1. Goldie MacDonald, PhD Coordinating Office for Global Health
National Inventory of Core Capabilities for Pandemic Influenza Preparedness and Response: The Path to Measurement in Other Domains
Goldie MacDonald, PhD Coordinating Office for Global Health

2. Definition of Preparedness
The extent to which country or region able to detect virus in animals or humans and respond appropriately.
Preparedness will help to maintain essential services and reduce the economic and social impact of a pandemic.
The World Health Organization (WHO) recommendations for national action include assessment of preparedness status and identification of immediate steps to fill gaps.

4. Purpose of the Evaluation and Intended Use of Data
Demonstrate accountability for resources
Document actual capabilities at a point in time
Assess progress over time
Provide data for decision-making
allocation of resources
evidence for sustained investment or revised focus
ongoing program development, strategic and program planning, quality improvement efforts
form of situational awareness (beyond threats or fixed assets)
Contribute to wider discourse on planning or performance measurement in this arena

5. Kazakhstan
Mongolia
Armenia
Georgia
Ukraine
Dominican Rep
Laos
Mexico
Morocco
Philippines
Papua New
Guinea
Belize
Brazil
Cambodia
Ethiopia
Solomon Isl.
Guatemala
Cote D’ Ivoire
India
Kenya
El Salvador
Vietnam
Ghana
Pakistan
Panama
Tanzania
Thailand
Fiji
Honduras
Nigeria
Afghanistan
Costa Rica
Nicaragua
Peru
Bangladesh
Uganda
New Caledonia
Argentina
Rwanda
Vanuatu

6. Scope of the Project
Documentation of select capabilities or functional areas of preparedness and response
Content aligned to relevant guidance documents and other measurement activities
Capabilities and indicators limited to human health
Ethical considerations in preparedness and response not included in National Inventory

7. Development of the Tool—Highlights of Process
Initial content from field staff in Southeast Asia
Comprehensive review of existing metrics relevant to preparedness and response
Detailed feedback from Atlanta-based subject matter experts and colleague worldwide
Pilot test of data collection process and tool in Thailand, India, and Guatemala
Revise materials, process, and tool based on pilot tests
Harmonization of process and metrics with related tools in PAHO and WPRO

8. Development of the Tool— Distinguishing Characteristics
Indicators are relational, not presence or absence of a characteristic or simple count
Primary use of process and findings in each country
Indicators developed from country and regional experiences in preparedness and response
Indicators allow all countries to demonstrate achievements over time
Prepare a succinct scorecard of findings by capability

9. Guiding Principles
Best available science and practice relevant to preparedness and response
Progress from one level to the next demonstrates a meaningful improvement in public health function
Data present composite progress in specific domains of preparedness and response—not all domains of preparedness and response
Full achievement of these capabilities does not guarantee that emergent pandemic will be interrupted
While all countries strive for enhanced preparedness, end-points are not identical

10. Core Capabilities Country Plan Research and Use of Findings
Communications
Epidemiologic Capability
Laboratory Capability
Routine Influenza Surveillance
National Respiratory Disease Surveillance and Reporting
Outbreak Response
Resources for Containment
Community-based Interventions to Prevent the Spread of Influenza
Infection Control
Health Sector Pandemic Response

12. Core Capabilities
Capabilities reflect summary domains of investment and activity
Indicators equal dimensions of coverage, quality, and timeliness
Each capability includes four indicators
Each indicator includes four levels of performance
Measurement Notes include operational definitions and references
References and resource documents provided to all participants on flash drive

13. Selection of Core Capabilities and Indicators—Challenges
Widespread, ongoing dialogue regarding evidence-base and standards of performance
Questions remain as to optimal markers of preparedness
Measurement strategies evolve as work continues to unfold
Important capabilities to be discussed—ethical considerations
Indicators must embrace or meet countries where they are now in planning and implementation

14. Implementation Agreements re. data ownership and distribution
First wave of data collection April – September 2008
Data collection days in each country
Standard materials and process for planning, data collection, and reports to Ministries of Health
Translation of tool to 6 languages
Participants identified by Ministries of Health
Collaboration with WHO via Regional and Country Offices
Preliminary reports to countries for comment (quantitative and qualitative data)
Second wave of data collection in 2010

15. Implementation in AFRO (2008)
Workshop in Tanzania to prepare for data collection (e.g., review design and content of tool, enhance consistency in data collection)
Demonstration of data collection
Tanzania allowed 10 countries to observe their dialogue and scoring
Forum for questions and clarification of instrument and implementation process
10 countries returned home with CDC colleague— data collection with Ministry of Health and partners

16. Analysis—Simple Calculations
Average four indicators for a capability-level score
< 1 = 0
1 - < 2 = 1
2 - < 3 = 2
3 = 3
For split indicators: (B1 + B2) / 2 = score for B used in equation above
(Indicator A + Indicator B + Indicator C + Indicator D) / 4

17. Presentation of Results based on Intended Users

18. Distribution of Capabilities for Pandemic Preparedness and Response
N=40 (NOT FOR DISTRIBUTION)

19. Use of Results For international and national technical agencies:
Information to guide resources to fill needed gaps
Information to guide regional planning for technical assistance
Information to show specific improvements over time
For countries (Ministries of Health and Partners)
Identify country strengths and plan for sustainability of these capabilities
Determine needs by capability and indicator
Direct resources and planning to address priorities
Use information for advocacy for resources within government
Demonstrate achievements at regular intervals

20. Important Considerations before Adapting the Tool
Stakeholders pleased with structured opportunity for sharing information across sectors
Having objectively-determinable cutoffs for defining levels of maturation is major advantage of design
Bringing countries together for training pre- implementation promotes transparency and intra- regional exchange of information
Dialogue yields many ideas for follow-up action—need a process in place to capture these items
Support available to country/region (e.g., planning, materials, data cleaning and analysis, prepare report for review, translation services—instrument, supporting materials, reports)

21. Questions for the Group
How will we know how and when ethical considerations are used in preparedness and response?
Would countries, donors, technical organizations, etc. value documentation of progress in this domain?
Should we create indicators that encourage practical, small achievements in this domain?
Could preparing indicators for wider review bring attention to the importance of ethical considerations in preparedness and response?