National Strategic Plan For Avian Influenza Control And Pandemic Influenza Preparedness 2006-2008

Objectives

Provide Indonesia’s 2006-2008 national framework for controlling avian influenza at its animal source, preventing animal-to-human transmission, and preparing for a possible human influenza pandemic through integrated animal and human health action.[1][2][3]The strategy seeks to protect lives, reduce illness and deaths, safeguard farmers, poultry businesses and food security, and limit wider social and economic disruption.[4][5][6]

• Maintain avian-influenza-free areas and control infection in affected areas.[7][8]
• Eliminate avian influenza from poultry-industry sectors 1 and 2, reduce cases in sectors 3 and 4, and prevent spread to other domesticated animals by the end of 2008.[7][9][8]
• Prevent animal-to-human transmission and achieve preparedness for a human influenza pandemic by the end of 2008.[7]
• Control highly pathogenic avian influenza in animals through disease control, biosecurity, quarantine, tracing, vaccination and poultry-industry restructuring.[9][10]
• Manage human cases, protect high-risk groups, strengthen health-service readiness, and improve diagnosis, referral, treatment and infection prevention.[9][11]
• Establish integrated surveillance of animals and humans, early warning, disease mapping, virus-mutation monitoring and pandemic surveillance.[10]
• Strengthen legislation, veterinary and quarantine services, laboratories, hospitals, research, communication, public awareness and community participation.[12][13]
• Develop domestic antiviral medicine and vaccine stockpiling or production capacity, including use of Indonesian virus seed material.[6][11]
• Apply guiding principles that prioritise human safety, consider economic impacts, integrate government, private-sector, community, professional and international contributions, and comply with national and international standards.[2]

Implementation

Implement the strategy as an integrated, multi-level animal and human health programme, with local government heads responsible for making systems functional in their autonomous areas and the Departments of Agriculture and Health holding technical responsibility for management and implementation.[14][3]National coordination is led by a National Committee on Avian Influenza Control reporting directly to the President, while a separate pandemic-control task force or committee is activated if the World Health Organization pandemic Phase 6 is reached.[15]

• Coordinate action across the Department of Health, Department of Agriculture, State Ministry for National Development Planning, local governments, communities, farms, poultry businesses, healthcare providers, professional bodies, private-sector organisations and international technical partners.[1][2]
• Use local governments as principal delivery actors under decentralisation, supported by cooperation across government levels and wider societal participation.[2][15][3]
• Operate a command chain for emergencies, including arrangements from the President to governors and district heads or mayors, and local command at governor and district-head level.[15]
• Apply a graduated contingency response according to whether Indonesia is unaffected or affected and whether the event is at village or kelurahan, sub-district, district or national scale.[11][14]
• Investigate extraordinary events, declare outbreaks or epidemics where appropriate, apply outbreak legislation, and mobilise central funds, reserve personnel and volunteers for larger events as authorised.[14]
• Control newly infected animal areas through stamping out, and use disease zoning to classify areas as free, threatened or infected.[8]
• Deliver human case management through antiviral medicines, referral systems, equipped hospitals, standard operating procedures and trained healthcare workers.[9]
• Establish surveillance through clinical, sentinel-hospital, laboratory-based, community-based, rumour-verification and animal-influenza systems, supplemented by epidemiological and virological studies.[16]
• Strengthen laboratories, including a Biosecurity Level 3 laboratory for animals and humans, regional and reference laboratories, veterinary laboratory accreditation, research facilities and quarantine services.[13]
• Recruit and train veterinary field workers, veterinarians, quarantine personnel, researchers, health workers and community health centres for surveillance, communication, case finding and referral.[13]
• Engage communities through risk communication, counselling, training, farmer organisations, community surveillance networks, advocacy and print and electronic media.[10][12][11]
• Use the World Health Organization six-phase pandemic framework and develop local, national, regional and international networks for control and preparedness.[2][7]
• Monitor implementation through an avian influenza protection monitoring and evaluation plan, with monthly, quarterly, biannual and annual reports, coordination and feedback to improve performance.[13][6]
• Track operational milestones including detection of human cases within three days through nine regional laboratories and one national reference laboratory, integrated human and animal surveillance by the end of 2006, pandemic surveillance by the end of 2007, and adequate surveillance resources by the end of 2008.[9][10]
• Mobilise domestic and international resources for surveillance, laboratories, hospitals, trained personnel, medicines, vaccines, equipment, logistics, communications and production capability; no quantified overall budget or financing allocation is specified.[6][16]

