Dengue Dengue Strategic Plan for the Asia-Pacific Region (2008-2015)

7/29/2019 Dengue Dengue Strategic Plan for the Asia-Pacific Region (2008-2015)

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THE DENGUE STRATEGIC PLAN

FOR THE ASIA PACIFIC REGION

20082015

World Health OrganizationWorld Health OrganizationWorld Health OrganizationWorld Health Organization

Regional Office for South-East Asia Regional Office for the Western PacificWorld Health House United Nations. Avenue, ErmitaMahatma Gandhi Road 1000 ManilaNew Delhi PHILIPPINESINDIA


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Executive Summary

The Dengue Strategic Plan for the Asia Pacific Region (20082015) has been

prepared in response to the increasing threat from dengue. Among an estimated 2.5 billion

people at risk globally, about 1.8 billion (more than 70%) reside in the Asia Pacific Region.

Development of this Strategic Plan is also important to meet the requirements of the

International Health Regulations (IHR) 2005. The goal is to reverse the rising trend of

dengue in the countries in the Region.

Countries in the Region vary in terms of their preparedness, their capacity to

respond and in the allocation of financial resources in the prevention and control of dengue.

The Strategic Plan provides generic recommendations to allow its local adaptation.

Dengue does not respect international boundaries. Effective dengue control is not

possible if control efforts are limited to one country or a few countries. It requires the

adoption of a regional approach through collaboration among countries and sustained

partnerships to enable countries to implement evidence-based interventions and the use of

best practices.

The Dengue Strategic Plan for the Asia Pacific Region will assist countries to

enhance their outbreak preparedness and response, and limit dengue epidemics througheffective prevention and control. The Strategic Plan should be implemented in harmony

with the Strategic Framework for the Asia Pacific Dengue Partnership (APDP).

A key component of the Dengue Strategic Plan for the Asia Pacific Region is the

Log Frame, which can be used as a road map to develop or improve upon existing national

operational plans; to build capacity and strengthen health systems; to establish networking;

to harmonize with the APDP strategic framework for mobilization of resources; to sustain

ongoing information exchange; and to advocate for prevention and control of dengue. It

should also assist in increasing access to innovation, including tools for the diagnosis,prevention and treatment of dengue.


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1. Introduction

Dengue is the fastest emerging arboviral infection. The maximum burden is borne by countries

of the Asia Pacific Region. Among an estimated 2.5 billion people at risk globally, about 1.8 billion

more than 70%reside in Asia Pacific countries. Its epidemiology is rapidly evolving, with increased

frequency of outbreaks and expansion to new geographical areas that were previously unaffected.

Mortality is highest during the initial period of the outbreak or epidemic. Children in particular are at

high risk of mortality as a result of complications and lack of access to prompt treatment.

The progressive worsening of dengue in the Asia Pacific Region is attributed to unplanned

urban development, poor water storage and unsatisfactory sanitary conditions, all of which contribute

to the proliferation of the main vector, the Aedes aegypti mosquito. High population density of the

vector increases the opportunities for transmission of dengue.

The occurrence of dengue in one country is a threat to other countries, and the spread of dengue

is worsened by increasing trade and travel. Therefore, dengue cannot be controlled if efforts are

limited to one country. Hence, the WHO Regional Offices for the Western Pacific and South-East

Asia decided to adopt a biregional approach in the Asia Pacific Region.

While current dengue control programmes in many Asia Pacific countries lack adequate

resources and have limited response capacities in their health systems. Others have had more

favourable experiences, including Malaysia, Singapore and Thailand. Although the interventions that

are currently available have been relatively effective for more than two decades, there is clearly a

need for the development of new and improved diagnostic, preventive and therapeutic tools. Until

then, available tools should be used wisely. The cost of not doing so could be very high.

2. Guiding principles

The Dengue Strategic Plan for the Asia Pacific Region underpins the following guiding

principles:

collaboration, cooperation and biregional solidarity for effective and sustained

prevention and control of dengue in countries of the Asia Pacific Region;

use of existing policy frameworks and infrastructure for dengue prevention and

control programmes, and integrating disease surveillance within the umbrella of basic

health services;


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use of national, multi-country, biregional and global partnerships to support country

activities;

use of evidence-based interventions and best practices in developing and

implementing dengue prevention and control programmes;

use of networking to optimize available resources;

intersectoral and inter-programmatic collaboration to maximize the provision of

integrated services, e.g. links developed with the Asia Pacific Strategy for Emerging

Diseases (APSED) to strengthen health systems for surveillance and contribute to

IHR (2005); and

adoption of evidence-based interventions that are currently available, while at the

same time recognizing the need for vaccine development, improved diagnostics and

other innovations for the prevention and treatment of dengue.

3. Constraints, opportunities and lessons learnt

Dengue is the fastest-growing arbovirus infection with a rapidly evolving epidemiology. It is

among 40 emerging diseases of global importance. The increasing burden of dengue in the Asia

Pacific Region is a matter of serious concern since the disease is spreading to new geographical areas.

Several countries continue to experience high mortality rates during the early stages of the epidemic,

especially in children.

Dengue epidemics are an indication of the failure of public health systems to respond rapidly.

Timely control of epidemics requires preparedness and capacity to undertake suitable and effective

control activities during the inter-epidemic period. Resolution of an epidemic requires sustained high-

level government commitment and strengthening of public health infrastructure, intersectoral

collaboration and community participation.

The disease was until recently predominantly urban. Dengue outbreaks do tend to attract

considerable adverse publicity and coverage in the media, whether an outbreak has been confirmed or

is only rumoured. This may impact negatively on tourism and other industries, and result in heavy

economic losses to countries affected by the disease.

Resources for dengue control programmes are insufficient. Among the biggest challenges in the

prevention and control of dengue is the mobilization of resources to implement interventions that have


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been known to be effective for more than two decades. At present, the allocation of funds for larval

control and source reduction through community participation is very low, even though this approach

has proven to be adequate.

There is no specific treatment for dengue fever (DF) and dengue haemorrhagic fever (DHF).

Existing antiviral drugs are not effective for prevention or treatment. No vaccine exists for the

prevention of dengue. Resources are required to strengthen capacity for research and development, to

intensify efforts to develop a vaccine, and to improve diagnostic tools as well as treatment options.

WHO and international partners need to advocate more to mobilize the required resources.

The spread of dengue involves many factors, making it a disease that calls for multisectoral

actions for its prevention and control. Dengue should be a concern for everyone. But despite the

worsening scenario, dengue has remained a neglected public health issue.

Although considerable progress has been made in source reduction and dengue prevention

through intersectoral partnerships and community mobilization, these interventions have not been

implemented widely enough to really have a national impact. Intercountry cooperation is required to

have an impact across the entire Asia Pacific Region.

Evidence shows that case fatality rates can be reduced to 1% or less if cases of dengue

haemorrhagic fever are admitted early and treated appropriately according to standard treatment

procedures. Achieving this target would require strengthened capacity in large and small hospitals in

standard case management of dengue haemorrhagic fever and dengue shock syndrome.

4. Rationale for the strategy on prevention and control of dengue fever and dengue

haemorrhagic fever

The emergence of dengue, its rapidly evolving epidemiology and the economic losses resulting

from the disease make a compelling case for accelerating prevention and control efforts. The disease

has attracted much media attention in recent years. Besides causing ill-health and excess mortality, it

has affected socioeconomic development due to loss of work and impacts the private sector, such as

the tourism industry.

The national programmes need to implement a healthy public policy as part of any

development project, both in urban and rural areas. At present, the national programmes expend little

resources in dengue control; and a major part of those expenses is incurred on insecticide sprays and

chemical larvicides, which have little impact on controlling the epidemic. In contrast, evidence shows


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that vector control through larval monitoring, source reduction and personal protection, combined

with a good sanitary environment within households and in communities, are effective in preventing

dengue.

Community participation and social mobilization for behaviour modification are beginning to

render good results in different settings. Investing in this approach and in an integrated vector

management (IVM) strategy needs to be encouraged.

