Business Continuity Plan (BCP) for Emergencies like Ebola Virus Diseases for Health sectors

Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 1 |

Preparedness

Ebola Virus Outbreak

Business Continuity Plan (BCP)

Generic Presentation

Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA

Public Health Specialist

Disclaimer: This presentation is developed with a view of advocating a need of

development of Business Continuity Plan (BCP) as part of preparedness or

readiness/response plan for emergencies like Ebola Virus Diseases or any other

emergencies, where the response may have to compromise the essential and critical

functions.


Outline

Difference between Contingency Plan and Business Continuity Plan (BCP)

Impacts of Ebola (socio-economic and others)

Potential impacts on health and non –health sectors

Rationale for BCP

Planning assumptions

BCP Planning and Steps

Lack of Preparedness: Example


Difference between CP and BCP

BCP is part of CP

A Contingency Plan

Protects life safety in the event of

an incident and is geographically

based, meaning that your office’s

plan should be specific to its

location. In other words, what will

you do in case of an immediate

emergency- where will you go, what

should go with you, how will you

account for everyone, etc.

A Business Continuity Plan

Protects the job that you do, and

should outline how you will

continue do essential tasks in the

event of an incident that may

affect operations. For example,

how will you provide the

immunization if there health care

workers are sick? Or how will you

do your job if you can’t use your

office space for a week


Socio-Economic Impact

EVD

outbreak


Potential Impact on Ebola Outbreak

Projections show a possible $32.6 billion loss to West Africa over the next

two years (only in West Africa) – source: WB

Deaths, absenteeism and attempts to avoid infection have consequences

for supply and demand side of economy – Markets close, utilities unreliable, telecoms break, cash in short supply

– Mining and production reduces

Threats to Rule of Law and Security (recently established peace after

decade long conflict


Potential Impacts on Health Sectors

Deaths/ Illnesses Quarantine

Care

Fear

Absenteeism

Decreased Supply

Reduced Services

Disrupted

transportation and

services

Cross Sectoral

Activities

Increased Demand

Care of Ebola/Fever

Water & Sanitation

Communication

Banking services

Mortuary & Burial

Electricity/Power

Routine Health Care

Security

Logistics

Breakdown of Health Services

Changed Demands

Lack of BCP

Potential Impacts on

Health Sectors


Potential Impacts on Non-Health Sectors

Deaths/ Illnesses Quarantine

Care

Fear

Absenteeism

Decreased Supply

Reduced production

Disrupted

transportation

Trade of

commodities

Cross sectoral

interdependencies

Increased Demand

Logistic support

Water & Sanitation

Communication

Banking services

Mortuary & Burial

Electricity/Power

Health Care

Security

Breakdown of Services

Economic and Social Disruption

Changed Demands

Lack of BCP

Decreased Demand

Retail Trade

Transportation

Leisure Travel

Gastronomy


Other Risk and Impact

Livelihoods

Human Health

Governance & Security

Social & Humanitarian Needs

Economic Systems

• Food and income loss from loss of mining and production and other source of incomes

• High illness & potentially higher death rates

• Overstretched health facilities

• Disproportionate impact on vulnerable

• Increased demand for governance & security

• Higher public anxiety

• Reduced capacity due to fear, illness & death

• Deterioration of coping & support mechanisms

• Interruption in public services

• Quarantine policies

• Trade & commerce disruptions

• Degraded labour force

• Interruption of regular supply systems

Categories of Risk


Rationale for BCP

During emergencies our health system will be overwhelmed and

challenged by various factors:

– Demand of Outbreak Response is High

• 30% of required ETC beds are only available (1188 available vs

requirement 4167)

• INSERT: Number of health Care required for the effective response

– Absenteeism

• More than 600 health care workers are affected

• More than half of them died

• Sickness of Health Care workers

• Fear Factors (we don’t know the exact number)


