Bagian I Kebijakan Umum
NATIONAL STRATEGIC PLAN
FOR AVIAN INFLUENZA CONTROL AND
PANDEMIC INFLUENZA PREPAREDNESS
2006-2008
REPUBLIC OF INDONESIA
Januari 2006
PREFACE
The Avian Influenza Outbreak (AI) at this time has become a global issue. Serious
measures must soon be taken so that the AI outbreak does not mutate and become a flu that
spreads from human to human, and becoming Human pandemic influenza (HPI). The losses
that would occur in the event that the avian influenza virus mutates into a virus that spreads
from human to human would be enormous, both economic losses from the great number of
poultry that must be destroyed and social costs from the large number of people who would fall
ill and even die in Indonesia.
As a member of the international community, Indonesia is also responsible for making a
National Strategic Plan for handling Avian Influenza. The National Strategic Plan is formed
comprehensively, from the aspect of animal healthcare as well as human healthcare. It is for
that purpose that the National Strategic Plan for Controlling Avian Influenza and Preparations
for Facing Human pandemic influenza is formed.
This National Strategic Plan for Controlling Avian Influenza and Preparations for
Facing Human pandemic influenza is formed is a national guide for handling avian influenza in
Indonesia for all stakeholders as has been identified by this National Strategic Plan.
Furthermore, on a regional and global level, this strategic plan is part of the regional and global
strategy. Therefore, Indonesia’s strategic plan is also part of the global solution to the avian
influenza problem.
Formulation of the National Strategic Plan for Controlling Avian Influenza and
Preparations for Facing Human pandemic influenza was done in three stages. The first stage
was joint formulation by the Department of Health, the Department of Agriculture and
coordinated by the State Ministry for National Development Planning/Bappenas. The second
stage was perfecting the plan by involving related authorities, associations, professional bodies
and the private sector as well as verification to fulfill international standards from international
bodies competent in the field of animal and human health. Therefore all components of society
are involved in the formulation as well as the application of this strategic plan, so that the
special goal in controlling avian influenza can be achieved and can prevent the emergence of
human pandemic influenza which we wish to avoid. In the third stage, all related authorities
will formulate more concrete operational plans complete with technical guidelines which refer
to this National Strategic Plan.
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Remembering that avian influenza develops dynamically and that the situation is
always changing, therefore this national strategic plan is a dynamic document and will
continually be updated according to existing conditions.
Jakarta, Januari 2006
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TABLE OF CONTENTS
PREFACE.....................................................................................................................................1
TABLE OF CONTENTS..............................................................................................................3
PART I
GENERAL POLICIES ..........................................................................................5
1. Background.......................................................................................................................5
2. Problems and Obstacles ....................................................................................................7
3. Common Goals .................................................................................................................8
4. Basic Principles.................................................................................................................9
5. Pandemic Phases.............................................................................................................10
6. Strategic Plan Framework...............................................................................................11
PART II
NATIONAL AVIAN INFLUENZA
CONTROL
STRATEGY.......................................................................................13
1. Goals... ............................................................................................................................13
2. Target ............................................................................................................................13
3. Strategy ...........................................................................................................................13
4. Interrelationship among Strategies .................................................................................14
5. Details of Strategy ..........................................................................................................14
5.1 Controlling Disease in Animals.............................................................................14
5.2 Management of Human Cases of AI......................................................................15
5.3 Protection of High-Risk Groups ............................................................................16
5.4 Epidemiological Surveillance on Animals and Humans .......................................16
5.5 Restructuring the Poultry Industry System............................................................17
5.6 Risk Communication, Information and Public Awareness....................................18
5.7 Strengthening Supporting Laws.............................................................................19
5.8 Capacity Building ..................................................................................................20
5.9 Action Research.....................................................................................................21
5.10 Monitoring and Evaluation ....................................................................................22
PART III
NATIONAL HUMAN PANDEMIC INFLUENZA
PREPAREDNESS
STRATEGY ...........................................................................23
1. Goals ............................................................................................................................23
2. Target ............................................................................................................................24
3. Strategy ...........................................................................................................................24
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4. Interrelationship among Strategies .................................................................................25
5. Details of Strategy ..........................................................................................................25
5.1 Strengthening Sustainable Management ...............................................................25
5.2 Strengthening Surveillance on Animals and Humans ...........................................26
5.3 Prevention and Control .........................................................................................27
5.4 Strengthening Health Service Response Capacity.................................................28
5.5 Communication, Information, and Public Awareness ...........................................29
5.6 Human pandemic influenza Contingency Plan......................................................29
PART IV
V ORGANIZATION .................................................................................................31
PART V
CLOSING ..............................................................................................................34
GLOSSARY.... ...........................................................................................................................35
APPENDIX
1. National Avian Influenza Control Strategy Matrix ........................................................39
2. National Pandemic Influenza Preparedness Strategy Matrix .........................................52
3. Human Pandemic Influenza Contingency Plan Matrix ..................................................61
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PART I. GENERAL POLICIES
1.