Dengue prevention and control should be everyones concern. The role of national policies is to

strengthen the response to dengue within the health sector, facilitate intra-programmatic collaboration

and effectively mobilize intersectoral collaboration.

The Dengue Strategic Plan for the Asia Pacific Region is intended to utilize currently availableevidence-based interventions while advocating for intensified research in the development of a

suitable vaccine, antivirus drugs and appropriate diagnostics for dengue.

5. Regional goal, vision and mission

The goal of the Dengue Strategic Plan for the Asia Pacific Region is to reduce the disease

burden due to major parasitic and vectorborne diseases to such an extent that they are no longer major

public health problems.

The vision of the Dengue Strategic Plan for the Asia Pacific Region is to minimize the health,

economic and social impact of the disease by reversing the rising trend of dengue.

The mission of the Dengue Strategic Plan for the Asia Pacific Region is to enhance the capacity

in countries and the Asia Pacific Region through partnerships, so that evidence-based interventions

can be applied in a sustainable manner through better planning, prediction and early detection,

characterization and prompt control and containment of outbreaks and epidemics.

Objectives

General objective

To reduce incidence rates of dengue fever and dengue haemorrhagic fever.

Specific objectives

(1) To increase capacity of Member States to monitor trends and reduce dengue transmission.


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(2) To strengthen the capacity of Member States to implement effective integrated vector

management.

(3) To increase the capacity of health workers to diagnose and treat patients and improve health-

seeking behaviour of communities.

(4) To promote collaboration among affected communities, national health agencies and major

stakeholders to implement dengue programmes for behavioural change.

(5) To increase capacity to predict, detect early and respond to dengue outbreaks.

(6) To address programmatic issues and gaps that require new or improved tools for effective

dengue prevention and control.

6. Supportive strategies

Dengue outbreaks and epidemics are reflections of the failure of public health systems to

prevent and control dengue. Dengue is a neglected disease that gains attention during an epidemic.

Public interest, as well as government commitment, tends to decline after the epidemic is controlled.

Many of the affected countries do not even have a national programme. Its control requires a high

level of sustained government and public commitment, strengthening of the public health

infrastructure, intersectoral and intercountry collaboration, and community mobilization.

A number of supportive strategies are needed for effective implementation of the Dengue

Strategic Plan for the Asia Pacific Region (20082015).

6.1 Mobilization of resources

Despite the growing threat of dengue, resources for the control of dengue have not increased.

National and international support continues to remain far short of the needs, even though there are

untapped resources at the national, regional and global levels. Countries need to prepare operational

plans that identify funding gaps and devise an advocacy plan for mobilizing the resources on a

sustained basis. The Asia Pacific Dengue Partnership (APDP) was conceived by WHO, Member

States and other key stakeholders to play an important role in advocating on behalf of the countries to

mobilize much needed resources for the prevention and control of dengue. The Dengue Strategic Plan

for the Asia Pacific Region was developed taking APDP's role and responsibilities into consideration.


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A national dengue prevention and control programme should be implemented as a part of

national policy in Member States. Such a programme needs to find a niche and visibility within the

existing disease surveillance programmes and should be linked to both the IHR (2005) and the

vectorborne disease control programme. It has to be a part of basic health services and must find a

place within the policy of decentralization in the national programme.

6.2 Partnerships

The Asia Pacific Dengue Partnership for dengue prevention and control was formed in

March 2006. The Dengue Strategic Plan for the Asia Pacific Region recognizes that partnerships are

required to mobilize additional resources for the prevention and control of dengue and to increase

collaboration among countries. Sustained partnerships are crucial for showcasing the cause of dengue

prevention and control through advocacy.

6.3 Programme planning and management

Effective programme management necessitates the preparation of an operational plan that

identifies the resources committed and the resource gaps. The capacity of staff at different levels

national, subnational and districtin programme planning and management has to be increased.

Human resource development is a key component of capacity development. The development of

capacity for the prevention and control of dengue is not an isolated effort but an integral part of

strengthening the health system for improving the control of vectorborne diseases, disease

surveillanceincluding IHR (2005)and the provision of basic health services. Capacity

development is to be undertaken based on training needs, the institutional environment and national

policy. Since health systems and policies vary throughout the Asia Pacific region, national dengue

prevention and control programmes have to be consistent with the country situation. The Dengue

Strategic Plan for the Asia Pacific Region should be used by countries as a framework to develop or

improve upon existing operational plans.

Even within a decentralized or an integrated framework, it is necessary to identify the specific

needs of dengue prevention and control so that control measures have adequate visibility. These

include increased laboratory capacity, standard case management of dengue, and vector surveillance.

Programme planning and management also includes developing a system for procurement, logistics

and effective supply management. The health management information system and revamped

surveillance are crucial in the context of dengue control since the disease often strikes in the form of

outbreaks.


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7. Monitoring and evaluation

A monitoring and evaluation framework is necessary to track the progress of implementation of

the operational plan. Monitoring should be results based, and the framework should include outcome

and output indicators that are easily measurable and verifiable. The indicators are included in the log

frame that follows (see Annex 1).

8. Implementation of the Strategic Plan

The first draft of the Dengue Strategic Plan for the Asia Pacific Region was discussed at a

meeting of partners on dengue from the Asia Pacific Region in Chiang Mai, Thailand, in March 2006.

It was further developed to include a Log Frame during an informal consultation in Manila,

Philippines, in August 2007. The informal consultation was attended by representatives of WHO andthe United States Centers for Disease Control and Prevention, as well as leading regional experts in

the field. The plan draft was further developed at a biregional programme managers meeting in

Phuket, Thailand, in September 2007. The last draft was revised and finalized in May 2008 during a

second biregional dengue meeting in Singapore, attended by most of the dengue programme managers

in Western Pacific and South-East Asia Regions. It will be presented to the Regional Committee for

the Western Pacific in September 2008 for consideration of endorsement.

During the May 2008 meeting in Singapore, programme managers agreed Member States

would require assistance in preparing operational plans, with budgets, and in identifying funding and

resource gaps as one of the initial steps that would need to be taken to implement the Dengue

Strategic Plan for the Asia Pacific Region. Political, technical and managerial expertise in counties

will need to be mobilized to increase capacity in order to implement the operational plans. To

implement the Dengue Strategic Plan for the Asia Pacific Region it will be necessary to harness the

expertise available in the countries through collaboration and networking. Additional technical

guidance should be provided by a biregional technical advisory group to be appointed following

endorsement of the biregional plan. Regular reviews of national programmes will be encouraged and

efforts will be made to encourage research and development in such areas as diagnostics, drugs and a

vaccine for the prevention and control of dengue in the Asia Pacific Region.

The Log Frame that follows provides a clear road map to the Dengue Strategic Plan for the

Asia Pacific Region. The "general objective" mentioned above in Section 5 is referred to as the

"regional objective" in the Log Frame. The specific objectives contained in the narrative section of

this document are listed, as is the purpose of each of six components which constitute the backbone of

the Log Frame and of the integrated dengue prevention and control approach. Each of these


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components comprises a set of expected results, indicators and activities (see Annex 1, Appendix 1).

Countries will be able to achieve the Strategic Plan's objective, purposes and expected results in the

context of their current capacities and policies.


