1. 1 PREPARATION AND RESPONSE OF THE HEALTH SERVICES TO AN INFLUENZA PANDEMIC

2. 2 Components to be considered in the Plan 1.- Organization: Organizational Chart Flows and Coordination Systems Responsible Parties Incorporation of other actors 2.- Functions: Definition of the functions of each one of the actors in the different phases of the Pandemic I.- Organization and Functioning

3. 3 Components to consider in the Plan 1.- Outpatient Attention Number of Establishments Assignment of available Human Resources Social, private organizations etc. Availability of :  Drugs  Supplies  Equipment II.- Installed Capacity, Assignment of Resources (1)

4. 4 Components to Consider in the Plan 2.- Hospital Attention Number of establishments (public and private) Number and quality of total available beds (public and private) Number of critical beds available (public and private) Availability of equipment to support critical activity Availability of RRHH to support critical activities Hospital management indicators Availability:  Drugs  Supplies  Equipment  Infection control supplies  Personal protection equipment II.- Installed Capacity, Assignment of Resources (2)

5. 5 Components to Consider in the Plan 1.- Outpatient Care Out fitting of additional services Availability of extra RRHH 2.- Hospital Attention Number of possible beds to reconvert RRHH that supports the increase in activity Installed physical capacity that allows an increase of beds Ability to establish strategic reserves (storage and distribution) III.- Potential Capacity

6. 6 Components to Consider in the Plan 1.- Outpatient Attention RRHH gap Gap in medical supplies and equipment Valuation of the estimated gaps 2.- Hospital Attention RRHH gaps Gaps in supplies and reactives Gaps in medicines Gap in equipment that provides support to critical activity Valuation of the Gaps IV.- Gap Analysis

7. 7 Model Outline to create the Health Services Network Capacity Response Plan before an eventual Pandemic I Interpandemic Period II Pandemic Alert Period III Pandemic Period

8. 8 I.- Interpandemic Period 1.- Formulation of the National Contingency Plan that incorporates the National Health Services Response Capacity during an eventual Influenza Pandemic a.- Organization and Functioning of the Health Services Network in response to an eventual Pandemic. 2.- Identify the Installed Capacity and the Assignment of Resources of the Health Services Network, outpatient as well as hospitalization. 3.- Identify the Potential Response Capacity of the Health Services Network.

9. 9 II.- Pandemic Alert Period 1.- Theoretical impact of the Pandemic simulation exercise a.- Establish assumptions under which the simulation exercise is being carried out 2.- Analysis of the gaps between the Installed Capacity and the Potential Capacity from the time of the results of the simulation exercise. 3.- Simulation exercise that allows the evaluation of how the Assistance Network and the structure in command are functioning. 4.- Analysis and evaluation of the response capacity of Bi- national Network Services in frontier scenarios in regions where there is a high exchange among countries. 5.- Preparation and Organization of the Health Services Network in the different periods of the Pandemic.

10. 10 III.- Pandemic Period Phase 6; Increased and continuous transmission in the general population (outside the country) Phase 6; Increased and continues transmission in the general population (in the country)

11. 11 Keep up the simulation exercises Evaluate the response capacity of the Services Network in a Pandemic and each time make the corresponding adjustments. Implement attention and infection control Protocols Apply the already established clinical norms for suspicious cases Make emphasis on the vigilance measures. III.- Pandemic Period Phase 6; Increased and continued Transmission in the general population (outside the country)

12. 12 Activation of the Structure established for this Phase Application of the norms established for the management of patients and the responsibility of other institutions during this period. Application of the measures proposed in the Contingency Plan in relation to isolation in specific attention centers and/or others planned for in the Contingency Plan. Categorize patients and implement the derivation flows of the same in accordance with the established norms. III.- Pandemic Period Phase 6; Increased and continued Transmission in the general population (in the country)

13. 13 PAHO Strategic Plan Activity 20052006 NovemberDecemberJanuaryFebruaryMarchApril Document Model Evaluation: Design Recompilation Processing Good Practices: Recompilation Systematization Expert’s network: Identification Invitation Functioning Development Reunion Regional Reunion Bogotá, Colombia

14. 14 PREPARATION AND RESPONSE OF THE HEALTH SERVICES TO AN INFLUENZA PANDEMIC

15. 15 I.- Interpandemic Period 1.- Formulation of the National Contingency Plan that incorporates the National Health Services Response Capacity during an eventual Influenza Pandemic a.- Organization and Functioning of the Health Services Network in response to an eventual Pandemic. 2.- Identify the Installed Capacity and the Assignment of Resources of the Health Services Network, outpatient as well as hospitalization. 3.- Identify the Potential Response Capacity of the Health Services Network.

