Transcript PRESENTATION BY THE NIGERIAN MINISTRY OF DEFENCE

DURING THE
AFRICAN PARTNER OUTBREAK RESPONSE
ALLIANCE
AT
ACCRA - GHANA
20 – 23 APRIL 2015
BY
MAJ GEN AE LIFE AJEMBA
MD FWACP
DIRECTOR GENERAL NIGERIA MIN OF DEFENCE HIP
COL K SALAWU
MD MIPH
COMMANDER 3 DIV HOSPITAL
THE ROLE OF THE NIGERIAN MILITARY
HEALTH SERVICES DURING DISEASE
OUTBREAK
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Huge population…..170 million
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1 in 5 African is a NIGERIAN
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250 Ethnic nationalities living as one country
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Has 46 Military HIV sites in collaboration with USDOD
WRPN
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Brought down HIV prevalence rate from 5.8% in 1991
to 2.5% in 2012 in the military sites
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These 46 sites have become the fulcrum to handle
other outbreaks
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EVD affected over 40 individuals in Lagos,Port
Harcourt and Enugu in 2014
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8 People died
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Kicked out EBVD through an unprecedented
and aggressive public health surveillance
Massive Health education
Early DETECTION
Early Treatment
345 AMH , KADUNA
1BDE MC, SOKOTO
DHQ MC , ABUJA
44 NARH, KADUNA
AFSH, KANO
21 BDE MC, MAIDUGURI
302 MRS, ONITSHA
108 NAFH
ABUJA
MIL. HOSP., BENIN
LEGEND
2 DIV. HOSP., IBADAN
3 DH
JOS
MH
LAGOS
NNRH OJO
68 NARH
YABA
347 NAFH, JOS
445 NAFH, IKEJA
45NAFH, MAKURDI
82 DIV HOSP., ENUGU
NNH, WARRI
NNMC ONNE,
NNH CALABAR
P/H
34 BDE MC, OWERRI
MIL HOSP. P/H
YEAR
2012
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Normally the Nigerian Military Health service is called in as last
resort during disease outbreaks.
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The facilities are located around the 6 geo-political zones of
the country.
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The Facility at the point of occurrence could become among the
first to be involved in containing the disease outbreak.
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For this reason the Nigerian Military Health service is patterned
after that of the Civil which is made up of Primary, Secondary,
and Tertiary health care level
The Primary is located at the battalion level, some of which are
located in far flung and remote areas and is known as Medical
Reception Station (MRS).
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The Secondary are located in the Brigade and Divisional
levels and are known as Brigade Medical Centres and
Divisional Hospitals.
The Tertiary are located at service Headquarters level
and are called Reference Hospitals.
For the purpose of containing disease outbreaks, the
Military Armed Forces Medical Service has robust
Directorate of Public Health which liaises with the Civil
Directorate of Public Health and National Emergency
Management Agency (NEMA).
NEMA is the coordinating organization for national
emergency and the Defence ministry is well represented
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TO HIGHLIGHT THE ROLE OF THE NIGERIAN
ARMED FORCES MEDICAL SERVICES DURING
OUTBREAKS
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OUT BREAK PREVENTION
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EARLY DETECTION
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EARLY RESPONSE TO OUTBREAKS
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RECOVERY FROM DISEASE OUTBREAKS
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GAPS ANALYSIS AND MITIGATION
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CONCLUSION
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Health education is carried out by the Preventive
Health units
Standing Barrack Health Committees is responsible
for regular education of the barrack community
and those contiguous to the barrack
Disposal of refuse and general cleanliness of the
barrack environment, and the communities around
the barracks.
Monthly barracks sanitation: troops and their
families take part in cleaning of the environment,
cleaning out blocked drainages and disposal of
refuse.
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The Military preventive team in collaboration with the
Civil Health authority use handouts, Radio jingles, the
electronic and print media to educate the populace on
the early symptoms and signs of suspected disease
outbreak.
The Military Health team also support the civil
prevention team for early detection at various points of
entry into the country.
The Nigerian army and Navy have Schools of Medical
sciences where middle level health care cadre are
trained on preventive and environmental health to be
able to detect early symptoms and signs of diseases.
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The Military healthcare service has a Standard
Operational Procedures (SOP) for early diagnosis,
treatment quarantine and decontamination
For instance, during the recent Ebola Virus Disease
(EVD) outbreak in West Africa, the Nigerian Battalion
stationed in Monrovia, Liberia was quarantined from the
rest of the population
Those who had contact with suspected Ebola Victim
were further segregated and made to undergo the
diagnostic procedures and were cleared after 42 days
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The Nigerian Military follows the World Health
Organization procedure for recovery.
This involves continuous clinical monitoring and
Laboratory investigations
Those who are free from the disease are reabsorbed into the society and are followed up.
ACTIVITIES AND
GAP ANALYSIS
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Percentage of Civilian Patients Treated by MTF:
Over 80% of civilians access MTF for treatment.
Pandemic Response Plan in Place:
Yes; Year Developed 80’s; Year last exercised/validated 2014.
Partnered Agencies with Military in Outbreak Response
Programs:
Federal Ministry of Health (FMOH)
National Emergency Management Agencies (NEMA)
Nigerian Centre for Disease Control (NCDC)
Has your country military formed multi-disciplinary teams
made up of Health and Wellness, Security, Emergency
Management and Communication sectors:
Yes – But the Military is represented at the National level
(Emergency Preparedness headed by NEMA).