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LOG FRAME DENGUE STRATEGICPLAN


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Component I. Dengue Surveillance

Planning elements Indicators Verification source Assumptions and risks

Regional goal

To reduce the diseaseburden due to majorparasitic and vectorbornediseases to such an extentthat they are no longermajor public healthproblems

Regional objective

To reduce incidence ratesof dengue fever and

dengue haemorrhagicfever

The rising trend indengue stemmed

between 2008 and2010 relative to20052007

Regional averagereported incidencerate reduced by atleast 20% (20102012 averageversus 20052007)

Regional averagereported incidencerate reduced by atleast 20% (20132015 averageversus 20102012)

Impact of outbreakmitigated

1

Regular WHO updates

Dengue outbreakresponse report

Political commitment

FundsHuman resources

Coordination andsurveillance systems inplace

PurposeTo increase capacity ofMember States to monitortrends and reduce denguetransmission

Number of MemberStates withsurveillance systemin place andreporting to WHOmonthly

Number of MemberStates with nationalsurveillance policystatementsconsistent with theIHR (2005)commitments

Number of MemberStates with resourcecommitments inplace for dengue

Member States monthlyreports

National policystatements

National plan andbudgets


Funds

Interest and capacity ofstakeholders toparticipate

1 Measured by morbidity and mortality rates, number of cases, geographical containment, and duration of outbreak


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programme basedon surveillance data

Number of MemberStates whoseinterventions arebased onsurveillance data

Number of MemberStates able to reportcases within 48hours from healthfacility to programmelevel

Surveillance reports

Guidelines on outbreakresponse

Expected results1. Existing standard

dengue casedefinition adopted

Number of Member

States using thestandard casedefinition based onWHO guidelines

Number of MemberStates in whichDF/DHF is notifiable

Policies on the use of

standard case definitionNational plans andstandard operatingprocedures

National policy

National legislation

Policies are applied by

Member States

2. Laboratorysurveillancestrengthened

Number of MemberStates with at leastone laboratory ableto serologicallyconfirm denguediagnosis, carry outserotyping and virusisolation procedures

Number of MemberStates withlaboratoriesupgraded forimprovedsurveillance (Note:needs to be defined)

Number of MemberStates withreferencelaboratoriesproviding qualitycontrol and qualityassurance (QC/QA)services

Number of regionalreferencelaboratoriesproviding QC/QAservices

Number of MemberStates withlaboratoriesparticipating inregional QC/QA

External evaluationreports (from WHO andpeer reviewers)

Cross-checking reports

Network reports

Official acceptance ofquality controlmechanism

Availability of sensitivetests

Human and financialresources


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networks

Number of

integrated laboratorynetworksestablished in theAsia Pacific Region

3. Regional dengueinformation systemdeveloped

System in place andfunctioning withinformation ontrends and updatedsituation analysis

Regional websiteoperational

Regional database

Data on website


Human resources

Time availability ofpersonnel assigned

Human and financialresources

4. Mechanisms forsharing timely and

accurate datastrengthened

Number of MemberStates reporting

validatedinformation, i.e. dataon case incidenceand case fatalityrates (CFR), forworking intervals(Note: differentintervals may applyfor case incidenceand CFR)

Shared informationsystem in place

Number of MemberStates that signagreement to

provide data into ashared surveillancesystem

Number of MemberStates whosemonthly data of theprevious quarter isaccessible from theregional website (i.e.dengue informationsystem)

Member States monthlyreports

Agreements

Website and/orDengueNet

Signed agreement

Data on website

Political commitment(i.e. Member States

willingness to share theirdata)

Human resources

User-friendly informationsystem in place

5. Regional/intercountryresponse to timelyadvisory and resource

(personnel, financial,stockpiling)mobilization improved

Number of MemberStates that act uponadvisory

Intercountry high-level discussions forcoordinatedresponse to denguesituation within theframework of IHR(2005)

Number of MemberStates reporting toWHO regionaloffices and

Advisories and reportson actions

Meeting reports

Country reports


Funds

Human resources


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Headquarters as perIHR (2005)

6. Incorporate denguesurveillance(case,vector andseroprevalence) intoan integrated andstrengtheneddiseasesurveillance system

Number of MemberStates reportingdengue via theintegrated diseasedsurveillanceprogramme (IDSP)

Number of MemberStates in whichdengue surveillanceand vectorsurveillance areintegrated

Country reports

Programme review(e.g. programmemanagers meetings,external reviews)


Funds

Human resources

7. Monitoring memberstate surveillance

systems

Number of MemberStates subject to

internal yearlymonitoring andexternal monitoringevery 3 years

Monitoring reports Political commitment



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Activities Outputs Responsible Resources and timeframe

Expected result 1: Existing standard dengue (DF/DHF) case definition adopted and case fatality ratestandardized

1.1 Circulate standardcase definition toMember States

Standard casedefinition packagedand distributed

Programme managers

WHO

Funds (e.g. duringregional programmemanagers meetings)

Q4 2008

1.2 Add DF and DHF onnotifiable diseaseslist

Legislation adopted:DF and DHF arenotifiable diseases inall member countriesin the Asia PacificRegion

Ministry of Health Starting 2009

1.3 Circulate standardcase fatality ratecriteria to MemberStates

Standard CFR criteriadistributed andadopted

Programme managers

WHO

Funds

Q4 2008

1.4 Conduct internaldiscussions incountry to promotestandard casedefinition

Agreements anddiscussionproceedings

WHO

Surveillance authorities

Funds

Documenter

Q1 2009

1.5 Organizeconsultation withMember States forconsensus

Consensus reachedduring programmemanagers meeting(Note: meeting needs

to happen during firstquarter of 2009)

WHO

Programme managers

Funds

Q1 2009

1.6 Provide technicalassistance forMember States toput in place thestandard definition

Terms of referenceand list of qualifiedconsultants

Appointment ofconsultant anddissemination ofconsultants report

WHO

Member States

Funds

Expert

Q1 2009

1.7 Support training forpersonnel wherenecessary

Training results andreports

WHO regional offices

WHO country offices

Funds

Experts

Partners

Q2 to Q4 2009

Expected result 2: Laboratory surveillance strengthened

2.1 Develop evaluationcriteria, assessand/or map outcurrent status andidentify gaps ofexisting laboratories

Inventory oflaboratories andtesting available

Assessment resultsand reports

Programme and/orlaboratory managers

WHO


Funds

Experts

Q4 2008 to Q1 2009


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2.2 Develop standards

for all laboratoriesincluding qualityassurance

Laboratory standards

and quality assuranceprocedures producedand disseminated toMember States

List of referencelaboratories that meetstandards

Regional reference

laboratories in the AsiaPacific Region

Funds

Experts

Regional referencelaboratory services

Q4 2008 to Q1 2009

2.3 Integrate dengueinto existingnational/regionallaboratory networkand ensure that thenetwork is functional

Dengue serologicalconfirmation and/ortyping integrated intosurveillance androutine reporting inlaboratories at alllevels

Functional(coordination andcommunication)laboratory network inplace

Ministry of Health andrelated agencies

WHO

Funds for monitoring andsupervision

Experts

2009 to 2015

2.4 Monitor laboratoryperformance once ayear

Performance reportsfrom assessments

Plans for qualityimprovement

Programme managers

Laboratory managers


WHO country offices

Funds

Human resources

Experts

2009 to 2015

2.5 Set up a nationalreference laboratoryfor virus isolationand characterizationor integrate it into anexisting emerging/remerging diseasesreference laboratory

Reference laboratoryin place with thecapacity for virusisolation andcharacterization andseroprovalence

Ministry of Health


WHO country offices

Partners

Funds

Human resources

Experts

2010+

2.6 Designate regionalreferencelaboratories, at leastone in each Region,and enhancecountry collaboration

At least one regionalreference laboratorydesignated in theSouth-East AsiaRegion and theWestern PacificRegion


Partners

Funds

Experts

2009

2.7 Enhance laboratory

capacity throughtraining and humanresourcedevelopment

Training courses for

laboratory personnelconducted

Training guidelinesdeveloped

Ministry of Health

National and regionalreference laboratories

WHO

Partners

Funds

Experts

2009 to 2015


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Expected result 3: Regional dengue information system developed