Rationale for BCP – Absenteeism e.g. Liberia

46 percent of those working at the start

of the Ebola crisis are no longer

working as of early November 2014

Self-employed and wage workers have

been the hardest hit, while agriculture

is beginning to see returns to work as

the harvest approaches

Food insecurity is worsening, especially

for the poorest, due to rising rice prices,

falling incomes, and transportation

restrictions

Source: World Bank Group: The Socio-Economic Impacts of Ebola in Liberia


Rationale for BCP…Contd

During emergencies our health system will be overwhelmed and

challenged by various factors:

– Other requirements

• Safe burial team and trained manpower in place

• Logistic Demands for the outbreak response

To over come the demands of response

– Other sectors will be compromised by mobilizing

• Health Care workforce

• Logistics

• Facilities

• Finance (Money)



During emergencies our health system has to operate other essential

functions in absence of that for instance may lead to following situation

– immunization rates have been dropping with loss of health care workers and

reluctance of the population to visit health facilities.

– The long planned measles campaign in one of the country has been

postponed until after the Ebola epidemic is over.

– Some evidence has shown collapse of routine health care as both patients and

providers have avoided clinics for fear of infection.

– It has also highlighted that the malaria control effort has been impacted and

likely to linger long after the outbreak ends.

– Achievements so far made (malaria deaths have fallen by about 30% in African

countries since 2000) are at stake in these countries.



During emergencies our health system has to operate other essential

functions in absence of that for instance may lead to following situation

– Locally endemic disease surveillance and laboratory confirmation have been

challenged and case reporting is already going down.

– Similar situation prevails in the area of maternal health services, where

pregnant women cannot get assistance delivering babies. In some places due

to ignorance, some of the pregnant mothers are visiting Ebola treatment center

with a view of receiving better services.

– Patients who need lifesaving emergency surgeries like appendectomy, C-

sections and others are at risk due to limitation of surgical capacity as well as

the risk of being turned away if they have signs of vomiting or fever.


Rationale for BCP…Cont

In absence of BCP may lead to:

– Disruption of essential services like immunization, maternal and child health care;

– Disruption of control of locally endemic diseases and other emergency care and

services.

Inability to provide these services not only impacts health of people but also

impact on overall development of the country,

– Can compromise achievements made for MDGs;

– Other goals of sustainable development and

– Put these countries at stake, where peace has established after decade long

conflict and this kind of situation may lead to newer form or revival of the conflict.


Plan and Planning

Plans alone are nothing; planning is everything.

Vital element is to involve stakeholders in the planning process and

identify their roles and responsibilities


Planning assumptions

EVD outbreak can overwhelm the health services

Health Care Workers’ Absenteeism due to one of the four causes

Saving life, reducing morbidity and mortality and decreasing impact on socio-economy are high

priorities.

Maintaining critical and essential services during EVD outbreak is a priority

Adequate training is delivered and is made aware of its existence and their and responsibilities

during outbreak.

During outbreak, health care workers are considered essential staff and can be mobilized to EVD

response and to other essential services.

Sharing the resources between departments, hospitals, and other partners are essential on the

success of responding the EVD outbreak.


Core Business Continuity Actions

Identify the critical functions

Identify the personnel, supplies and equipment vital to maintain essential functions

Consider how to deal with the anticipated level of staff absenteeism

Provide clear command structures, delegations of authority and orders of succession

Stockpile strategic reserves of supplies and equipment

Determine the ability of the organisation to continue operations if critical infrastructure services and/or supplies become unavailable


Core Business Continuity Actions….Contd

Agree on a system of communication with staff, partners, HQs, suppliers and customers

Identify units/departments that could be downsized or closed to reallocate resources

Assign and train alternates for critical posts

Plan for security risks to operations and supply chains

Consider alternative methods of working, e.g. changes to shift patterns, working from home

Consider the implications of travel restrictions and develop procedures to follow if such restrictions are imposed


Core Business Continuity Actions CONTD

Train staff on infection control and communicate essential safety messages

Consider ways of reducing social mixing (e.g. working from home, reducing

meetings and travel) and test these in advance

Consider the need for family and childcare support for essential workers

Consider the need for psychosocial support services to help staff remain

effective

Consider and plan for the recovery phase


Business Continuity Planning (Organizations, facilities, departments)

Step 2

Business Impact Analysis (Identifying Essential Services/Functions)

Step 1

Governance and Leadership

and establishment of BCP

Committee

Step 3

Identifying required skills sets and

staff allocation and reallocation.

