ประสบการณ์ การ
ดาเนินงาน
Provincial
One Health
สพ.ญ. เสาวพักตร์ ฮิน้ จ้ อย
สานักระบาดวิทยา กรมควบคุมโรค
One Health:
Mission (IM) possible ! ?
Rational for using a multi-sectoral
approach
The outbreaks of SARS and HPAI sent an alarm to the world regarding
the pandemic threats that human beings are confronting
Thailand has developed a new 5-year National Strategic Plan for EIDs
Preparedness, Prevention and Control 2013-2016
The key emphasis is the importance of an interdisciplinary and multisectoral collaboration using the One Health approach
Improve EID preparedness and to strengthen the capacity of the key
government employees responsible for human, animal and wildlife health
Thailand’s National Strategic
Plan for Emerging Infectious
Disease Preparedness, Prevention
and Response 2013-2016
Training of Field Epidemiologists in Thailand
National
FETP
Advanced level
(MD/DVM)
Provincial
SRRT
(Public Health/Animal
Health/Environmental
Health/Laboratory)
Intermediate level
Community
Basic level
Public Health Volunteers/Animal Health
Volunteers/Wildlife Park Rangers/Zoo Keepers
Surveillance under “One Health” Concept
What was accomplished?
FEMT: Field Epidemiology and Management Training
SRRT: Surveillance and Rapid Response Team
DLD: Department of Livestock Development
FETP-V: Field Epidemiology Training Program for Veterinarians
In 2012;
In 2005;
In 2008;
Implementing a short-course training
FEMT to provide a six month inservice training for physicians and
public health professionals as part of
SRRT
The collaboration has been
developed with the DLD to expand
the program FETP-V, joint training
activities between the two
ministries and the collaboration
In 2014;
In 2015; Expanding
“One Health” to 14
provinces
Thai One Health
Coordinating is
officially
established
In 2013; Fostering
multi-sectoral
collaboration to
achieve the goal
of “One Health”
for humans,
animals and the
environment in
The 6th National
Health Assembly
(NHA)
Short-term multisectoral training in
applied
epidemiology and
field investigations
of EIDs.
In 2013;
A continuing support
to the existing
epidemiological “One
Health” teams in
those 5 provinces and
also expand into new
5 provinces
The multi-sectoral strategy used
1. Training Strategy and Process
Activity
Target
Training of Trainer
Advisors/Mentors
(1 Week)
Training of District/Provincial
Team (1 Week)
Field Project
(6 Months)
Seminar
(1 Week )
Teammembers
(Human/Livestock/Wildlife)
Field staff
All members
– Collaborative effort between the three ministries namely
Ministry of Public Health (MoPH), Ministry of Agriculture
and Cooperatives (MoA) and Ministry of Natural Resources
and Environment (MoNRE) and Thailand One Health
University Network (TOHUN)
– Training methodologies included classroom training
(lectures, presentations, exchanges, panel and group
discussions, scenario work and case studies), field visits and
observations, field work implementation, and after-action
reviews to share lessons learned from the field projects.
The multi-sectoral strategy used
2. Advocate the usefulness of “One Health”
collaborations and successful projects to
policymakers at local, national and
international levels
MOU for Strengthening Epidemiology in
Emerging Infectious Diseases Surveillance of
One Health Network
The multi-sectoral strategy used
3. Establish provincial “One Health” centers to serve as coordinating units and resources
centers
• Each model province proposed the proposal with a workplan
for setting up the provincial One Health Center as a main
outcome
• Thai One Health Coordinating unit in the central team is a
supporting unit as the provinces’ request on technical issues
and evaluate a successful project in each province
• Holding a workshop among stakeholders for sharing results
and experiences of setting up the Provincial One Health
Centers in each province
The multi-sectoral strategy used
4. Field Project Implementation
Each provincial team designed a 4-6 month field project to implement a multi-sectoral
collaborative activity that encompassed the One Health approach in their provinces
Example
