Plenary three: Aligning

WHO collaborating centres' work to country needs

Dr Takeshi Kasai, Director of Programme Management,

WHO Regional Office for the Western Pacific

2009 2011 2012

2014

Part of regional WHO reforms since 2009

WHO (global) reform

Plenary three: Aligning

WHO collaborating centres' work to country needs

Viet Nam

Dr Lokky Wai, WHO Representative in Viet Nam

Introduction • What are the functions of the Institute of Tropical Medicine (ITM),

Nagasaki University as a WHO CC? (TORs)

1. To support surveillance and response activities by conducting epidemiological and virological studies of tropical and emerging viruses, including those that are vector-borne.

2. To evaluate and compare (rapid) diagnostics tests for the detection of tropical and emerging viruses and provide technical support with ensuring quality of diagnostics testing to WHO Member States.

3. To build capacity for laboratory diagnosis of tropical and emerging viruses, including organization of trainings and filed support activities.

• How does ITM-Nagasaki Univ as a WHO CC work with WHO country office and Regional Office?

WHO/WPRO ⇔ ITM-Nagasaki Univ. WHO/Vietnam ⇔ Station of Nagasaki Univ. at NIHE

J-GRID Program supported by the Government of Japan (2015-Present）

Major infectious diseases in Vietnam

degree of risk: very high • food or waterborne diseases: bacterial diarrhea,

hepatitis A, and typhoid fever • vectorborne diseases: dengue fever, malaria, and

Japanese encephalitis (2016) https://www.cia.gov/library/publications/the-world-factbook/fields/2193.html

External Quality Assurance Collaboration with the Regional Office

• Second informal consultation on the Regional Action Plan for dengue prevention and control , 1 and 2 Dec 2015

• First round of external quality assessment of dengue diagnosis in the WHO Western Pacific Region, 2013

Diagnosis of strange diseases and ad hoc trainings Collaboration with the WHO Country Office (Vietnam)

• Collaborative surveillance (WHO-CC, WHO/Vietnam and NIHE)

Severe skin disease emerged in Quang Ngai Province in Vienam in 2011. (More than 200 cases with more than 20 deaths)

Confirmation of the Zika virus infection in Southern Vietnam in 2016

Capacity-building for laboratory testing • Zika, MERS, Ebola, other emerging infectious diseases

Ad hoc trainings for Zika laboratory diagnosis

Collaboration with the WHO Country Office (Vietnam)

Aug. 2016.

First case of Zika virus related-microcephaly was identified in Highland in October, 2016.

Conclusions • Identify needs of collaboration in each

relevant country, • Maintain routine communication with the RO

and relevant WHO country office(s), • Enhance circulation of human resources

between WHO and WHO-CCs including internship of graduate students. (A long term issue)

WHO CC Forum: Plenary Session 3 Aligning WHO Collaborating Centres' work to country needs

Viet Nam and Nagasaki University: Working together on emerging virus diseases

as part of the regional approach

Frank Konings Division of Health Security and Emergencies

Emerging Disease Surveillance and Response Unit

Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III) as regional action framework

• Generic system for preparedness, alert and response

• Stepwise approach to capacity development

• Connecting surveillance and response systems

• Value of learning from real-world events for continuing improvement

• Investment in preparedness

Features of laboratory strengthening under APSED

• Connecting laboratories at sub-national, national and international levels

• Building generic capacities to deal with multiple emerging infectious diseases (EIDs)

• Taking a step-wise approach and upgrading when the time is right • Using existing systems to build capacity for EIDs, for example:

– Laboratory quality program for EIDs, including dengue, established based on influenza system;

– Flexibility to adapt the system to new threats such as H7N9, MERS-CoV and Zika virus.

