Mongolia: Better Prepared for Avian and Human Influenza

The Avian and Human Influenza Control, Preparedness and Response Project strengthened the capacity of Mongolia’s emergency agencies, hospitals and veterinary services to detect and respond to potential outbreaks of infectious diseases, such as an avian and human pandemic influenza (AHI). The project helped set up 22 joint response teams, integrating these organizations across the country. For the first time, the concept of “One Health” --an initiative to forge collaboration between physicians, veterinarians and other scientific and health-related disciplines-- was put into practice in the country.

Challenge

Mongolia is a land-locked country bordered by China and the Russian Federation. Both countries have reported outbreaks of highly pathogenic avian influenza that could be transmitted to humans. Mongolia became vulnerable to this serious disease.

Mongolia also plays a unique role in the global response to avian influenza. Every year millions of birds migrate through Mongolia between their Arctic breeding ground and the wintering ground in the south. Monitoring those birds is an essential task for Mongolia.

In response to the threat posed by the disease, the Government of Mongolia prepared a three-year National Strategy and Action Plan for Avian and Human Pandemic Influenza and requested that the World Bank evaluate the strategy. The Bank’s assessment of this plan in 2007 noted the country’s progress in disease preparedness, but also pointed out the existing gaps, such as lack of technical and financial resources and low personnel capacity in Mongolia to fight diseases.

Solution

The project focused on strengthening the capacity of key agencies involved in the Avian and Human Influenza preparedness and response: the National Emergency Management Agency, the Department of Veterinary Services of the Ministry of Food, the Agriculture and Light Industry of the Ministry of Health, and their counterparts at the aimag (province) level. The project aimed to raise awareness among senior policy makers and officials, review and improve the existing policy and regulatory framework related to the disease, improve the existing command and control structures with international best practices, and develop standard operational procedures.

The project also helped establish computer-based early warning and surveillance systems across the country, equipped response teams in different sectors with better technical skills, and upgraded infection control and intensive care facilities in provincial hospitals that could be most exposed to such diseases.

" Before, we used to screen and treat our patients using only a stethoscope. Today the in-patient department in my hospital has eight different types of modern medical diagnostic equipments. "

Ms. Myagmar

a doctor at the Darkhan Uul Central Health Center

Results

From 2008 to 2011, with the project support, emergency agencies in Mongolia organized 16 trainings and exercises to improve their capabilities in coordinating and managing hospitals and veterinary clinics during an outbreak of influenza and other infectious diseases.
The project helped train 125 call center attendants that work at emergency agencies from 21 aimags to improve their communications skills.
The project helped set up 22 joint response teams (including health, agriculture, emergency management, professional inspection) across the country.
Three provincial veterinary laboratories were accredited by the government for avian influenza outbreak detection.
A number of national policies and strategies were developed or revised. The project also helped develop working tools and technical guidelines, including:
1. Incidence Response Information System (IRIS);
2. Standard Operating Protocols for rapid response, command and control, surge capacity;
3. Guidelines for exercise and drills, guidelines for hospital infection control; and
4. Risk communication plan for influenza.
Significant progress was made in the scale and speed with which test results are processed. This response time has enabled authorities to treat animals and human patients faster and more effectively:
1. All poultry mortality events are investigated now, whereas only 75 percent of the events were investigated before.
2. The average number of days between taking a suspected influenza specimen in the field and arrival at reference labs has been reduced to 1-1.4 days from almost 3 days before.
3. The average number of days between receipt of biological specimen in lab and lab sending the testing results to the requestor has been reduced to 1 day from 7-8 days before.
4. Now it only takes 4-5 days from the start of an AHI investigation to completion of filing in the national information system, compared to a month previously.

Bank Group Contribution

The project was financed by a grant of US$ 4.7 million from the Avian and Human Influenza Facility (AHIF), a trust fund administered by the World Bank and currently supported by 10 donor agencies led by the European Commission.

Partners

A number of international organizations such as the World Health Organization (WHO), the Food and Agriculture Organization (FAO) of the United Nations, the Wildlife Conservation Society, the United Nations Children's Fund (UNICEF) and the United Nations Development Programme (UNDP) provided technical assistance to the project, or supervised the project implementation.

Moving Forward

The project outcomes are highly sustainable since the One Health Approach is now set firmly in place in the country. Capacity to respond to other emerging infectious disease has been also improved and further improvement can be expected.

Beneficiaries

Ms. Myagmar is a doctor at the Darkhan Uul Central Health Center. “Before, we used to screen and treat our patients using only a stethoscope. Today the in-patient department in my hospital has eight different types of modern medical diagnostic equipments,” she said.

Joint response teams set up across the country to provide health, agriculture, emergency management, and professional inspection services.

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