THE REPUBLIC OF
THE GAMBIA
National Preparedness Plan for
Influenza A H1N1
Banjul, The Gambia
15 June 2009
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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1. Summary
Requirementnf
Introduction
This Influenza A H1N1 Preparedness 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:
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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 H1N1
Preparedness 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
Phases 1-6 of Influenza A H1N1.
The Objectives are to:
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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
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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.
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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, Spain & Israel). On 29 April, the Pandemic alert phase was raised 4 to 5.
As of 3rd June, statistics were as follows:
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USA 10,054 cases and 17 deaths
Mexico 5,563 cases and 103 deaths
Canada 1,530 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 and in 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.
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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.
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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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:
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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 NonGovernmental 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.
Preparedness Plan for Influenza A: INFLUENZA A H1N1 in The Gambia
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Hazards, Risks and Mitigation Strategies during the Pandemic Period for The Gambia:
LGA
Banjul
BCC
LGA
KMC
Human Capital
Population: 35,061
Productive working class
Some people with vocational &
technical skills
Estimated literacy rate of 70%
Commercial people & civil
servants
Social Capital
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
Human Influenza Vulnerability Factors:
 Higher population density
 Dependence on external supply of food
Natural Capital
Mouth of River Gambia
The Atlantic Ocean & its tributaries,
wetlands & mangroves
The beaches & other marine & coastal
habitats
Human Capital
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
Natural Capital
The Atlantic Ocean & its tributaries,
wetlands & mangroves
The beautiful beaches at TDA
Other marine & coastal habitats
Social Capital
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
Human Influenza Vulnerability Factors:
 Higher population density
 Dependence on external supply of food
 Koto Creek Coastal Wetland Area
Preparedness Plan for Influenza A H1N1 in The Gambia
Physical Capital
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
Financial Capital
NDMC appeal funds
Private sector financial
contribution
Civil Society financial contribution
City Council’s financial
contribution
Human Influenza Capacity Factors:
 Good communications and health facilities
 Highly skilled and educated population
 Easy access to government resources
Physical Capital
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
Human Influenza Capacity Factors:
 Good communications and health facilities
 Highly skilled and educated population
 Easy access to government resources
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Financial Capital
NDMC appeal funds
Private sector financial
contribution
Civil society financial contribution
Municipal council’s financial
contribution
LGA
WR
Human Capital
Population: 389,594
Some civil servants
Some people with voc. & technical
skills
Estimated literacy rate of 55%
High Population of aliens &
refugees
Social Capital
Natural Capital
Physical Capital
Regional level DMC
The Atlantic Ocean & its tributaries,
Few access road network
Security Institutions (army, police,
wetlands & mangroves
Fully equipped ambulance & fire
intervention force, etc.)
The beautiful beaches at TDA
service infrastructure
Area council
Other marine & coastal habitats
Police & intervention force
Youth clubs and VDCs
Gazetted forest reserves & plantations infrastructure
Some Women’s kafos
Other forest resources
Army Barracks at Yundum
Some Women’s “asusu” clubs
Airport (GCAA) fire service
School Red Cross Societies
Many health centres and clinics
Human Influenza Vulnerability Factors:
Human Influenza Capacity Factors:
 Allehein River (Kombo South-Kartong) and Bijol Island (Kombo North) Wetland Areas
 Relatively good communications
 High refugee population
 Relatively good access to health facilities
 Good emergency infrastructure
Financial Capital
NDMC appeal funds
Area council financial contribution
VDC financial resources
Village youth club’s & women’s
kafo contribution
Financial resources of community
networks
LGA
NBR
Human Capital
Population: 172,835
Mainly small farmers
Few people with voc. & technical
skills
Estimated literacy rate of 49%
Financial Capital
NDMC appeal funds
Area council financial contribution
VDC financial resources
Village youth club’s & women’s
kafo contribution
Financial resources of community
networks
Household incomes
Social Capital
Regional level DMC
VDCs & Village Traditional Council of
elders
Security Institutions (army & police) &
Area council
Youth clubs & Women’s kafos
Women’s “asusu” clubs
School Red Cross Societies
Human Influenza Vulnerability Factors:
 Bambali and Dankunku Freshwater Wetlands
 Baobolon Wetland Reserve and Nuimi National Park Wetlands
 High trade passage with Senegal
Preparedness Plan for Influenza A H1N1 in The Gambia
Natural Capital
Physical Capital
River Gambia & its wetlands tributaries A good paved highway & access
& mangroves
earth roads
Other marine & coastal habitats
Army barracks at Farafenni & 3
Gazetted forest reserves & community Police stations
forest resources
Farafenni hospital & other health
Farmlands, orchards & swamp rice
centres
fields
Women’s vegetable gardens
Human Influenza Capacity Factors:
 Relatively good communications
 Relatively good access to health facilities
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LGA
LRR
Human Capital
Population: 72,167
Mainly small farmers
Few people with voc. & technical
skills
Estimated literacy rate of 50%
Social Capital
Regional level DMC
VDCs & Village Traditional Council of
elders
Gambia Police Force
Area council
Women’s & other village kafos
Women’s “asusu” clubs
School Red Cross Societies
Human Influenza Vulnerability Factors:
 Bambali and Dankunku Freshwater Wetlands
 High trade passage with Senegal
LGA
CRR(S)
Human Capital
Population: 107,212
Mainly small farmers
Few people with voc. & technical
skills
Estimated literacy rate of 50%
Social Capital
Regional level DMC
VDCs & Village Traditional Council of
elders
Gambia Police Force
Area council
Women’s & other village kafos
Women’s “asusu” clubs
School Red Cross Societies
Human Influenza Vulnerability Factors:
 Distance from Central Government
Preparedness Plan for Influenza A H1N1 in The Gambia
Natural Capital
River Gambia & its wetlands tributaries
& mangroves
Other marine & coastal habitats
Gazetted forest reserves & community
forest resources
Farmlands, orchards & swamp rice
fields
Women’s vegetable gardens
Physical Capital
Banjul-Basse highway & access
earth roads
2 police stations
MRC at Keneba & few other health
centres
Financial Capital
NDMC appeal funds
Regional level DMC appeal funds
Area council financial contribution
VDC financial resources
Village youth club’s & women’s
kafo contribution
Financial resources of community
networks
Household incomes
Human Influenza Capacity Factors:
 Relatively good communications
 Relatively good access to health facilities
Natural Capital
River Gambia & its fresh water,
tributaries & wetlands
Gazetted forest reserves & community
forest resources
Farmlands, orchards & swamp rice
fields
Women’s vegetable gardens
Physical Capital
Banjul-Basse highway & access
earth roads
Army barracks at Kudan & 4 police
stations
Bansang Teaching Hospital & few
other health centres
Financial Capital
NDMC appeal funds
Regional level DMC appeal funds
Area council financial contribution
VDC financial resources
Village youth club’s & women’s
kafo contribution
Financial resources of community
networks
Household incomes
Human Influenza Capacity Factors:
 The governor of Central River Division (CRD) launched an AHI sensitization
campaign
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LGA
CRR(N)
LGA
URR
Human Capital
Population:78,491
Mainly small farmers
Few people with voc. & technical
skills
Estimated literacy rate of 50%
Social Capital
Regional level DMC
VDCs & Village Traditional Council of
elders
Gambia Police Force
Area council
Women’s & other village kafos
Women’s “asusu” clubs
School Red Cross Societies
Human Influenza Vulnerability Factors:
 Distance from Central Government
Natural Capital
River Gambia & its fresh water,
tributaries & wetlands
Gazetted forest reserves & community
forest resources
Farmlands, orchards & swamp rice
fields
Women’s vegetable gardens
Human Capital
Population:182,586
Mainly small farmers
Few people with voc. & technical
skills
Estimated literacy rate of 49%
Commercial people & civil
servants
High population of aliens &
refugees
Natural Capital
River Gambia & its tributaries &
wetlands
Gazetted forest reserves & community
forest resources
Farmlands, few orchards & swamp rice
fields
Women’s vegetable gardens
Social Capital
Regional level DMC
Multi-Disciplinary Facilitation team
Ward Devt. Council
VDCs & Village Traditional Council of
elders
Security Institutions (army & police) &
Area council
Youth clubs & Women’s kafos
Women’s “asusu” clubs
School Red Cross Societies
Human Influenza Vulnerability Factors:
 Long Distance from Central Government
Preparedness Plan for Influenza A H1N1 in The Gambia
Physical Capital
Barra-Laminkoto gravel highway &
earth access roads
3 police stations
few health centres
Financial Capital
NDMC appeal funds
Regional level DMC appeal funds
Area council financial contribution
VDC financial resources
Village-base financial resources
Household incomes
Human Influenza Capacity Factors:
 Relatively poor communications
 Relatively poor access to health facilities
Physical Capital
Banjul-Basse highway & earth
access roads
Army barracks at Basse & some
police stations
2 major health centres
Human Influenza Capacity Factors:
 Relatively poor communications
 Relatively poor access to health facilities
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Financial Capital
NDMC appeal funds
Area council financial contribution
VDC financial resources
Village youth clubs & Women’s
kafo contribution
Financial resources of community
networks
Household incomes
Financial contributions from
resident large businessmen
4. Roles and Responsibilities by Sector, Current Level of Preparedness and Limitations
Area of Focus
Human Health
Animal Health
Roles and Responsibilities
Current Level of Preparedness
Limitations
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National Public Health Laboratory exists
Some surveillance officers, regional health authorities and
local authorities sensitised Influenza A H1N1.
50 PPE sets for training available from WHO
2,200 Emergency doses of Tamiflu available.
Some TV awareness raising conducted on Influenza A
H1N1
WHO reference lab conveniently located in Dakar
Weekly surveillance reports being received for Influenza
A H1N1
Influenza A H1N1 Focal point available for (MOH).
National Task Force on Influenza A H1N1 constituted.
Screening of incoming passengers at all points of entry.
Isolation centre identified at the old International Airport,
Farafenni and Amdalai.
More training required to address high attrition of
health staff, especially at the field level
4 public veterinarians exist in The Gambia, three at the
national and one regional level, plus seven private
veterinarians (in the capital).
Reference laboratory for animal samples is in Padova,
Italy, no in-country PCR capacity
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community sensitisation
surveillance using the IDSR strategy
case management
laboratory diagnosis of Influenza A H1N1 virus in humans
training of lab and health workers
reporting to WHO and other partners
sensitization of Pig Breeders Association
training of livestock field agents for livestock services
clinic surveillance at field level
clinical and laboratory diagnosis in pigs
decontamination
reporting to AU/IBAR and the OIE
20 para-veterinarians available as field service vets at the
six agricultural regions
1 main veterinary lab exists with three senior technicians,
three technicians, and three laboratory assistants
Department of Veterinary Services (DVS) developing
basic serology ability. Training and equipment provided,
but no samples have been tested in The Gambia so far.
DVS has ordered some rapid test kits with FAO assistance
and should have rapid testing capacity in two months.
DVS has 210 PPE sets for field response (from US and
FAO) and 2 disinfectant sprayers
Dakar has capacity for PCR and stronger connections on
the animal health side should be developed
Preparedness Plan for Influenza A H1N1 in The Gambia
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Transport to remote areas difficult - more vehicles
required
More PPE required. Supplies inadequate should there
be a small number of outbreaks
Insufficient quantities of Tamiflu.
Need to formalize some of the relationships with
Senegal, especially for border cooperation, and for
testing. Dakar link for PCR required
Planning should rely on initial extermination of all
chickens in the 5km range, followed by reassessment
of policy if there are many outbreaks and
compensation becomes problematic. Should the virus
become endemic in The Gambia, then vaccination
may be a useful control policy.
AHI laboratory is not yet up to the required bio-safety
level, and work is ongoing to accomplish this.
Need to conduct simulation exercises to test planning
and improve response
MOA has a good relationship with animal health
colleagues in Senegal, and they have assisted with
locusts, etc.
DVS has conducted some sensitization workshops and
provided information posters for stakeholders at national,
Regional, district and village levels. Stakeholders include:
livestock,
health,
wildlife,
security,
community
development, local government, religious groups, Red
Cross, and forestry officers.
Rapid Response Teams have been established at the
Regional level.
Security Services
Cross-cutting
issues
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Alert all security services to the unfolding situation