3.1 Agree on a dengueinformation systemand designatenational focal points

System defined

Focal points available

Ministry of Health

WHO


Funds

Q1 2009

3.2 Produce anddisseminateguidelines

Manual of operation WHO

Programme managers

Funds for training

Expert

Functional system

Q2 2009

3.3 Develop and pilottest the informationsystem at differentlevels within the

health sector

Functional system

Reports of MemberStates experiencesduring pilot test

Evaluation andenhancement ofsystem

WHO

Programme managers

Funds for pilot test

Expert

Functional system

Q3 2009 to Q4 2010

3.4 Support training oninformation system


WHO

Programme managers

Funds for training

Expert Facilitator

Functional system

2011+

3.5 Implementation anduse of the system

Reports of MemberStates feeding and/oraccessing data fromthe system

Programme managers Human and financialresources

2011+

3.6 Monitor performance

of the system andimplement correctiveaction as needed

Sustained use of theinformation systemverified throughmonitoring reports

WHO

Programme managers

Human resources andfinancial resources

2011+

Expected result 4: Mechanisms for sharing timely and accurate data strengthened

4.1 Conduct mappingexercise of existingmechanismincluding informationon how they function

Inventory report ofexisting mechanismsfor subnational,national and regionalsharing of data

Programme managers

WHO

Ministry of Health

Funds

Human resources

2009

4.2 Establish system forreporting timely (tobe defined) and

accurate data withinthe countries, withinthe Regions andbetween the twoRegions

Memorandum ofunderstandingbetween WHO andMinistry of Health

Reporting system inplace

Focal person in eachMember State and atsubnational level

Ministry of Health


WHO country offices

Funds

Expert

2009


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4.3 Support workshops

to train on timelyreporting of accuratedata

Training results and

report

Ministry of Health

Officers in VBDCTSresponsible for denguedata

WHO

Funds for training

Experts2009 to 2010

4.4 Conduct monitoringand assessments ofthe reporting system

Reports byprogrammemanagers andreference laboratorymanagers to assesscompliance withagreed uponstandards

Programme managers

Reference laboratories


Funds

Experts

2011+

Expected result 5: Regional and intercountry response to timely advisory and resource (personnel, financial,stockpiling) mobilization improved

5.1 Use mechanismsestablished toexchangeinformation withinthe IHR (2005)framework

Protocol forintercountry response

List of contactpersons

Regular informationsharing between thetwo Regions


WHO country offices

Partners

Political commitment (alllevels)

2010

5.2 Conduct orientationand briefing of WHORepresentatives

Mission reports WHO regional offices

WHO country offices

Funds

2009

5.3 Mobilize financialresources,

personnel andstockpiles

Funds, humanresources available

Stockpiles defined,purchased andmaintained

WHO country offices


Focal points at regionaland country offices

2009+

Expected result 6: Incorporate dengue surveillance (case, vector and seroprevalence) into an integrated andstrengthened disease surveillance system

6.1 Identify strengthsand weaknesses ofexisting nationaldiseasessurveillance systemsthrough mappingand desk review

SWOT analysis Ministry of Health

WHO


Funds

Experts

2009

6.2 Initiate activities toaddress theweaknesses

Strengthenednational diseasessurveillance system

Ministry of Health

WHO


Funds

Experts

2010+


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6.3 Operationalize and

integrate denguesurveillance with thenational diseasesurveillance systemin accordance withIHR (2005)

Integrated

surveillance planand/or framework

Testingoperationalization ofintegrated plan at alllevels

Ministry of Health

WHO


Funds

Experts

2010+

6.4 Enhance thesurveillance capacitythrough training andfeedback

Training programmes

Impact assessment oftraining programmes

Ministry of Health

WHO

Partners


Funds

Experts

Ongoing

Expected result 7: Monitoring member state dengue surveillance systems

7.1 Conduct externalsituation analysis ofexisting surveillancesystems

Monitoring reports Ministry of Health

WHOPolitical commitmentFunds

Experts

Every three yearsstarting in 2010

7.2 Internal review ofexisting surveillancesystems

Monitoring reports Ministry of Health Political commitment

Funds

Experts

Yearly starting in 2010


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Component II. Dengue Integrated Vector Management

Planning elements Indicators Verification source Assumptionsand risks

Regional goal

To reduce the diseaseburden due to majorparasitic and vectorbornediseases to such anextent that they are nolonger major publichealth problems

Regional objective

To reduce incidencerates of dengue feverand denguehaemorrhagic fever

The rising trend indengue stemmedbetween 2008 and2010 relative to

20052007 Regional average

reported incidencerate reduced by atleast 20% (20102012 average versus20052007)

Regional averagereported incidencerate reduced by atleast 20% (20132015 average versus20102012)


2

Regular WHO updates



Funds

Human resources


Purpose

To strengthen thecapacity to implementeffective integratedvector management

Number of MemberStates with vectorcontrol policiesimplemented


Programme reports


Funds

Expected results

8. Vectors fullydescribed andvector indicatorsregularly monitored

Number of MemberStates monitoringand reporting

Reports of identifiedvector keycontainers and/or

habits Records of changes

in vector populations Number of Member

States reportingreduced vectorpopulation

Annual reports

Vector surveillancereports

Availability of qualifiedvector surveillance team

Funds



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9. Regional integratedvector management

(IVM) strategydeveloped

Regional IVMstrategy produced

and disseminated

Regional strategy Political commitment

Funds

10. Evidence-basedstrategies to controlvector populationsadopted accordingto IVM principles

Number of MemberStates that haveadopted IVMstrategy andguidelines as anintegral componentof their denguenational plan

Number of countriesthat have adoptedhealthy public policy

Number of Member

States withregulatorymechanisms in placein relation toenvironment andpesticidemanagement

Number of partnersand/or sectorsparticipating in andcontributing to vectorcontrol


Regulatory mechanisms

Plans of key sectorsand/or agenciesintegrating vector control


Funds

Availability of qualifiedvector surveillance team

11. Member State-levelIVM strategy andguidelines

developedconsistent withregional strategy

Number of MemberStates with IVMimplementation plan

Number of MemberStates adhering tothe regional IVMimplementationguidelines

National plan with IVMcomponent

Implementationguidelines

Political commitment ofMinistry of Health andother sectors

12. Capacitystrengthened toimplement IVMincluding trainingand recruitment ofentomologists

Number of MemberStates implementingIVM for control ofdengue

Number of MemberStates with non-health-related stafftrained on IVM

Number of MemberStates with trainedentomologistssupporting IVMactivities

Number of MemberStates with trainedpersonnel at nationaland subnationallevels implementingIVM activities (e.g.changes in watermanagement,

Training reports

Progress reports onnational planimplementation


Interest of agencies andpublic sector

Staff motivation andincentives


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changes inarchitectural design,environmentalmodification, solidwaste management)

13. Mechanisms tofacilitate communityinvolvement forvector control

established3

Number of MemberStates withorganizedcommunity-basedgroups planning andimplementing vectorcontrol activities

Survey reports to identifygroups

Staff motivation andincentives

14. Rational use ofinsecticide forvector controlpromoted

Number of MemberStates with policiesand/or guidelines onthe rational use ofinsecticides based

on the guidelines ofthe WHO PesticideEvaluation Scheme(WHOPES)

Number of MemberStates that enforceguidelines

Reports from regulatoryagencies

Annual reports


Local expertise

15. Vector resistancemonitoringstrengthened

Number of MemberStates that haveestablished a vectorresistancemonitoring system

Monitoring results Funds

Local expertise

3 Community involvement in vector control elaborated in Component IV. Social Mobilization and Communication for

Dengue


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Expected result 8: Vectors fully described and vector indicators regularly monitored

8.1 Analyse and reviewcurrent vectorsurveillanceactivities andavailability ofbaseline data

Baseline data onvector distribution,ecology abundanceand seasonal trendsgathered for one year

Ministry of Health

WHO collaboratingcentres (data to begathered from otheravailable sources ifnecessary)

Funds

Experts

Q4 2009

8.2 Develop vectorsurveillance plan atnational level (lowerlevels if needed)

Vector surveillanceplan to include:

stratified areas at riskfor interventionidentified (district,provincial levels);

frequency andcoverage of surveys.