Monitoring & Evaluation

Monitoring and evaluation form a dedicated component of the avian influenza strategy, combining animal and human epidemiological surveillance, early warning, disease detection, response management and feedback to improve implementation.[7][9][10][13]The pandemic preparedness component extends this approach through community, clinical, hospital, laboratory, sentinel, rumour-verification and animal surveillance.[16]

• Establish integrated human and animal surveillance by the end of 2006, develop pandemic surveillance by the end of 2007, and ensure sufficient surveillance resources by the end of 2008.[10]
• Detect human cases within three days through nine regional laboratories and one national reference laboratory.[9]
• Use early-warning systems, disease zoning, vaccination monitoring, reservoir surveillance, molecular epidemiology, vaccine-effectiveness assessment, disease mapping, virus-mutation data and integrated animal-health information systems to guide control.[10]
• Conduct continuous epidemiological analysis by collecting, processing and disseminating information to health providers for effective and efficient control action.[8]
• Monitor poultry, poultry products and human traffic, community signals, antiviral resistance, contacts and outbreak events to support early detection, investigation and response.[16][11][14]
• Track outcomes including maintenance of avian-influenza-free areas, control in infected areas, elimination from poultry sectors 1 and 2, reduced infection in sectors 3 and 4, prevention of transmission to other domesticated animals, prevention of animal-to-human transmission and pandemic preparedness by 2008.[7][9][8]

A formal avian influenza protection monitoring and evaluation plan provides for regular monthly, quarterly, biannual and annual reports, coordination and functional feedback on progress, impact and implementation problems.[13][6]Monitoring and evaluation also cover development of avian influenza control and implementation of the national contingency plan.[6][16]

• Coordinate preparedness monitoring and contingency-plan implementation through the National Human Pandemic Influenza Committee and Command Post.[16]
• Use surveillance networks, laboratories, hospitals, veterinary services, community health centres and Regional Veterinary Disease Investigation Centres to support detection, reporting, referral and response.[12][13][17]
• Assign implementation responsibility to local government heads, with national committees, command arrangements and technical cooperation supporting coordination across government and society.[15][3]
• Analyse the epidemiological situation continuously and adapt action to changing circumstances and outbreak scale.[14]

The available text does not provide a complete indicator framework, detailed indicator definitions, reporting templates, audit arrangements, evaluation methodology or formal accountability sanctions.[2][7][6][16]It identifies institutional responsibilities and outbreak-response authorities, but does not specify a consolidated accountability mechanism beyond these arrangements.[11][14][15][3]

Costing & Financing

Financing is framed principally as resource mobilisation for integrated avian influenza control and human pandemic influenza preparedness, rather than through a quantified budget or expenditure framework.[16][14]Economic considerations include avoiding social and economic losses from poultry destruction, illness and deaths, protecting farmers and poultry businesses, and considering socio-economic impacts alongside limited available resources.[1][4][2]

• Mobilise domestic and international resources for surveillance, laboratory services, reference hospitals, trained personnel, medicines, vaccines, medical equipment, logistics, communication systems, scientific capacity and production capability.[6][16]
• Mobilise central government funds and forces for district-level outbreaks and national funds, resources, reserve forces and volunteers for a national-scale epidemic when authorised.[14]
• Strengthen resource availability for surveillance at all levels, including personnel, facilities, infrastructure and funds, by the end of 2008.[10]
• Address inadequate funding, technology, facilities and human resources, as well as limited compensation for farmers subject to selective or total poultry depopulation.[5]
• Support resource-intensive measures including laboratory and hospital expansion, Biosecurity Level 3 laboratory capacity, quarantine services, animal-health posts, recruitment, training, accreditation and action research.[12][13]

The poultry sector is described as having estimated investment of US$3-3.5 billion in 2004 and annual business cash flow of US$30 million.[4]No total public budget, costed implementation plan, funding allocation, financing share, compensation rate, unit cost, funding-gap estimate or monetary economic assumption is specified in the supplied text.[9][10][6][16][14]