ประสบการณ์การดำเนินงาน Provincial One Health สพ.ญ. เสาวพักตร์ ฮิ้นจ้อย สำนักระบาดวิทยา กรมควบคุมโรค

One Health: Mission ! ? possible (IM)

Rational for using a multi-sectoral approach Thailand’s National Strategic Plan for Emerging Infectious Disease Preparedness, Prevention and Response 2013-2016 The outbreaks of SARS and HPAI sent an alarm to the world regarding the pandemic threats that human beings are confronting Thailand has developed a new 5-year National Strategic Plan for EIDs Preparedness, Prevention and Control 2013-2016 The key emphasis is the importance of an interdisciplinary and multi-sectoral collaboration using the One Health approach Improve EID preparedness and to strengthen the capacity of the key government employees responsible for human, animal and wildlife health

Training of Field Epidemiologists in Thailand FETP (MD/DVM) SRRT (Public Health/Animal Health/Environmental Health/Laboratory) Public Health Volunteers/Animal Health Volunteers/Wildlife Park Rangers/Zoo Keepers National Advanced level Provincial Intermediate level Community Basic level Surveillance under “One Health” Concept

What was accomplished? DLD: Department of Livestock Development FETP-V: Field Epidemiology Training Program for Veterinarians FEMT: Field Epidemiology and Management Training SRRT: Surveillance and Rapid Response Team In 2005; Implementing a short-course training FEMT to provide a six month in-service training for physicians and public health professionals as part of SRRT In 2008; The collaboration has been developed with the DLD to expand the program FETP-V, joint training activities between the two ministries and the collaboration In 2012; Short-term multi-sectoral training in applied epidemiology and field investigations of EIDs. In 2013; A continuing support to the existing epidemiological “One Health” teams in those 5 provinces and also expand into new 5 provinces In 2013; Fostering multi-sectoral collaboration to achieve the goal of “One Health” for humans, animals and the environment in The 6th National Health Assembly (NHA) In 2014; Thai One Health Coordinating is officially established In 2015; Expanding “One Health” to 14 provinces

The multi-sectoral strategy used 1. Training Strategy and Process Collaborative effort between the three ministries namely Ministry of Public Health (MoPH), Ministry of Agriculture and Cooperatives (MoA) and Ministry of Natural Resources and Environment (MoNRE) and Thailand One Health University Network (TOHUN) Training methodologies included classroom training (lectures, presentations, exchanges, panel and group discussions, scenario work and case studies), field visits and observations, field work implementation, and after-action reviews to share lessons learned from the field projects.

The multi-sectoral strategy used MOU for Strengthening Epidemiology in Emerging Infectious Diseases Surveillance of One Health Network 2. Advocate the usefulness of “One Health” collaborations and successful projects to policymakers at local, national and international levels

The multi-sectoral strategy used 3. Establish provincial “One Health” centers to serve as coordinating units and resources centers Each model province proposed the proposal with a workplan for setting up the provincial One Health Center as a main outcome Thai One Health Coordinating unit in the central team is a supporting unit as the provinces’ request on technical issues and evaluate a successful project in each province Holding a workshop among stakeholders for sharing results and experiences of setting up the Provincial One Health Centers in each province

The multi-sectoral strategy used 4. Field Project Implementation Each provincial team designed a 4-6 month field project to implement a multi-sectoral collaborative activity that encompassed the One Health approach in their provinces Example

The multi-sectoral strategy used 5. Building One Health community Recruit the members having common interest in One Health This community of practice is through the process of sharing information and experiences with the group http://www.thaionehealth.org/home Exchange trip between two provincial one health teams for sharing experiences of conducting One Health in their local contexts

Challenges had to be overcome Developing collective leadership Setting and implementing strong commitment among national and local collaborators Building trust and team spirit Need to be fostering sustainability in One Health communities