Ministry of Health withsupport of WHO countryfocal point

Ministry of Healthcommitment

Funds

Experts

8.3 Develop trainingmanual andguidelines onvector surveillance

Training needsassessment in termsof available resourcesand target groups

Training manual onvector surveillancedisseminated

Ministry of Health

WHO

Funds

Experts

8.4 Training on vectorsurveillancemethods includingdata analysis andreporting


Training of trainersand refresher coursesto be considered

Ministry of Health

WHO

Funds

Experts

Expected result 9: Regional IVM strategy developed

9.1 Develop guidelinesfor situationanalysis and needsassessment on IVM

Guidelines developedand disseminated

WHO regional offices Funds

Experts

20082009

9.2 Conduct meetingswith programmemanagers tofinalize the regionalIVM strategic plan

9.3 Establish IVM

intersectoral taskforce to develop thenational IVMstrategy

Agreements recordedin minutes of meetings

Regional and nationalstrategies

Financial proposaloutlining needs forpotential funding


WHO country offices

Ministry of Health

Partners

Funds

Expected result 10: Evidence-based strategies to control vector populations adopted according to IVMprinciples10.1 Organize

workshops ongeographicinformation

Develop risk maps atappropriate levels

Ministry of Health Funds

Technical support

20092010


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systems (GIS) or

basic mappingmethods

10.2 Develop vectorcontrol plan and/orstrategy based onmapping

Vector control strategydeveloped based onrisk mapping

Ministry of Health

WHO

Partners

Funds

Experts

10.3 Conduct periodicre-mapping (to belinked to periodicsurveillance 8.1)

Vector mapsperiodically updated

Ministry of Health

WHO

Partners

Funds

Expert

Collaborating centresfor vector control

10.4 Carry out vectorcontrol trials and/orpilot test forevidence-basedIVM approach atlocal levels

Documentedevidence-basedstrategies with

appropriate indicators

Ministry of Health

Research andcollaborating centres incollaboration with otheragencies (e.g. GlobalEnvironment Facility)

Funding for pilot

Experts

Expected result 11: Member States adopt or develop IVM strategy and guidelines consistent with regionalstrategy

11.1 Disseminateregional IVMstrategy amongprogramme staff

National plans thatincorporate IVM

Programme managers


WHO country offices

Funds

Human resources

2009

11.2 Conduct internaldiscussion andanalysis withinprogrammes toencourageadoption andintegration intonational plans

Agreements recordedin minutes

Programme managers


WHO country offices

Funds

Experts

11.3 Identify andselect IVM taskforce and draftstrategy

National IVM strategy Ministry of Health

WHO

Funds

Experts

11.4 Obtain politicalsupport forstrategy

Political commitmentfrom nationalgovernment

Prime Ministers orPresidents office

Ministry of Health

Programme managers

Chair of the national IVMtask force

Effective advocacy(e.g. MelanesianSpearhead Group,ASEAN heads of

government)

11.5 Mobilizeintersectoralsupport for IVM

Intersectoralcollaboration(including public andprivate sector)

Ministry of Health

WHO

Partners

Effective advocacyamong other sectors

Funds


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Expected result 12: Capacity to implement IVM including training and recruitment of entomologists

strengthened

12.1 To assess thenational need forentomologists andregionalentomology trainingcentres

Entomologist needassessment

Regional training toaddress needs ofcountries

Ministry of Health orMinistry of Environment

Funds

20092010

12.2 Mapping ofentomologists orother qualifiedtechnical support atthe regional level(including vector

control personnel)

List of personnelworking asentomologists and onvector control

Programme managers Funds

Experts

12.3 Training ofentomologists andvector controlpersonnel on IVM

Entomologists andvector controlpersonnel trained onIVM


Integrated training toinclude entomology

WHO Headquarters


WHO country offices

Funds

Experts

Expected result 13: Mechanisms to facilitate community involvement for vector control established4

13.1 Conductassessment of

Member States thathave organizedcommunity-basedgroups

Assessment resultsand report

Inventory of availableadvocacy resourcesfor communityawareness in MemberStates

Programme managers

WHO

PartnersUrbani School Health Kit

Funds

Experts

2009

13.2 Committee to besetup to providetechnical support onsocial mobilization

Task force set up

Country couldestablish their owntask force

Ministry of Health

WHO

Resources

13.3 Disseminate andconduct advocacybased on results ofassessment

Documents, websiteand/or reports ongood practices

Advocacy of politicalleaders

WHO

Programme managers

Political will

Funds

13.4 Develop orientationmodules oncommunityinvolvement forvector control

Modules available forvarious target groups

Contents to be targetgroup specific


WHO country offices

Partners

Funds

Experts

4 Community involvement in vector control elaborated in Component IV. Social Mobilization and Communication for

Dengue


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13.5 Conduct orientation

among MemberStates on thedeveloped modules

Orientation workshop

agendas and reportsfor community groups

Programme managers

Community leadersCivil society

Funds

Experts

Expected result 14: Rationale use of insecticide for vector control promoted

14.1 Draft legalframework for

judicious use ofchemicalinsecticides

Develop draftlegislation

Ministries of Agriculture,Health and Environment

Focal point onStockholm Convention,etc.

Intersectoralcoordination

14.2 Provide WHOPESguidelines onpesticidemanagement toMember States

Recommendationsduring regionalprogramme managers

meeting

National policy onrational use ofinsecticides accordingto WHOPESguidelines

Member Statesguidelines adaptedfrom WHOPES

Annual reporting ofinsecticide use

WHO

Ministry of Health

Political will

Funds

Expected result 15: Vector resistance monitoring strengthened

15.1 Provide regionaltraining on vectorresistancemonitoring

Regional training

conducted

WHO Funds

15.2 Identify monitoringsites for insecticideresistance andcollect baselinedata

Maps showing currentlevels of resistance toinsecticides in use:species, insecticide,location

National vectorbornedisease contolprogramme (VBDCP)

Political will

Funds for fieldcollection, laboratorytesting, compilingand reporting data

15.3 Collection of data inmonitoring sites attwo- to three-yearintervals

Updated mapsshowing recordedchanges ineffectiveness ofinsecticides

National VBDCP

WHO

Political will

Funds for fieldcollection, laboratorytesting, compilingand reporting data

15.4 Use data to changenational policy

Change policy onpurchase and use ofinsecticides based onresults of resistancetests

Ministry of Health

Ministry of Environment

WHO

Partners

Funds

Political will

15.5 Develop guidelinesand train personnelon use of newinsecticides

New guidelines issued


National VBDCP

Regulatory procurementauthorities

WHO

Funds for newguidelines andtraining


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Component III. Dengue case management

Planning Elements Indicators Verification source Assumptions andrisks

Regional goal


Regional objective

To reduce incidence rates of

dengue fever and denguehaemorrhagic fever

The rising trend in

dengue stemmedbetween 2008 and 2010relative to 20052007

Regional averagereported incidence ratereduced by at least 20%(20102012 averageversus 20052007)


Impact of outbreak

mitigated5

Regular WHO updates



Funds

Human resources

Coordination andsurveillance systemsin place

Purpose

To increase health workerscapacity to diagnose andtreat patients and improvehealth-seeking behaviour ofcommunities

Case fatality rate (CFR)

Number of patients whoseek consultation inhealth facilities within 48hours of fever onset

Notification as early aspossible

Surveillance reports(day of illness at timeof notification)

Death records

Community-based

survey results6


Funds

Standardizeddefinition of caseand CFR

Deaths are properlyrecorded

Expected results

16. Public awareness onwarning signs andactions to be taken fordengue, increased

Proportion of targetpopulation able to

identify key warningsymptoms and takeappropriate action

Comparative analysisof knowledge, attitude

and practices (KAP)and communication forbehavioural impact(COMBI) surveyresults (pre and post)

Funds

Facilitators

Willingness ofcommunities

5 Measured by morbidity and mortality rates, number of cases, geographical containment, and duration of outbreak.6 Community-based surveys shall be conducted in conjunction with KAP surveys under Component IV. Social mobilization and

communication for dengue.


