International Networks in Public Health

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International Networks in Public Health the
linkage with National Networks
Dr Maureen BirminghamWHO representative to
Thailand
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This presentation

• Definition of a network
• Roles of a public health network
• Examples - CDs, NCDs, surveillance
• What makes a good network?

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What is a Network?

• an interconnected system of things or people
• an association of individuals having a common
  interest, formed to provide mutual assistance,
  helpful information, or the like

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Role of Public Health Networks

• Sharing to strengthen capacity or inform those
  who need to know (on a specific issue)
• Experiences
• Knowledge
• Expertise
• Methods/tools
• Information/data
• Collaborate on a specific issue or problem(e.g.
  research network)
• Advocate for needed actions/resources

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Some examples

• NCDnet

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Global Network to combat Non-Communicable
Diseases NCDnet
Mission Help implement the global Strategy Action Plan
Catalyze country-level implementation
Raise awareness
Increase resource availability
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Growing importance of Non-Communicable Diseases
(NCDs) Cause of deaths in the world
25 million
2.3M
6.8 M
Source
20 million
2.3M
3.7M
15 million
10.2M
13.6M
10 million
0.5M
5.9M
0.6M
3.3 M
3.3M
3.0M
3.0M
1.1M
0.9M
High-income countries
Lower middle-income
Upper middle-income
Low-income countries
Group III - Injuries
Low-income countries
Group II Other deaths from noncommunicable
diseases
Group II Premature deaths from noncommunicable
diseases (below the age of 60), which are
preventable
Group I Communicable diseases, maternal,
perinatal and nutritional conditions
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Advocacy to promote action There are low cost
interventions to prevent NCDs
Disease/risk factor Intervention Cost of implementation (Low lt I1 per capita High gt I2 per capita) Health impact (DALYs per 1m popn) (Small lt 100 Large gt 1,000) Cost-effectiveness (I per DALY averted) (Very lt GDP per capita Quite 1-3 GDP per capita)
Risk factors Tobacco use Excise tax on tobacco products Low Large Very cost-effective
Risk factors Tobacco use Smoke-free workplaces Low Modest Quite cost-effective
Risk factors Tobacco use Packaging, labelling and awareness countermeasures Low Modest Very cost-effective
Risk factors Tobacco use Comprehensive ad bans Low Modest Very cost-effective
Risk factors Harmful use of alcohol Excise tax on alcoholic beverages Low Modest Very cost-effective
Risk factors Unhealthy diet and physical inactivity Reduce salt intake Low Large Very cost-effective
Risk factors Unhealthy diet and physical inactivity Food taxes (fat) and subsidies (fruit and vegetables) Low Modest Very cost-effective
Risk factors Unhealthy diet and physical inactivity Intensive counselling Very high Large Quite cost-effective
NCDs Diabetes Glycaemia control High Large Quite cost-effective
NCDs Cardiovascular diseases Hypertension drug treatment Low Large Very cost-effective
NCDs Cancer Treatment of 1st stage breast cancer Low Modest Very cost-effective
NCDs Cervical cancer screening (PAP smear) and treatment Low Modest Very cost-effective
NCDs Respiratory disorders Inhaled corticoid-steroids for asthma Low Small Quite cost-effective
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Advocacy to create new perspectives on NCDs and
investments to control them
World Economic Forum Global Risk 2010 Report
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Communicating a clear global vision on how to
move forward
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Roadmap for implementation in countries

• 6 objectives
• 1. Raise priority of NCDs integrate NCDs control
  into all public policies
• 2. Strengthen national policies and programmes
• 3. Address risk factors
• 4. Prioritize research
• 5. Strengthen partnerships
• 6. Monitor NCD trends

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SEANET-NCD

• Objectives
• Contribute to the global efforts
• Facilitate national NCD networks
• Share experience, expertise, resources
• Collaborate in research
• Advocate mobilize resources
• Strengthen national NCD policies and strategies
• Support capacity building

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What is INFOSAN?

• A global network of national food safety
  authorities, established in 2004 to
• Promote information exchange of important food
  safety issues
• Respond to food safety emergencies
• Help countries strengthen their capacity to
  manage food safety risks
• As of today, there are 177 country members of
  INFOSAN

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Structure of INFOSAN
INFOSAN Secretariat International Food Safety
Authorities Network
WHO surveillance response
systems
Advisory Group
INFOSAN Focal point in Food Safety Authority
INFOSAN Focal point in Agriculture Sector
INFOSAN Focal point in other Sectors
INFOSAN Emergency Contact Point
INFOSAN Focal point in Health Sector
INFOSAN Focal point in Trade Sector
Counterparts across the farm to table continuum
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ExampleMelamine Contamination of Infant Formula

• Melamine added in the primary production sector
  (milk collection centres) to disguise the
  dilution of milk with water
• 22 of 79 Chinese producers of powdered infant
  formula were affected
• Products from affected producers exported to 5
  countries
• Levels detected range from lt0.1 2600 mg/kg

gt294,000 children ill gt50,000 hospitalized 6
deaths
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Other products contaminated