closure of borders in case of an outbreak
sensitisation of border villages about the pandemic
provide escorts for the Rapid Response Teams (RRTs) to
the affected areas
cordon the outbreak areas
provide security to the disposal sites
support mobilisation of manpower
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sensitisation
training
reporting
surveillance
Preparedness Plan for Influenza A H1N1 in The Gambia
50 Police and Army Officers participated in a one-day
sensitization on AHI and Influenza A H1N1
Media has been involved (with some initial oversensitization of the population)
Page 15 of 67
Roles and Responsibilities by Organisation
The following table indicates anticipated roles and responsibilities by Organisation. It is not meant to establish or restrict official roles, but only to
identify roles for planning purposes. Departments and organisations are listed with actions according to Level of Phase.
Organisation
Roles and Responsibilities
Office of the Vice President
Coordinate preparedness and response actions as chair of the NDMC
Coordinate development and implementation of the Preparedness Plan for Influenza A H1N1
Call emergency meetings of the National Disaster Management Council if the situation internationally or regionally changes significantly
The National Disaster Management
Governing Council (NDMGC)
The National Disaster Management
Technical Council
Meet as required to ensure that preparedness and response efforts of all member Ministries are sufficient to face the threat
Manage problems as they arise
Phase 1: Absence of Influenza A H1N1 in The Gambia
Meet regularly to obtain updates on the situation
Meet regularly to obtain updates on the state of preparedness in The Gambia from the RRT
Compile data and coordinate national level sensitization efforts
Phases 2 and 3: Presence of Influenza A H1N1 in animals in The Gambia and Transmission of Influenza A H1N1 from animals to humans in The Gambia
Integrate Influenza A H1N1 response into disaster management structure (officially declaring outbreaks)
Convene a crisis Council meetings
Convene IO, NGO, Embassy, and press briefing to give update on the intervention measures
Present resource requirements
Compile relevant data and manage information flow, keeping press, donors and partners informed of the situation
Coordinate border closure/movement restrictions
Coordinate national level sensitization efforts
Phases 4, 5 and 6: Transmission of Influenza A H1N1 from humans to humans in The Gambia
Integrate Influenza A H1N1 response into disaster management structure (officially declaring human cases and quarantine actions)
Convene crisis Council meetings
Order appropriate response actions from line ministries to support the MOH&SW led effort
Declare a state of emergency, if the situation dictates
Convene an IO, NGO, Embassy, and press briefing on the situation to provide an update on the extent of the intervention measures
Present resource requirements to Government and partners
Compile relevant data
Coordinate border closure/movement restrictions
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 16 of 67
Influenza A H1N1 Task Force (National
Rapid Response Team)
Phase 1: Absence of Influenza in The Gambia
Train Regional Response Teams and District and Village level leaders on public info dissemination.
Assess the state of readiness at all levels of government and make recommendations for improvement.
Ensure that surveillance communication systems are functioning and that operators understand their roles during all pandemic phases.
Enhance Influenza A and pandemic Influenza readiness, and assist with current Influenza A surveillance as necessary.
Develop a human resource training programme to increase understanding on Influenza A H1N1 by all departments.
Organise logistics for rapid response interventions for surveillance and rapid containment should the virus emerge in The Gambia.
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Coordinate and organize security tasks in support of rapid intervention efforts.
Phases 3 to 6: Transmission of Influenza A H1N1 from animals to humans and from humans to humans in The Gambia
Organising the logistics of establishing temporary medical facilities.
Trigger logistics for rapid intervention, should the virus emerge in The Gambia
Engage the Gambian Red Cross Society and coordinate with NGOs and other institutions to support pandemic response efforts
Liaise with IOs, NGOs, Embassies and affected families
Ministry for The Interior and Ministry of
Defence (Armed and Security Services
including Border Patrol)
Phase 1: Absence of Influenza A H1N1 in The Gambia
Participate in planning exercises as part of AHI Task Force/RRT
Perform appropriate security measures at borders
Restrict pig and human movement, as appropriate, when cases occur in neighbouring countries
Train Police on outbreak management and quarantine enforcement.
Phase 2: Presence of Influenza A H1N1 in The Gambia
Perform appropriate security measures at borders, and restrict pig and human movement, as appropriate
Ensure enforcement of all relevant decrees for animal and human health measures at all levels of government.
Ensure security and safety during Influenza A H1N1 outbreak response and culling.
Support and prevent illegal activities related to illegal movement of animals.
Inform people on what is legal and illegal.
Phase 3: Transmission of Influenza A H1N1 animals to humans in The Gambia
Ensure security and safety during outbreaks and rapid response to initial human to human transmission.
Phases 4 to 6: Human to human transmission
Ensure security and safety during a pandemic.
National Environmental Authority (NEA)
Phase 1: Absence of Influenza A H1N1 in The Gambia
Collaborate closely with IEC activities to support information dissemination, especially in relation to school children
Assist with distribution of PPEs to frontline Influenza A H1N1 workers
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 17 of 67
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Work closely with DVS to procure suitable disinfectants and ensure they are used properly
Ministry of Finance and Economic Affairs
Phase 1, 2 and 3: Absence of Influenza A H1N1, and transmission of Influenza A H1N1 from Animals to Humans in The Gambia
Allocate resources from the public funds to the MOHSW and MOA to respond to Influenza A H1N1.
Work with MOA to calculate economic impact to the farming sector of Influenza A H1N1.
Work with the MOHSW and NDMGC to mobilise preparedness and response resources for the country.
Assist MOA with the development of incentives for cooperation/compensation on Influenza A H1N1 surveillance and control.
Estimate the economic impacts of various pandemic scenarios and develop an economic plan to stimulate recovery from a pandemic.
Phases 4 to 6: Human to human transmission
Release funds to ministries of MOHSW and MOA for emergency response operations
Study the pandemic and assist with economic stimulation efforts to encourage rapid recovery
Evaluate resource needs for subsequent waves if they occur
Ministry of Agriculture (Department of
Veterinary Services (DVS)
Phases 1 to 3: Absence of Influenza A H1N1 and Transmission from Animals to Humans in The Gambia
Lead planning and preparedness efforts in the Agricultural Sector
Lead surveillance efforts in collaboration with human Health through the Influenza A Task Force
Develop Laboratory for Influenza analysis
Call internal emergency meetings to discuss Influenza A H1N1 situation as situation changes in the region/internationally
Maintain and update a website on Influenza A H1N1
Maintain contact addresses of RRT members, medium-large scale Pig Breeders Association, MOH (MOA)
Stop cross-border pig movement in case of outbreaks in the region
Identify quarantine stations
Conduct cross-border sensitization and simulations
Establish a cross-border RRT
Lead RRT efforts to contain outbreaks
Lead surveillance efforts in collaboration with the Influenza A H1N1Task Force
Phase 4: Human to human transmission
Study the pandemic and play the key role in economic recovery for rural areas
Continue Laboratory analysis for Influenza A H1N1
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 18 of 67
Ministry of Health and Social Welfare
Phase 1: Absence of Influenza A H1N1 in The Gambia
Participate in surveillance efforts with Security and Department of Veterinary Services through the Influenza A Task Force
Call internal emergency meetings to discuss Influenza A H1N1 situation as situation changes in the region/internationally
Prepare Influenza A H1N1Plan of Action and Protocols
Print and distribute case definitions and fact sheets to health workers
Sensitize communities
Conduct Training of Trainers for health worker, and undertake step-down training
Intensify surveillance system
Inform local authorities
Update health workers on Influenza A H1N1
As cases
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increase in the sub-region:
Hold Emergency Task Force meetings with partners
Intensify community sensitization
Conduct weekly epidemiological reporting
Intensify IEC activities
Mobilize resources
Train health workers on Influenza A H1N1
Strengthen the NPHL
Organize weekly meetings and update central level authorities
Alert all health workers
Hold consultative meetings with Pig Breeders Association.
Intensify cross-border surveillance
Map out high-risk areas, especially along borders
Report and investigate all suspected cases to the Epidemiology and Disease Control Unit
Liaise through the National RRT and work closely with all partners
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Participate in surveillance with Parks and Wildlife and Department of Veterinary Services through the Influenza A Task Force
Intensify community sensitization
Prepare nurses and other health workers
Prepare and revisit the Plan of Action
Officially declare an outbreak
Mobilise international and regional assistance (technical and logistical support)
Have a hotline for reporting of cases
Intensify surveillance
Close down all weekly markets
Monitor the borders with help from security services
Transport blood and nasopharaengeal samples to the NPHL
Ensure the proper use of PPEs
Ensure the proper and safe disposal of all infected materials (bio hazardous materials)
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 19 of 67
Phase 3: Transmission of Influenza A H1N1 from animals to humans in The Gambia
Focus IDSR on Influenza A
Manage cases and isolate patients
Phases 4 to 6: Human to human transmission
Conduct daily press briefings with information updated daily
Meet with partners every two days
Monitor and assess national impact (morbidity, mortality, workplace absenteeism, regions affected, risk groups affected, health-care worker availability,
essential worker availability, health-care supplies, bed occupancy/availability, admission pressures, use of alternative health facilities, mortuary capacity,
etc.)
In close collaboration with NDMC, assess need for emergency measures, e.g. expansion of screening clinics, emergency burial procedures, use of legal
powers to maintain essential services, and assist with addressing psychological impacts
Gambia Bureau of Statistics (GBOS)
Phase 1: Absence of Influenza A H1N1 in The Gambia
Collaborate with MOH to conduct a study to test people’s awareness of Influenza A H1N1 following sensitization process in the regions
Analyze and produce a report on the findings
Disseminate information to help target actions
Phases 2 and3: Presence of Influenza A H1N1 in Animals in The Gambia
Collect secondary data from NGOs and partners to update GBOS database.
Analyze and disseminate information to policy makers and researchers
Ministry of Education
Phase 1, 2 and 3: Absence of Influenza A H1N1 in The Gambia
Liaise with MOHSW and MOA to disseminate information about Influenza A H1N1 through schools
Phases 4 to 6: Human to human transmission
Close schools in outbreak areas
Close all schools
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 20 of 67
Ministry of Tourism and Culture (Gambia
Tourism Authority)
Phase 1: Absence of Influenza A H1N1 in The Gambia
GTA to spearhead preparations for Influenza A H1N1 and related issues in the Tourism Sector
Form a Tourism Emergency Response Group with representatives from all of the tourism sub-sectors: Gambia Hotel Association (GHA), Tourism and
Travel Association of The Gambia (TTAG), and the Association of Small-Scale Enterprises in Tourism (ASSET).
Coordinate plans for the tourism sector covering preparedness, evacuation procedures, care for tourist who become ill, etc.
Update databases of all Tourism stakeholders and government agencies for info about the response of the tourism industry
IEC campaign to minimize impact on tourism should Influenza A H1N1 occur nearby
Conduct travel industry workshops in collaboration with the RRT
Phase 2: Presence of Influenza A H1N1 in Animals in The Gambia
Hold IEC campaign in association with TTAG to minimize tourism impact should Influenza A H1N1 occur in the country
Provide health and safety information on the GTA website for tourists and other stakeholders
Encourage basic personal hygiene
Print information leaflets in various languages (English, French, German etc) and distribute through the Gambia Hotel Association.
Phase 3: Transmission of Influenza A H1N1 from Animals to humans in The Gambia
Hold IEC campaign to minimize tourism impact should Influenza A H1N1 occur in the country
Phases 4 to 6: Human to human transmission
Provide emergency hotline for tourist family and friends
Establish a health/safety information website at the MOHSW and update daily
Provide a detailed map showing locations of outbreaks in relation to major tourist areas
Issue advice to travellers going to areas of potential risk
National Water and Electricity Company
(NAWEC)
Ministry of Trade, Industry and
Employment (MOTIE)
Phases 1 to 6: Transmission of Influenza A H1N1 from animals to humans and from humans to humans in The Gambia
Ensure provision of a stable water and electric supply during the pandemic
Develop staffing plans to maintain essential operations, given possible high worker absenteeism
Seasonal Influenza vaccination and/or antiviral stocks may be considered for front-line essential workers
Phase 1: Absence of Influenza A H1N1 in The Gambia
Assist with development of pandemic preparedness plans, especially focused on pandemic staffing policies
Phase 2 and 3: Presence of Influenza A H1N1 and Transmission from Animals to Humans in The Gambia
Participate in National post-pandemic recovery efforts
Relief Agencies and NGOs in The Gambia:

The Gambia Red Cross Society
(GRCS)
Phase 1: Absence of Influenza A H1N1 in The Gambia
Identify focal person/partners
Brief management, branches, volunteers about Influenza A H1N1 and human pandemic Influenza and how to prevent spread and protect themselves
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 21 of 67
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Catholic Relief Services
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CARE
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Concern Universal
Develop an action plan for Influenza A H1N1 preparedness
Sensitize volunteers on Influenza A H1N1 and participate in IEC campaigns
Participate in the National Influenza A H1N1 Task Force
As outbreaks occur in the sub region:
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Hold planning meeting with the Task Force
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Develop action plan to respond to outbreaks in consultation with MOH
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Strengthen the capacity of volunteers
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Alert and update emergency response teams
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Conduct house-to-house social mobilization with technical support from the Task Force
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Request PPE and Tamiflu (or other resource requirements) from stockpiles
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Participate in IEC campaigns
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Establish internet presence and access
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
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Participate in emergency meeting with partners and the Task Force
Collaborate in the distribution of resources and equipment
Participate in IEC campaigns, continue social mobilisation
Purchase and distribute detergent as part of proper hygiene campaign
Phases 3 to 6: Transmission of Influenza A H1N1 from animals to humans and from humans to humans in The Gambia
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Establish confirmation with Response Team
Request Disaster Relief Emergency Fund
Recruit and train additional volunteers for additional care and support
Provide additional resources and equipment as required
Provide care and support as part of human case management
Request external help is available and required
Support management of human cases
Assist with addressing psychological impacts
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 22 of 67
Phase 1: Absence of Influenza A H1N1 in The Gambia
NGO/CSOs
Assist with monitoring and surveillance, especially conservation organisations
Participate in IEC campaigns
Phase 2: Presence of Influenza A H1N1 in Animals in The Gambia
Assist with monitoring and surveillance
Participate in IEC campaigns
Phase 3: Transmission of Influenza A H1N1 from Animals to humans in The Gambia
Assist with case management and social cooperation for quarantines
Participate in IEC campaigns
Phases 4 to 6: Human to human transmission
Assist in providing essential services to communities
Ministry of Communication and
Information Technology (MOCIT)
Phase 1: Absence of Influenza A H1N1 in The Gambia
Create a communications Council and develop strategy and materials before pandemic phase increases
Establish official channels of communication with RRTs, and DMCs
Inform media associations of official sources for Influenza A H1N1 story confirmation
Establish an information website for Influenza A H1N1, with sub links to the MOHSW, MOA and DMA.
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Maintain information website with latest information from RRTs
Facilitate press conferences and official exchanges of information
Phase 3: Transmission of Influenza A H1N1 from animals to humans in The Gambia
Maintain information website with latest information from RRTs and MOH&SW
Facilitate press conferences and official exchanges of information
Phases 4 to 6: Human to human transmission
Facilitate press conferences and official exchanges of information
Coordinate dissemination of information during pandemic
Maintain capacity for meeting expected domestic and international information demands
Activate all elements of communications plan, including acknowledgement of public anxiety, grief and distress associated with pandemic
The Gambia Press Union (GPU) and
Association of Health Journalists (AOHJ)
Phase 1: Absence of Influenza A H1N1 in The Gambia
Inform the public of the presence of Influenza A H1N1 in the sub-region through MOHSW/MOA and NDMGC, and prepare them effectively to be on guard
for any possible outbreaks
Provide orientation and up-to-date information to media personnel on issues relating to Influenza A H1N1 for public consumption
Solicit cooperation of policy makers and the general public in the advent of Influenza A H1N1
Participate in IEC campaigns with general coverage of issue and proper hygiene behaviour
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 23 of 67
Establish official contact points for verification of stories related to Influenza A H1N1
Note: there should be an emergency number available to the Public in the advent of any possible outbreak for reporting to the relevant authorities (see
Gambia Telephone Organisations)
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Participate in IEC campaigns
Report on outbreaks and control measures
Phase 3: Transmission of Influenza A H1N1 from animals to humans in The Gambia
Participate in IEC campaigns
Report on cases and control measures
Report on appropriate hygiene behaviour as related to pig handling
Phase 4: Human to human transmission
Participate in IEC campaigns
Report on cases and control measures
Report on proper hygiene behaviour and social distancing (school and market closings, meetings cancelled, etc.)
Radio and Television Services
Provide precise, accurate and up to date information on Influenza A H1N1 through all programmes via electronic media.
Sponsor messages related to Influenza A H1N1 on these programmes to increase the effectiveness of IEC campaigns
Solicit business sponsorship for public service messages.
Broadcast messages on Influenza A H1N1 awareness during popular series and sports programmes.
Enlist drama groups and local musicians to sensitize the public and mobilise resources.
Telecommunications Providers (Gamtel,
GamCel, AfriCell, Comium…)
Phases 1 to 6: Transmission from Animals to Humans and from Humans to Humans
Send SMS to all customers to advise them of what to do, where to seek help and where to report suspect sick people.
If call sites go down due to network overload, calls through 112 will be accessible and should be used to report outbreaks and other emergencies. This
number can be accessed by any GSM phone, even without a SIM card.
Universal access should be online some time in 2009 to ensure coverage to all parts of The Gambia. Parts of the country not currently covered will have
one access point every 2 km as a minimum.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 24 of 67
The Gambia National Youth Council
Phase 1: Absence of Influenza A H1N1 in The Gambia
Establish network of youth organisations at municipal and regional level (the council has an elected chairperson in all regions)
Coordinate with them to develop a holistic national comprehensive Influenza A H1N1 plan in collaboration with the MOH
Train youth leaders as advocates and sensitize young people at grassroots to understand their responsibilities related to Influenza A H1N1
If the situation changes internationally or regionally, the national youth council will call their counterparts in other countries for an emergency meeting of
the disaster management Council to focus on Influenza A H1N1
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Conduct a national sensitization programme and awareness campaign regarding Influenza A H1N1 transmission
Phase 3: Transmission of Influenza A H1N1 from animals to humans in The Gambia
Train the young Pig Breeders Association on how to handle outbreaks and human cases
Incorporate the Regional Youth Chairperson in all regions to be part of regional RRTs
Phases 4 to 6: Human to human transmission
Meet with National Youth Organisations in consultation with the community and report to DMCs for recommended actions
Use radio and TV programmes allocated for youth programmes for appropriate IEC messages
Conduct mass sensitization campaign on appropriate hygiene behaviour for all communities
Contact National Youth Councils in the neighbouring countries to form a federation of youth against Influenza A H1N1
Obtain contact persons and telephone, email addresses for emergency meetings at the international level
Pig Breeders Association and National
Farmers Platform
Phase 1: Absence of Influenza A H1N1 in The Gambia
Assist with monitoring and surveillance
Participate in IEC campaigns with association members
Assist MOHSW and MOA with developing compensation mechanism
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Assist with monitoring and surveillance
Participate in IEC campaigns with association members
Assist with administering compensation mechanism in liaison with MOA and NDMGC
Phase 3: Transmission of Influenza A H1N1 from animals to humans in The Gambia
Assist MOHSW and MOA with monitoring and surveillance
Participate in IEC campaigns with association members
Promote safe live pig handling
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 25 of 67
Embassies, High Commissions and
Consulates in The Gambia
Phase 1: Absence of Influenza A H1N1 in The Gambia
Work with Embassies, High Commissions and Consulates in The Gambia to assist with surveillance, prevention and control, and advise the government
accordingly
Share information with Embassies, High Commissions and Consulates in The Gambia and the government to support development of national strategy for
pandemic Influenza
Provide resources (e.g. protective gear to MOH/DVS) and training for staff to prepare for outbreak response
Study the situation in the sub-region and advise staff in the embassy on preparedness in case of outbreaks
Phase 2: Presence of Influenza A H1N1 in animals in The Gambia
Monitor the outbreaks and advise staff to restrict movement in the affected areas
Provide resources to contain the outbreak. Cooperate with relevant government institutions (like MOH and DVS) to determine assistance needed and
provide support
Support training of staff, as may be requested by the government
Phase 3: Transmission of Influenza A H1N1 from animals to humans in The Gambia
Provide assistance to the government to carry out mass sensitization of Pig Breeders Association (training and logistical support)
Provide drugs and other required support to MOHSW/MOA(DLS) to contain the pandemic
Phases 4 to 6: Human to human transmission
Help the government to monitor situation and collect, analyse, interpret and disseminate relevant information to partners
Provide antiviral drugs on request from government to help treat and control the spread of the disease
Provide all relevant information on the disease for local and embassy staff
Enact strong restrictions on movement in and out of the embassy
United Nations System
Phases 1 to 6: Transmission of Influenza A H1N1 from Animals to Humans and from Humans to Humans in The Gambia
Provide advice/assistance with preparedness, IEC, prevention and surveillance activities
Sensitize staff and share information among UN agencies related to Influenza A H1N1
Meet with the National Task Force to assess needs and provide necessary financial and technical support as feasible
Plan for joint operations/training/simulations with counterparts and relevant stakeholders
Advocate for mobilisation of additional resources
Facilitate international and regional information sharing and cooperation
Share relevant information at all levels
Assist with surveillance, prevention and control, as well as response actions
Participate in IEC campaigns
Assist with case management and social cooperation for quarantines
Intensify mobilisation of resources to sensitize the public on post-pandemic recovery strategies in collaboration with government and stakeholders
Assist in providing essential services to communities
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 26 of 67
5. Pre-Pandemic Phase – Threat Preparedness and Resource Requirements
Increasing Cases in
the Region
Response Actions:
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MOHSW and MOA will call internal meetings
OVP will call meetings of the National Disaster Management Technical Council focusing on Influenza A H1N1
The National Influenza A H1N1 Task Force/RRT will meet with a broad range of stakeholders to mobilize/intensify IEC activities at all levels
RRTs will be alerted and provided with additional information/training/simulations
Field officers will be alerted and updated, especially at border points and reporting will be increased
Pig ban instituted and enforced on all infected countries
Influenza A H1N1 Fact sheets would be distributed to all health workers and MDFTs
Influenza A H1N1 information would be provided at the airport, borders and ferry crossings
Screening of all passengers arriving through air and sea routes
IDSR for Influenza A H1N1 would be strengthened through training and provision of resources for implementation of activities.
Stocktaking and additional resource mobilization to enhance preparedness
Response Limitations:
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Inadequate transportation and trained staff
Inadequate test kits and laboratory capacity
Resource Requirements:
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Outbreaks in the
neighbouring
countries
Logistical support (four-wheel drive field vehicles, motorcycles, and fuel for transportation)
Expanded training on surveillance and case management techniques
Response Actions:
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MOHSW and MOA will call immediate internal emergency meetings and the RRT will meet as soon as possible
OVP will call an emergency meeting of the National Disaster Management Technical Council focusing on Influenza A H1N1
OVP will coordinate a meeting of the Task Force on Influenza A H1N1/RRT, stakeholders and the Press to intensify IEC activities at all levels
RRTs will be alerted and provided additional information
Field officers will be alerted and updated. Intensive surveillance will be activated and reporting will be daily
Lumos (weekly markets) will be targeted for IEC and active surveillance (joint animal and human health teams)
Cross-border surveillance cooperation will be activated, including movement restrictions, as required.
Influenza A H1N1 fact sheets would be distributed to all health workers and MDFTs, with specific targeting to border officials and communities
Influenza A H1N1 information would be provided at the airport, borders and ferry crossings
IDSR for Influenza A H1N1 would be strengthened through training and provision of resources for implementation of activities.
Stocktaking and additional resource mobilization to enhance preparedness
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 27 of 67
Response Limitations:
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Inadequate transportation and trained staff.
Inadequate test kits and limited laboratory capacity.
Cross-border preparedness/training activities not occurred (this will impede cross-border surveillance).
Communication channels with Senegal and regionally not officially established and regularized.
Limited pre-printed IEC materials to distribute, particularly if outbreaks coincide with festivals (when messages may be ignored).
Resource Requirements:
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Outbreaks in The
Gambia
Logistical support to enhance surveillance (four-wheel drive field vehicles, motorcycles, and fuel for transportation).
Expanded training on surveillance and case management techniques;
More field equipment to support expanded surveillance efforts;
Laboratory and testing equipment (including sample management kits and deep freezers);
Additional PPEs and disinfectants;
Office equipment for enhanced reporting and IEC activities (including copiers, fax machines, computers, laminators, etc.);
Equipment to upgrade facilities to serve as isolation wards; and additional drugs and supplies.
Surveillance and Protection will be strengthened to contain the spread of the virus within the country, and stamping out the virus. Since lab capacity is limited, there will be
some delay until Influenza A H1N1 can be confirmed by a reference lab., so rapid testing kit results will be required for mobilizing the initial response.
Response Actions:
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MOHSW and MOA will call immediate internal emergency meetings and the RRT will meet as soon as possible
OVP will call an emergency meeting of the National Disaster Management Technical Council focusing on Influenza A H1N1
OVP will coordinate a meeting of the Task Force on Influenza A H1N1/RRT, stakeholders and the Press to intensify IEC activities at all levels
All RRTs will be alerted and provided additional information
RRTs for outbreak areas will be provided with additional support.
Emergency funds will be mobilized and private veterinarians will be engaged
Gambia Police and Security forces will assist with movement restrictions and checkpoint operations
Field officers will be alerted and updated, especially in areas surrounding the outbreak zone.
Intensive surveillance will be activated and reporting will be daily
Lumos (weekly markets) will continue to be targeted for IEC
Cross-border surveillance cooperation will be activated, including movement restrictions, as required.
Influenza A H1N1 fact sheets would be distributed to all health workers and MDFTs, with specific targeting to border officials and communities
INFLUENZA A H1N1 information would be provided at the airport, borders and ferry crossings
IDSR for Influenza A H1N1 would be strengthened through training and provision of resources for implementation of activities.
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Screening and quarantine of suspected cases.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 28 of 67
Response Limitations:
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Human Cases in
The Gambia
Inadequate transportation, trained staff, rapid test kits, and limited laboratory capacity.
Limited IEC materials to distribute, particularly if outbreaks coincide with festivals (when messages may be ignored).
Training and simulations for outbreak response have not occurred and are required to ensure an adequate response at the local level.
The occurrence of human cases of Influenza A H1N1 in The Gambia will heighten anxiety among the population and will call for an effective and rapid response coupled
with a strong IEC campaign to reassure a frightened population and to enlist their support in controlling the spread of the virus. Since the laboratory capacity is limited at
present, there will be some delay until Influenza A H1N1 can be confirmed by a reference lab, so clinical diagnosis will be the basis for mobilizing the initial response.
Response Actions:
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
DVS and DPI will call immediate internal emergency meetings and the RRT will meet as soon as possible
OVP will call an emergency meeting of the National Disaster Management Technical Council focusing on Influenza A H1N1
OVP will coordinate a meeting of the Task Force on Influenza A H1N1/RRT, stakeholders and the Press to intensify IEC activities at all levels
All RRTs will be alerted and provided additional information
RRTs for areas with human cases will be provided with additional support.
Emergency funds will be mobilized and private doctors will be engaged as required
Human Health response will follow WHO protocols for case management.
Movement restrictions/quarantine and monitoring of family members of suspected cases will be instituted as appropriate.
Family members of suspected cases will be treated with antiviral prophylaxis.
Case management guidelines and fact sheets will be widely distributed.
Seasonal Influenza vaccines will be provided to all frontline health workers.
Reporting of human cases will follow 2005 International Health Regulations
Gambia Police and Security forces will assist with movement restrictions
Field officers will be alerted and updated, especially in areas near the human cases. Intensive surveillance will be activated and reporting will be daily
Lumos (weekly markets) will continue to be targeted for IEC, especially if near human case areas.
Cross-border surveillance cooperation will be activated, including movement restrictions, as required. Human movement may be restricted, as required
Influenza A H1N1 fact sheets would be distributed to all health workers and MDFTs, and will target border officials and neighbouring communities
Influenza A H1N1 information would be provided at the airport, borders and ferry crossings
The Gambia Tourism Authority will inform tourists of the outbreaks and control measures, reassuring them that The Gambia is safe destination and that food is
also safe.
IDSR for Influenza A H1N1 would be strengthened through training and provision of resources for implementation of activities.
Response Limitations:






Inadequate transportation and limited trained staff.
Inadequate health facilities, rapid test kits and limited laboratory capacity.
Limited IEC materials to distribute, particularly if cases coincide with festivals (when messages may be ignored).
Training and simulations for case management insufficient, and is required to ensure an adequate response at the local level.
Inadequate stock of antivirals (i.e. Tamiflu), O2 respirators, and other medical supplies.
Critical shortage of isolation wards or equivalent facilities.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 29 of 67
Resource Requirements:
To enhance outbreak response efforts and manage human cases, as well as surveillance and sensitization/training activities may include:











Antivirals (Tamiflu), other drugs and treatment equipment;
Quarantine resources (including food, water, electrical generators, etc.);
Additional sampling, sample handling and transportation equipment;
Seasonal flu vaccine for outbreak responders and health care workers;
Resources for enhanced IEC production and distribution; resources to support training and mobilization of volunteers;
Logistical support (four-wheel drive field vehicles, motorcycles, and fuel for transportation);
Expanded and specialized training on surveillance, outbreak response, and case management techniques;
More field equipment to support expanded surveillance efforts (rapid test kits, etc.);
Laboratory and testing equipment (including sample management kits and deep freezers);
Office equipment for enhanced reporting and IEC activities (including copiers, fax machines, computers, laminators, etc.);
Equipment to upgrade facilities to serve as isolation wards; and additional drugs and supplies.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 30 of 67
6. Pandemic Phase – Threat Preparedness and Resource Requirements
Pandemic Phase
Outside of The
Gambia
Should the current virus mutate, or should a new virus appear, a new pandemic (WHO phases 4, 5, 6-depending on transmissibility) phase will have begun. With modern global
transportation, the virus has reached most of the globe. Health facilities will be quickly overloaded and social distancing and home care approaches will be implemented. The
Gambia will implement IEC actions activities to control fear and anxiety, to maintain calm and to engage support of the population in the population.
Response Actions:


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



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





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
MOHSW and MOA will call immediate internal emergency meetings and the RRT will meet as soon as possible
OVP will call an emergency meeting of the National Disaster Management Technical Council focusing on Influenza A H1N1
OVP will coordinate a meeting of the Task Force on Influenza A H1N1/RRT, stakeholders and the Press to intensify IEC activities at all levels
All RRTs will be alerted and provided additional information
RRTs for areas with human cases will be provided with additional support.
Emergency funds will be mobilized and private doctors will be engaged as required.
Information will be distributed on proper hygiene behaviour and home care, as well as the need for social distancing to restrict the spread of the disease.
Human Health response will follow WHO protocols for case management.
Movement restrictions/quarantine and monitoring of clusters of suspected cases will be instituted as appropriate.
Community members where cases are suspected will be treated with antiviral prophylaxis.
Case management guidelines and fact sheets will be widely distributed.
Seasonal Influenza vaccines and antiviral prophylaxis will be provided to all frontline health workers.
Health facilities will be quickly overloaded and the use of civil society resources such as churches and mosques
Encouraging home care will quickly be emphasized.
Reporting of cases will follow 2005 International Health Regulations
Gambia Police and Security forces will assist with movement restrictions
Lumos (weekly markets) will be suspended and/or hygiene controls implemented
Cross-border surveillance cooperation will be activated, including movement restrictions, as required.
Borders will be closed near human case cluster areas.
Intensive cooperation will be required, especially if cases occur during festival time.
Pandemic Fact sheets would be distributed to all health workers and MDFTs, with specific targeting to border officials and neighbouring communities
Pandemic information would be provided at the airport, borders and ferry crossings (transport of all kinds will be reduced dramatically)
IDSR will focus on the pandemic

Screening of all arriving passengers at all points of entry

Intensify messages on personal hygiene
Response Limitations:





Inadequate transportation and trained staff.
Inadequate health facilities and limited laboratory capacity.
Limited IEC materials to distribute, especially as related to pandemic Influenza :
Appropriate hygiene, social distancing and home care methods.
Civil Society actors such as the Red Cross, Churches and Mosques have not been sufficiently engaged in pandemic preparedness efforts.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 31 of 67



Inadequate stock of antivirals (i.e. Tamiflu), O2 respirators, PPE and other medical supplies.
Critical shortage of isolation centres or equivalent facilities.
Limited pandemic awareness and there has been little preparedness planning, especially outside of the human and animal health sectors.
Resource Requirements:
To limit spread and manage human cases, as well as surveillance and sensitization/training activities may include:










Pandemic Phase
in The Gambia
Access to the WHO antiviral (Tamiflu) stockpile and technical resources; other drugs and treatment equipment;
Quarantine resources (including food, water, electrical generators, etc.);
Additional sampling, sample handling and transportation equipment;
Seasonal flu vaccine for cluster responders and health care workers; PPEs;
Resources for enhanced IEC production and distribution; resources to support training and mobilization of volunteers;
Logistical support (four-wheel drive field vehicles, motorcycles, and fuel for transportation);
Expanded and specialized training on case management techniques;
Laboratory and testing equipment (including sample management kits and deep freezers);
Office equipment for enhanced reporting and IEC activities (including copiers, fax machines, computers, laminators, etc.); and
Equipment to upgrade facilities to serve as isolation wards.
Should the current virus mutate, or should a new virus appear, with the ability to spread easily among humans, a new pandemic will have begun. The country will embark on
prompt action to save lives. IEC activities will be used to control fear and anxiety in the population, maintain calm and engage support of the population.
Response Actions:



















MOHSW and MOA will call immediate internal emergency meetings and the RRT will meet as soon as possible
OVP will call an emergency meeting of the National Disaster Management Technical Council focusing on Influenza A H1N1
OVP will coordinate a meeting of the Task Force on Influenza A H1N1/RRT, stakeholders and the Press to intensify IEC activities at all levels
All RRTs will be alerted and provided additional information
RRTs for areas with human cases will be provided with additional support.
Emergency funds will be mobilized and private doctors will be engaged as required
Human Health response will follow WHO protocols for case management.
Movement restrictions/quarantine and monitoring of clusters of suspected cases will be instituted as appropriate.
Community members where cases are suspected will be treated with antiviral prophylaxis.
Case management guidelines and fact sheets will be widely distributed.
Seasonal Influenza vaccines and antiviral prophylaxis will be provided to all frontline health workers.
Reporting of cases will follow 2005 International Health Regulations
Gambia Police and Security forces will assist with movement restrictions
Field officers will be alerted and updated, especially in areas near the human clusters.
Intensive surveillance will be activated and reporting will be daily
Lumos (weekly markets) will be suspended near human case clusters.
Cross-border surveillance cooperation will be activated, including movement restrictions, as required.
Borders will be closed near human case cluster areas.
Pandemic fact sheets would be distributed to all health workers and MDFTs, with specific targeting to border officials and neighbouring communities
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 32 of 67


Pandemic information would be provided at the airport, borders and ferry crossings (transport of all kinds will be reduced dramatically)
IDSR will focus on the pandemic

Screening of all passengers arriving through all points of entry
Response Limitations:






Inadequate transportation and trained staff.
Limited health facilities and laboratory capacity.
Limited IEC materials to distribute, particularly if human cases coincide with festivals (when messages may be ignored).
Training and simulations for case management has been insufficient, and is required to ensure an adequate response at the local level.
Inadequate stock of antivirals (i.e. Tamiflu), O2 respirators, PPE and other medical supplies.
Critical shortage of isolation wards or equivalent facilities.
Resource Requirements:
To limit spread and manage human cases, as well as surveillance and sensitization/training activities may include:










Access to the WHO antiviral (Tami flu) stockpile and technical resources; other drugs, PPE and other equipment/supplies;
Quarantine resources (including food, water, electrical generators, etc.);
Additional sampling, sample handling and transportation equipment;
Seasonal flu vaccine for cluster responders and health care workers; PPEs;
Resources for enhanced IEC production and distribution; resources to support training and mobilization of volunteers;
Logistical support (four-wheel drive field vehicles, motorcycles, and fuel for transportation);
Expanded and specialized training on case management techniques;
Laboratory and testing equipment (including sample management kits and deep freezers);
Office equipment for enhanced reporting and IEC activities (including copiers, fax machines, computers, laminators, etc.); and
Equipment to upgrade facilities to serve as isolation centres.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 33 of 67
7. Coordination
Coordination Arrangements
During the Pandemic period, the Office of the Vice President, assisted by the National Task Force for
Influenza A H1N1, will provide overall coordination and resource mobilization for the Plan, through the
disaster management structure of The Gambia. The latter has been modified and strengthened. The Office
of the Vice President (OVP) chairs the National Disaster Management Governing Council (NDMGC). The
Council will meet to discuss the disaster risk situation in the Country. The Council is chaired by the Vice
President and has Ministers from critical sectors, which are as follows:
Minister of Health and Social Welfare
Minister of Agriculture
Minister of Forestry and Environment
Minister of The Interior
Minister of Defence
Minister of Finance and Economic Affairs
Minister of Fisheries and Water Resources
Minister of Local Government and Lands
Minister of justice and Attorney General
President of The Gambia Chamber of Commerce and Industry
Executive Director – Association of Non-Governmental Organisations (TANGO)
Chairman of National Planning Commission (Ex Officio)
The National Technical Advisory Group comprising all critical sectors in government, the Gambia National
Planning Commission and The Gambia Bureau of Statistics, and other stakeholders from the NGO
community, civil society, academia, Security and Emergency Services and UN agencies serves to advise the
NDMGC on disaster management issues. The Group meets once monthly in non-emergency periods to
discuss the general disaster management situation in the country. Influenza A H1N1 issues are discussed at
these meetings as appropriate.
For planning and preparedness, the GoTG will activate the National Task Force which comprises technical
experts in the Ministry of Health and Social Welfare (MOH&SW), Ministry of Agriculture (MOA), the Ministry
of Forestry and Environment (Parks and Wildlife), The Gambia Police Force, and the Disaster Management
Agency. In order to expand preparedness efforts in The Gambia, the membership of the National Task Force
has been expanded to include other national, regional and international partners, viz:








The Gambia Red Cross Society (GRCS)
Pig Breeders Association (PFA)
Gambia Tourism Authority (GTA)
Media (GPU/AOHJ)
Ministry of Finance and Economic Affairs (MOFEA)
National Environment Agency (NEA)
The Association of Non Governmental Organisations (TANGO)
National Youth Council
At the Regional and Municipal Levels, Disaster Management Committees are chaired by Regional Governors
and Municipal Mayors. These DMCs are responsible for coordination of all emergency operations at their
level, including those related to Influenza A H1N1. The DMCs have established Rapid Response Teams for
AHI, but their activities will now include Influenza A H1N1. The RRTs will respond to outbreaks from the
regional level, with assistance from relevant counterparts at the district and village level. Informed people
at the district and village levels will be essential for monitoring and reporting suspicious human deaths to
the RRTs.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 34 of 67
The Office of the Vice President, assisted by the National Task Force, will liaise with the partners for
technical and financial support, including ensuring that the national efforts are consistent with regional and
international policy. These include:

The UN system in The Gambia, resident Embassies, High Commissions and Consulates;

The African Union Inter-African Bureau for Animal Resources (AU-IBAR) Support programme to
integrated National Action plans for avian and human Influenza (SPINAP-AHI) (Nairobi, Kenya);

The UN Office for Coordination of Humanitarian Assistance (OCHA), Bureau of Crisis Prevention and
Recovery (BCPR): Inter-Agency Regional Platform on Avian and Human Pandemic Influenza
Preparedness (Office in Dakar for West Africa);

The Economic Community of West African States (ECOWAS) has been supporting “Harmonization
of Avian Influenza Control Policies and Strategies in West Africa”;

The International Federation of the Red Cross and Red Crescent;

The World Bank supported Alive Partnership for Livestock Development, Poverty Alleviation and
Sustainable Growth, and;

The Government of Senegal (for strengthening of surveillance and response activities).
Human Resource Management
Objective:
To ensure that allowances of essential staff are paid during the crisis period;
To facilitate mobilisation of funds for joint procurement of equipment and supplies;
Strategies:


