Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries.
BACKGROUND
Since 2003, Asia-Pacific, particularly Southeast Asia, has received substantial attention because of the anticipation that it could be the epicentre of the next pandemic. There has been active investment but earlier review of pandemic preparedness plans in the region reveals that the translation of these strategic plans into operational plans is still lacking in some countries particularly those with low resources. The objective of this study is to understand the pandemic preparedness programmes, the health systems context, and challenges and constraints specific to the six Asian countries namely Cambodia, Indonesia, Lao PDR, Taiwan, Thailand, and Viet Nam in the prepandemic phase before the start of H1N1/2009.


METHODS
The study relied on the Systemic Rapid Assessment (SYSRA) toolkit, which evaluates priority disease programmes by taking into account the programmes, the general health system, and the wider socio-cultural and political context. The components under review were: external context; stewardship and organisational arrangements; financing, resource generation and allocation; healthcare provision; and information systems. Qualitative and quantitative data were collected in the second half of 2008 based on a review of published data and interviews with key informants, exploring past and current patterns of health programme and pandemic response.


RESULTS
The study shows that health systems in the six countries varied in regard to the epidemiological context, health care financing, and health service provision patterns. For pandemic preparation, all six countries have developed national governance on pandemic preparedness as well as national pandemic influenza preparedness plans and Avian and Human Influenza (AHI) response plans. However, the governance arrangements and the nature of the plans differed. In the five developing countries, the focus was on surveillance and rapid containment of poultry related transmission while preparation for later pandemic stages was limited. The interfaces and linkages between health system contexts and pandemic preparedness programmes in these countries were explored.


CONCLUSIONS
Health system context influences how the six countries have been preparing themselves for a pandemic. At the same time, investment in pandemic preparation in the six Asian countries has contributed to improvement in health system surveillance, laboratory capacity, monitoring and evaluation and public communications. A number of suggestions for improvement were presented to strengthen the pandemic preparation and mitigation as well as to overcome some of the underlying health system constraints.
Hanvoravongchai
Piya
P
Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Piya.Hanvoravongchai@lshtm.ac.uk
Adisasmito
Wiku
W
Chau
Pham Ngoc
PN
Conseil
Alexandra
A
de Sa
Joia
J
Krumkamp
Ralf
R
Mounier-Jack
Sandra
S
Phommasack
Bounlay
B
Putthasri
Weerasak
W
Shih
Chin-Shui
CS
Touch
Sok
S
Coker
Richard
R
D001208:Asia; D004189:Disaster Planning / Q000458:organization & administration*; D004196:Disease Outbreaks / Q000517:prevention & control*; D006295:Health Resources / Q000600:supply & distribution; D006296:Health Services; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000517:prevention & control*; D012307:Risk Factors