• milk (powder), yoghurt, biscuits, instant
  liquid coffee preparations
• egg powder, fresh eggs, animal feed
• Sodium bicarbonate (raising agent)
• Exports reported all over the world

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Measures Taken by INFOSAN

• Secured websites
• INFOSAN provided regular updates of information
  to its emergency network
• Close collaboration with Chinese MOH
• Collaboration with affected countries to verify
  information and provide alerts
• Assistance to countries on laboratory
  information, analytical methods, safety limits
  etc.
• Public Websites
• Special websites set up to provide continuous
  updates to the public

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The global polio eradication initiative
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Global Laboratory Network for Polio Eradication N
145 laboratories
















































































































































Specialised Reference Laboratory
Regional Reference Laboratory
National/ Sub-national Laboratory
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Structure of the polio laboratory network Every
country need not have the same capacity
networking provides access to services
Liaises with immunization surveillance personnel
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Mekong Malaria Programme networking
ACTMalaria Foundation Armed Forces Research
Institute of Medical Sciences (AFRIMS) American
Refugee Committee (ARC) Asian Development Bank
(ADB) Bill Melinda Gates Foundation (BMGF) CDC
MOH Thailand (TUC) Center for Disease Control
(CDC) Atlanta Family Health International
(FHI) Health Unlimited (HU) Institute Pasteur
Cambodia Institute of Tropical Medicine (ITM)
Antwerp, Belgium International Office for
Migrations (IOM) INTERPOL Japanese Ministry of
Health Kenan Institute Asia (Kenan) Mahidol-Oxford
-Wellcome-trust Research Unit (MORU) Malaria
Consortium Management Sciences for Health
(MSH/RPM) MEASURE / evaluation Medecins Sans
Frontieres (MSF) Medicine for Malaria Venture
(MMV) MEKONG COUNTRIES(MOH) National academies /
Research Institutions Partners for Development
(PFD) Population Services International
(PSI) SEAMEO TROPMED SOKHLO Malaria Research Unit
(SMRU) Tropical Diseases Research
(TDR) University Research Co (URC) US
Pharmacopeia / DQI USAID-RDM-Asia World Food
Programme (WFP) WHO Collaborating Centers WHO
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Technical Networking Workshop every 2-3 years
since 1999 Last technical consultation in Phuket,
Thailand in September 2007
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Build evidence of malaria drug resistance,
Prepare a multi-country response
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Qinghaosu - Artemisinins
Rapid action, broad stage specificity, safe,
gametocytocidal
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More study sites of the intensified TES
(Therapeutic Efficacy Studies) network to better
understand malaria drug resistance
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Artemisinin resistance, the doom scenario
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EWGLINET

• European surveillance scheme for
  travel-associated legionnaires' disease network
• aims
• reduce incidence of travel associated
  legionellosis
• provide an early warning system
• objectives
• maintain a European surveillance
• detect a common source
• inform all those need to know about
  travel-associated Legionellosis
• inform the public

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Strengthening Global Networksfor Health Security
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Epidemics and Pandemics have shaped our history
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They continue to threaten us..
WHO has detected assessed gt 2,800 events during
2001 to 2009
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Modeling EID events Relative risk of an EID
Hot Spots global distribution of relative risk
of an EID event caused by zoonotic pathogens from
wildlife, (Jones Nature, 2008).
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The Global Outbreak Alert and Response Network
(GOARN)

• Assist countries with disease control efforts
• Investigate events and assess risks of rapidly
  emerging epidemic disease threats
• Support national outbreak preparedness

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GOARN includes gt 190 technical institutions and
networks coordinating actions and resources to
respond to public health events of international
concern.
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GOARN partners have provided experts for gt 104
operations in 75 countries for 197 missions.
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GOARN deployments (as of April 2009)
Disease outbreaks Deployments
Ebola 10 286
Avian Influenza 21 206
Marburg 2 122
SARS 5 81
Yellow Fever 8 58
Cholera 3 52
Rift Valley Fever 5 42
Tsunami 3 40
Meningitis 2 14
Other 17 168
Total 76 1007
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GOARN direct technical assistance and field
support

• Materials
• Expertsepidemiology, public health, infection
  control, case management, risk communication,
  crisis management, logistics, laboratory,
  contingency planning
• Teams
• multi-disciplinary experts
• Funding

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GOARN and Specialist Networks
COMBI (Health education)
EDPLN (BSL4 laboratories)
Clinical
GOARN
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What makes a good network

• Clear purpose
• Mutual benefits for all involved
• Ownership
• Clear roles deliverables
• Complementary and efficient division of labor
• Sufficient resources
• Accountability
• Spirit of comradery togetherness

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Conclusion

• Networks exist usually to share something or
  solve something of shared interest
• Networks can help provide access to information,
  expertise, methods, tools
• Networks can be more efficient and effective than
  working alone

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Thank you