Identification of suitable local partners for resource mobilisation;
Use of government financial management system for collection and distribution of funds.
The Ministry of Finance and Economic Affairs will mobilise financial contributions for the emergency. These
funds will be used as articulated in the budget tables, and to supplement the stockpile (see Procurement
List) as necessary.
Essential Staff
This Preparedness Plan envisages that only essential staff will be required for Government business
continuity during the pandemic period. The Office of the Vice President will ensure that essential staff report
to duty during the pandemic period. It also assumes that selected staff will be working from home. Existing
basic office items will be provided, including the following:
1.
2.
3.
4.
Computers
Mobile phones
Stationery
Office files on memory sticks
There are no implications on the existing budget. Due to connectivity problems, staff working from home
may not normally be linked to internet facility, except those that are already connected to the internet.
Office vehicles will be made available to facilitate easy communication with the office.
The Task Force will continue to train all relevant role players on Influenza Preparedness and Response. The
Team will organise regular sessions to give updates and emerging developments regarding the response to
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 35 of 67
the pandemic. Role players will be trained on their roles, duties and responsibilities during an emergency
situation, work norms, ethics and principles that they should observe during the emergency.
The Ministry of Finance will pay allowances of staff identified as essential during the pandemic period. This
will include other costs necessary for keeping the Government operations running.
Testing of Plan
Simulation exercises will be performed to continually test and improve the planning and preparedness
process in The Gambia, and to engage a broad range of stakeholders in the process. Resources will be
required to support a minimum of two national and two regional level simulation exercises every year.
Preparedness Plan Update Schedule
The Plan is a living document. It will, thus, be regularly reviewed and updated as demanded by the
changing circumstances.
The Task Force will review and update the Plan twice a year from the current version. The next review will
be February 2010 or as circumstances so require.
Framework and Budget for Influenza A H1N1 Coordination
Objective: To strengthen national capacity to coordinate all Influenza A H1N1 preparedness and response activities nationally,
among regions in The Gambia, and across the border with Senegal
Activities by Objective
Cost (Dalasis)
Time frame
Indicators
Responsible
1 Information and Networking
# of Meetings
No. of training
sessions
No. of training
reports
1.1 Conduct regular Influenza A H1N1 Stakeholder
Meetings and Workshops for Information sharing
and Plan Preparation
210,000
Apr 09 - Jul 10
1.2 Support for Influenza A H1N1 Coordination
150,000
Apr 09 - Jul 10
1.3 Regional RRT Sensitization/Updating/Training
(semi-annually)
2 Improve Civil-Military Influenza A H1N1
210,000
Apr 09 - Jul 10
Minutes, contact
lists maintained
# of regions
updated, # of
participants
150,000
Apr 09 - Jul 10
# of participants
3.1 Cross-border Cooperation/Simulation Workshop
(including Wildlife Research, IEC, Health, Livestock)
300,000
Apr 09 - Jul 10
3.2 Establish/maintain cross-border surveillance and
response team
50,000
GoTG/UNDP:DMA with
Influenza A H1N1 Task
Force
DMA/A Influenza A
H1N1 Task Force
Influenza A H1N1 Task
Force
Preparedness
2.1 Civil-Military Influenza A H1N1 Preparedness
Exercise
Influenza A H1N1Task
Force
3 Improve Cross-border Cooperation
Influenza A H1N1Task
Force
Apr 09 - Jul 10
Workshop and
follow-on activities
Regular email,
phone information
sharing established
50,000
Apr 09 - Jul 10
# of simulations
conducted
Influenza A H1N1 Task
Force
150,000
Apr 09 - Jul 10
# of simulations
conducted
Influenza A H1N1 Task
Force
Influenza A H1N1 Task
Force
4 Simulation Exercises
4.1 National Level with Various Stakeholders (2)
4.2 Regional Level with Broad Range of
Stakeholders (2 for each region)
Total Cost in Dalasis:
1,270,000
Total Cost in USD (26GDs/USD):
$49,000
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 36 of 67
8. Surveillance
According to WHO, all countries are considered at risk of transmission and infection with Influenza A H1N1.
While the West African sub-region has no confirmed cases, preparedness to cope with the pandemic is
essential for a rapid situation assessment and implementation of interventions. Influenza A H1N1 cases in
other countries denote the potential for infection in The Gambia. In this regard, a quick situation analysis of
the existing national surveillance systems has been conducted including the strengths in IHR
implementation. The results of the analysis identified the under-listed gaps for the development of a
national surveillance, preparedness and response plan.
Objectives
Strengthen national capacity in the timely detection, prevention, control, investigation and reporting of
Influenza A H1N1 within animal and human populations.










A critical mass of staff will be established for early recognition of Influenza A H1N1 and adequate
sample collection for confirmatory laboratory diagnosis.
Integrated Disease Surveillance and Response (IDSR) strategy will be strengthened including IHR
(2005) for early detection of Influenza A H1N1 virus strain.
Diagnostic capacity of National Laboratories for veterinary and public health will be enhanced.
Existing mechanism for the timely collection, storage and transportation of samples to reference
laboratories (i.e. IPD, Rep. of Senegal) will be enhanced.
Awareness and involvement of communities to recognise and report immediately any Influenza A
H1N1 suspected cases.
Adequate and effective referral system for all suspected cases at all levels especially at PoE (Points
of Entry) will be established.
Cross border surveillance of Influenza A H1N1 will be strengthened and harmonised.
Influenza A H1N1 integrated information system will be established for information sharing.
Protocols and guidelines will be provided for capacity building.
Adequate required resources will be provided to strengthen prevention, surveillance and control
measures at PoE and referral points and through the existing Epidemiological Surveillance Network
for Trans-Boundary Animal Diseases.
Strategies











Mobilise resources and strengthen capacity of surveillance officers in case investigation and
reporting.
Monitor and supervise surveillance activities and interventions.
Monitor preparedness status especially at PoEs.
Establish collaboration/cooperation and coordination among partner institutions.
Consolidate and expand existing surveillance points.
Increase community awareness, participation and involvement.
Ensure availability of adequate referral system and feedback mechanism.
Make available protocols and guidelines for use by health staff.
Increase capacity of PoE officials to facilitate and improve surveillance of Influenza A H1N1.
Re-activate Health for Peace Initiative between The Gambia and the participating countries.
Enhance sample collection and transportation to the national and regional reference laboratories.
Activities by Objectives
Objective 1: Establish and train a critical mass of staff (livestock and health) for early
recognition of Influenza A H1N1 and adequate sample collection for confirmatory laboratory
diagnosis
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 37 of 67
Activities: Train staff on disease recognition, sample collection, and laboratory diagnostic techniques in
conjunction with IHR issues:
Training:
Livestock Assistants
Veterinarians (public, private and research institutions)
Health Sector Officers/Clinician/case investigator/surveillance
Lab Technicians and Assistants (Health and Livestock Sectors)
Sensitise security personnel on IHR2005 issues and Influenza A H1N1





Develop/modify and adapt Influenza A H1N1 surveillance training materials

Adapt health manuals and guidelines on Influenza A H1N1
Conduct joint monthly supportive supervisory visits to all potential especially at risk areas (PoE, RHT, and
Facilities including labs)


Health Sector
Livestock Sector
Provide additional sampling kits, laboratory equipment, consumables and protective gear for Influenza A
H1N1 surveillance


Health Sector
Livestock Sector
Objective 2: Strengthen Integrated Disease Surveillance and Response (IDSR) for Influenza A
H1N1





Produce adequate copies of the Standard case definition for Influenza A H1N1 and distribute to all
health facilities, RHTs and potential partners and parties involved in the implementation of IHR
2005.
Incorporate Influenza A H1N1 into IDSR priority disease list and training manuals.
Include Influenza A H1N1 in all the IDSR guidelines and protocols.
Produce and make available to all reporting units, revised IDSR Technical Guidelines to all levels
Intensify community involvement and participation in Influenza A H1N1 surveillance and response.
Objective 3: Strengthen national diagnostic capacity for livestock and human health sectors.
Animal Health




Provide ELISA system (i.e. Automatic Plate washer, Computer and Printer, ELISA Reader and ELISA
kits), Microscopic Slides, Fitc, Specific Conjugation, Polyvalent Antiserum, Acetone
Network with LNERV on Influenza A H1N1 surveillance
Train laboratory staff on ELISA kits for Influenza A H1N1 specific assays
Incorporate Influenza A H1N1 into the quality control panel from reference laboratories
Human Health





Provide additional laboratory logistics (reagents samples collection toolsets)
Provide protocols and guidelines on Influenza A H1N1 for lab staff on sample management
Train laboratory staff on sample collection techniques, storage, packaging and transportation to
reference lab
Train lab staff on IHR 2005 diseases, issues and implementation
Incorporate Influenza A H1N1 into the quality control panel from reference lab
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 38 of 67
Objective 4: Strengthen timely collection, storage and transmission of samples to reference
laboratories





Provide additional logistical support for sample transportation to reference laboratories
Provide additional transport support for central laboratories and for case investigators
Sensitize hospital security and concern staff in the proper handling of samples
Provide results of sample analysis as soon as possible to the sender (feed back) or facility or region
concern.
Disseminate results to appropriate authorities or community concerned as soon as possible.
Objective 5: Enhance awareness and involvement, and build capacity of communities to enable
them recognise and report immediately any Influenza AHIN1 suspected cases







Train sanitary defence council on Influenza A H1N1 disease recognition and reporting
Identify community structures for message dissemination and education
Produce copies of community simplified messages on the disease
Livestock: Sensitise/train religious/community leaders, community health workers, traditional
healers/ Communicators and Community Based Organisations (CBO) in recognition of Influenza A
H1N1 disease and reporting.
Humans: Sensitise/train religious/community leaders, community health workers, traditional
healers/ Communicators and Community Based Organisations (CBO) in recognition of Influenza A
H1N1 disease and reporting.
Intensify community radio and TV sensitization programs on Influenza A H1N1
Conduct quarterly participatory surveillance meetings with RHTs.
Objective 6: Strengthen or harmonize cross border surveillance of Influenza A H1N1





Share Epidemiological Information with neighbouring countries
Increase border surveillance activities on Influenza A H1N1 recognition and case detection
Conduct trans-boundary Surveillance Committee meetings.
Train PoE surveillance officers on the implementation of IHR and Influenza A H1N1
Conduct trans-boundary surveillance council meetings
Objective 7: Establish Influenza A H1N1 integrated information system








Provide additional computers to key stakeholders.
Provide heavy-duty photocopiers for reproduction of data collection tools.
Incorporate Influenza A H1N1 data into the existing health information system – eg (HIS)
Train livestock and health personnel on the database software package.
Establish and maintain wider area computer network.
Solicit free hotline reporting for Influenza A H1N1 from our communication partners.
Improve communication between field staff, communities and national level.
Distribute data collection and reporting tools for Influenza A H1N1 weekly and monthly reporting.

Restore and provide Email services at all central and regional levels to facilitate feedback and
information sharing.
Objective 8: Include Trans-boundary Animal Disease Surveillance (TAD)






