THE REPUBLIC OF / / THE GAMBIA

National Preparedness Plan for

Influenza A H1N1

Banjul, The Gambia

15 June 2009

Foreword

Influenza A H1N1 is one of the many hazards facing The Gambia. The nation has had recent experience with many human and animal health related emergencies including cholera and locust outbreaks. This experience tells us that we can tackle these threats if we are properly prepared.

This Preparedness Plan for Influenza A H1N1 represents a set of steps we will take to respond to the threat of the pandemic should it reach our shores. This is work in progress; and we expect that through constant reviews, revisions and simulations, the document will be adapted to suit new developments, and will be able to enhance the security of the nation and its citizens.

The threat of human Influenza is a matter of tremendous global importance. The Gambia counts on the international community to complement this important effort to help the Gambian people and the Government of the Republic to fulfil its role here at home, and in the broader regional and international community.

______

H.E. Dr. Isatou Njie-Saidy, Vice President of The Gambia

Chair of the National Disaster Management Council

Date: 15th June 2009

Table of Contents

1. Summary...... 7

Introduction...... 7

Strategies...... 7

Limitations...... 7

2. Background Information...... 8

Preparedness Plan for Influenza A H1N1 Outbreak...... 8

Objectives to be Accomplished during the Intervention...... 9

Strategies...... 9

3. Risk Assessment, Hazard and Risk Analysis...... 10

Summary and Update of the Risk Situation and State of Preparedness...... 12

Hazards, Risks and Mitigation Strategies during the Pandemic Period...... 13

4. Roles and Responsibilities by Sector, Current Level of Preparedness and Limitations...... 17

5. Pre-Pandemic Phase Threat Preparedness and Resource Requirements...... 31

6. Pandemic Phase Threat Preparedness and Resource Requirements...... 35

7. Coordination...... 38

Coordination Arrangements...... 38

Human Resource Management...... 39

Essential Staff...... 39

Testing of Plan...... 40

Preparedness Plan Update Schedule...... 40

Framework and Budget for Influenza A H1N1 Coordination...... 40

8. Surveillance...... 41

Objectives...... 41

Strategies...... 41

Activities by Objectives...... 41

Framework and Budget for Influenza A H1N1 Surveillance...... 44

9. Prevention and Control...... 47

Strategy 1: Infection Prevention and Control...... 47

Strategy 2: Case Management...... 47

Framework and Budget for Prevention and Control...... 49

10. Communication...... 50

Key messages...... 51

Framework and Budget for Communication...... 52

11. Preparedness Actions and Plan Updating...... 56

12. Overall Financial Resource Requirements...... 57

Budget for Immediate Priority Actions...... 58

Table of Appendices

Appendix A: Composition of the Emergency Preparedness and Response Team...... 59

Appendix B: List of Essential Personnel (Updated May 2009)...... 60

Appendix C: List of Emergency Numbers (Updated May 2009)...... 62

Appendix D: Health Care Facilities in The Gambia (Updated May 2009)...... 63

Appendix E: Regions and Municipalities in The Gambia (Updated May 2009)...... 64

Appendix F: What the General Public Must Know About Influenza A H1N1...... 68

Appendix G: Use of Personal Protective Equipment Kit...... 70

Appendix H: List of 6-Week Supplies to be Stocked...... 71

Appendix I: Standard Operating Procedures (SOPs) for the Department of Veterinary Services for Influenza A H1N1 Response 74

1. Summary

Requirementnf

Introduction

This Influenza A H1N1Preparedness Plan is based on the Comprehensive Plan developed in February 2006 to help the Republic of The Gambia prepare and respond to Avian and Human Influenza (H5N1). It explains the priority areas and articulates the actions that the Government and Partners will undertake to ensure health, safety and security of the citizens should an outbreak of Influenza A H1N1 occur. It includes the Pandemic Period (that is, the period during which there is significantly increased and sustained transmission of the Influenza A H1N1 virus in the general population). The Plan prioritises the following areas for rapid response:

  • Coordination
  • Surveillance
  • Prevention and Control, and
  • Communication

It spells out preparedness and emergency activities, as well as the roles various stakeholders are expected to play. It envisages that the programmes will be adjusted as per the resource demands and prioritised actions.