Background
There are three types of influenza virus, types A, B and C. Even though all three can
infect humans, the type-A virus generally attacks low-level types of animals and birds. The
type-A influenza virus consists of 16 subtypes, all of which can attack birds. All highly
pathogenic avian influenza (HPAI) is caused by type-A influenza virus subtypes H5 and H7.
The avian influenza or bird flu (caused by subtype H5N1 virus) that is currently occurring
was first detected in poultry in South Korea in December 2003. This virus developed in stages,
first attacking pet birds, wild birds and migratory birds, then attacking other animals - such as
pigs, cats and tigers - as well as. It has also spread to other countries. Currently this virus has
attacked birds in 12 countries, including Indonesia. Until now, 150 million chickens are
recorded as having died from or been destroyed after being infected by the bird flu. The bird flu
virus has continued to be detected in 6 countries, which are Vietnam, Indonesia, Thailand,
China, Cambodia and Laos.
Actually the AI virus does not easily spread to humans. But this can change because of
mutation or genetic re-assortment (mixing of influenza genes in animals and humans) so that in
its development AI not only attacks birds, but attacks humans as well (zoonotic). By August 25
2005, 112 confirmed cases in humans had been recorded worldwide, with 57 cases ending in
death.
At this time, the AI outbreak attacking animals in Indonesia is very serious, having spread
to 23 provinces, covering 151 districts/cities. The increasingly wide spread of AI is caused by
the uncontrolled movement of infected birds, poultry products and wastes, labor and
transportation from infected areas to uninfected areas, as well as low animal heath institution
capacity and a lack of trained animal healthcare workers.
The emergence of deadly AI in poultry on poultry farms was first reported in August
2003 in several districts in Central Java. The test results in animal health diagnostic
laboratories were that the deadly Newcastle Disease virus caused it. Until the months of
October - November 2003, the number of cases rose, with high mortality and spreading to other
locations that was then discovered to be bird flu. The disease then attacked breeding farms as
well as egg farms and broiler farms. The other types of poultry attacked are village chickens,
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ducks and quails. The areas infected by bird flu in 2003 were 9 provinces, covering 51 districts
with poultry deaths numbering 4.7 million.
By December 2004, the cumulative number of cases of AI related poultry deaths
exceeded 8 million. The number of provinces with cases of AI infections increased to 16
provinces, covering 100 districts/cities. The greatest number of AI related poultry deaths
occurred in the provinces of Central Java, West Java, East Java, and Lampung, each of which
had over 1 million poultry deaths.
By November 2005 the area of viral spread had reached 23 provinces, covering 151
districts/cities. The number of dead poultry caused by AI from August 2003 to November 2005
had reached 10.45 million birds, most of them in non-commercial farms.