Purchase additional motor bikes for field agents (livestock and health).
Provide additional field sampling kits and materials.
Provide fuel and maintenance costs to mobilise additional field agents for Influenza A H1N1.
Create additional surveillance points.
Train existing and additional field agents on Influenza A H1N1 surveillance.
Re-activate a rapid response team to carry out emergency field visits during suspected Influenza A
H1N1 outbreaks.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 39 of 67
FRAMEWORK AND BUDGET FOR AVIAN INFLUENZA SURVEILLANCE
Objective: To strengthen national capacity in the timely, detection, prevention, control, investigation and reporting of AH1N1 within animal and human
populations
Activities by Objective
Cost (Dalasis)
Time frame
Indicators
Responsible
1 Train critical mass of field staff
1.1 Trainings
1.1.1Training sessions 100 Livestock Assist. for 3 days
DVS
200,000
July 09-Sept 09
%Lab Assist trained
DVS
1.1.2 Veterinary Lab. technicians (one)
85,000
July 09-Sept 09
Vet Lab tech trained
DVS
1.1.3 Veterinarians (25) for 3 days
80,000
July 09-Sept 09
% of Vets trained
DVS
1.1.4 Clinicians/case investigators/surveillance (300 Health Workers
for 4 days)
540,000
July 09-Sept 09
No of staff trained
MOH
1.1.5 Lab.Staff ( 30 Lab. staff) for 5 days
120,000
July 09-Sept 09
No. of lab tech trained
MOH
1.1.6 100 security Personnel 2 day
200,000
July 09-Sept 09
No. of lab asst. trained
MOH
380,000
July 09-Sept 09
No. of T.manuals dev.
MOH
1.3.1 Health
285,000
July 09-June 2010
No. of visit
MOH
1.3.2 Livestock
160,000
July 09-June 2010
No. of visits
DVS
1.4.1 Livestock
200,000
July 09-June 2010
%equipment acquired
DVS
1.4.2 Health
200,000
July 09-June 2010
% equipment acquired
MOH
1.2 Develop/modify and adapt AH1N1 training materials:
1.2.1 Health
1.3 Conduct monthly supervisory visits
1.4 Provide additional sampling kits
2 Strengthen IDSR
2.1 Treated under IDSR Training Manual and guideline budget
July 09-Sept 09
MOH
2.2 Include AH1N1 in all IDSR guidelines and protocols
July 09-Sept 09
MOH
2.3 Distribute revised IDSR documents
July 09-Sept 09
MOH
2.4 Intensify Community involvement & participation in AH1N1
Preparedness Plan for Influenza A H1N1 in The Gambia
250,000
July 09-June 2010
% communities involved
Page 40 of 67
MOH
3 Enhance national diagnostic capacity
3.1 Provide ELISA system & reagents for immunofluorence for
livestock
100,000
July 09-Sept 09
No. of equipment procured
DVS
80,000
July 09-Sept 09
No. of staff trained
DVS
3.4 Provide AI quality control panel
220,000
July 09-Sept 09
No. of equipments procured
DVS
3.5 Provide ELISA system & reagents
100,000
July 09-Sept 09
No. of equip./reagents provided
MOH
80,000
July 09-Sept 09
Person trained
MOH
July 09-June 2010
networking report
MOH
3.3 Train in AH1N1 ELISA locally for 10 persons for 5 days
3.6 Train in ELISA at Pasteur Institute for one (1) person
3.9 Quarterly network with Pasteur Institute
4 Strengthen timely collection, storage and transmission of
samples to reference laboratories
4.1 general logistical support
4.1.1 Livestock
100,000
July 09-June 2010
No. of samples sent
DVS
4.1.2 Health
100,000
July 09-June 2010
No. of samples tested
MOH
4.2 Additional transport support for case investigation
4.2.1 Livestock (1) vehicle
625000
July 09-June 2010
No of vehicles acquired
DVS
1875000
July 09-June 2010
No of vehicles acquired
MOH
4.4.1 Livestock/ Health
20,000
July 09-June 2010
% of feed back given
MOH/MOA
4.4.2 Dissemination of results to appropriate authorities
50,000
July 09-June 2010
% of feed back given
MOH/MOA
4.4.3 Publication of monthly newsletter
65,000
July 09-June 2010
No. of news letter published
AOHJ
150,000
July 09-Sept 09
No. of trained defence committee
DVS
75,000
July 09-Sept 09
No. of trained committees
DVS
350,000
July 09-Sept 09
No. of meeting conducted
MOH
4.2.2 Health (3) 4- Wheel Drive Vehicles)
4.4 Feedback
5 Enhance community involvement
5.1 Train sanitary defence committee
5.2 Livestock trainings
5.3 Health (VDC/CAC members)
6 To strengthen cross border surveillance
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 41 of 67
6.1 Share epidemiological information
6.1.1 Health/Livestock
200,000
JULY 09-JUNE2010
No. of meeting held
MOH/MOA
135,000
July 09-Sept 09
No. of computers
MOH
35,000
July 09-Sept 09
No. of computers
DVS
7.2.1 Health
105,000
July 09-Sept 09
no.of photocopiers
MOH
7.2.2 Livestock
105,000
July 09-Sept 09
no.of photocopiers
DVS
8.1.1 Livestock (5 motor bikes)
325,000
July 09-June 2010
No.of motorcycles
DVS
8.1.3 Health (10 Motor cycles)
650,000
July 09-June 2010
No.of motorcycles
MOH
8.2.1 Livestock (1 freezer)
500,000
July 09-Sept 09
No.of sample kits acquired
8.2.2 Health (1 freezer)
500,000
July 09-Sept 09
No.of sample kits acquired
7 To establish an integrated AH1N1 information system
7.1 Provide additional computers
7.1.1 Health(3 laptop computers)
7.1.2 Livestock (1 computer)
7.2 Provide heavy duty photocopiers for each sector
8 Include AH1N1 in Trans-boundary Animal Disease
Surveillance (TAD)
8.1 Purchase additional motor cycles for field agents
8.2 Purchase additional sampling kits (for storage in deep
freezers -70 degrees)
8.3 Fuel & maintenance cost for motor bicycles & vehicles:
Livestock/Health
2,000,000
Total Cost in Dalasis:
11,245,000
Total Cost in USD (26GDs/USD):
$432,500
Preparedness Plan for Influenza A H1N1 in The Gambia
July 09-June 2010
MOH/MOA
Page 42 of 67
9. Prevention and Control
Prevention of Influenza A H1N1 is made difficult by the antigenic shift and drift of the virus that serves as a
source of infection to humans. Strict bio-security, public awareness on Influenza A H1N1 and heightened
surveillance activities are integral in the exclusion and early detection of the disease in The Gambia.
Vaccination (when available), as a control strategy, has to be combined with the activities stated above as
recommended by the WHO. Presently, the country is faced with a weak surveillance system, inadequate
capacity in both human and animal laboratories, inadequate human resources, medical equipment and other
supplies as well as weak bio security at farms and entry points. In light of this the Country is ill prepared for
an Influenza A H1N1 outbreak. Therefore the outlined intervention strategies and activities stated below
are aimed at the prevention and control of Influenza A H1N1.
General Objective: To prevent and control Influenza A H1N1 in pigs and humans, also to prevent human
to human transmission
Specific Objectives
1.
2.
3.
To detect Influenza A H1N1 early in humans and animals.
To follow up persons at risk of Infection.
To reduce morbidity and mortality in humans.
Strategies







Infection Prevention and Control
Case Management
IEC and Social Mobilization
Epidemiological Surveillance
Laboratory surveillance and Research
Coordination
Bio-security and hygiene at all levels.
Strategy 1: Infection Prevention and Control
Activities:







Establish infection control measures in all health facilities and PoE (Point of Entry)
Create awareness on infection control and personal hygiene
Provide protective gears for veterinary and health workers
Disinfect housess and other materials including vehicles and formites
Train farmers on basic personal hygiene
Quarantine – Restrict movement of people from and into infected areas
Recruit and train community structures to enhance empowerment and involvement
Strategy 2: Case Management
During the Pandemic Period, the WHO standard case definition will be used for clinical diagnosis. The
standard case definition of Influenza A H1N1 is as follows: Acute febrile respiratory illness (fever >38°C)
with the spectrum of disease from Influenza -like illness to Pneumonia.
A Suspected Case
A suspected case of the new A H1N1 virus infection is defined as a person with acute febrile respiratory
illness (reported or documented fever, and one of the following: cough, sore throat, shortness of
breath, difficulty in breathing or chest pains) with onset:
-within 7 days of close contact with a person who is a probable or confirmed case of the new influenza
A (H1N1) virus infection, or -within 7 days of travel to a community internationally where there has
been one or more confirmed novel influenza A (H1N1) cases, or resides in a community where there
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 43 of 67
are one or more confirmed new influenza cases
A Probable case of new influenza A(H1N1) virus infection is defined as an individual with an influenza
test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza
virus infection
OR
An individual with a clinically compatible illness or who died of an unexplained acute respiratory illness
who is considered to be epidemiologically linked to a probable or confirmed case.
1.
2.
3.
A Confirmed case of new influenza A(H1N1) virus infection is defined as an individual with laboratory
confirmed new influenza A(H1N1) virus infection by one or more of the following *:
real-time RT-PCR,
viral culture
four-fold rise in new influenza A(H1N1) virus-specific neutralizing antibodies.
Reporting requirements for confirmed and probable cases of Influenza A H1N1
Under the IHR (2005), immediate reporting to WHO is required for human Influenza due to a new Influenza
virus sub-type. All information will be treated in accordance with the IHR (2005) provisions.
Activities:



















Develop, print and distribute standard Case Management guideline to Health Workers
Establish infection control at all levels including the PoEs
Train all surveillance personnel on infection control and personal hygiene
Establish treatment and isolation centres at community level
Ensure security and control of isolation/quarantine points
Procure stockpile and pre-position Tamiflu, Vaccines (if available) and other Essential Drugs and
non-medical supplies
Procure and distribute other essential drugs to recommended referral points
Purchase adequate supply of seasonal flu vaccines to protect health and livestock workers
Provide chemoprophylaxis for children, elderly and immuno-depressant individuals
Purchase adequate quantities of PPE and other medical and non-medical supplies
Train Health Care workers on the use of the standard case management guideline and manuals
Sensitise NGO and private health care workers on the use standard case management guidelines
Provide adequate stock levels of specimen collection and other materials for all health facilities
Create night allowances for additional rapid response team from central level
Conduct sensitization workshops for community health workers at village health posts.
Sensitise traditional healers on recognition, reporting, prevention and control of INFLUENZA A
H1N1
Sensitise Multi-Disciplinary Facilitation Teams (MDFT) on the prevention and control of
INFLUENZA A H1N1
Sensitise teachers, relief agencies and youth on the prevention and control of INFLUENZA A
H1N1
Institute regular monitoring and supervision of intervention measures at all levels.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 44 of 67
Framework and Budget for Influenza A H1N1 Prevention and Control
FRAMEWORK AND BUDGET FOR INFLUENZA A H1N1 PREVENTION AND CONTROL
Objective: To prevent and control Influenza A H1N1 in animals and humans
Activities by Objective
Cost (Dalasis)
1. Prevention & Control of Influenza A
H1N1
1.1 Provide protective gears for farm workers,
health workers and PoE staff
Indicators
Responsible/Partners
Number of protective
gears bought and
distributed
MOH
DLS
Number of
disinfectant bought
and used
MOH
DLS
250,000
Number of staff
trained and training
reports
MOH,DVS
250,000
Number of case
management
guidelines developed
printed and
distributed
Number of Rx and
isolation centre
established at
community level
MOH
UN System Agencies
Foreign Embassies
Other Partners
Amount of drugs
purchased
MOH
UN System Agencies
Foreign Embassies
Other Partners
Receipts and
payment vouchers
Signatures of staff
MOH
Partners
1.2 Disinfect premises, ambulances, visiting
vehicles and other materials and formites
1.3 Train staff on basic personal hygiene
Time
frame
2. Case Management
2.1 Adapt, print and distribute standard case
management guidelines for health workers
2.2 Establish treatment and isolation centres at
community level
3,000,000
2.3-2.10 Procure drugs and other Medical
supplies
5,000,000
Provide allowance for staff at screening sites
500,000.00
Total Cost in Dalasis:
5,600,000
Total Cost in USD (26GDs/USD):
$215384.61
Preparedness Plan for Influenza A H1N1 in The Gambia
MOH
Page 45 of 67
10. Communication
Considering low awareness on Influenza A H1N1 and inadequate health service infrastructure to respond
effectively to the virus, it is prudent that preventive measures through organized communication are
developed and implemented.
Overall Aim:
The overall aim is to inform The Gambian public of the existence of Influenza A H1N1 and prepare them to
effectively respond to any possible outbreak and to promote healthy behaviours for the prevention and
control of the virus in The Gambia.
Specific Objectives:







Raise awareness of the general public with selected key messages for protecting and preventing
themselves against Influenza A H1N1
Promote improved hygiene and sanitation practices among the general population
Mobilize Regional and district authorities and NGOs for moral and logistical support
Equip selected partners with essential messages and IPC skills for transmission of Influenza A
H1N1 in their spheres of influence
Provide orientation and essential up-to-date information to media personnel for public transmission
Provide basic equipment and skills to communication institutions in the transmission of messages
on Influenza A H1N1.
Solicit continued commitment of policy makers
The process involved in the implementation of the strategy will entail a lot of interpersonal communication
to enhance actions for behaviour change. This will be complemented by intensive mass media
communication. Thus the process will:
a)
Strengthen interpersonal communication at the community level by mobilizing and strengthening
the capacity of existing communication networks of teachers, religious leaders, Pig Breeders
Association, agricultural extension workers, health workers, women’s groups, livestock extension
workers and relevant NGOs.
b)
Optimise use of mass media especially the radio and TV to complement the above and balance
messages about Influenza A H1N1 with opportunities for local people to discuss the issue and
suggest solutions for improved basic personal hygiene.
c)
Will be cognizant of rumours about Influenza A H1N1 that will inhibit health-seeking behaviour and
have credible local and religious leaders to refute them
The strategy will take maximum advantage of ongoing programmes, available opportunities, and reliable
outlets to get the correct messages out.
Immediate Next Steps (implementation)




Message development and material review workshop
Immediate utilization of the health education slots on national radio
Orientation of the media on Influenza A H1N1
Training of a pool of trainers at Regional level.
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 46 of 67
Framework and Budget for Influenza A H1N1 Communication
Objective 1. Raise awareness of the general public with selected key messages for protecting and preventing themselves against Influenza A H1N1
Activities
Expected Output
Responsible Institution
A. Training a pool of trainers at the central, Regional and
district levels
-Awareness in the community raised
HEU/DLS/(GRCS, GRTS,
ACU, AOHJ, AFRICELL)
B. Community/ Household based training and
sensitization
-Messages developed for each phase of the epidemiological
situation
Resources
GMD
500,000
C. Mass media (national radio in particular)
D. Community film shows
-Communication materials developed and disseminated for different
audiences
E. Community interactive drama
-IPC networks trained
F. Message development workshops
G. Development of communication materials.
(Dissemination)
Objective 2 Promote improved hygiene and sanitation practices among the general population
Audience: Schools, families and communities, media, IPC networks
Activities
-Intensify health education in service outlets
Expected Output
Responsible Institution
Hygienic and sanitation practices adhered to by families and
communities.
-Message development
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 47 of 67
HEU/DLS
Resources
GMD
-Mass media emphasizing local language program
-Production of communication materials
-Home visits and household sensitization
-Training (a, IPC Skills)
Objective 3 Mobilize Regional and District Authorities, NGOs and Media to support the Influenza A H1N1 initiative.
Audience: Regional Authorities & Decks, District Authorities, NGOs/Fobs, Cobs,
Activities
Expected Output
Responsible Institution
-Mobilization and sensitization of Regional and district
authorities
Local resources mobilized.
HEU/DLS
-mobilization and sensitization of NGOs/CBOs with
potential IPC networks
Active participation of NGOs,CBOs and media institutions
Resources
GMD
42,500
Objective 4: Equip selected partners with essential messages and IPC skills for transmission of Influenza A H1N1 in their spheres of influence
Audience: GRCS, CBOs , MDFTs, DCCs
Activities
Expected Output
Responsible Institution
Training of selected partners
Selected partners mobilized and trained
HEU/DLS
Message and IEC material development,
Relevant messages and IEC materials developed on Influenza A
H1N1
Resources
GMD
42,500
Mobilization of selected partners
Objective 5: Provide orientation and essential and up-to-date information to media personnel for public transmission
Audience: Media Institutions (print and electronic)
Activities
Preparedness Plan for Influenza A H1N1 in The Gambia
Expected Output
Responsible Institution
Page 48 of 67
Resources
GMD
Mobilization of media institutions
Media institutions equipped with up- to- date information on
Influenza A H1N1
HEU/AOHJ
50,000
Orientation of media institutions on Influenza A H1N1
Objective 6 Provide basic equipment to communication institutions in the transmission of messages on Influenza A H1N1
Audience: HEU, ACD, GRTS, AOHJ, EEU
Activities
Procure and supply basic equipment/material to
communication institutions to disseminate Influenza A
H1N1 messages
Expected Output
Responsible Institution
Availability of relevant materials to disseminate Influenza A H1N1
messages
Resources
GMD
MOH/GRTS
Objective 7: Solicit the continued commitment of policy makers and International Community
Audience: policy makers (Executive, NAMs, Heads of Departments, Local Authorities, Bilaterals)
Activities
Expected Output
Advocacy with the above audience
Operational policies and plans in place
Development and implementation of policies and plans
Advocacy carried out with donors
Preparedness Plan for Influenza A H1N1 in The Gambia
Responsible Institution
National Disaster Task
Force/DLS/MOH
Page 49 of 67
Resources
GMD
42,500
11. Preparedness Actions and Plan Updating
Actions
Status
By whom
Timeline
1.1 Update and Facilitate Approval of Preparedness Plan