These interventions will be carried out through the existing National Task Force for Influenza A H1N1Preparedness and Response. The Office of the Vice President will coordinate the national response to the pandemic through the Task Force. Specialised Ministries such as Health and Social Welfare, and Agriculture, as well as the UN system and development partners will help mobilise supplemental support in the form of technical and financial resources to sustain the response operations.

The overall goal of the proposed interventions is to ensure health and safety of the entire population during Phases1-6 of Influenza A H1N1.

The Objectives are to:

  • Increase awareness on Influenza A H1N1 in all sectors of the population;
  • Reduce the impact of the emergency situation on the population;
  • Ensure continuation of Government operations during the crisis period.

Strategies

  • Promotion of information sharing for all people in The Gambia;
  • Situation assessments and regular monitoring of the pandemic;
  • Monitoring of the impact of the pandemic on the people, and;
  • Mitigation of impact during the pandemic period.

Limitations

In addition to strategies for intervention, this Plan makes reference to human and financial resource limitations in The Gambia’s capacity to respond to the Influenza A H1N1 pandemic. An effort is, therefore, made to clarify the needs and present a case for resource mobilisation through specific activities and budgetary requirements. The Government will also utilise the services and support available in the greater West Africa region and the global community as appropriate.

2. Background Information

The Gambia is one of the smallest countries on the West Coast of Africa. The country is surrounded on the East, North and South by Senegal and on the West by the Atlantic Ocean. It is a narrow strip of land on either sides of The Gambia River, stretching inland for 400 km.

The Gambia has an estimated population of 1.3 million (2003 census) with an annual growth rate of 2.8%. Forty-four percent (44%) of the population is below the age of 15 years; females constitute 51% of the total population and women of the reproductive age group (i.e. 15 – 49 years) represent 23.3%. Crude birth and death rates are 46.2 and 19.2 per 1000 populations respectively. Main causes of morbidity and mortality are malaria, respiratory infections, diarrhoea and malnutrition, especially among children. Episodes of outbreak of meningitis and cholera have also occurred in recent years.

The country’s comprehensive Emergency Preparedness and Response Plan for Avian Influenza (H5N1) was approved in February 2006. It spelled out actions for addressing the threat of H5N1, which had the potential to advance towards the country and spread from human to human.

Preparedness Plan for Influenza A H1N1 Outbreak

“Influenza ” is a viral respiratory disease caused by a virus that is passed easily from person to person (Influenza A), most often through droplets and aerosols created by people when they cough or sneeze. Usually, the virus infects mainly the upper respiratory tract, the nose, throat, and bronchi but in severe cases, the virus can spread to the lungs (upper tract).

Most people recover within one or two weeks without the need for medical treatment, however for the very young, the elderly, and those suffering from certain medical conditions, Influenza can pose a serious risk to health and can result in other complications such as pneumonia and even death.

WHO reported confirmed 7 cases of Swine Influenza in USA on 24th April 2009. One day later, Swine Influenza was declared as a public health emergency of international concern, following outbreaks in other countries. On 27 April, the level of Influenza Pandemic alert was raised from 3 to 4 as more countries in Europe reported cases (UK, SpainIsrael). On 29 April, the Pandemic alert phase was raised 4 to 5.

As of 3rd June, statistics were as follows:

  • USA10,054 cases and 17 deaths
  • Mexico5,563 cases and 103 deaths
  • Canada1,530 cases and 2 deaths
  • Australia 633 cases and no deaths
  • Japan 394 cases and no deaths
  • Chile 360 cases and 1 death
  • Egypt 1 case and 1 death
  • United Kingdom 339 cases and no deaths

As of 3rd June 2009, WHO reported 20,609 confirmed human cases of Influenza A H1N1 with 125 confirmed deaths in 72 countries across all continents, including Egypt (in Africa) as the first confirmed case. In light of this, The Gambia has joined in the global efforts to activate a response to the pandemic.

This Preparedness Plan has been prepared to trigger a national response during animal to human transmission and heightened human to human transmission in the West Africa region andin The Gambia. It is a result of a broadly consultative process involving the Government and Partners. It articulates actions that the Government will activate to respond to the worst case scenario of Influenza A H1N1 pandemic (that is, the period during which there is significantly increased and sustained transmission of the Influenza A H1N1 virus in the general population). It explains the priority areas and measures to be taken to ensure safety and security of the people during this period.