• Maintaining and strengthening test capacity and referral mechanisms for emerging infectious diseases in Asia-Pacific

• New technologies for detection and characterization • Focus on functionality

External Quality Assessment under APSED: Existing systems and Step-by-step

Influenza 2007, Global

Dengue 2013, WPR

Dengue + Chikungunya

2015, SEAR + WPR

Dengue + Chikungunya + Zika

2016, Global (ongoing)

EQA Technical working group, 1st meeting, June 2012 Tokyo, Japan

Good practices

• Being on-site to provide technical support • Establishing and strengthening relationships

between countries, other CCs and WHO • CC involvement in development and

implementation of regional strategies, plans and activities

• Regular meetings of CCs and countries to coordinate efforts

Thank you

Dr Corinne Capuano Director, Pacific Technical Support

WHO Representative in the South Pacific

Pacific Technical Support

• 21 Countries and Areas

• Serving 2 million people

Health Priorities in the Pacific • A triple burden

– Noncommunicable diseases – Communicable diseases – Health impacts of climate change

25

Source: WHO, The first 20 years of the journey towards the vision of Healthy Islands in the Pacific, 2015

The vision of Healthy Islands • 1995 Yanuca Island declaration

– Children are nurtured in body and mind – Environments invite learning and leisure – People work and age with dignity – Ecological balance is a source of pride – The ocean which sustains us is protected.

• 2015 reaffirmed commitment, with four recommendations – Strengthening leadership, governance and

accountability – Nurturing children in body and mind – Reducing avoidable disease burden and

premature deaths; and – Promoting ecological balance

26

How can WHO CCs get involved • The Pacific context is unique

– It is important to come with an appreciation of the different histories, cultures and contexts of the islands we serve

• The Regional Office is the central point for coordination – Our colleagues in Manila can refer WHO collaborating centres to us – We can work with our country offices in the Pacific to determine the best

fit for WHO collaborating centres

• E.g. the Pacific Paramedical Training Centre (PTTC) – Has supported our work for many years – With good understanding to the Pacific context – The training they provide through the Pacific Open Learning Health Net

(POLHN) lets health workers improve their skills without leaving their communities

27

THANK YOU!

Phil Wakem, Chief Executive Officer Navin Karan, Programme Manager Wellington New Zealand

Diploma in Medical Laboratory Science

in the Pacific

WHO Collaborating Centre for

External Quality Assessment in Health Laboratory Services.

Teaching and training is provided in one of five ways: 1. Short term training courses of four weeks duration in selected

disciplines for laboratory staff at its Centre in Wellington, New Zealand.

2. Short-term training attachments to appropriate New Zealand medical laboratories where training in a specific medical laboratory discipline and the acquisition of a specific skill set is required.

3. The PPTC External Quality Assessment Programme.

4. PPTC in - country teaching and training with on- site workshops.

5. The PPTC Diploma in Medical Laboratory Science offered through distance learning. (POLHN).

TEACHING AND TRAINING FOR PACIFIC COUNTRIES

PROGRESS AND ACHIEVEMENTS

Development, review, and continuous improvement of training modules. 2011 A separate module was introduced as a foundational platform to provide

students with an understanding of the fundamental principles of the biological, chemical and physical sciences from which the medical laboratory sciences have evolved.

Technical work books were introduced as a means towards the extension of

practical skills and a measure of practical competence. Delivery of this revised teaching programme re - commenced as a two year

study programme. 2013 Examination based assessments (parts 1 and 2) were introduced to increase

the credibility and accountability of this Diploma programme. In response to the recent adoption of the WHO Asia-Pacific Strategy for

Strengthening Health Laboratories , the addition of a Laboratory Quality Management Systems [LQMS] module was introduced, and considered an essential component of the PPTC Diploma in Medical Laboratory Science. This increased the total number of modules to 6 from the initial 5.

PROGRESS AND ACHIEVEMENTS cont Ministries of Health within selected Pacific Island countries recognize the

Diploma to be an essential qualification for all medical laboratory technicians. The Diploma delivered through POLHN is available to students in the Pacific

Region at no cost.

The NZAID Overseas Development Programme is currently funding 32 students this year which is the final year of the 2015-2016 cycle.

32 students will also be funded in each of two separate cycles (64 in total) that are to follow until 2020.

In the 2015–2016 cycle, 39 laboratory technicians representing the countries ,

American Samoa, Fiji, Kiribati, Marshall Islands, the Federated States of Micronesia, Samoa, Papua New Guinea and Tonga are currently enrolled.

SELECTION CRITERIA AND PROGRAM REGULATIONS

Implementing the right selection criteria and minimum requirements to ensure that participants:

(i) benefit from their training, (ii) are able to apply the knowledge gained. (iii) act as agents for change for other students.