16. 16 I.- Interpandemic Period Organization and Functioning of the Health Services Network in response to an eventual Pandemic. Organization: There must be an organizational chart that explains the hierarchy at different levels up to the national level. Flow and expedited coordination systems must be established, known and agreed by consensus by the different parties involved in each one of the Pandemic’s Phases. The parties responsible at different levels must exist in accordance to the organizational chart set out. It must be clear in which Phase of the Pandemic other self managing hierarchical institutions are incorporated, for example, Private Attention Systems, Armed Forces, Firefighters etc. Duties: The duties of each party must be defined in each distinct Phase of the Pandemic  Outpatient Care  Hospital Care  Referenced Hospitals  Local and Referenced Laboratories  Private Attention  Armed Forces  Firefighters  International Organizations (Red Cross, etc.) 1.- Creation of a National Contingency Plan that incorporates the Health Services Network’s Capacity to Respond during an eventual influenza Pandemic

17. 17 a. Outpatient Care Number of outpatient establishments in the Health Services Network, according to territorial jurisdiction Staffing of Human Resources Available for outpatient care (doctors, nurses and physiotherapists) Existence of outpatient personnel that provide respiratory therapy. Knowledge and/or registration of social and private Organizations that exist, for example: Red Cross, Rotary Clubs, N.G.O’s Availability of: Drugs, antibiotics, antiviral, others Supplies: to control infections Personnel protection equipment I.- Interpandemic Period 2.- Identify the Actual Capacity and the Availability of Resources of the Health Services Network, both outpatient and hospitalization.

18. 18 b.- Hospital Care Number of hospital establishments in the Health Services Network, according to territorial jurisdiction (if it corresponds) Number of hospital establishments in the Private Care Network Total number of beds available by establishment in the Health Services Network Total number of beds available by establishment in the Private Care Network Total number of critical beds (intermediate and intensive) available in the Private Care Network Availability of Equipment that supports critical activity in the Health Services Network establishments Availability of Human Resources to support actual critical activity Actual Hospital Management indicators: occupational indexes, average patient stays etc. Availability of: Medications; antivirals, antibiotics and others Supplies and equipment to control infections Personnel protection equipment I.- Interpandemic Period 2.- Identify the Actual Capacity and the Availability of Resources of the Health Services Network, both outpatient and hospitalization.

19. 19 a.- Outpatient Care Ability to outfit additional services in non traditional attention spaces, examples Community Centers, Schools or other Availability of extra Human Resources, example: Red Cross personnel, trained volunteers in support assistance, privates etc. b.- Hospital Care Number of possible beds to be reconverted in the Health Services Networks’ establishments Availability of Human Resources that support the increase in hospital activity Installed physical capacity that allows an increase in the number of hospital beds Ability to establish strategic reserves with respective storage and distribution mechanisms. I.- Interpandemic Period 3.- Identify the Potential Response Capacity of the Health Services Network

20. 20 II.- Pandemic Alert Period 1.- Theoretical impact of the Pandemic simulation exercise a.- Establish assumptions under which the simulation exercise is being carried out 2.- Analysis of the gaps between the Installed Capacity and the Potential Capacity from the time of the results of the simulation exercise. 3.- Simulation exercise that allows the evaluation of how the Assistance Network and the structure in charge are functioning. 4.- Analysis and evaluation of the response capacity of Bi-national Network Services in frontier scenarios in regions where there is a high exchange among countries. 5.- Preparation and Organization of the Health Services Network in the different periods of the Pandemic.