The Plan is structured in accordance with latest WHO information on developments regarding the virus since its outbreak was reported in April. It is an operational action and resource mobilisation document. It is not meant to contain detailed sector-specific plans, required for human and animal health, nor does it constitute a complete pandemic preparedness plan. It includes a brief risk assessment based on vulnerabilities and capacities of The Gambia, including a summary of the current assessment of risk and preparedness for Influenza A H1N1. It also describes the coordination structure, and the integrated response actions for the worst case scenario.

Objectives to be Accomplished during the Intervention

The overall goal of the proposed interventions is to ensure health and safety of the entire population during Phase 6 of Influenza A H1N1.

The Objectives are to:

  • Increase awareness on Influenza A H1N1 in all sectors of the population;
  • Reduce the impact of the emergency situation on the population;
  • Ensure continuation of Government operations during the crisis period.

Strategies

  • Promotion of information for all people in The Gambia;
  • Situation assessments and regular monitoring of the pandemic;
  • Monitoring of the impact of the pandemic on the people, and;
  • Mitigation of impact during the pandemic period.

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3. Risk Assessment, Hazard and Risk Analysis

With Influenza A H1N1 already confirmed in several countries (see above), there is a real need to assess the risk of infection in the country, specific vulnerability issues, as well as the capacity to address the threat. Below is a brief analysis of the risks by sector (human and animal health), the health surveillance system, and an update on the risk situation and current level of preparedness.

Sector / Current Situation
Health Care Delivery / Primary Health Care (PHC) strategy in 1979
Government, non-governmental organisations and private institutions provide the services
System follows primary healthcare strategy
System is organised into three levels primary, secondary and tertiary
There are eighty-seven health facilities in both public and private sectors
Health surveillance system / Consists of Central level, National Reference Laboratory, and Regional level
Supported by network of health facilities and laboratories at the peripheral and tertiary levels.
37 priority diseases under surveillance
Influenza A H1N1 recently included in the integrated disease surveillance and response system (IDSR)
In livestock there is an Epidemiological surveillance system for nine Trans-boundary Animal Diseases and Influenza A H1N1 is now included in the surveillance network.
However, main national reference laboratories of health and livestock poorly equipped for virology.
Surveillance systems in health and livestock weak due to inadequate human resources, logistic support, inadequate rapid response system, laboratory preparedness and lack of vaccines and essential drugs for humans
Livestock Systems / Population: cattle 340,000, sheep 175,000, goats 241,000, equines 58,000 and pigs 140,000 predominantly traditional subsistence system
Traditional pig production is extensive & characterised by small flocks, owned & managed by women and children Small–scale commercial pig farms are located in the peri-urban areas
Pig profile is as follows: traditional backyard system 90%, commercial system 8% and semi commercial system 2%
Migration/Tourism / Influenza A H1N1 is spreading rapidly across the world
The Gambia lies along the coast of West Africa & provides a sanctuary for tourists who may be infected before travel to The Gambia. May show no signs and symptoms of the disease but can introduce low pathogenic H1 and N1 viruses to the country
Trade / Trade links exist between the Gambia, Nigeria, Ghana and Ivory Coast
ECOWAS protocol on free movement of people and commodities poses a risk for the spread of the disease in the sub-region where the national boarders are porous and quarantine measures extremely difficult to implement.
Movement of people in the region is high
Border between The Gambia and Senegal porous
Weekly markets at border villages constitute high risk for the country

Summary and Update of the Risk Situation and State of Preparedness

General Vulnerability

Specific points of vulnerability in The Gambia are as follows:

  • Border areas are highly vulnerable (active trading and movement of people especially during festivals). Recent Cholera experience shows that family obligations may be stronger than disease concerns during the festivals
  • Weekly markets, where people interact, (mostly at the borders) are areas of high concern.
  • 90% of pig farming is backyard (3-35 pigs), free-range and not bio secure
  • The medium and large scale (10%) producers appear to be quite bio-secure and not near human habitats.
  • Hunters may be vulnerable and can also be useful partners for surveillance if properly trained.
  • Pig breeders are vulnerable due to their role in pig farming.

