1. Central Asia Regional Health Security Workshop Co-organized with the Command Surgeon, US Central Command and the George C. Marshall European Center for Security Studies 17-19 April 2012, Garmisch-Partenkirchen, Germany Legislations and Disease Surveillance In IHR (2005) Dr Hashim Elzein Elmousaad Public Health Specialist 17 April 2012

2. Learning objectives On completion of the exercise, participants will be able to: - Identify the hazards to be assessed and the core capacities needed for implementation of IHR. - Identify what are the needs for developing a legislation policy compatible with IHR (2005) as well as strong event surveillance system.

3. Introduction l ALL member States have legal frameworks (may support many IHR 2005) l IHR (2005) may have many functions and provisions not considered in current legislation Main Question: What needs to be adjusted in the national legal framework to ensure that your country can implement all rights and obligations in the IHR ?

4. IHR (2005) Under the IHR (2005), each Member State is required to develop, strengthen and maintain, as soon as possible but no later than five years from the entry into force of these Regulations (i.e. by 2012). The capacity to detect, assess, notify, report and respond promptly and effectively to public health risks and public health emergencies of international concern.

5. You are the Director of International Health Department in country C. You were called by H.E. the Ministry of Health for a meeting 2 days later to discuss the preparation of your department with the Director of Epidemiology to assess the core capacities of the IHR (2005) in the country. H.E. the Minister has fair knowledge on IHR (2005) and its importance. He wants to know more about certain components of the planned assessment so as to help him facilitating the formation of health coordination committee when meeting representative of other line ministries. H. E. the Minister put the following 3 Questions to be answered:

6. 3 Questions What are the hazard areas and core capacities that will be assessed? What needs to be adjusted in the national legislation and policy frame work to ensure that the country can implement all rights and obligations in the IHR? What are the requirements needed in order for the national surveillance to comply with the IHR (2005)?

7. What are the hazard areas and core capacities that will be assessed? Question 1

8. The main hazards (Infectious diseases, zoonoses, Chemical, food safety and in some countries radio- nuclear) Core Capacities –National legislation and policy –Coordination. –Surveillance. –Response. –Preparedness. –Risk communication. –Laboratory. –Human resource capacity.

9. Question 2 What needs to be adjusted in the national legislation and policy frame work to ensure that the country can implement all rights and obligations in the IHR?

10. Assessment and Decision l Assess to identify gaps or other potential concern. -Compares IHR provisions with existing national legal framework l Decide for each gap or concern - country to decide what action is required to address it. l Further more: Updating - Any additional legislation changes (e.g. general update to legislation)

11. Legally Binding…… IHR is legally binding upon each country as a whole, not only the Ministry of Health or other part of the government.

12. Areas and functions affected by IHR implementation Health Environment Ports, airports, ground crossings Customs Food safety Borders Immigration Security Agriculture (and animal health) Radiological / nuclear activities Chemical related activities International transport/trade/travel Human rights Industry / Commerce Defense Dissemination of health information

13. Prioritize –What needs to be done most urgently? –What are the most important elements for each country? –Consider options to expedite the legislative process if urgently needed.

14. Strengthening the Role of NFP Establish a clear, specific legal / governmental mandate for all NFP functions

15. Resources

16. IHR Disease Surveillance

17. Question 3 What are the requirements needed in order for the national surveillance to comply with the IHR (2005)?

18. Surveillance System Structure Legislation Surveillance Strategy Trained Human Resources Trained Stakeholders Networking - Partnership

19. Surveillance Core Functions Case Detection Case Registration Case Confirmation Case Definitions Reporting Data Analysis and interpretation Epidemic Preparedness Response and Control Feedback Events

20. Surveillance Quality Completeness Timeliness Usefulness Simplicity Acceptability Flexibility Sensitivity and Specificity Positive predictive value Representativeness

21. Other Supporting Aspects Standards and guidelines Training Supervision Communication Equipment Resources (Material, Money, Manpower) Monitoring & Evaluation Coordination

22. Questions Questions?

23. Dr. Hashim A. Elzein Elmousaad Public Health Specialist Cairo – Egypt elmousaadh@gmail.com Tel: 00201120400733