Participants must:

be working in a diagnostic routine medical laboratory. have at least 12 months experience prior to enrolment in the programme. be on rotation through the appropriate laboratory sections. complete all six modules, log books and examinations within the 2 year cycle for

the award. Regulations: Grounds for disqualification.

Failure to participate once registered, offering no valid explanation. Failure to pass end of year examinations. Inappropriate behaviour during the academic year or during examinations.

Applicant liable for cost of a individual module before sponsorship is given for future study, if has been study started and NOT completed, with no valid explanation for this noncompliance,

CURRENT DIPLOMA PROGRAMME 2 year Diploma course (each module 12 – 14 weeks in duration) 1. Laboratory Technology 2. Biochemistry + Practical Workbook 3. Haematology + Practical Workbook Part 1 Examination 4. Microbiology + Practical Workbook 5. Transfusion Science + Practical Workbook 6. Laboratory Quality Management Part 2 Examination

Year 1: Mar - Dec

Year 2: Mar - Dec

DIPLOMA GRADUATES SINCE 2006

76 Graduates in total from: 3 - Fiji 19 - Tonga 5 - Palau 7 - Kiribati 13 - Federated States of Micronesia 1 - Marshall Islands 1 - American Samoa 11 - Samoa 2 - Tuvalu 3 - Solomon Islands 6 - Vanuatu

Thank you all for your undivided attention.

Health workforce development

The Lao People’s Democratic Republic

Dr Juliet Fleischl, WHO Representative in the Lao People’s Democratic Republic

WHO Collaborating Centre for Research and Training in Child and Neonatal Health

Early Essential Newborn Care

implementation in the Lao People’s Democratic Republic

Collaboration between Lao Ministry of Health, WHO and the Centre for

International Child Health, The University of Melbourne Australia

CICH in Lao People’s Democratic Republic

Child health and

improving hospital

care

Medical education

development at University

of Health Sciences

WHO Pocketbook of Hospital Care for Children

Oxygen systems for

district hospitals

Hospital data reporting and

child death review

EENC

EENC implementation in Laos March Aug 2013 Lao PDR endorses regional newborn action plan & planning workshop

April 2014 EENC Coaching begins in central hospitals (4)

March 2015 Coaching begins at provincial hospitals (4)

September 2015 Health facility strengthening coaching

2017 Planned expansion to district level

2016 Expansion to all provincial hospitals (17) & incorporation into MoH 5 year plan

CICH role • Technical partner

– Training facilitators – direct involvement alongside local facilitators – Quality assurance for coaching methods – Membership of EENC steering committee and attendance at local hospital

EENC committee meetings – Evidence review and resource development – Monitoring and evaluation – observation of births using observation

checklists, post-partum interviews with mothers, assistance with facility-level data collection

• “Developmental evaluator”

– Developmental evaluation focuses on evaluation in a complex environment with innovative programs that evolve over time.

– The developmental evaluator is a collaborator and facilitator who works within the project team, introducing evaluative concepts and facilitating change together, in real time, with the project team

DE example • Impact of fortnightly monitoring visits at the

start of implementation – Increasing amount of real-time feedback to health

facility staff – Building of rapport with staff – Increase motivation in improving practice – Allowed staff to take ownership of reporting back

at EENC committee meetings.

DE example • In March 2015 one hospital reported they were

“unable” to implement skin-to-skin due to ward arrangement/bed availability. Request for equipment donation before EENC could proceed.

• Solution: change in monitoring approach – Visited every day for 2 -4 weeks with aim of assisting staff

to overcome “barriers” to skin-to-skin at the time they were encountered.

– Led to first substantial rise in skin-to-skin practice which has been maintained.

• Lesson – Important to be available but also responsive to what is

happening and willing to adapt to what is needed.

CICH role March 2013 Laos endorses EENC

April 2014 EENC Coaching begins central hospitals

March 2015 Provincial hospitals (4)

September 2015 Health facility strengthening coaching

2017 Planned expansion to district level

2016 Expansion to all provincial hospitals

Interested partners who happen to have people in-country & existing relationship with Lao paediatricians

• Training facilitators • Adapting coaching and

resources to local context • Monitoring, evaluation and

data collection & management • Steering committee

membership

• Quality assurance • Technical support to

MoH and WHO staff in data management

• Institutional memory

?