ความสำเร็จ Provincial OH Coordinating Center Official center 5 จังหวัด Informal center 9 จังหวัด One Health line group (N=111) เพื่อแจ้งข่าว outbreak/ผลงานดำเนินการ เกิดศูนย์ประสานงานเครือข่ายสุขภาพหนึ่งเดียว การสอบสวนโรคร่วมกัน ในกรณีกระทิงและเลียงผา (DNP+ZPO) การประชุมประสานความร่วมมือโรคติดต่อระหว่างสัตว์และคน 4 กรม ความร่วมมือในการเฝ้าระวังโรคในลิง ค้างคาว Rodent Avian Reptile Amphibian (โครงการโรคอุบัติใหม่) และการพัฒนาบุคลากร องค์กรระหว่างประเทศสนับสนุน provincial OH/ THOHUN มี MOU – MoPH/DLD/DNP/THOHUN/ZPO ความสำเร็จ

ปัญหาและอุปสรรค ขาดกลไกการบริหารทรัพยากรร่วมกัน Rotation of personnel คนเปลี่ยน งานไม่เดิน ผู้บริหารคิดว่างาน OH เป็น overload ไม่ส่งเสริมเจ้าหน้าที่ ยังไม่มีประเมิน output/outcome ของการดำเนินงาน OH network ขาด Leadership ผู้บริหาร นโยบาย ยังไม่ให้ความสำคัญกับ OH มากพอ ขาดการสนับสนุนด้านงบประมาณในภาคส่วน DNP ยังไม่มีการบูรณาการเครือข่ายการฝึกอบรมระหว่างภาคคนและสัตว์ ยังไม่มี OH network ในระดับเขตที่เป็นรูปธรรม ขาดการ Risk assessment ของโรคที่สำคัญที่จะดำเนินการร่วมกันในแต่ละพื้นที่ ปัญหาและอุปสรรค

Prioritization Process PREPARATION STEP 1 Prepare for Group Work Select 6-12 stakeholder representatives to participate in facilitated group work; generate a list of all zoonoses to be ranked FACILITATED GROUP WORK STEP 2 Develop the Criteria Identify 5-8 criteria that will be used to define the relative importance of the zoonoses selected in Step 1 STEP 3 Develop the Questions Develop one categorical question for each criterion selected in Step 2 Qualitative Method Group selection of criteria and questions relevant to prioritization STEP 4 Rank the Criteria Each representative individually ranks the criteria developed in Step 2. Individual scores are combined to produce an overall ranked list of criteria Semi-Quantitative Method Analytic Hierarchy Process used to rank criteria FINAL PRIORITIZED LIST STEP 5 Rank the Zoonoses Score each zoonotic disease based on the answers to the categorical questions for each weighted criterion Quantitative Method Decision tree analysis of each zoonotic disease

Criteria for prioritization Group 1 Group 2 Final Severity in human Ability to control Human / animal transmission Socio – Economic Impact Socio – Economic impact Socio-economic impact Existing collaboration Ability to collaboration Transmission Human – Human transmission (pandemic potential) Human – Human transmission Biosafety Level

Ranking Criteria Severity 2. Ability to control 3. Transmission 4. Pandemic potential 5. Economic impact

Endemic Zoonotic Diseases Rank Disease Severity (weight=5) a. <5 b. 5-19 c. >=20 Control -Tx/Vc (weight=4) a. Both b. Human c. Animals d. None Pandemic H-H (weight=3) a. No evidence b. Close contact c. Sustained Transmission (weight=2) a. Food/ water b. Close contact c. Vector d. Airborne Economic impact - production (weight=1) a. None b. Reduced c. Death/ culling Score Morbidity 2013 (per 100k) 1 Influenza viruses c a d 0.827 68 2 Hepatitis B b 0.804 13.95 3 Herpes B 0.781 . 4 Anthrax 0.758 Melioidosis 4.39 Tuberculosis 7 Chlamydiasis (C. psittaci) 0.712 Tularemia 9 Leptospirosis 0.689 4.8 Rabies 0.01

Challenges Validity of disease information Morbidity and mortality information Policy

One Health for Network, Network for action 2014