Include roles and responsibilities in the Appendices

Include final revisions and SOPs from DVs

Influenza A H1N1 Task Force to finalise the document

Submit for approval
Ongoing
Task Force
29 May 2009
1.2 Revise simulation to include Post-Pandemic Recovery

Tourism promotion

Agriculture promotion

General economic recovery
Ongoing
Task Force
September 2009
1.3 Letters to donors to request assistance for priority activities

Include high level advocacy
Ongoing
Task Force
June 2009
1. Planning and Coordination
1.4 Organise team, secure resources and begin development of IEC materials (HEU
and others)

Review, print and distribute existing materials

Posters and brochures (targets: security forces, youth groups, farmers,
local government etc)

Community sensitisation (Outreach)

Radio and TV presentation

Plan for emergency alerts: (SMS)

Video production (ACD-Ag Comm Division)
June 2009
1.5 Secure basic coordination resources (Secretariat support to AHI Task Force to
be provided by DMP)

Regular coordination meetings

Track and report on progress

Establish active website/information contacts/media liaison

Simulation exercises

Media training (include heads of organisations)

Security force training

Cross-border simulations and workshops

High level sensitivity training (for National Assembly members, HoDs, etc)

Quarterly updating of Regional RRTs
June 2009
2. Medical interventions
2.1 Secure essential surveillance resources/training

Request training to address priority gaps (to be identified)

Rapid test kits (40)

PPE and Disinfectants

Sample collection and transportation
TBD
2.2 Secure essential outbreak response resources

Emergency communication

Transportation
TBD
2.3 Secure specialised coordination resources

Civil-military simulations

Clarify emergency fund access, establish special EPR fund

Establish cross-border Council to monitor disease progression
TBD
Preparedness Plan for Influenza A H1N1 in The Gambia
Page 50 of 67
12. Overall Financial Resource Requirements
RESOURCE REQUIREMENTS SUMMARY
Objective
Cost (Dalasis)
COORDINATION
280,000
1 Information and Networking
-
2 Improve Civil-Military Influenza A H1N1 Preparedness
400,000
3 Improve Cross-border Cooperation
125,000
4 Simulation Exercises
805,000
Total for Coordination:
SURVEILLANCE
2,378,000
1 Train critical mass of field staff
50,000
2 Strengthen IDSR
362,000
3 Enhance national diagnostic capacity
4 Strengthen timely collection, storage and transmission of samples to reference laboratories
8,395,000
5 Enhance community involvement
750,000
6 To strengthen cross border surveillance
200,000
475,000
7 To establish an integrated AI information system
8 Include Influenza A H1N1in Trans-boundary Animal Disease Surveillance (TAD)
Total for Surveillance:
5,425,000
18,035,000
PREVENTION AND CONTROL
1. Prevention & Control of Influenza A H1N1
2,050,000
2. Case Management
3,050,000
Total for Prevention and Control:
5,100,000
COMMUNICATION
500,000
Objective 1: Raise awareness of the general public with selected key messages for protecting and
preventing themselves against Influenza A H1N1.
-
Objective 2: Promote improved hygiene and sanitation practices among the general populace
Objective 3: Mobilize Regional and district authorities, NGOs and Media to support the Influenza A
H1N1 initiative.
42,500
Objective 4: Equip selected partners with essential messages and IPC skills for transmission of
Influenza A H1N1 in their spheres of influence
42,500
Objective 5: Provide orientation and essential and up-to-date information to media personnel for
public transmission
50,000
Objective 6: Provide basic equipment to communication institutions in the transmission of
messages on Influenza A H1N1
42,500
Objective 7: Solicit the continued commitment of policy makers and International Community
Total for Communication:
677,500
Grand Total (Dalasis):
24,617,500
Grand Total (USD=Dalasis/26):
$946,827
51
Budget for Immediate Priority Actions
3 Budget for Immediate Priority Actions
Objective: To commence immediate priority Influenza A H1N1 emergency preparedness activities and thereby increase
surveillance and response capacity
Activities by Objective
Cost (Dalasis)
Indicators
Responsible
10,000
Workshop minutes
GoTG/UNDP:DMP
5,000
minutes and emails
AH1Task Force
1 Coordination
1.1 Conduct Influenza A H1N1 Stakeholder
Meeting/Resource Mobilisation Workshop
1.2 Secretariat Support (3 mo) for Influenza A
H1N1Coordination
1.3 Regional RRT Sensitization/Updating/Training (1
round-all regions)
250,000
# of regions trained, #
of people trained
AH1Task Force
1.4 Cross-border Cooperation/Simulation Workshop
(including IEC, Health, Livestock)
300,000
Workshop and follow-on
activities
AH1Task Force
2.1 Resources for Immediate Training Needs (1/3
Livestock & health 1/2 security training)
400,000
# of staff trained
AH1Task Force
2.2 Procure Rapid Test Kits (20)
100,000
# of kit procured
DVS
2.3 Procure Sample Prep and Transport Kits
250,000
# of kits procured
Health
# of farmers assisted
Partner organisations
50,000
# of farmers trained
DVS
200,000
# of material printed,
and distributed
HEU and partners
4.2 Design and Produce new IEC materials including
electronic media
50,000
# and quality of new
material produced
HEU and partners
4.3 Training for Media and stakeholders on Influenza A
H1N1communication skills
50,000
# of media and other
stakeholders trained
HEU and partners
# of communities
reached
HEU and partners
2 Surveillance
3 Prevention and Control
3.1 Support for enhanced farmer bio security
3.2 Training farmers on proper hygiene
250,000 ***
4 Information, Communication and Education (IEC)
4.1 Review, Print and Distribute Existing Materials on
Influenza A H1N1and basic hygiene procedures
4.4 Additional Community sensitization efforts
105,000
*** Partners to support farmer's bio-security efforts
Total Cost in Dalasis:
1,675,000
Total Cost in USD (26GDs/USD):
$64,423
52
13. Appendices
Appendix A: Composition of the Emergency Preparedness and Response Team
Name
Designation
Agency
53
Appendix B: List of Essential Personnel for the Worst Case Scenario (to be agreed 2009)
S/N
Area
Name
Title
Address
Agency
Callsign
Cell phone
Res. Tel.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
54
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
List of Emergency Numbers (Updated May 2009)
EMERGENCY CONTACT NUMBERS
Agency
Callsign
Selcall
Satellite Phone
Office Tel #
Ambulance
116
Police
117
Fire Services
118
Banjul Police Station
4227256
Serekunda Police Station
4392208
Bakau Police Station
4495328
Telephone Service
4229999 Ext 131
Electricity Service
4227951 / 4496430
Water Service
4370269
FAX #
VSAT TEL. #
55
Appendix C: Health Care Facilities in The Gambia (to be updated)
Key Medical Responders
Name
Location
Office Tel #
Mobile #
REFERRAL HOSPITALS
Hospitals
Location
Contact Numbers
Royal Victoria Teaching Hospital
Banjul
4223756/42228223/4
Medical Research Council
Fajara
4495442/3/4/5/6
Ahmadiyya Hospital
Tallinding Kj
4392143
Jemus Junkung Hospital
Bwiam
4489085
APRC Hospital
Farafenni
5735259
Jammeh Foundation for Peace Hospital
Bundung
439725
DIVISIONAL HEALTH CARE FACILITIES
DHT Western
Kanifing, KSMD
4394272
DHT Central River Division
Bansang, CRD
5674229
DHT North Bank Wests
Essau, NBD
5710168
DHT North Bank East
Farafenni, NBD
57355008
DHT Upper River Division
Basse, URD
5668439
DHT Lower River Division
Mansakonko, LRD
5531222
56
Appendix D: Regions and Municipalities in The Gambia (Updated May 2009)
LGA (8)
LGA
Headquarters
Regions and Municipalities
Districts (37)
Banjul (Capital)
Banjul LGA
Banjul City Council (BCC)
Banjul District
Kanifing
Kanifing LGA
Kanifing Municipal Council
(KMC)
Kanifing District
WR
Brikama
Western Region
Foni Bintang-Karenai | Foni Bondali |
Foni Brefet | Foni Jarrol | Foni Kansala |
Kombo Central | Kombo East | Kombo
North/Saint Mary | Kombo South
NBR
Kerewan
North Bank Region
Central Baddibu | Jokadu | Lower
Baddibu | Lower Niumi | Upper Baddibu |
Upper Niumi
LRR
Mansa Konko
Lower River Region
Jarra Central | Jarra East | Jarra West |
Kiang Central | Kiang East | Kiang West
CRR(S)
Janjanbureh
(South) Central River Region
CRR(N)
Kuntaur
(North) Central River Region
Fulladu West | Janjanbureh | Niamina
West | Niamina East | Niamina Dankunku
|
Lower Saloum | Sami | Niani | Nianija |
Upper Saloum
URR
Basse
Upper River Region
Fulladu East | Kantora | Sandu | Wuli
East| Wuli West | Tumana
57
PHYSICIANS/HOSPITALS IN GREATER BANJUL
NAME OF PHYSICIAN
NAME OF HOSPITAL/CLINIC
TELEPHONE
CELL PHONE
DR. LENRIE PETERS-Gen. Surgeon
Westfield Clinic, Serrekunda
439-3523
DR. M.K.B. FAAL-Obstetrician/Gynecologist
Ndeba-an Medical Centre, Bakau
449-6426
9970022
DR. ULRIC O. E. JONES-Gen. Surgeon/Neurosurgeon
UN Physician- UN House, Cape Point, Bakau
4494772
997-2123 7874685
DR. S. A. L. CEESAY-Gen. Surgery
Kololi Clinic, Kololi
4463434
9903762
DR. ABA DUMBUYA-Obstetrics/Gynecology
Westfield Clinic, Serrekunda
4393523
9906633
DR. ADAMA SALLAH-Pediatrics
Lamtoro Medical Centre, Kololi
4460934
9964418
DR. Dr Omar Jagne – Gen. Practice
Africmed Clinic, Kerr Serign
4465359
7739415
DR. MARIATOU JALLOW-Pediatrics
Ndeba-an Medical Centre, Sait Matty Road, Bakau
4496426
9921305
DR. TUMANI CORRAH-Internal Med.
Medical Research Centre Lab. Atlantic Road, Fajara
4495442
DR. OUSMAN NYAN-Internal Med.
Royal Victoria Teaching Hospital.
4228223/4
DR. TEJAN SENGHORE-Gen. Practice
The Medical Clinic. Banjul
4226941
DR. BABA MUSA NJIE-Gen. Practice
Momodou Musa Memorial Hospital. Serrekunda
4371683
9917830
DR. ALHASSAN NJIE-Gen. Practice
Momodou Musa Memorial Hospital. Serrekunda
4371683
9906280
DR. MALICK NJIE-Gen. Practice
NJAI&NJIE Medical & Dental Clinic. Cape Point, Bakau
4494888
7780045
Dr Musa Touray
Bijilo Medical Centre Bililo
4464868
9980371
Dr M O George
By Midway Centre - Kairaba Avenue
4375345
DR. AKAR-Dentistry/Oral Health
Kairaba Avenue
422588
DR. BABOUCARR NJAI-Dentistry/Oral Health
Old Cape Road Bakau
4494888
9931782
DR. SAYERR NJIE-Dentistry/Oral Health
Sangamar Dental Clinic Allen Street Banjul - Swedent Clinic Kotu
4461212
9924149
9934848
58
APPENDIX E: What the General Public Must Know About Influenza A H1N1
Introduction


In view of the fact that Influenza A H1N1 has been reported in a number of countries in other
regions, there is a possibility that it may soon spread to countries of the African Region.