Step 4 Step 5

Documentation for each

Essential Service/Function

Step 6

Compare to the

“preparedness checklist”

Maintain

essential services

Business

Continuity

Identifying relevant issues and/or

Implications for Implementation

Step 7

Review, Test the Plan and

Revise


Step 1: Governance and Leadership

Establishment of BCP Committee

Public Health Agency/institute’ senior management team is responsible

for overseeing BCP process.

– Having policy by determining how the agency/institute will manage and control

EVD outbreak and its risk

– Resourcing qualified personals and sufficient resources to apply BCP.

– Ensure the BCP is tested and reviewed; staff are trained and are aware of their

roles and responsibilities.

– Monitor and evaluate the application of BCP and make adjustment accordingly


Step 2: Business Impact Analysis

(Identifying Essential Services/Functions)

Business Impact Analysis: The process lead on identifying and

prioritization of essential functions.

Essential Services is defined as follows:

– A service and/or function that when not delivered creates an impact on the

health and safety of individuals.

– A service and/or function that may lead to the failure of a business unit if

activities are not performed in a specified time period.


Step 3: Identify Required Skill Sets and Staff Allocation

Identify the number of staff (by classification) required to maintain the

essential services/functions. Include essential services/functions

created or increased by the “surge activity”.

Mapping of Human Resource Capacity of the agency/institute.

Identify any special requirements necessary to perform the essential

services/functions.


Step 4: Identify any Relevant Issues and Implications

for Implementation

Recognizing vital issues and implications that may have consequences in any

essential service reduction, modification, and/or elimination is an important

procedure.

Each should be discussed and any relevant comments/solution should be

documented.

It is recommended that part of this process include documentation and a planned

response for each essential service/function.

– Activation of Plan

– Planning

– Policies and Procedures

– Surveillance and Attendance

– Delivery of Services

– Human Resources

– Communications

– Testing of Plan


Step 5: Documentation for Each Essential Service/Function

Identified essential services/functions

Identified any relevant issues/implications that may arise when the level

of service/function is modified and/or reduced

This part of the plan explains how each of the essential service/function

is maintained, reduced, modified and/or eliminated, who makes the

decision, what are the solutions are in place, any other necessary

actions to follow and any communication strategy.


Step 6: Compare to the “Preparedness Checklist”

Review the Emergency Preparedness of your agency/institute to

safeguard that all issues have been addressed such as the decision-

making process and authority for implementing service modification,

reduction and/or elimination.

To review, additional documentation may be necessary to ensure that

all critical elements have been addressed.

Compare the checklist with preparedness checklist of agency/institute;


Step 7: Review, Test the Plan and Revise

Circulate the plan for information and training purposes within the agency/institute

once the Business Continuity Plan is ready.

Conduct annual review, test the plan and revise the Business Continuity Plan as

necessary. .

Finally, conducting an emergency exercise to test the plan will help staff

understand the Business Continuity Plan, how and when it’s activated, who is

responsible for what, and how it fits with agency/institute strategy to deal with a

EVD outbreak.

Plans alone are nothing; planning is everything; however, if we

don’t use and test it then planning alone is nothing too.


Lack of Preparedness: Maternal Health Services

Pregnant

mother goes

to health care

facility for

delivery

Health Care

workers

absent and

some

mobilized to

ETC

Complication

of Pregnancy

and delivery

Increased in MMR

and IMR


Lack of Preparedness: Logistic or Energy Department


Operational Status

Human Resources - Operation and maintenance of

Wards/Departments. E.g ICUs

Full Operational

Capacity,

24 hours services

No. of available

qualified health care

workers: 11-13 people

(Full Human Resources

Reserve)

No. of available

qualified health care

workers:

< 8 people

Reduced

Operational

Capacity,

24 hours services no

longer possible

No. of available qualified

health care workers:

9-10 people

(Limited Human

Resources Reserve)

No. of available qualified

health care workers:

8 people

(Minimum Required

Human Resources – No

Reserve)

Health Care Workers: All types of workers from doctors, nurses,

technicians, cleaning team and other ICU operational staff.


