis to support surveillance in member states will be strengthened and monitored. I The World Health Report 2001. 2 Report from Member States to WHO/AFRO 2 3 4 J III. MISSION 5 The mission of the Multi Disease Surveillance Centre is to provide high level technical support to Member States in surveillance for onchocerciasis and other priority communicable diseases3 IV. OBJECTIVES 6. The specific objectives of the MDSC are the following To provide critical information to African countries for the effective management of priority communicable disease prevention and control programmes, To provide continuous entomological and epidemiological surveillance support to countries to maintain the achievements of OCP; To offer facilities for high level quality assurance to the laboratories and diagnostic services of African countries, To predict the anti-microbial susceptibility of aetiological agents of priority communicable diseases; To predict the occurrence of epidemics of priority communicable diseases in the African region; To facilitate the exchange of information between countries that is critical for effective prevention and control of priority communicable diseases; To contribute to in-service training for priority communicable diseases to Nationals in-charge of surveillance; To initiate/participate in research activities leading to the better understanding of the major communicable diseases of the region. V. EXPECTED RESULTS Contribution to good decision making for the prevention and control of epidemics and communicable diseases by providing timely information to countries. Contribution through training to build national capacity for the prevention and control of epidemics and communicable diseases. Contribution of MDSC laboratory to the surveillance activities and control of communicable diseases in countries established. a a o o o a a 7 8 9 vI. 10. 11 Achievements of OCP maintained in countries. STRATEGIC ORIENTATION Tracking major communicable and epidemic prone diseases A system of high level analysis of surveillance data has been set up to provide accurate information to countries for timely decision making and contribute to the 4 ' Initially HIV/AIDS, Malaria & Meningitis o t2 l3 t4 15. 16. l7 18 global alert system. In addition a specific entomological and epidemiological surveillance system is being put in place to support countries to prevent the recrudescence of Onchocerciasis in former OCP target countries. Reaction time and frequency of epidemics will be reduced to contribute to the reduction of morbidity and mortality and surveillance, communicable disease prevention and control interventions will also be improved through widely used research. Promotion of communication The Centre will set up to become a hub for the sharing of surveillance information between countries and with partners. This will be used as a proactive tool for response to epidemics and communicable disease of the geographical area concerned. Building capacity Countries will be supported to build and improve National capacities related to surveillance and laboratory investigations for communicable disease control. For this purpose the Centre will offer relevant training and guidelines. Exchange of technical staff with similar centres and institutions will be promoted to enhance cross- fertilisation of ideas and improve skills. Development of database The Centre will expand its database for the major endemic communicable diseases. This database will be accessible to countries and partners and will complement the global database of AFRO. Building partnership The member states will regularly provide epidemiological data and information related to communicable diseases and surveillance of Onchocerciasis to the Centre through WHO country offices. The WHO inter-country teams in sub-regions of Africa will be major collaborators since they will be in the front line of epidemics. In return, the Centre will perform in-depth data analysis, including sub-regional trends and predictions and provide feedback to the countries The Centre will establish partnership with other institutions and organisations serving similar purposes. The partnership will be complementary and will include Research Institutions, Disease Surveillance Institutions, Training institutions, Reference Laboratories, and Sub Regional health organisations. The MDSC will also promote and build partnership with Bilateral and Multilateral organizations interested in the reduction of morbidity and mortality due to the major communicable diseases. 5 VII. AREA OF INTERVENTION 19 Epidemiological surveillance The MDSC is a source of technical advice and support for the implementation of Integrated Disease Surveillance and Response [DSR). To this effect, it assists countries in the preparation of surveillance guidelines and tools, formulation/revision of strategic disease surveillance plans and evaluation of surveillance activities. The MDSC compiles and analyses data on epidemic-prone diseases from Member States in order to establish epidemiological trends and predict future epidemics. Non- communicable diseases arc anemerging problem in Africa. MDSC will initiate studies on the epidemiology of NCDs and advise Member States accordingly. 20 Entomological Surveillance The MDSC will continue to support member states in the surveillance of Onchocerciasis based on the gains of the devolution and using the structures and methods already established by OCP. In addition the Centre will support countries in the surveillance of other disease vectors. 2t Laboratory support A key component of priority communicable disease surveillance is the existence of a functional network of public health laboratories able to provide rapid confirmation of aetiological agents. Therefore, the MDSC will establish microbiology, parasitology, virology and basic molecular biology laboratories to contribute to monitoring and prediction of the pattern of resistance of aetiological agents and serve as a reference point in the Region. To support countries in the detection and management of major epidemics beyond their capacity, MDSC will establish a P2 Laboratory and put its services at their disposal. 22. Training The MDSC will organise high level training activities on surveillance and laboratory techniques to contribute to the strengthening of national capacities. Special effort will be placed on the relationship between surveillance and laboratory support in the control of epidemics. 23 Research The Centre will undertake research activities on major communicable disease in order to improve their prevention and control. The Centre will establish scientific collaboration with other research institutions for some of these research activities. The Centre will issue publications as appropriate on the outcome of the researches. 