NEMA has earmarked 36 military units in different locations
for Emergency preparedness
MILITARY SPECIFIC ROLE
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Country Military’s specific Role during outbreak:
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Yes – Prevention, Diagnosis and Treatment
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Has your country military formed a task force to
respond to disease outbreak:
Yes – There is a standing task force at the various
Preventive Units that can be activated at short notice
Has your country military formed a multi-disciplinary
team for investigation:
Yes – Prevention, Clinical and Laboratory Teams
MILITARY SUPPORT 2
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Military supports civil authorities
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In preventing disease outbreaks:
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In early detection of disease outbreaks:
In response to disease outbreaks:
During recovery from disease outbreaks:
Through collaboration with Civil Health Authorities at the local
Government, State and Federal levels
By providing manpower and making the military health facilities
available to the general populace
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MULTI DISCIPLINARY TEAM
List multi-disciplinary team’s capability:
CAPABILITIES
Country Military assists with illness screening at airports and border
crossings:
Country Military has Case Definition for Hemorrhagic fever: The
previous outbreaks of Lassa fever and the recent out break of Ebola viral
disease have made the country to take the issue of haemorrhagic fever
seriously
Detection of Early Signs and Symptoms are carried out through basic
Health Education, Prevention, Laboratory Diagnosis.
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BSL-2 Deference Reference Laboratory at
Mogadishu Barracks Abuja,
5 Star Graded laboratories at the 445 Air
force Hospital Ikeja and 68 Army Hospital
Yaba)
4 star Labs at 44 NARH Kaduna and NNRH
Ojo Lagos .
Others are being upgraded
The FMOH has a dedicated Lab at Irrua for
Lassa fever
WHO GUIDLINES
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IAW World Health Organization’s guidelines for patient
movement?
We adhere to these guidelines of movement of critically ill
patients to higher level health care facilities:
But challenges such as lack of quick means of evacuation like
Air Ambulance, Intensive Care Ambulance, lack of Skilled
Manpower and inadequate supply of needed medications.
Sufficient, well equipped medical centers to isolate
treat patients (rooms away from traffic):
YES. But there are few. Plans are underway to build 5
Containment centres
in different military locations for
Haemorrhagic fever and NRBC incidents to compliment the civil
set up
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Plans for social distancing:
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Yes – No Kissing, No Shaking of Hands, No Body Contacts.
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and to
During social distancing enforcement, do you have plans for
home delivery of necessary supplies as food, water, medicine:
INCINERATORS AND PPEs
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Do you have incinerator to discard waste products:
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Yes….But not adequate
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Health care facilities have sufficient and functional autoclave
or steam sterilizer:
Yes…But there are not enough in some of the facilities
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Are staff trained to obtain, store and examine post mortem
specimens:
Yes …though there is need for more to be trained
What are the sources of PPEs (local sources, World Health
Organization, United States Agencies:
List – Few from Federal Ministry of Health
SURVELLANCE SYSTEM 1
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Does your country have a disease surveillance system:
Yes
Type of surveillance system (paper-based, Electronic, Both, I
don’t know):
Both
Surveillance system meets the International Health Regulation
2005 standards:
Yes
Cases reported from health care facilities are reported to
central public health authorities (daily, weekly, monthly, I do
not know)
Daily during outbreaks, Monthly in normal times
The percent of military health care facilities that are covered
by the disease surveillance system is (90%-100%, 75%-<90%,
<75%-50%, <50%, I don not know).
90-100%
SURVELLANCE AND INFORMATION
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Military has an independent disease surveillance program:
No….It is a joint surveillance system with FMOH
Military has an outbreak communication plan for public
information:
Yes…The Directorate of Defence Information and the MOD
Information unit assist in disseminating information on
outbreaks to the military formations and the public
Military has trained and designated staff responsible for
public information
Yes …The Armed Forces Programme on AIDS Control {AFPAC}
has taken up other roles in public information dissemination
on other haemorrhagic viral diseases.
But there is need to train and designate specific personel for
this role
Military has established information verification and
clearance/approval process
Yes…There is hierrachy of verification from the MRS to the
Service Headquarter
LAB DIAGNOSTIC CAPABILITIES
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Country’s highest Biosafety Level (BSL) laboratory:
BSL-1; BSL-2; BSL-3; BSL-4; I Do Not Know (Choose one)
What type of institution has the highest BSL laboratory in your
country:
Ministry of Health; Military Institution; Public Health Laboratory;
University Information; Other (Please specify); I Do Not Know
Samples are tested at ( Local;
Regional; International
Laboratories; Other (Please specify); I Do Not Know):
There is a strategy for sample collection:
Yes
There is access to reference laboratory, e.g. World Health
Organization:
Yes; If yes, where is the WHO reference laboratory located ABUJA
Sealed sterile dry tubes are used (Yes; No; I Do not Know)
Staff is trained on safe collection of blood samples:
Yes
LAB DIAGNOSTIC CAPABILITIES
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Military follows procedures for shipping blood samples and
other specimens:
Yes
Military uses International Air Transport Association boxes for
shipping:
Yes
Country
has
ongoing
laboratory
capacity
building
engagements occurring: If yes, Does your Military Treatment
Facility benefit form it, or/and engaged in these initiatives
Yes – Defence Reference Laboratory in conjunction with USDOD Walter Reed Programme Nigeria.
There are ongoing projects to enhance laboratory capacity
building:
Yes – There is a accreditation roadmap to meet with CAP and
ISO level
LAB DIAGNOSTIC CAPABILITIES
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Country has the following type of laboratory
capabilities
PCR molecular assays - YES
tissue culture - YES
antigen detection - YES
Provide additional thoughts, concerns or suggestions
about ongoing laboratory capacity building projects or
future engagements.
Need to upgrade Defence Laboratory to BSL-4