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Planning Elements Indicators Verification source Assumptions andrisks

17. Strengthen capacity of

health care providersto diagnose, treat orrefer cases

Number of health

facilities per countrythat have standardtraining guidelines

Number of MemberStates with healthworkers trained on casemanagement

Number of MemberStates with healthworkers who applystandard casemanagement

Proportion of healthfacilities with at leastone trained health

professional

Number of MemberStates that have afunctional clinicalmanagement committee

Percentage of MemberStates health carefacilities withreorganized services forpatient care

Number of MemberStates with a functionalblood bank

Follow-up, observation

and/or monitoringreports

Health facility records

Survey of facilities

Standards for casemanagement

Listing of availableblood banks

Funds

FacilitatorsInterest andwillingness of healthfacilities

Cases are properlyrecorded

18. Laboratory support forcase managementimproved

Number of health

facilities and/orlaboratories perMember State capableof performing laboratoryclinical tests (i.e.complete blood count,at the very least amicrohaematocrit andmicroscope for plateletcount)

Health facility records

Survey of facilities

Ministry of Healthrecords

Laboratory records

Funds

Willingness ofhospital authorities

Available equipment

Competentpersonnel

19. Referral network systemin public and privatesectors established

Number of MemberStates with a functionalpatient referral system

Ministry of Healthreport

External review

Funds

Experts


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Expected result 16: Public awareness on warning signs and actions to be taken for dengue increased

16.1 Conduct KAP7

survey andinvestigateconstraints toearly health careseeking by thecommunities

KAP survey results Ministry of Health Political commitment

Funds

Human resources

Q1 2009

16.2 Develop andimplementCOMBI approach

Improvement in KAP asagainst baseline

COMBI resourcegroup

8

Partners

Funds

Human resources

Q3 2009Q1 2010

16.3 Assess impact of

COMBI strategyon behaviouralchange

COMBI impact assessment COMBI resource

group9

Funds

ExpertsSix months afterimplementation

16.4 Evaluation ofsustainability ofCOMBI strategy

Monitoring and evaluationreport

COMBI resource group Funds

Experts

12 months afterimplementation

Expected result 17: Capacity of health professionals to diagnose, treat or refer cases strengthened

17.1 Set up a coregroup (clinicalmanagementcommittee)

composed ofpublic and privatesector and otherstakeholders

Terms of reference and workplan for clinical managementcommittee

Ministry of Health

WHO

Partners

Funds


Q4 2008 at the latest

17.2 Conduct situationanalysis and mapcapacity levels ofpublic and privatehealthprofessionals

Assessment results and

reports10

Ministry of Health

WHO

Clinical managementcommittee

Partners

Experts

Funds

Q1 2009

17.3 Develop trainingprogrammes andguidelines for

different targetgroups

Training programmes,modules with guidelines andcontent areas

Ministry of Health

WHO

Clinical management

committee

Experts

Funds

Q1 2009

7 Knowledge, attitude and practices (KAP) survey will be conducted in conjunction with Component IV. Social Mobilization and

Communication for Dengue.8 Refer to Component IV, Expected Result 1.9 Refer to Component IV, Expected Result 1.

10 Assessment should include training gaps and other capacity needs such as medical supplies and equipment.


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17.4 Conduct training

for various targetgroups, startingwith priority areas

Training results and reports Ministry of Health

WHOPartners

Experts

FundsQ2 2009Q4 2009

17.5 Monitorimplementation oftraining andhealth caremanagementcapacity

Monitoring reports showingextent to which targetedfacilities adhere to guideline

Targeted facilities witheffective system in place

Ministry of Health

WHO


Experts

Funds

Q3 2010

17.6 Monitor themanagement andoutcome ofsevere cases

(DHF/DSS)

Case fatality rate Ministry of Health


WHO

Funds

Ongoing

17.7 Conduct mortalityreview

Chart review

Clinical audit

Ministry of Health


Experts

Funds

Ongoing

17.7 Establish and/orstrengthencapacity at bloodbank to respondto DHF/DSS

A system in place capable ofadequately addressing needsin complicated cases

Ministry of Health

Partners

Funds

Equipment

Human resources

Q1 2009

Expected result 18: Laboratory support for case management improved

18.1 Conduct situationanalysis onclinical laboratorycapacity includingprivate sector

Situation analysis report withidentified gaps ininfrastructure, supplies andhuman resources

Ministry of HealthClinical managementcommittee

Partners

ExpertsFunds

Private sectorinvolvement

Q1 2009

18.2 Strengthencapacities(supplies,infrastructure)

Laboratories are properlyequipped

Ministry of Health

Public and privatehealth laboratories

Funds

Private sectorinvolvement

Experts

Q3 2009

18.3 Build capacitybuilding of

personnel develop trainingmodules

Training programmes andmodules and content areas

Ministry of Health

Public and private

health laboratoriesClinical managementcommittee

Funds

Private sector

involvementExperts

Q2 2009


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Component IV. Social Mobilization and Communication for Dengue

Planning elements Indicators Verification source Assumptions and

risks

Regional goal


Regional objective

To reduce incidence ratesof dengue fever and

dengue haemorrhagicfever

The rising trend in denguestemmed between 2008

and 2010 relative to20052007




11

Regular WHO updates


Politicalcommitment

Funds

Human resources

Coordination andsurveillancesystems in place

Purpose

To promote collaborationamong affectedcommunities, nationalhealth agencies and majorstakeholders to implementdengue programmes forbehavioural change

Number of nationaldengue controlprogrammes engaged incommunity-based socialmobilization andcommunication strategiesthat are changingbehaviour towards dengueprevention and control

Regional and nationalplans

Politicalcommitment

Funds

Interest andcommitment of thecommunities andother majorstakeholders

Expected results

20. Establish a COMBI

resource group

12

forCOMBIimplementation

COMBI resource groupestablished andinteracting with relevantagencies of denguecontrol programme

Reports from COMBIresource group

Funds

COMBI expert

Availability ofresource groupsand/or coordinator

11 Measured by morbidity and mortality rates, number of cases, geographical containment, and duration of outbreak.12 The COMBI resource group is conceived as a professional service provider that supports development and implementation of COMBI

programmes, training of personnel and impact assessment.


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Planning elements Indicators Verification source Assumptions andrisks

21. Assessment including

situation analysis ofcurrent strategies(social mobilization,health education) andextent and successof COMBI ifimplemented (withrespect to dengueand othervectorbornediseases)

Assessment reports by

Member States

Assessment reports Funds

Social and/orbehavioural expert

22. COMBI trainingimplemented

Number of countriesbenefiting from COMBItraining

Training materials

Training report

Funds

Experts

Political

commitment

23. COMBI approachdisseminated andpromoted

Number of Member Statescommitted to COMBI

Promotional materialsReports of activitiesMission reports

Other socialmobilizationapproaches havenot been effective

24. Development andimplementation ofCOMBI plansupported

Number of Member Statesadopting COMBI in theirNational Plan

Number of Member Statesdesignating nationalCOMBI focal point

COMBI plan

National COMBI focalpoint

Politicalendorsement

Funds

Availability ofresource group

25. Partnerships set upwith private sectorand other majorstakeholders

Number of partnershipagreements with private

sector and other majorstakeholders

Memoranda ofunderstanding

Reports of meetingsand joint planningexercises

Interest of privatesector and other

major stakeholders


35/49

Activities Outputs Responsible Resources Time frame

Expected result 20: COMBI resource group13

for COMBI implementation set up

20.1 Prepare terms ofreference forCOMBI resourcegroup

Terms of reference WHO

COMBI experts

(in consultationwith MemberStates)

Funds Q1 Year 1

20.2 Identify expertsand practitionerswith experience inCOMBI training,implementationand assessment,and socialmobilization and

communication

Roster of qualifiedexperts and theiravailability

Multi-agency andmultisectoral COMBIresource groupestablished

WHO

COMBI experts


Politicalcommitment

Funds

Experts

Q1 Year 1

20.3 Convene meetingand brief resourcegroup

Business plan WHO

COMBI experts


Funds

Experts

Q2 Year 1

Expected result 21: Assessment including situation analysis of current strategies (social mobilization andhealth education) and extent and success of COMBI if implemented (with respect to dengue and othervectorborne diseases)

21.1 Develop terms ofreference onprocess forconducting theassessment

Terms of reference Resource group(in consultationwith MemberStates)

Funds Q2 Year 1

21.2 Conductassessment foreach MemberState

Assessment report Resource group

Member States

Funds

Experts

Q3 and Q4Year 1

Expected result 22: COMBI training implemented

22.1 Modify COMBItrainingcurriculumadapted tocountry settingand based on theoutcome of theassessment

Modified trainingcurriculum

Resource group

Member States

Funds

Politicalcommitment

Experts

Q1 Year 2

22.2 Conduct COMBItraining

COMBI trainingconducted

Resource group

Member States

Funds

Politicalcommitment

Experts

Q2 Year 2

13 The COMBI resource group is conceived as a professional service provider to support development and implementation of COMBI programmes,

training of personnel and impact assessment.