Human resources: Qualified

Health Care workers

24 hours service capacity

13 – 10 Full capacity with sufficient reserve

10 - 9 Operation possible with limited reserve

8

(Minimum to run

24 - hour operation)

Critical – Unable to maintain operation if one more

staff is absent

< 8 Continuity of operation impacted

Operational Status Coding


Institutional body (Ministry / Specific Team or Committee)

to monitor operational status of all facilities

“Network Planning and Management

Facility A Facility B Facility C


Role of Ministry of Health

MoH should provide advice to businesses on business continuity

planning and maintaining essential services despite worker

absenteeism

MoH should work with the private sector to ensure business continuity

planning is coordinated and integrated


Business continuity plans

Be specific

Identify who is going to do what when and how

Identify what actions need to be undertaken in each phase of pandemic

List emergency contacts

Plan around 2 scenarios: rapid onset pandemic with wide impact and slow onset

pandemic with moderate localised impact

Discuss plans with staff, suppliers and banks


Test

Test contingency plans

Simulation exercises

Scenario planning

Tabletop exercises

Learn lessons from tests

Identify areas that need improvement


References and Acknowledgement

Nirmal Kandel. Presentation on Whole of Society Approach for Pandemic Preparedness in National

Training of Trainers on WHOLE-OF-SOCIETY APPROACH on Pandemic Preparedness, Dhulikhel, Nepal,

29-30th June 2010

WHO. Whole of Society of Pandemic Readiness. WHO Guidelines for pandemic preparedness and

response in the non health sector. Geneva, July 2009

UN. Socio economic impact of Pandemic Influenza. United National System for Influenza Coordination,

2009

World Bank. The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for

West Africa. Accessed on 29th November 2014 (http://www.worldbank.org/en/region/afr/publication/the-

economic-impact-of-the-2014-ebola-epidemic-short-and-medium-term-estimates-for-west-africa

World Health Organization: Ebola Response Roadmap Situation Report. Geneva: WHO 7 Nov 2014. 11 p

(Accessed on 11 Nov 2014 http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141107)

http://www.worldbank.org/en/region/afr/publication/the-economic-impact-of-the-2014-ebola-epidemic-short-and-medium-term-estimates-for-west-africa































http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141107





References and Acknowledgement

Nirmal Kandel. Draft Business Continuity Planning Tool Kit for Ebola Virus Disease Outbreak. Unpublished.

2014

World Health Organization. Ebola and Marburg virus disease epidemics: preparedness, alert, control, and

evaluation. Interim version 1.2. Geneva: WHO/HSE/PED/CED/2014.05. 2014

Loose VW, Vargas VN, Warren DE, Starks SJ, Brown TJ, Smith BJ: Economic and Policy Implications of

Pandemic Influenza. USA: Sandia National Laboratories; Mar 2010. 28 p. Sandia Report SAND2010-1910.

ACAPS Briefing Note. Ebola Impact on Health. Geneva: ACAPS; 26 Sep 2014. 10 p. Accessed on 18 Nov

2014 http://acaps.org/img/documents/b-acaps_briefing_note_ebola_impact_health_26_sept_2014.pdf)

Hayden EC. Ebola obstructs malaria control. Nature; 2 October 2014. Vol 14; Pg 15

Images used in the presentations are downloaded from Google Image search option using best available

title for the image topic. Access in 29th November, 2014: https://www.google.com/imghp?gws_rd=ssl

(these images are used for orienting purpose only and not for commercial any use)

http://acaps.org/img/documents/b-acaps_briefing_note_ebola_impact_health_26_sept_2014.pdf







https://www.google.com/imghp?gws_rd=ssl


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Health & Medicine

Business Continuity Plan (BCP) for Emergencies like Ebola Virus Diseases for Health sectors