1. Dr. Nyphonh Chanthakoummane Country Coordinator X-MBDS Project Senior Technical Officer, DOHP, MOH, Laos MBDS Information Communication & Technology Forum April 2 nd -3 rd,2009 Ploy Palace Hotel,Mukdahan Province, Thailand

2. Outline - National Surveillance System of Notifiable Selected Diseases - Avian Influenza National Hotline

3. Flow Chart of Information of NSSNSD Special Task Force During an Outbreak Natl / Prov Hospitals Private Clinics District Hosp Active Surv Passive Surv Active Surv Passive Surv Weekly report Fax/phone Weekly report Fax/phone/Radio Weekly/ monthly Feed-back report

4. Conditions/Diseases under surveillance Lao P.D.R. (1) 1. Acute Flaccid Paralysis (AFP) 2. Measles 3. Neonatal tetanus 4. Tetanus of all ages 5. Diphtheria 6. Pertussis 7. Severe diarrhea (including cholera)

5. Conditions/Diseases under surveillance, Lao P.D.R. (2) 8. Dengue virus infection (DF/DHF/DSS) 9. Total dysentery 10. Food poisoning 11. Typhoid fever 12. Anthrax 13. Total Hepatitis 14. Meningitis 15. Encephalitis 16. Plague The surveillance of SARS and Avian flu has been integrated and collaborated into the CDC Task Force located at NAHICO and DOHP

6. Activities : 1. Daily (Nov. 2004) and Weekly Surveillance Report of Disease under Surveillance currently performed, 2. Unusual event(s) reported any time. 3. In addition to Passive Surveillance, Regular Active Surveillance by visiting health facilities currently performed, 4. Supplementary Surveillance (Community based active case search periodically conducted). 5. Weekly Feed back report regularly done at national level and some provincial level 6. Regular supervision and monitoring combined with AFP case follow up 7. Annual National Meeting on Surveillance regularly conducted. 8. Border selective area co-operation, collaboration with DHP. 9. Early Warning System of potentially epidemic diseases currently monitored 10. Outbreak investigation

7. Province:_____________________Date:___________________ Chief of Provincial Hygiene and Epidemiology section: ________________________ Reporter _______________________

8. Information Sharing Network intra and inter-country Data and information shared through: Fax/phone Written feed-back weekly report E-mail/internet (nclep@laotel.com)nclep@laotel.com with WHO, FAO, MBDS/Bureau of Epidemiology,Thailand, ASEAN-DS.Net, DengueNet, JICA, Japan Embassy.

9. Avian Influenza National Hotline

10. Why work on Piloting a National Hotline: Reporting of suspected outbreaks in Poultry in Laos was slow Limited reports of poultry deaths because of perceived stigma There is an awareness of AI however people still have questions Overview

11. Purpose: The AI HOTLINE is center for public to get answer to their questions and concerns about AI and allows people to call in and report poultry deaths without delay. Tool for AI surveillance, rapid respond to outbreak, and to reach all people includes backyard farmers.

12. Establishment  The National Avian Influenza (AI) Hotline was officially launched on 18th February, 2008.  Advertise since February 2008 Radio TV Print Stickers, posters, etc Transit (Tuk-Tuk, buses, etc) Phone refill card Officials/Vet, head of villages Trainings

13. To provide information about Avian Influenza through a simple single point of access to the public To provide feedback for the government / line ministries about attitudes and concerns of the public and relevant data collection for research To provide support for reporting of suspected AI cases Objective

14. Management Human resources: Two call operators and one project officer. Two call operators work in different shift (7 a.m. - 1 p.m.) and (12 p.m. - 6 p.m.). Set up messages receivers after hours (from 6 p.m. to 7 a.m.). Callers could leave voice message up to 100 massages.

15. Management Training and skills: Call operators have been trained in technical information such as Overview of AI, Animal issues, Human issues, Current Situation, Telephone counseling skills…etc., Call operators answer the question on AI based on the pre- approved (technically correct) Q&A. Training curriculum for the Hotline staffs.

16. Management Daily Activities: Answer of basic questions and concerns about Avian Influenza and related issues for the general public. Check back if information by callers are true. Input data into daily report. Daily and weekly report compiled includes: Reports for suspected AI Questions asked on AI Source of hearing about the hotline Calls received after hours

17. NAHICO NAHC National Animal Health Center NCLE National Center Of Laboratory & Epidemiology AI Hotline 166 V V W Village Volunteer Work Callers Provincial Department of Agriculture and Forestry Reporting Process Provincial Health Department (Surveillance Unit)

18. Outcomes There is an increasing number of people awareness of AI hotline. Many people call in directly and report poultry deaths and ask for information on AI. Other animal sickness is also being reported (Pigs and Cows…). The designed Microsoft Access as Data base could operate both English and Laos and call operators could be used as a sources of AI information.

19. Outcomes Simply use of Microsoft excel to keep daily records for all calls. Call operators check back very carefully when getting suspected information from callers before sending out report. Call operators are able to give answer and information on AI confidently. Call operators calmly and patiently advice all callers who call to disturbs, tell lies and rude calls.

20. Total Call Volume March 2008 – February 2009

21. Monthly AI call March 2008 – February 2009

23. Challenges There is still huge number of wrong purposes, fake calls and call to disturb. Unclear on reporting process There is no feedback after sending reports out. Unclear on AI hotline’s role and responsibility

24. What are the next steps? Expanding hotline to other diseases and increasing call operator capacity. Survey on possibility of using SMS system to alert local officials or officials involve (included VVW…) on AI as a tool for rapid response when there is an outbreak. Identify formally reporting structure for hotline reports (human and animal health) Identify reporting back structure

25. What are the next steps? Train persons to be casual call operators (used for rapid expansion if needed or as needed when permanent call operators are on leave) Develop database on Microsoft Access to be used to keep for all purposes (keep data, report system and monitoring and sources of information)