36/49


Expected result 23: COMBI approach disseminated and promoted

23.1 Request eachMember State todesignate acountry COMBIteam

Local COMBI teamsappointed

Resource groupMember States

Politicalcommitment

Q3 Year 2

23.2 Compile COMBIorientationpackage

COMBI packagedeveloped (availableonline)

Resource group Funds

Expert

Q3 Year 2

23.3 Advocate COMBIto stakeholders atcountry level

Reports of advocacymeetings withstakeholders

Resource group

Country COMBIteams

Funds Q3 and Q4Year 2

Expected result 24: Development and implementation of COMBI plan supported

24.1 Facilitate thedevelopment ofcountry COMBIplans

Country COMBIplans developed

Resource group(in collaborationwith countryCOMBI teams)

Funds

Experts

Q4 Year 2

24.2 Secure fundingand resourcesneeded beforeimplementation

Funding andresources secured

Country COMBIteams

Resource group

Experts

PoliticalCommitment

Q4 Year 2

24.3 ImplementCOMBI plan

Plan implemented Country COMBIteam (supportedby resourcegroup)

Funds

Experts

Human resources

Q1 Year 3

24.4 Monitor andevaluateimplementation ofCOMBI plan

Progress andevaluation reports

Publication ofexperiences

Country COMBIteam (supportedby resourcegroup)

Funds

Human resources

Experts

From Q2Year 3

Expected result 25: Partnerships set up with private sector and other stakeholders

25.1 identify keystakeholders (e.g.donorcommunities,private sector)who can makesignificantcontributions

towards denguecontrolprogramme atregional level

Number ofstakeholdersidentified

Resource group(in consultationwith MemberStates)

Stakeholders

Politicalcommitment

Q1 Year 1

25.2 Formalizepartnershipsthroughmemoranda ofunderstanding

Memoranda ofunderstandingdefining roles andcommitments of eachpartner


Key stakeholdersand partners

Politicalcommitment

Funds

Q2 Year 1


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25.3 Developworkplans

Strategies andactivities defined in

workplans and/orproposals

Resource group(in consultation

with MemberStates)


Funds

Experts

Q2 and Q3Year 1

25.4 Implementcommitments

Report ofaccomplishments



Funds

Human resources

Q3 Year 1

25.5 Disseminatereports and

achievements

Publication Media exposure

Resource group(in consultationwith Member

States)


Funds

Experts

From Q3Year 1


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Component V. Dengue Outbreak Response

Planning elements Indicators Verification source Assumptions and

risks

Regional goal

To reduce the diseaseburden due to majorparasitic andvectorborne diseases tosuch an extent that theyare no longer majorpublic health problems

Regional objective

To reduce incidencerates of dengue fever

and denguehaemorrhagic fever

The rising trend in denguestemmed between 2008

and 2010 relative to 20052007

Regional average reportedincidence rate reduced byat least 20% (20102012average versus 20052007)

Regional average reportedincidence rate reduced byat least 20% (20132015average versus 20102012)

impact of outbreak

mitigated14

Regular WHO updates



Funds

Human resources

Coordination andsurveillance systemsin place

Purpose

To increase capacity topredict, detect early andrespond to dengueoutbreaks

Number of Member Stateswith an effective earlywarning system in placeand articulated into existingepidemic response (i.e.pandemic influenza, globaloutbreak alert responsenetwork)

Number of Member Statesthat have allocatedfinancial and humanresources for dengueoutbreak response

Number of Member Sateswith a rapid responsesystem in place and thecore capacity to respond asper IHR (2005)requirements

Emergency operationcentre records and IHR(2005) focal pointappointed

National plans andbudgets

Bureau ofepidemiology IHR(2005) focal pointreports


Funds

Human resources



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26. Early warning system

and denguesurveillance systemdeveloped andscaled up

Number of countries having

operationalized earlywarning system based ondisease surveillance data,epidemiologicalinformation, virus serotypes(from Component I), vectordensities/distribution (fromComponent II) andenvironmental data (i.e.rainfall, temperature) andnotify within (xx) period oftime

Member States

surveillance reports



Functionalsurveillance system

27. Standard operatingprocedures (SOPs)and system

developed fordengue outbreaks

Number of Member Stateswith dengue outbreakSOPs in place

Number of Member Stateswith adequate designatedstaff and necessaryinfrastructure in place

Number of Member Stateswith the capacity torespond to dengueoutbreaks by followingstandard operatingprocedures

Standard operatingprocedures manual

Staffing records

National plans andSOPs manuals

Funds

Experts

28. Coordinationmechanisms withinthe Ministry ofHealth and withother programmes

and sectorsestablished

Number of Member Stateswith functional intersectoraldengue emergency taskforce

Terms of reference fordengue emergencytask force

Reports of task force

Funds

Experts

29. Intercountrycoordinationmechanisms inplace

Number of intercountrymeetings held

Number of biregionalcoordinating meetings

Intercountry meetingreports

Biregional meetingreports

Funds


30. A mechanism toincorporate rumoursurveillancedeveloped andimplemented

Number of Member Stateswith a mechanism (IHRframework) incorporatingrumour surveillance intothe national surveillancesystem

Number of Member Stateswith a system incorporatingfocal persons (healthworkers) to verify rumoursin the community

Number of Member Stateswith the capacity to verifyoutbreaks within aspecified number of hours

National surveillancereports

WHO and partnersmission reports,outbreak investigationteam reports

Funds

Experts



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31. Regional outbreak

responseguidelinesdeveloped

Regional outbreak

response guidelinesavailable

Copy of regional

guidelines

Funds

ExpertsHuman resources

32. The ability of healthworkers to respondto the dengueoutbreakstrengthened

Number of Member Stateswith outbreak responseguidelines and trainingmanuals for health workersavailable

Number of Member Stateswith responsible healthworkers trained onoutbreak response SOPs

National trainingreport

15

Staffing records

Funds

Human resources

Staff motivation

33. Risk communicationplan developed

Risk communication planwith clear roles and

responsibilities incommunicating with thepublic

Number of Member Stateswith programmesincorporating riskcommunication included intheir national plan

Number of Member Stateswith standard operatingprocedures for mediainteraction

Copies of regional riskcommunication plan

National plan

Written SOPs


Funds

Experts

15 Showing results of competence tests on standard operating procedures and guidelines


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Activities Outputs Responsible Resources andtime frame

Expected result 26: National early warning system/dengue surveillance system developed and scaled up

26.1 Agree and adhere tocomponents of earlywarning system

Outbreak response plans

Adherence to IHR (2005)commitments

Ministry of Health (orrelevant agency)

WHO

Politicalcommitment

Funds

Human resources

Functional EOC atMinistry of Healthand WHO

Q4 Year 2

26.2 Develop guidelinesfor early warningsystems

Guidelines Ministry of Health (orrelevant agency)

WHO

Funds

Experts

Q4 Year 2

26.3 Develop indicatorsfor forecasting ofoutbreaks.

Expert meeting report WHO

Experts

Funds

Experts

Q4 Year 2

26.4 Establish system ofweekly reporting

Weekly reports Ministry of Health (orrelevant agency)

Politicalcommitment

Funds

Q1 Year 3

Expected result 27: Dengue outbreak standard operating system developed

27.1 Development ofSOPs includingtriggers for declaring

outbreaks anddefiningstakeholders andtheir roles andresponsibilities

SOPs manual Ministry of Health(orrelevant agency)

