4.1 Outbreak management committee | Guías de práctica clínica MSF

Contenido

An outbreak management committee must be formed at the national, regional and district levels. This committee is charged with “managing” the outbreak, that is, ensuring that resources are appropriate to needs.

The committee meets on a regular basis: daily at the start of the outbreak, and then weekly until the operation is over. The meetings are short and have clear agendas.

The minutes are distributed to managers at the various levels and to the partners. Feedback can also be given via a weekly report relaying the essential information.

4.1.1 Composition of the committee

At each level, the committee is composed of representatives from:

the Ministry of Health (including representatives from the national immunisation programme);
the laboratories;
the hospitals;
the administrative authorities;
the support agencies (WHO, UNICEF, bilateral cooperation) and non-governmental agencies involved.

Outbreak response requires close coordination with other sectors, which participate in the committees according to the needs. These sectors are:

information (radio, newspapers and television): the media disseminates information on the existence of an outbreak, the symptoms of the disease, treatment locations, free care, and vaccination dates/locations;
education: schools can host vaccination sites; teachers can help make up vaccination cards and keep a tally of those vaccinated ;
customs: it can facilitate the importation of drugs, medical supplies and vaccines ;
public safety: the police can help maintain order during mass vaccination campaigns.

4.1.2 The committee’s role

The Terms of Reference (responsibilities and decision-making level) are drawn up on a case-by-case basis.

The major strategic directions are generally decided at the national level. The other levels (regional and district) are involved in the warning system and in implementing the response. Subcommittees can be charged with specific technical aspects such as laboratory, vaccination, information and communication, logistics, etc.

Defining strategies

The committee defines the surveillance, patient management, vaccination and public information strategies (Table 4.1). It implements activities by mobilising the necessary resources and coordinating and informing the partners.

Table 4.1: Objectives and key steps in defining strategies

	Objectives	Key steps
Epidemiological surveillance	To provide weekly data for decision-making. To define priorities.	Reach a consensus on a standard case definition. Strengthen or establish a simple, regular and reliable data collection system. Define patient management and vaccination priorities. Get feedback from staff and partners.
Patient management	To shorten the time between the first signs of the disease and treatment. To reduce the CFR and sequelae. To make treatment available at all times and at all levels.	Create and distribute treatment protocols (hospital and peripheral centres). Assess needs in terms of: specific treatments; inpatient capacity (beds, staff and means); nutrition care. Define the drug supply strategy: determine the composition of the kits; centralise kit preparation; organise the distribution (timetable and priorities). Set up a monitoring system for quantities distributed and drug availability.
Vaccination	To quickly protect the at-risk population. To limit the spread of the outbreak.	Decide whether or not to conduct a mass vaccination campaign. If yes, define: WHO: define the target population; WHERE: identify the places to bevaccinated and prioritize them; HOW: approach and planning; WHEN: revise the vaccination schedule as a function of the weekly epidemiological data.
Public information	To provide the public clear, practical information on the outbreak, patient care and vaccination.	Determine: WHICH messages; TO WHOM they are addressed; HOW to transmit them.

Arranging for free care

The committee decides what will be free of charge to the public and identifies who will pay the costs for the different components of patient care:

outpatient visits;
hospitalisation;
medications provided specifically for measles and its complications;
other treatments (e.g., for malaria);
laboratory tests done as part of measles surveillance;
transfer of severe cases.

Estimating the budget

The committee draws up budget forecasts, taking into account the following costs:

personnel: salary, per diem and training;
drugs and medical supplies;
vaccination: vaccines, cold chain, injection supplies, kits and modules;
international and domestic shipping;
staff transportation: vehicle rentals, fuel, travel, etc.;
logistics equipment: ropes, stakes, tents, megaphones, etc.;
administrative supplies: vaccination cards, date stamps, tally sheets, training documents, etc.;
information and social mobilisation;
communications equipment (telephone and card, radio, etc.).

The cost of vaccinating one person in a mass vaccination campaign will vary depending on the context and the means deployed. In 2011, it was estimated to be between €1.4 and €2 per person vaccinated.

Evaluating the response

Evaluation is an essential component of any operation. It should be planned and prepared before the response begins. The aim is to improve operations by formulating recommendations with regard to what was done in practice.

As soon as the operation begins:

Define the objectives.
Define the evaluation indicators.
List the information that will be needed.
Set up data collection (e.g., stock cards, donation forms, patient registers, epidemiological forms, etc.).
Define the methodology.
Identify and train the people who will be in charge.
Train and supervise the evaluators.