The multi-sectoral strategy used
5. Building One Health community
• Recruit the members having common interest in One Health
• This community of practice is through the process of sharing
information and experiences with the group
http://www.thaionehealth.org/home
Exchange trip between two provincial one health teams for sharing
experiences of conducting One Health in their local contexts
Challenges had to be overcome
– Developing collective leadership
– Setting and implementing strong commitment among national and local collaborators
– Building trust and team spirit
Need to be fostering sustainability in One Health
communities
• Provincial OH Coordinating Center
• Official center 5 จังหวัด
• Informal center 9 จังหวัด
• One Health line group (N=111) เพือ่ แจ้ งข่ าว outbreak/ผลงาน
ดาเนินการ
• เกิดศูนย์ ประสานงานเครื อข่ ายสุขภาพหนึ่งเดียว
• การสอบสวนโรคร่ วมกัน ในกรณีกระทิงและเลียงผา (DNP+ZPO)
• การประชุมประสานความร่ วมมือโรคติดต่ อระหว่ างสั ตว์ และคน 4 กรม
• ความร่ วมมือในการเฝ้าระวังโรคในลิง ค้ างคาว Rodent Avian Reptile
Amphibian (โครงการโรคอบุ ัติใหม่ ) และการพัฒนาบุคลากร
• องค์ กรระหว่ างประเทศสนับสนุน provincial OH/ THOHUN
• มี MOU – MoPH/DLD/DNP/THOHUN/ZPO
•
•
•
•
•
•
•
•
•
•
ขาดกลไกการบริหารทรัพยากรร่ วมกัน
Rotation of personnel คนเปลีย่ น งานไม่ เดิน
ผ้ บู ริ หารคิดว่ างาน OH เป็ น overload ไม่ ส่งเสริมเจ้ าหน้ าที่
ยังไม่ มีประเมิน output/outcome ของการดาเนินงาน OH network
ขาด Leadership
ผ้ บู ริ หาร นโยบาย ยังไม่ ให้ ความสาคัญกับ OH มากพอ
ขาดการสนับสนุนด้ านงบประมาณในภาคส่ วน DNP
ยังไม่ มีการบูรณาการเครื อข่ ายการฝึ กอบรมระหว่ างภาคคนและสัตว์
ยังไม่ มี OH network ในระดับเขตทีเ่ ป็ นรูปธรรม
ขาดการ Risk assessment ของโรคที่สาคัญที่จะดาเนินการร่ วมกันในแต่
ละพืน้ ที่
Prioritization Process
PREPARATION
FACILITATED GROUP WORK
STEP 1
Prepare for Group Work
STEP 2
Develop the Criteria
STEP 3
Develop the Questions
Select 6-12 stakeholder
representatives to participate in
facilitated group work; generate a list
of all zoonoses to be ranked
Identify 5-8 criteria that will be used
to define the relative importance of
the zoonoses selected in Step 1
Develop one categorical question for
each criterion selected in Step 2
Qualitative Method
Group selection of criteria and questions relevant
to prioritization
FINAL PRIORITIZED LIST
STEP 4
Rank the Criteria
STEP 5
Rank the Zoonoses
Each representative individually ranks the criteria developed in Step 2.
Individual scores are combined to produce an overall ranked list of criteria
Score each zoonotic disease based on the
answers to the categorical questions for each
weighted criterion
Semi-Quantitative Method
Analytic Hierarchy Process used to rank
criteria
Quantitative Method
Decision tree analysis of each
zoonotic disease
Criteria for prioritization
Group 1
Group 2
Final
Severity in human
Severity in human
Severity in human
Ability to control
Human / animal transmission
Ability to control
Socio – Economic Impact
Socio – Economic impact
Socio-economic impact
Existing collaboration
Ability to collaboration
Transmission
Human – Human transmission
(pandemic potential)
Human – Human transmission
Biosafety Level
Ranking Criteria
1. Severity
2. Ability to control
3. Transmission
4. Pandemic potential
5. Economic impact
Endemic Zoonotic Diseases
Rank
1
2
3
4
4
4
7
7
9
9
Disease
Influenza viruses
Hepatitis B
Herpes B
Anthrax
Melioidosis
Tuberculosis
Chlamydiasis (C. psittaci)
Tularemia
Leptospirosis
Rabies
Severity
(weight=5)
a. <5
b. 5-19
c. >=20
c
c
c
c
c
c
c
c
c
c
Control -Tx/Vc
(weight=4)
a. Both
b. Human
c. Animals
d. None
a
b
d
a
a
a
a
b
a
a
Pandemic H-H
(weight=3)
a. No evidence
b. Close contact
c. Sustained
c
c
a
b
b
b
b
a
b
b
Transmission
(weight=2)
a. Food/ water
b. Close contact
c. Vector
d. Airborne
d
b
b
d
d
d
d
d
b
b
Economic
impact production
(weight=1)
a. None
b. Reduced
c. Death/
culling
c
b
a
c
c
c
a
a
c
c
Score
Morbidity
2013
(per 100k)
0.827
0.804
0.781
0.758
0.758
0.758
0.712
0.712
0.689
0.689
68
13.95
.
.
4.39
.
.
.
4.8
0.01
Challenges

Validity of disease information

Morbidity and mortality information

Policy
One Health
for Network,
Network for
action 2014