WHO

Politicalcommitment

Funds

Human resourcesQ4 Year 1

27.2 Training in the use ofSOPs

Training report Ministry of Health (orrelevant agency)

WHO

Funds

Human resources

Q2 Year 2

27.3 Monitoring use ofSOPs

Monitoring reports WHO


Funds

Human resources

Annually beginningQ4 Year 2

Expected result 28: Coordination mechanisms within the Ministry of Health and with other programmes and

sectors established

28.1 Constitute anintersectoral dengueemergency taskforce

Intersectoral task forcecoordinated by theMinistry of Health orrelevant agency

Minutes and accordsresulting from intersectoralmeetings within the publicas well as involving theprivate sector


WHO

Other sectors

Politicalcommitment

Funds

Human resources

Interest of othersectors

Q1 Year 2


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28.2 Collaboration with

other healthprogrammes anddisease surveillance

Interdepartmental joint

plans, reports and recordsof intervention

Ministry of Health

WHO

Funds

Politicalcommitment

Q2 Year 2

Expected result 29: Intercountry coordination mechanisms in place

29.1 Intercountrycoordinationmeetings (four tofive)

Meeting reports WHO

Ministry of Health

Politicalcommitment

Funds

Human resources

29.2 Biregional meetings(two)

Meeting reports WHO Funds

29.3 Share-point site orequivalentintercountry andbiregionalcommunicationmechanism

Electronic communication

system in place

Ministry of Health

WHO

Funds

Human resourcesQ2 Year 2

Expected result 30: A mechanism to incorporate event-based surveillance developed and implemented

30.1 Establish effectivemedia and rumourscanning mechanism

Effective media scanningmechanism in place

Ministry of Information

Ministry of Health

WHO

Politicalcommitment

Media participation

Funds

Human resources

Q2 Year 2

30.2 Strengthen rumour

verificationmechanism

Effective rumour

verification mechanism inplace

Ministry of Health

WHO

Partners (e.g. CDC)

Political

commitmentFunds

Human resources

Q1 Year 3

Expected result 31: Regional outbreak response guidelines developed

31.1 Develop regionaloutbreak responseguidelines and SOPstargeting differentlevels

Guidelines SOPs

Ministry of Health

WHO

Politicalcommitment

Funds

Experts

Q2 Year 2

Expected result 32: The ability of health workers to respond to the dengue outbreak strengthened

32.1 Mapping of personnelalready engaged inoutbreak response(e.g. avian influenza)

Inventory of trained staff inoutbreak response (e.g.avian influenza)

Ministry of Health

Other ministries (e.g.Environment)

WHO

Politicalcommitment

Funds

Human resources

Q2 Year 1

32.2 Training needassessment

Assessment report Ministry of Health

WHO

Funds

Human resources

Q2 Year 1


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32.3 Training in outbreak

response

Training reports Ministry of Health


WHO

Political

commitmentFunds

Human resources

Q2 Year 2

Expected result 33: Risk communication plan developed

33.1 Develop riskcommunication planand incorporate itinto dengue outbreakSOPs andincorporate riskcommunicationcomponents specific

to dengue intoexisting epidemicalert and responserisk communicationplan

Risk communication planto be incorporated intodengue outbreak SOPs

Risk communicationcomponents specific todengue incorporated intoexisting epidemic alert andresponse risk

communication plan

Ministry of Health


WHO

Politicalcommitment

Funds

Human resources

Q4 Year 1

33.2 Training of focalpoints in all relevantaspects of riskcommunication

Training reports Ministry of Health


WHO

Funds

Human resources

Q2 Year 2

33.3 Collaborate with othersectors to harmonizeimplementation ofrisk communication

Joint plans

Intersectoral meetingreports

Ministry of Health


WHO

Funds

Human resources

Q4 Year 2


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VI. Dengue research

Planning Elements Indicators Verification Source Assumptions and risks

Regional goal

To reduce thedisease burden dueto major parasitic andvectorborne diseasesto such an extent thatthey are no longermajor public healthproblems

Regional objective

To reduce themorbidity and

mortality rates due todengue fever anddengue haemorrhagicfever

The rising trend in denguestemmed between 2008 and

2010 relative to 20052007

Regional average reportedincidence rate reduced by atleast 20% (20102012average versus 20052007)

Regional average reportedincidence rate reduced by atleast 20% (20132015average versus 20102012)

Impact of outbreak

mitigated16

Regular WHO updates



Funds

Human resources


Purpose

To addressprogrammatic issuesand gaps that requirenew or improved toolsfor effective dengueprevention andcontrol

Programmatic issues andgaps identified

Research priorities identified

Programmatic issues andgaps successfully addressedthrough research

Situation analysisreports

Research findings (e.g.publications, reports)


Funds

Experts

Human resources

Expected results

34. Operationalresearch capacityin dengue ofexisting academicand scientificinstitutions inMember Statesenhanced

Number of reports andpublications specificallyaddressing programmaticgaps

Number of collaboratingcentres participating in

operational research Number of institutions

engaged in twinning orcollaborations/partnershipswithin or outside the AsiaPacific Region per year

Publications

List of WHOcollaborating centres

List of memoranda ofunderstanding, jointresearch protocols andimplemented projects

Grant agreements


Commitment of academicsector/ national researchcouncils or ministries

Commitment of WHOcollaborating centres

Funds

Experts

Human resources



45/49

Planning Elements Indicators Verification Source Assumptions and risks

Number of grants directlyaddressing programmatic

gaps in the Asia PacificRegion

35. Disease burdenestimated(epidemiologicimpact, socialcosts and costof illness)

Number of Member Statesengaged in disease burdenestimate studies

Number of countries thathave completed diseaseburden estimates

Country reports Political commitment

Commitment of academicsector, national researchcouncils or ministries


Funds

Experts

Human resources

36. New knowledgegained, new toolsdeveloped,existing toolsimproved andnew strategiesdeveloped

Number of research projectsper country addressingdevelopment of tools

Number of Member Stateswhere new tools are beingresearched

Number of Member Stateswhere new or improved toolsare being validated

Publications or reports

Country and/orprogramme reports


Commitment of academic

sector and nationalresearch councils orministries and privatesector


Funds

Experts

Human resources

37. Evaluation oftools andstrategies fordengue controland casemanagement

Number of cost evaluationstudies involving new andimproved tools

Number of cost evaluationstudies involving new and

improved strategies Number of economic studies

such as cost minimization,cost-effectiveness, cost ofutility, budget impact

Publications or reports



Commitment of academicsector and nationalresearch councils orministries and private

sectorCommitment of WHOcollaborating centres

Funds

Experts

Human resources

38. Translation of newand improvedtools intoprogrammaticactivities

Number of programmes inMember States adoptingresearch recommendations inpolicy formulation andprogramme implementation

Number of programmespublishing operationalresearch findings

Number of Member Statesthat have establishedresearch priorities based onprogramme needs



Commitment of academicsector and nationalresearch councils orministries


FundsExperts

Human resources


46/49


Expected result 34: Operational research capacity in dengue of existing academic and scientificinstitutions in Member States enhanced

34.1 Map of researchinstitutions,researchers andresearch networksin the Asia PacificRegion

Listing and/orinventory

WHO

Ministry of Health

Other ministries

Funds

Human resources

Year 1

34.2 Conduct workshopsto developoperationalresearch protocols

Workshop reports Research protocols

WHO

Special Programmefor Research andTraining in TropicalDiseases (TDR)

Research councils

and/or academicinstitutions

Funds

Experts

Human resources

Established inYear 1 and ongoing

34.3 Set up a system forinformationexchange

Share Point or othersystem

WHO

Research councilsand/or academicinstitutions

Ministry of Health

Other ministries

Political commitmentand interest ofresearch institutions

Funds

Experts

Human resources

Established inYear 1 and ongoing

34.4 Training in appliedand operationalresearch

People trained inoperational research

Established inYear 1 a

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