21. 21 Establish assumptions under which the simulation exercises are carried out: General Assumptions Attack Rate (two scenarios) Population to be considered, example, Total Country Population, Population that benefits from the Public System plus population that benefits form the Private Care System broken down into separate groups etc. Lethality by group etc Periods and percentages in which consultations and/or hospitalization will take place Assumptions Outpatient Care Percentage of consultations to be carried out Number of consultations per patient Output of consultations per hour Hospitalization Assumptions Hospitalization percentages according to groups, older than and younger than 65 years Percentage of patients that will require critical beds Percentage of patients that will require a bed that is less complex than a critical bed Average length of hospitalization of patients in critical beds II.- Períod of Pandemic Alert 1.- Theoretical impact / simulation exercise of the impact of the disease and the demand on the Pandemic services

22. 22 a.- Outpatient care: Estimated Human Resource gaps according to the simulations Estimated gaps in supplies, medicines and personnel protection equipment Estimate requirements and gaps for antiviral, antibiotics or others Assess estimated gaps: Human Resources, equipment, supplies, antibiotics, antiviral etc. Estimate gaps in requirements that are not outlined in this guide but appeared as a need in the simulation exercises. b.- Hospital Care: Estimate gaps in equipment used to support critical activity (fans or others) Estimate gaps in supplies and reactives needed for increased activity Estimate Human Resource gaps that allow for the reconversion of beds and increased activity in critical units Estimate requirements and gaps for antiviral, antibiotics or others Assess estimated gaps: Human Resources, equipment, supplies, antibiotics, antivirals etc. Estimate gaps in requirements that are not outlined in this guide but appeared as a need in the simulation exercises. II.- Pandemic Alert Period 2.- Analysis of the gaps between the Installed Capacity and the Potential Capacity based on simulation exercise results.

23. 23 Evaluate established command structure. Evaluate local, regional and national coordination. Evaluate patient flows according to what has been established. Evaluate incorporation of other parties in the established organizational chart. Evaluate cadaver management response. Evaluate coordination between bordering countries. II.- Pandemic Alert Period 3.- Simulation exercise that allows the functioning of the Assistance Network and command structure to be evaluated

24. 24 Share among countries the proposed plans Establish respective coordination between the countries involved Carry out simulation exercises in conjunction II.- Pandemic Alert Period 4.- Analysis and evaluation of the capacity of Binational Network Services to respond to frontier scenarios in Regions with a high interchange among countries

25. 25 a.- Period of Pandemic Alert (Phase 3 to 5) Existence of Guides for the prevention, diagnosis and treatment of the Influenza Existence of Guides for the control of infections Existence of Guides for the management of cadavers (manipulation, storage and disposal) Design training of personnel to identify suspicious cases of influenza and the corresponding flow of consequences. Formulate Protocols that clearly indicate in which stage or at which moment national organizations and other actors responsible for the creation of non traditional attention scenarios will be incorporated. Carry out periodic simulation exercises Keep periodic and systematic information on hospital indicators and outpatient care. II.- Pandemic Alert Period 5.- Preparation and Organization of the Health Services Network in the different periods of the Pandemic

26. 26 III.- Pandémic Period Phase 6; Increased and continues transmission in the general population (outside the country) Phase 6; Increased and continues transmission in the general population (in the country)

27. 27 Keep up the simulation exercises Evaluate the response capacity of the Services Network in a Pandemic and each time make the corresponding adjustments. Implement attention and infection control Protocols Apply the already established clinical norms for suspicious cases Make emphasis on the vigilance measures. III.- Pandemic Period Phase 6; Increased and continued Transmission in the general population (outside the country)

28. 28 Activation of the Structure established for this Phase Application of the norms established for the management of patients and the responsibility of other institutions during this period. Application of the measures proposed in the Contingency Plan in relation to isolation in specific attention centers and/or others planned for in the Contingency Plan. Categorize patients and implement the derivation flows of the same in accordance with the established norms. III.- Pandemic Period Phase 6; Increased and continued Transmission in the general population (in the country)

29. 29 Stragegic PAHO Plan Actividad 20052006 NovemberDecemberJanuaryFebruaryMarchApril Document Model Evaluation: Design Recompilation Processing Good Practices: Recompilation Systematizaion Expert’s Network: Identification Invitation Functioning Meeting development Regional Meeting Bogotá, Colombia

30. 30