Human Health Sector

Human Health Capacity and Preparedness Activities

There are 39 public health facilities comprised of hospitals (4), major health centres (6), minor health centres (13) and dispensaries (16). A total of 34 Non-Governmental Organizations (NGO’s), private health facilities and clinics compliment the efforts of the public health facilities in delivering health care services, most of which are situated in the Greater Banjul area.

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Hazards, Risks and Mitigation Strategies during the Pandemic Period for The Gambia:

LGA / Human Capital / Social Capital / Natural Capital / Physical Capital / Financial Capital
Banjul BCC / Population: 35,061
Productive working class
Some people with vocational & technical skills
Estimated literacy rate of 70%
Commercial people & civil servants / Many Govt. Institutions
Security Institutions (army, navy, police, etc.)
Effective city council
Sufficient social clubs & various Councils
The Secretariat for emergencies and NDMC
Other emergency response institutions
Women’s “asusu” clubs
School Red Cross Societies / Mouth of River Gambia
The Atlantic Ocean & its tributaries, wetlands & mangroves
The beaches & other marine & coastal habitats / Good access road network
Fully equipped ambulance & fire service infrastructure
GPA and navy sea rescue equipment
Army, Navy & Police Headquarters
Royal Victoria Teaching hospital & other clinics / NDMC appeal funds
Private sector financial contribution
Civil Society financial contribution
City Council’s financial contribution
Human Influenza Vulnerability Factors:
Higher population density
Dependence on external supply of food / Human Influenza Capacity Factors:
Good communications and health facilities
Highly skilled and educated population
Easy access to government resources
LGA / Human Capital / Social Capital / Natural Capital / Physical Capital / Financial Capital
KMC / Population: 322,735
Productive working class
Some people with voc. & technical skills
Estimated literacy rate of 60%
Commercial people & civil servants
High Population of aliens & refugees / Some Govt. Institutions
Security Institutions (army, police, intervention force, etc.)
Effective municipal council
Sufficient social clubs & various Councils
Many Women’s “asusu” Clubs
Many local & international NGOs
Gambia Red Cross Society Headquarters / The Atlantic Ocean & its tributaries, wetlands & mangroves
The beautiful beaches at TDA
Other marine & coastal habitats / Good Access road network Fully equipped ambulance & fire service infrastructure
Police & intervention force infrastructure
Army Barracks at Bakau
MRC at Bakau & many other health centres / NDMC appeal funds
Private sector financial contribution
Civil society financial contribution
Municipal council’s financial contribution
Human Influenza Vulnerability Factors:
Higher population density
Dependence on external supply of food
Koto Creek Coastal Wetland Area / Human Influenza Capacity Factors:
Good communications and health facilities
Highly skilled and educated population
Easy access to government resources
LGA / Human Capital / Social Capital / Natural Capital / Physical Capital / Financial Capital
WR / Population: 389,594
Some civil servants
Some people with voc. & technical skills
Estimated literacy rate of 55%
High Population of aliens & refugees / Regional level DMC
Security Institutions (army, police, intervention force, etc.)
Area council
Youth clubs and VDCs
Some Women’s kafos
Some Women’s “asusu” clubs
School Red Cross Societies / The Atlantic Ocean & its tributaries, wetlands & mangroves
The beautiful beaches at TDA
Other marine & coastal habitats
Gazetted forest reserves & plantations
Other forest resources / Few access road network
Fully equipped ambulance & fire service infrastructure
Police & intervention force infrastructure
Army Barracks at Yundum
Airport (GCAA) fire service
Many health centres and clinics / NDMC appeal funds
Area council financial contribution
VDC financial resources
Village youth club’s & women’s kafo contribution
Financial resources of community networks
Human Influenza Vulnerability Factors:
AlleheinRiver (Kombo South-Kartong) and BijolIsland (Kombo North) Wetland Areas
High refugee population / Human Influenza Capacity Factors:
Relatively good communications
Relatively good access to health facilities
Good emergency infrastructure
LGA / Human Capital / Social Capital / Natural Capital / Physical Capital / Financial Capital