Collaboration between Lao MoH, WHO and the Centre for International Child Health, The University of Melbourne Australia

Child health and

improving hospital

care

Medical education

development at University

of Health Sciences

WHO Pocketbook of Hospital Care for Children

Oxygen systems for

district hospitals

Hospital data reporting and

child death review

EENC

2013 Lao PDR endorses regional newborn action plan & planning workshop

2014 EENC Coaching begins in 4 central hospitals

2015 March Coaching begins at 4 provincial hospitals

2015 September Health Facility Strengthening coaching

2017 ?extend to districts ?target provinces which need strengthening

2016 Expansion to all (17) provincial hospitals & incorporation into MoH 5 year plan

Technical partner Training facilitators – direct involvement alongside local facilitators Quality assurance for coaching methods and results Membership of EENC steering committee and attendance at local hospital EENC committee meetings Evidence review and resource development Monitoring and evaluation –

observation of births using observation checklists post-partum interviews with mothers assistance with facility-level data collection

“Developmental evaluator”

Developmental evaluation focuses on evaluation in a complex environment with innovative programs that evolve over time The developmental evaluator is a collaborator and facilitator who works within the project team, introducing evaluative concepts and facilitating change together, in real time, with the project team

Impact of fortnightly monitoring visits at the start of implementation

Increasing amount of real-time feedback to health facility staff Building of rapport with staff Increase motivation in improving practice Allowed staff to take ownership of reporting back at EENC committee meetings.

In March 2015 one hospital reported they were “unable” to implement skin-to-skin due to ward arrangement/bed availability. Request for equipment donation before EENC could proceed. Solution: change in monitoring approach

Visited every day for 2 -4 weeks with aim of assisting staff to overcome “barriers” to skin-to-skin at the time they were encountered. Led to first substantial rise in skin-to-skin practice which has been maintained.

Lesson Important to be available but also responsive to what is happening and willing to adapt to what is needed.

Data shows uptake in all EENC practices overall However it is…

Incomplete Variable between sites

Central vs provincial hospitals Provincial sites are smaller organisations and potentially less complicated to change

Hospital-to-hospital Depending on local champion, level of input (eg follow up visits and monitoring), etc

Variable between practices Delayed cord clamping quick to change Skin-to-skin slower, required organisational by in and rearrangement on ward

2013 Laos endorses EENC

2014 EENC Coaching begins central hospitals

2015 Provincial hospitals (4)

2015 Health facility strengthening coaching

2017 ?extend to districts ?target provinces which need strengthening

2016 Expansion to all provincial hospitals

Interested partners who happen to have people in-country & existing relationship with Lao paediatricians

• Training facilitators • Adapting coaching and

resources to local context

• Monitoring, evaluation and data collection & management

• Steering committee membership

• Quality assurance • Technical support to

MoH and WHO staff in data management

• Institutional memory

?

Plenary three: Aligning

WHO collaborating centres' work to country needs

CHALLENGES CHALLENGES RESPONSE

Lack of remuneration and little opportunity of promotion on completion of the Diploma.

Lack of drivers of laboratory education. Lack of experienced staff and knowledge

transfer. Failure to appreciate the value of the

learning experience and the opportunity of professional development.

Poor staff management, and lack of staff motivation by laboratory managers.

Lack of Quality Culture in the work environment.

Non compliance or failure to complete the

Diploma programme. Practical workbook incompletion. Dishonesty/ inappropiate behaviour. Lack of commitment to the study

programme through disinterest. English language as a barrier – not

understanding the principle’s being taught.

• Promote the recognition of the Diploma, and its incorporation into established salary scales.

• Promote the appointment of a Professional Development Officer to monitor CPD and encourage a continuous learning environment for all staff.

• Develop a supervisors instruction booklet and provide opportunistic onsite training for supervisors.

• Promote professionalism and quality practise in the workplace through the implementation of ISO15189 Quality Essentials.

• Identify a funding source to increase in-

country interaction with students, providing one-on-one support.

• Establish an in-country mentorship programme within hospitals and the MOH.

• Provide constant online interaction and feedback to students.

• Ensure that the learning material is non-ambiguous , clearly defined and well understood.