towards effective emerging infectious diseases surveillance: the cases of indonesia and cambodia

8/11/2019 Towards Effective Emerging Infectious Diseases Surveillance: The Cases of Indonesia and Cambodia

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Towards

Effective

Emerging

Infectious

Diseases

Surveillance:TheCasesof

Indonesiaand

Cambodia

SophalEar,Ph.D.AssistantProfessor

NavalPostgraduate

School

10March2011

Disclaimer:

Material

contained

herein

is

made

available

for

the

purpose

of

peer

review

and

discussion

and

does

not

necessarily

reflect

the

views

of

the

Department

of

the

Navy

or

the

Department

of

Defense.


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Contents

1.

TheProblems

2.

Timeline Context

3.

Indonesia

Case

Study

4.

CambodiaCaseStudy

5.

H1N1

6.

Conclusion


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MyriadProblems

Poortononexistent

surveillance Poordiagnostic

laboratory

capability Disincentivestoreport

Viral

sovereignty

(Indonesia)


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Page213:

In2006,

Indonesia

claimed

viral

sovereignty

oversamplesof

H5N1collectedwithinitsborders

andannouncedthatitwouldnot

sharethemuntiltheWHOand

developedcountriesestablished

anequitablemeansofsharingthe

benefits(e.g.,

vaccine)

that

could

derivefromsuchviruses.


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Page3:

inthepoorestcountries

percapitaexpenditureonall

aspectsof

health

care

[is]

3%

expenditureinhighincome

countries staffinover90%

notfamiliar

with

quality

assuranceprinciples more

than60%oflaboratory

equipment

is

outdated

or

notfunctioning

August

2001

report


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2010

[F]rommyownexperiencesincountries(

CentralAsia,

Southeast

Asia,

India,

Sub

Saharan

Africa)Ibelievethestatushasnotchanged

muchfromthedateofthe

[2001GAO]

report.

DirectorofLaboratorySystemsDevelopmentata

majorAmericanuniversity


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TimelineContextHuman

Pandemic

Flu

Timeline

Spanish(H1N1) HKfluH3N2 HPAIH5N1 H7N2 H7N3H10N7


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DownsideofGlobalization:

GlobalReach

of

Diseases


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QualityofHealthCare,2002


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H5N1:HighlyPathogenicAvianInfluenza


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AFewWordsonMethodology Qualitative

research

methodology

CambodiaandIndonesiacasescompared

~50one

on

one

semi

structured

interviews

acrossgovt(donorandhost),privatesector,

&NGOs

in

2009

and

2010

200pagesofnotes

Content

analysis/tagging Frequencyofissuesraised


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IndonesiaCaseStudy


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AfterFOUR

decades,the

NavalArea

Medical

Research

Unit2

(Namru

2)

is

kickedoutof

Indonesia


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AndallbecauseofoneMinister?AndallbecauseofoneMinister?

Maybenot.Maybe

not.


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IssuesRaisedinIndonesia


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CambodiaCaseStudy


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H5N1Animal

Outbreaks

2004

2008

2008

2007

2006

2005

2004


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2007

2006

2005

2008

H5N1Human

Victims

2005

2008


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IssuesRaisedinCambodia

l d d l h ld


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Goal:reducepandemicpotentialthatcould

strikedonorcountriesthemselves


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ButletButletsendwherewestarted,withsendwherewestarted,with

Indonesia

and

CambodiaIndonesia

and

Cambodia


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Dateline:11April2010

Namru2Jakartaisshuttingdown.Ihavebeenvery

sad.Not

only

because

I

amlosingmyjob,butmorethanthat,Indonesia

willloss

[sic]

an

establishedlaboratoryresearchcoz[sic]ofpoliticalreasons

SeniorIndonesianscientist


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Churchill


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IssuesandPossibilities

Indonesia Poorhostdonorrelationship

Differinghostanddonorpriorities

Low

salaries DeclineinMin.ofHealthquality

Namru2ismisunderstood

Problematiccompensationforculling

Locallevelsdontseereportingtranslatedintoresponse

Cambodia Lowsalaries

Donordependenceculture

Poor

staff

management/HR Patronagenetworks

Nocompensationforculling

Differinghostanddonorpriorities

Indonesia Dontlettherelationshipsour!

Alignyourprioritiesmore

This

is

a

national

problem Helpbuildcapacity(albeitlowpay)

Namru2needsbetterPR

Spendcompensationthatexists

Make

it

a

point

to

close

the

feedback

loop

Cambodia Thisisanationalproblem

Improveaideffectiveness

Helpbuildcapacity(albeitlowpay)

This

is

a

national

problem

Nocompensation=noreporting

Alignyourprioritiesmore


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The

end

or

the

beginning?

25June2010:Directorof

Namru2PhnomPenhsteps

down

FormerNamru2Jakarta

CommandingOfficer

was

to

headNamru2PhnomPenh

(butdidnotendupthere)

Awarenessofissuesbothin

IndonesiaandCambodiafor

whereverNamru

2ends

up.


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Thank

you.Thankyou.

Questions?Questions?

towards effective emerging infectious diseases surveillance: the cases of indonesia and cambodia

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