Meeting Documents - Mekong Basin Disease Surveillance

SUMMARY REPORT OF
CROSS BORDER COLLABORATION PROJECT
2004 -2007 EXECUTIVE SUMMARY
The MOU among MBDS Health Ministers were put into practice about cross
border collaboration between MBDS Counties, the Cross Border Project has
been formulated and approved for funding by the Rockefeller Foundation for
3 years with the total amount of 630,000US$ for 5 countries (Yunan
Province, China, Cambodia, Laos, Thailand and Vietnam), starting from May
2004 -2006 and extended to the end of 2007.
The Goal of this project is to reduce morbidity and mortality from
communicable diseases amongst the marginalized people living in the Mekong
region by developing and integrated approach to disease surveillance and
response across borders. The MBDS not only helps improve health outcomes and empower health
workers in the Mekong Region; it also provides a neutral mechanism for
information-exchange and collaboration between countries that do not
traditionally share information freely or work together easily. | | | | | |
|Partners | |Activities | |Priority Diseases |
| | | | | |
|Kingdom of Cambodia | |Regular, cross-border | |Avian Flu |
|Yunnan province, | |information exchange | |Cholera |
|People's Republic of| |Joint outbreak | |DF/DHF/DSS |
|China | |investigation and response | |Dysentery |
|Lao PDR | | | |Emerging Infectious Diseases |
|The Union of Myanmar| |Training of health | | |
| | |personnel | |HIV/AIDS |
|The Socialist | |Development and | |Malaria |
|Republic of Vietnam | |implementation of protocols| |Measles |
| | | | |Pneumonia |
|The Kingdom of | |Disaster preparedness and | |SARS |
|Thailand | |response table-top | |Tuberculosis |
| | |exercises | |Typhoid fever |
| | | | | |
KEY TECHNOLOGY MBDS Net is an open-source web-based application that serves as a data
integration hub for the various surveillance systems used by the six
participating MBDS countries. The website was developed after the
designated MBDS project coordinator and consultants traveled to each member
country to review and collect information on the surveillance systems to
ensure compatibility. Data managers from each country submit surveillance data to their
respective MBDS coordinator, who then collates the information within the
regional database, making it available to other MBDS members. Each of the
six participating countries has one information officer who is responsible
for collecting, posting, and translating surveillance information.
Currently, all data is posted in English. The next phase of work on the
system will explore language translation software.
ACTIVITIES MBDS countries have piloted an integrated approach to disease surveillance
and response across borders through the following activities: Regular, Cross-Border Information Exchange
Data from routine surveillance on priority diseases in each site are
exchanged via e-mail or fax to national coordinators and the adjacent
province's site coordinator using standard forms.[1] Reports of suspected
outbreaks are also conveyed informally by phone. Information exchanges are
carried out daily, weekly, monthly, and/or quarterly (depending on the
disease) across border provinces. While country and site coordinators
closely monitor these exchanges, the timely and relevant flow of
information between surrounding, communities cross-border sites, district
and provincial levels remain a challenge. The details of diseases exchanged
are illustrated by Table 1 of the Appendix. Joint Outbreak Investigation & Response
After the establishment of cross-border teams made up of health,
customs, immigration, and border officials in 2006, three activities took
place: 1. Joint dengue fever investigation between the Lao and Thai provincial
sites, enabling officials to effectively stamp out the cross-border
outbreak.
2. Joint typhoid investigation between the Lao and Vietnam provincial
sites.
3. Joint avian influenza investigation of cases in humans, triggered by
the discovery of an infected Lao citizen in Thailand. Within less than
24 hours of the initial report from the MBDS Coordinator in Thailand to
his counterpart in Laos, a team was dispatched from Thailand to Laos to
support the Lao investigation.
Development and Implementation of Protocols
Regular meetings are held between the adjacent border teams to discuss
standards for common forms. Training of Healthcare Personnel
The joint Thai-U.S. CDC Field Epidemiology Program, Mahidol University
and SEAMEO-Trop Med programs coordinate annual training for MBDS
participants.[2] Participants are selected from central surveillance
offices, border provinces, and other peripheral areas essential to a
coordinated regional response. As a result of these efforts, participants
have enhanced their skills in research, outbreak investigation, and
communication, as well as established friendships and mutual trust with
officers from adjacent provinces across borders. (PEOPLE AND COMMUNITIES The MBDS served the region both by empowering health workers and
preventing the spread of disease throughout the general population.
| | | |
|Health Workers | |People Served |
| | | |
|Each implementation site is | |The sharing of information covers |
|composed of a border health team of| |diseases of the Greater Mekong |
|between 5 to-7 public health | |Sub-region, comprising a population |
|workers, border control and | |of 254 million people. |
|immigration officers, and community| |The cross-border project focuses on |
|members. | |strategic border crossing areas |
| | |along major emerging transport |
| | |corridors. | The MBDS sub-regional network demonstrates and supports mechanisms for
multi-country collaboration and response at two levels: sub-regional, and
provincial/cross-border. Four demonstration sites comprise cross-border
collaboration, with Laos at the geographic center of the region (Table 2 in
Appendix). While neither Thailand and Vietnam nor Cambodia and China share
common borders, they do share information, strategies and experiences
through the MBDS national-level coordination mechanisms. IMPACT & ACHIEVEMENTS The MBDS Network has given birth to new relationships that have
influenced the way health officials in the region interact with each other
and how much information they share. Additionally, the policy impact of the
MBDS in terms of strengthening country-to-country ties and transparency is
evident by the increase in the collaborative nature of each new disease
detection and response activity and the willingness of each Ministry of
Health to help their counterparts build capacity through training. A Policy Framework for Cross-Border Cooperation
During the 2003 SARS outbreak the MDBS communications infrastructure
and relationships between technical officers in each country's Ministry of
Health proved essential to the sub-region's coordinated response. The 2001
MBDS Memorandum of Understanding also served as a model for a subsequent
collaborative agreement of ASEAN+3. Additionally, the Thai Ministry of
Public Health hosted an MBDS-facilitated meeting of ASEAN+3 to jointly
develop a training plan for disease surveillance. A Proven Model for Collaboration, Growing in Strength and Capacity
The Asian Development Bank has since committed $30 million to
strengthen surveillance systems in Vietnam, Lao PDR and Cambodia. The MBDS
has also facilitated broad regional discussions with regional and
international bodies, such as WHO, ASEAN, and PACNET. Examples include: . The MBDS Network helped establish a working relationship between WHO-
SEARO and WPRO in Asia.
. The MBDS Network demonstrates systems that facilitate compliance with
International Health Regulations through development and testing of
guidelines and protocols with multiple sectors at border sites,
including customs, immigration, transport, interior and communities.
. Participating countries' Ministries of Health have allowed bilateral
and multilateral investigations of disease outbreaks through MBDS.
Efforts now focus on strengthening pandemic preparedness, with the
regional simulation exercises that took place in Cambodia in March 2007
(described in the next section of this case study).
DISASTER PREPAREDNESS & RESPONSE: TABLE-TOP EXERCISES The MBDS has held in-country exercises for over 6 years; however, in
March 2007 participating countries joined forces to test their preparedness