Transcript Organization and Functioning of the Health Services Network in

PREPARATION AND RESPONSE
OF THE HEALTH SERVICES TO
AN INFLUENZA PANDEMIC
1
Components to be considered in the Plan
I.- Organization and Functioning
1.- Organization:
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Organizational Chart
Flows and Coordination Systems
Responsible Parties
Incorporation of other actors
2.- Functions:
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Definition of the functions of each one of the
actors in the different phases of the Pandemic
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Components to consider in the Plan
II.- Installed Capacity, Assignment of Resources (1)
1.- Outpatient Attention
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Number of Establishments
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Assignment of available Human Resources
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Social, private organizations etc.
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Availability of :
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Drugs
Supplies
Equipment
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Components to Consider in the Plan
II.- Installed Capacity, Assignment of Resources
(2)
2.- Hospital Attention
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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
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Components to Consider in the Plan
III.- Potential Capacity
1.- Outpatient Care
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Out fitting of additional services
Availability of extra RRHH
2.- Hospital Attention
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Number of possible beds to reconvert
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RRHH that supports the increase in activity
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Installed physical capacity that allows an increase of beds
•
Ability to establish strategic reserves (storage and
distribution)
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Components to Consider in the Plan
IV.- Gap Analysis
1.- Outpatient Attention
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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
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Model
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Outline to create the Health
Services Network Capacity
Response Plan before an
eventual Pandemic
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I Interpandemic Period
II Pandemic Alert Period
III Pandemic Period
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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.
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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 Binational 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.
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III.- Pandemic Period
Phase 6;
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Increased and continuous transmission in the
general population (outside the country)
Phase 6;
• Increased and continues transmission in the
general population (in the country)
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III.Pandemic
Period
Phase 6; Increased and continued Transmission in
the general population (outside the country)
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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.
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III.Pandemic
Period
Phase 6; Increased and continued Transmission in
the general population (in the country)
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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.
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PAHO Strategic Plan
2005
Activity
November
December
2006
January
February
March
April
Document Model
Evaluation:
Design
Recompilation
Processing
Good
Practices:
Recompilation
Systematization
Expert’s network:
Identification
Invitation
Functioning
Development
Reunion
Regional Reunion
Bogotá, Colombia
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PREPARATION AND RESPONSE
OF THE HEALTH SERVICES TO
AN INFLUENZA PANDEMIC
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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.
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1.- Creation of a National Contingency Plan that
I.- Interpandemic incorporates the Health Services Network’s Capacity
Period
to Respond during an eventual influenza Pandemic
Organization and Functioning of the Health Services Network in response to an
eventual Pandemic.
Organization:
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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:
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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.)
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Identify the Actual Capacity and the
I.- Interpandemic 2.Availability of Resources of the Health Services
Period
Network, both outpatient and hospitalization.
a. Outpatient Care
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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
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2.- Identify the Actual Capacity and the
I.- Interpandemic Availability of Resources of the Health Services
Period
Network, both outpatient and hospitalization.
b.- Hospital Care
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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
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Personnel protection equipment
3.- Identify the Potential Response
the Health Services Network
I.- Interpandemic
Capacity of
Period
a.- Outpatient Care
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Ability to outfit additional services in non traditional
attention spaces, examples Community Centers, Schools
or other
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Availability of extra Human Resources, example: Red
Cross personnel, trained volunteers in support assistance,
privates etc.
b.- Hospital Care
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Number of possible beds to be reconverted in the Health
Services Networks’ establishments
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Availability of Human Resources that support the increase
in hospital activity
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Installed physical capacity that allows an increase in the
number of hospital beds
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Ability to establish strategic reserves with respective
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storage and distribution mechanisms.
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.
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1.- Theoretical impact / simulation exercise of the
impact of the disease and the demand on the
Pandemic services
II.- Períod of
Pandemic Alert
Establish assumptions under which the simulation
exercises are carried out:
General Assumptions
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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
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Percentage of consultations to be carried out
Number of consultations per patient
Output of consultations per hour
Hospitalization Assumptions
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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
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II.- Pandemic
Alert Period
2.- Analysis of the gaps between the Installed
Capacity and the Potential Capacity based on
simulation exercise results.
a.- Outpatient care:
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Estimated Human Resource gaps according to the simulations
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Estimated gaps in supplies, medicines and personnel protection equipment
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Estimate requirements and gaps for antiviral, antibiotics or others
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Assess estimated gaps: Human Resources, equipment, supplies, antibiotics,
antiviral etc.
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Estimate gaps in requirements that are not outlined in this guide but appeared
as a need in the simulation exercises.
b.- Hospital Care:
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Estimate gaps in equipment used to support critical activity (fans or others)
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Estimate gaps in supplies and reactives needed for increased activity
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Estimate Human Resource gaps that allow for the reconversion of beds and
increased activity in critical units
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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.
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3.- Simulation exercise that allows the functioning
of the Assistance Network and command structure
to be evaluated
II.- Pandemic
Alert Period
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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.
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4.- Analysis and evaluation of the capacity of
Binational Network Services to respond to frontier
scenarios in Regions with a high interchange
among countries
II.- Pandemic
Alert Period
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Share among countries the
proposed plans
Establish respective coordination
between the countries involved
Carry out simulation exercises in
conjunction
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5.- Preparation and Organization of the Health
Services Network in the different periods of the
Pandemic
II.- Pandemic
Alert Period
a .- Period of Pandemic Alert (Phase 3 to 5)
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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.
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III.- Pandémic Period
Phase 6;
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Increased and continues transmission in the
general population (outside the country)
Phase 6;

Increased and continues transmission in the
general population (in the country)
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III.Pandemic
Period
Phase 6; Increased and continued Transmission in
the general population (outside the country)





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.
27
III.Pandemic
Period
Phase 6; Increased and continued Transmission in
the general population (in the country)




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.
28
Stragegic PAHO Plan
2005
Actividad
November
December
2006
January
February
March
April
Document
Model
Evaluation:
Design
Recompilation
Processing
Good
Practices:
Recompilation
Systematizaion
Expert’s Network:
Identification
Invitation
Functioning
Meeting
development
Regional Meeting
Bogotá, Colombia
29
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