Strengthening emergency preparedness through the WHO emergency medical team mentorship and verification process: experience from Thailand.

The World Health Organization (WHO) emergency medical team (EMT) mentorship and verification process is an important mechanism for providing quality assurance for EMTs that are deployed internationally during medical emergencies. To be recommended for classification, an organization must demonstrate compliance with guiding principles and core standards for international EMTs and all technical standards for their declared type, in accordance with a set of globally agreed minimum standards. A rigorous peer review of a comprehensive documentary evidence package, combined with a 2-day verification site visit by WHO and independent experts, is conducted to assess an EMT's capacity. Key requirements include having sufficient systems, equipment and procedures in place to ensure an EMT can deploy rapidly, providing clinical care according to internationally accepted standards, being able to be fully self-sufficient for a period of 14 days and being able to fully integrate into the emergency response coordination structure and the health system of the country affected during deployment. Through the WHO mentorship programme, each EMT is provided with a mentor team, which guides and supports it during the preparatory process. The process typically takes around 1 to 2 years to complete. The Thailand EMT is the first team from the WHO South-East Asia Region to successfully complete the WHO mentorship and verification process. The experience of this process in Thailand can serve as an example for other countries in the South-East Asia Region and encourage them to strengthen their emergency preparedness and operational readiness by getting their national EMTs verified.

Building operational readiness for responding to emergencies in the WHO South-East Asia Region.

The World Health Organization (WHO) has an essential role to play in supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. Operational readiness for known and unknown hazards and emergencies requires a risk-informed and structured approach to building capacities within organizations such as WHO offices and national ministries of health. Under the flagship priority programme on emergency risk management of the WHO Regional Office for South-East Asia, a readiness training programme consisting of four modules was implemented during 2017-2018, involving staff from WHO country offices as well as from the regional office. The experience of and lessons learnt from designing, developing and delivering this phased training programme have fed into improvements in the curriculum and training methodology. The training programme has also facilitated the development of business continuity plans and contingency plans in some of the 11 Member States of the region and has increased the readiness of WHO staff for swift deployment in recent emergencies. It is recommended that the strengthening of operational readiness for responding to emergencies in the region be sustained and accelerated through the development of a regional training consortium that can scale the training programme up at national level, taking into account country contexts, national health systems and the needs of populations. The resilience of the populations and health systems in the region will be increased if disaster risk reduction and emergency preparedness and response activities are supported by operational readiness.

The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms.

BACKGROUND: As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia. METHODS: Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities. RESULTS: Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed. CONCLUSIONS: The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries - a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.