title: Pandemic influenza and health system resource gaps in Bali: an analysis through a resource transmission dynamics model.
abstract: The failure to contain pandemic influenza A(H1N1) 2009 in Mexico has shifted global attention from containment to mitigation. Limited surveillance and reporting have, however, prevented detailed assessment of mitigation during the pandemic, particularly in low- and middle-income countries. To assess pandemic influenza case management capabilities in a resource-limited setting, the authors used a health system questionnaire and density-dependent, deterministic transmission model for Bali, Indonesia, determining resource gaps. The majority of health resources were focused in and around the provincial capital, Denpasar; however, gaps are found in every district for nursing staff, surgical masks, and N95 masks. A relatively low pathogenicity pandemic influenza virus would see an overall surplus for physicians, antivirals, and antimicrobials; however, a more pathogenic virus would lead to gaps in every resource except antimicrobials. Resources could be allocated more evenly across Bali. These, however, are in short supply universally and therefore redistribution would not fill resource gaps.
authors.affiliation: Universitas Indonesia, Depok, Indonesia.
authors.forename: Wiku
authors.initials: W
authors.lastname: Adisasmito
authors.affiliation: London School of Hygiene & Tropical Medicine.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Hunter
authors.affiliation: Hamburg University of Applied Sciences, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Krumkamp
authors.affiliation: Universitas Indonesia, Depok, Indonesia.
authors.forename: Kamal
authors.initials: K
authors.lastname: Latief
authors.affiliation: London School of Hygiene & Tropical Medicine.
authors.forename: James W
authors.initials: JW
authors.lastname: Rudge
authors.affiliation: London School of Hygiene & Tropical Medicine.
authors.forename: Piya
authors.initials: P
authors.lastname: Hanvoravongchai
authors.affiliation: London School of Hygiene & Tropical Medicine richard.coker@lshtm.ac.uk.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Coker
mesh_terms: D000998:Antiviral Agents; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D015233:Models, Statistical; D058873:Pandemics
chemical_list: D000998:Antiviral Agents