The World Health Organisation Regional Office for Africa has compiled the information below
to facilitate the development, dissemination and use of key messages regarding Influenza A
H1N1 at country level.

This information should supplement other Regional Office documents that countries are using
to respond effectively to Influenza A H1N1.

The document is intended for use as a reference for all those involved in health promotion
relating to prevention and control of the disease.
What is Influenza A H1N1?

Influenza A H1N1 is a disease that is caused by a virus that affects the respiratory system.

The symptoms of Influenza A H1N1 are:








High fever
Cough or sore throat
Body aches
Headache, chills and fatigue
In some cases, vomiting and diarrhoea
Complications of the disease include pneumonia and difficulty in breathing.
How does Influenza A H1N1 spread?

Influenza viruses are mainly spread from one person to another through droplets released
during coughing or sneezing;

Sometimes people may become infected by touching surfaces or holding objects contaminated
with Influenza viruses (e.g., hands, door handles, handkerchiefs, tissue paper) and then
touching their own mouth, nose or eyes.
How is Influenza A H1N1 managed?

There is no vaccine available at the moment; however, studies are being conducted to produce
a vaccine;

By using antivirals (medicines used for managing infection with a virus), the illness can be
made milder and recovery faster. Oseltavimir (Tamiflu) is one of the effective medicines
currently being used;

Antivirals also prevent serious Influenza complications;

Antiviral medicines work better if started soon after getting sick (within two days of
appearance of symptoms);

Those treated with antivirals usually recover fully; so far, no resistance to the recommended
medicines for Influenza A H1N1 has been documented;

Health workers should make treatment decisions based on clinical and epidemiological
assessments. Particular attention should be paid to patients with complications.
59

If a person is in contact with or likely to be exposed to a sick person, how can he avoid
being infected?

Regular washing of hands with soap and water (or with an alcohol-based hand rub, if
available) is strongly recommended;

Keep a distance of at least two metres (six feet) from the infected person to avoid coming into
contact with the Influenza droplets;

If contact with a sick person or with potentially infected surfaces or objects occurs, those
involved must not touch their eyes, nose or mouth with unwashed hands;

Close contact with a sick person should be avoided; people are advised to refrain from
handshaking, kissing or hugging during an outbreak;

Those taking care of a sick person should use a face mask in accordance with guidelines
provided by national health authorities;

People should be physically active, drink plenty of fluids, eat well, reduce stress and have
enough sleep to boost their immunity.
What can infected individuals do to prevent spreading Influenza A H1N1 to others?


They should cover their mouth with a piece of cloth or tissue paper when sneezing or
coughing; the used tissue should be properly disposed of while the cloth should be washed
with soap, dried and replaced as often as required;

The infected person should wear a mask when in contact with others;

Tissue paper, cloth, a handkerchief or other material used by the sick person for wiping his
nose or mouth, must not be used by others;

If there is no tissue paper or cloth, the sick person should sneeze or cough into his elbow, and
not into his hands which can contaminate surfaces or things that may be touched or held;

Hands should be washed with soap and water especially after sneezing, or coughing, and
before touching door handles and other objects or surfaces so as to prevent contamination
with droplets;

Sick persons should stay at home and limit contact with others as much as possible.

People should seek treatment immediately if infection is suspected, if symptoms occur or
when advised by a health worker.
What should communities do to help prevent the spread of Influenza A H1N1?

Ensure community members know how to prevent the spread of Influenza , the symptoms of
the disease and what to do if infection occurs;

Ensure provision of care for those infected;

Support social distancing, isolation or quarantine when requested by a health worker (or as
determined by health authorities);

Establish contact with the nearest health facility that will provide support in managing the
disease;

Report suspected cases and deaths to a health worker or other relevant authority.
60
APPENDIX F: Use of Personal Protective Equipment Kit
If full personal protective equipment needs to be worn, please note the following
The order for putting on personal protective equipment is not important, however, for practicality, the
following sequence is given as an example:

When required, wear boots / or shoe covers with trousers tucked inside

Wear a mask (N95 or equivalent). This should be correctly fitted ensuring a good face seal
Mould the nose piece to the shape of your nose. Ensure there is a correct seal.





Wear
Wear
Wear
Wear
Wear
a gown
an impermeable apron if splashes of blood or body fluids are expected
a cap
protective eye wear / goggles (reusable, wash with water and detergent after every use)
gloves with gown sleeve cuff tucked into glove
Removing personal protective equipment
The key principle when removing personal protective equipment is that the wearer should avoid contact
with respiratory secretions and other contaminants. Mask should be kept on until all other PPE is removed.
Hands should be washed or decontaminated with 70% alcohol solution once all PPE has been removed.
The following is an example of how to remove personal protective equipment:

Remove gloves.

Remove gown/apron.

Remove goggles and cap.

Remove boots (if worn).

Remove mask. Do not touch face

Wash hands or decontaminate hands using 70% alcoholic hand-rub.
Full personal protective equipment using coverall instead of a surgical gown
(Reference: WHO. Practical Guidelines for Infection Control in Health Care Facilities, WHO, 2004.)
61
APPENDIX G: List of 6-week Supplies to be Stocked
1. Water
Stock bottled water or store water in plastic containers such as soft drink bottles
A normally active person needs to drink around two litres of water each day. Plan to store 4 litres of water
per person per day (2 litres for drinking and two litres for household use such as food preparation and
sanitation). Water requirements will also depend on other factors such as temperature, in hot climates an
individual’s water requirement may double and children, nursing mothers and those who are ill often require
additional supplies.
You should store enough water for at least a six-week period. Water purification kits or filters are readily
available and should be purchased as a back up.
2. Food
 Store a six-week supply of non-perishable foods, you may wish to consider if you can start a vegetable
garden and what you could grow yourself during the winter season, in order to supplement your
provisions.
 Select foods that require no refrigeration as electricity supplies may not be available. Consider how you
will cook the food, if you need to stock up on gas bottles, for example. As clean water may be limited,
choose foods that require little or no water to prepare. Foods that you may consider are:

Ready-to-eat canned meats and soups, fruits and vegetables

Dry goods such as noodles (remember that you will need to allow for enough water to
cook these items). Dry cereal, granola, dried fruits and crackers

Canned juices

Peanut butter or nuts

Staples (salt, sugar, pepper, spices, etc.)

High energy foods such as protein or fruit bars

Food for infants – canned or jarred baby food and formula

Comfort/stress foods

Pet food
 Other supplies such as soap and water or alcohol based hand wash

Buy extra garbage bags and cleaning supplies; viruses such as Avian Influenza are easily
cleaned away with formalin and iodine-based disinfectants. For bathing soap and water is
sufficient

Spare contact lenses

Denture and personal hygiene needs (tissues, toilet paper, disposable diapers)
 Other supplies (continued)







Hearing aid batteries
Fire extinguisher (make sure you all know how to use it)
A clock that runs off batteries (include spare batteries)
Flashlight
Extra batteries
Portable radio
Manual can opener
62
2.1 Food Storage Advice
 Keep food in the driest and coolest spot in the house – a dark area if possible. Make sure that it is
sealed off from possible vermin
 Keep food covered at all times
 Open food boxes or cans carefully so that you can close them tightly after each use.
 Wrap cookies and crackers in plastic bags, keep them in tight containers, this will stop them from going
stale and prolong shelf life
 Empty opened packages of sugar, dried fruits and nuts into screw-top jars or airtight cans to protect
them from pests
 Inspect all food containers for signs of spoilage before use
 If you lose power, minimize waste by using the food in your fridge first, then the freezer and then
finally your non-perishable items
2.2 Shelf Life of Foods for Storage
Here are some general guidelines for rotating common emergency foods.
2.2.1 Use within six months
Powdered milk (boxed), dried fruit (in metal container), dry, crisp crackers (in metal container), and
potatoes
2.2.2 Use within one year
Canned condensed meat and vegetable soups: canned fruits, fruit juices and vegetables; ready-to-eat
cereals and uncooked instant cereals (in metal containers); peanut butter, jams; hard candy, chocolate bars
and canned nuts
2.2.3 May be stored indefinitely (in proper containers and conditions)
Wheat: vegetable oils; corn; backing powder, soybeans, instant coffee, tea, vitamin C and cocoa, salt, noncarbonated soft drinks, white rice, bouillon products, dry pasta, powdered milk (in nitrogen-packed cans)
3. Fuels
 Purchase an emergency supply of petrol/diesel for your car
 Buy extra provisions of candles, paraffin lamps, batteries, etc. as electricity supplies may not be
available
 Consider how you will prepare foods and consider non-electrical alternatives
4. Disposal of Wastes
Remember that if there is movement restrictions imposed in an area, the collection of waste may not be
possible. It is important that you consider alternative arrangements such as composting food wastes, worm
farms, etc. If you live in a multiple storey building, ask the building manager if there are emergency plans in
place to deal with not only waste disposal but also possible disruption to water and electrical supplies
5. Medical Kits
Emergency services may be limited during a time of crisis, therefore make sure your home emergency
medical kit is not out-of-date, check all supplies for expiry dates and replace any items that are out-of-date
or nearing the expiration date.
63
You may wish to consider the following items:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Glucose and blood pressure monitoring kit
Adhesive bandages, various sizes
Sterile dressings, small and large
Conforming roller gauze bandage
Triangular bandages
Packs of sterile gauze pads, large and small
Adhesive tape, 2” width
Pairs of medical grade non-latex gloves, medium and large
Waterless alcohol-based hand sanitizer
Antiseptic wipes
Anti-bacterial ointment
Cold pack
Scissors (small, personal)
Tweezers
Thermometers – remember to have a spare
CPR breathing barrier, such as a face shield
Face masks, 3-ply simple surgical masks
Pain and fever reliever – remember to include both children and adult supplies
Anti-diarrhoea medication
Antacid (for stomach upset)
Vitamins
Fluids with electrolytes (an oral rehydration solution (ORS))
Stock up on prescription medications that you might need, for example, if one of your family members is
diabetic, ensure that you have enough supplies for at least 6 weeks, or if someone has a heart condition,
ask your doctor for an extra prescription so that you can have an emergency supply of all the medications
your family members need.
You may need extra bedding if a family member becomes sick, such as sheets, towels, plastic mattress
covers, etc. Consider where you could make up a sick bay which could be isolated from the rest of the
house, how would you ventilate this room? It is important that air from the room is expelled to the outside
of the house and not back into the house, consider how this might be done.
64
APPENDIX H: Standard Operating Procedures (SOPs) for the Department of
Veterinary Services for H5N1 and Influenza A H1N1 Response
Standard Operating Procedures
DISINFECTING FOR INFLUENZA A H1N1
In consultation with the National Environ Agency (NEA), the Department of Veterinary Services recommends
the use of only NEA approved chemical disinfectants, Virkon, for example.
Procedures for cleaning and disinfecting premises:
Personal Protective equipment should be worn at all times during cleaning and disinfecting.

WEAR a mask to prevent the inhalation of virus particles

WEAR eye glasses or goggles to prevent splashing of contaminated liquids in the eye

WEAR disposable boots or boots that can be disinfected, to prevent carrying the virus from the
affected farm

WEAR disposable overalls or clothing which can be destroyed or cleaned appropriately before
leaving the affected premises.
NB: - At all times, follow the instructions of the manufacture in using disinfectants and Personal Protective
Equipment (PPEs).
- Feed and Manure / litter should be burnt and (or) buried with lime.
Remove as much dirt and debris as possible before treating surfaces with the disinfectant. Dirt and debris
must be removed to allow for proper penetration of the disinfectant.
Spray each area long enough to allow the disinfectant maximum contact time with sprayed surfaces, etc.

All equipment associated with the Pig facility must be cleaned and disinfected or destroyed
o
o
o
o
o
o
Vehicles
Pork cages
Feeders
Wheelbarrows
Sacs/bags
Feed, manure, etc
None of the above-mentioned items should be removed from the quarantined / affected facility without
the proper authorization of the Director of the Department of Veterinary Services.
65
Standard Operating Procedures
QUARANTINE: INFLUENZA A H1N1
Provisions are made in the Diseases of Animal Act, 1948 to control the movement and marketing of animals
in the presence of a disease situation.
The Department of Veterinary Services should ensure that a farm or Pig house(s) under quarantine should
have:

Notices of quarantine should be posted at the gate(s) and on the fences, and easily read from
a distance of 15-25 meters.

a number of persons entering the quarantine area should be limited to the following:
 Essential farm labourers,
 Personnel from the veterinary services.
The following groups of people should not be allowed into the area:

Children, old and sick people

Pork vendors

Job seekers
NB: Pigs, litter, feed, and other disposable materials found on the farm should be burnt and or buried, and
should not leave the quarantined premises.

All persons leaving the quarantined area should clean and disinfect their shoes, clothing and
equipment.

Vehicles and all other forms of transport should be prohibited from entering the quarantined
farm.

All vehicles leaving the quarantined area should be disinfected with non corrosive disinfectants

Quarantine will be maintained until a written order is received from officials of the Department
of Veterinary Services.
66
THE REPUBLIC
OF THE GAMBIA
DEPARTMENT OF STATE FOR AGRICULTURE
NATIONAL AGRICULTURAL DEVELOPMENT AGENCY
DEPARTMENT OF VETERINARY SERVICES
Influenza A H1N1
QUARANTINE AREA
ENTRY PROHIBITED TO
PERSONS, ANIMALS VEHICLES AND MERCHANDISE
(Diseases of Animal Act, 1948)
67