24 Data Management Information Technology and Data Management are essential to handle the volume of surveillance data expected in the MDSC. The current Data management unit under the Directors office will be strengthened to provide support to all the units. Library/Documentation Centre. The Documentation Centre has archived all that was ever written about the Onchocerciasis Control Programme. To support the pioneering work of OCP, this centre subscribed to several journals on parasitology and medicine, today the journals 6 25 have been reviewed to reflect the multi disease scope of the MDSC. The library will continue to be the source of information and literature reviews during research. 26 Communication network OCP had a radio network with about 45 stations. MDSC has negotiated with the countries to transfer at least one of the radios to the National Disease Surveillance Unit/Division to facilitate direct communication with MDSC. Four radios have been replaced with new models with modems and relocated. This process will need to be continued. V[I. STRATEGY FOR IMPLEMENTATION (a) Management 27 The MDSC will be under the supervision of the Director of Prevention and Control of Communicable diseases, DDC division of WHO/AFRO. To facilitate the participation of partners, a Steering Committee incorporating representatives of partners will be appointed to over see and mobilise resources for the work of the MDSC. A scientific Advisory Committee will be appointed by WHO/AFRO to ensure that MDSC covers issues of global interest to all parties. The Centre's organisational structure is as shown in appendix l. There are seven main units, Directorate, Administration and support, Information technology and Data Management, Epidemiology, Entomology, Laboratory, and Documentation. Research and training will be an activity within each unit. (b) Inputs Existing resources The MDSC is established in the WHO facilities formerly used by the Onchocerciasis Control Programme, in Ouagadougou, Burkina Faso. These facilities include a three- story building with office space, meeting rooms, a DNA laboratory and a documentation centre and are currently shared with the African Programme for Onchocerciasis Control (APOC). 29 The DNA laboratory uses polymerase chain reaction techniques (PCR) for the differentiation of Onchorcerca volvulus strains and Simulium damnosum, complex, the vectors of Onchocerciasis. The technique will be employed in other vectors and the identification of aetiological agents not easily detected by the conventional laboratory methods. 28. 30. 31 Communication facilities include a radio network connecting all OCP countries to Ouagadougou, an Internet server and a well equipped garage to ensure that the field vehicles are well maintained. These resources have been handed over to the World Health Organisation at the termination of OCP, in December 2002. They benefit the implementation of the activities of the MDSC and APOC. The level of additional resources needed depends on the phase of implementation of the project. During the first phase, the MDSC has co-existed with OCP supported 7 32 33. 34 37 38 (c) Implementation Schedule 35 The MDSC will be implemented in phases. For the moment 4 major diseases that are contributing to high disease burden and poverty are targeted: Onchocerciasis, Malaria, HIV/AIDS and Meningitis. With limited resources, the Centre has started with Onchocerciasis and Meningitis. The Centre with the expansion of its capacity will later on cover other priority communicable and non-communicable diseases that are of public health importance. Initially the Centre will start with West Africa and expand its geographical coverage to the rest of the WHO Africa region when resources permit. The first phase (2001-2003) focused on building the MDSC management structure and technical capacity. The Centre also participated in the devolution process and in defining the role of the Centre post OCP. The second phase (2004-2005) the MDSC focused on establishing a framework for surveillance on Meningitis and built functional relationship with countries to maintain entomological and epidemiological surveillance activities on Onchocerciasis to ensure that the gains of OCP are sustained. The laboratory function has been adapted to the orientation of the Centre and its scope of activities expanded. The communication system is being adapted and strengthened to facilitate communication with Member States. 36. with resources from existing programmes of the Division of Communicable Diseases Prevention and Control of WHO/AFRO. During the 2nd phase of expansion, the cunent personnel will be augmented to meet the growth of activities. The office equipment inherited from OCP will be upgraded or replaced. The resources needed in the third phase are reflected in the 6year strategic plan which is presented in biennial work-plans. Basically, there will be need for additional experts, additional and up-to-date facilities and equipment. The budget estimates for the different phases in detailed in the attached work plan. The third phase (2006-2011) will aim at strengthening laboratory capacity and expanding the MDSC's scope of work. It will focus on country support for more accurate decision making in communicable and epidemic prone diseases control, and the strengthening of national capacities. This will meet the expectations of Member States, regional priorities and create opportunities for partnership. Ix. MONITORING AND EVALUATION 39 A scientific committee will be established for monitoring and evaluation of the MDSC. The committee will be composed of independent scientific personalities. Their orientation will be sought whenever the need arises. The Centre performance will be reviewed by the Steering Committee annually, but the Centre will also submit a quarterly and semestrial report of activity to WHO/AFRO. At each annually Regional Committee meeting, a report on achievements of the 40 8 Centre will be submitted. A mid term review will be conducted at the end of the first phase and a biennial evaluation at the end of each biennial period. All reports will be made available for partners consideration. 41. Indicators Monitoring indicators - Presence of functional bacteriology, parasitology, virology and molecular biology laboratories - Presence of a functional network of epidemiological data transmission systems in Africa - Presence of an updated database on priority communicable diseases at the MDSC - Presence of key staff to run the MDSC - Updated and regular disease surveillance bulletins Improved public health laboratory quality control and quality assurance for priority communicable diseases in Africa Updated documentation of antimicrobial resistance and priority communicable disease trends in Africa Tested predictive models for the occurrence of epidemics in Africa Significant contributions of the MDSC to improved disease surveillance in Africa. X. BUDGET A biannual work plan will be prepared in accordance with WHO/AFRO schedules based on available resources. A ten years proposed strategic plan for 2006-2015 is available for your consideration. 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