We must be cautious of the process by which AI infects humans, because it is deadly and
has the potential to spread among humans. The first human case in Indonesia was discovered in
June 2005 in the District of Tangerang. By December 12 2005 14 confirmed cases of bird flu in
humans had been recorded, 9 of them ending in death. From the analysis of bird flu cases in
Indonesia there appears to be a tendency towards a decreasing pathogenesis and an increasing
number of cases.
One thing that worries the world at this time is the emergence of a new influenza virus
subtype in humans that comes from an adaptive mutation or genetic re-assortment, that is the
mixing of influenza viruses in animals and humans. This new viral subtype would be able to
quickly and easily spread from human to human.
In relation to that, the problem of bird flu needs integrated handling from the standpoint
of managing animal and human healthcare systems by the principles of speed, accuracy,
systematic and sustainable. Some specific reasons for the importance of comprehensive
handling are the impact on:
1. Livestock industry that involves a large population of animals. Indonesia’s poultry
population in 2004 was approximately 1,3 billion birds, which consisted of 271,8
million village chickens (ayam buras), 80,6 million layers, 895 million broiler
chickens and 35,5 ducks. Of the total population almost 62% is in Java, 18% in
Sumatra, 7% in Kalimantan, 6% in Sulawesi, the remaining 7% is in Bali, Nusa
Tenggara and other areas.
2. Livestock industry that involves many businessmen and farmers, directly and
indirectly both by backwards and forwards lineages. The national poultry industry at
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this time includes 15 breeding farms that produce Grand Parent Stock, 95 breeding
farms producing parent stock, 2,289 commercial poultry companies that hire 25
thousand labors. The total number of farming households directly involved in poultry
raising businesses is 550 households. Total investment in the poultry industry is
estimated to reach US$ 3-3.5 billion; the cash flow from these poultry businesses
reaches US$ 30 million per year.
3. The impact on food availability and safety. From the poultry industry, Indonesia is
capable of producing 1,2 billion tons of poultry meat each year or contributing 56%
of total meat supply. Meanwhile the production of eggs reaches 1.164 billion tons,
which can fulfill all domestic egg consumption. Because of the occurrence of a bird
flu outbreak and the decline of poultry product consumption, it is estimated that there
will be a decline in the poultry population and the domestic production of meat and
eggs.
4. The potential for infection in humans and even the development into human pandemic
influenza. The effects of the spread of the bird flu outbreak have impacted humans.
Right now in Indonesia there have already occurred cases of bird flu infections from
animals to humans, which have already claimed many victims. Human victims of bird
flu continue to increase and it is feared that it will develop to the stage of infection
from human to human (pandemic).
2.
Problems and Obstacles.
Problems and obstacles faced by Indonesia in the effort to control bird flu and prepare for
human pandemic influenza are, among other things:
1. Lack of inter-sector coordination in planning and controlling bird flu and preparedness
for human pandemic influenza.
2. Lack of early warning capacity and nonexistence of integrated network of surveillance
systems on animals and humans.
3. Limited ability to provide financial compensation to farmers in the event of selective
extermination (depopulation) or total extermination (stamping out).
4. Limited vaccines and vaccination coverage in poultry.
5. Limited stocks of medicine and non-existence of human vaccine.
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6. Lack of understanding and awareness of AI and HPI and its potential risks in all layers
of society.
7. Lack of supporting resources (human resources, costs, technology and supporting
facilities).
8. Limited research and development capabilities.
9. The distortion of information received by the community.
10. Lack of animal and animal product traffic surveillance.
11. Uncertainty as to when human pandemic influenza might occur.
3.
Common Goals
Referring to the cases outlined above, the integrated goal of national bird flu
control/management are as follows:
1. Preventing the bird flu from developing into the next stage.
Preventing the development of bird flu, which must soon be conducted, is controlling bird
flu at source so that bird flu cases in poultry do not develop into human pandemic
influenza, which can spread from human to human. The development of bird flu into a
common flu in humans is extremely dangerous because it can affect many human victims.
Cases of human pandemic influenzas that occurred in 1918 (Spanish flu), then in 1957
(Asian flu) and 1968 (Hong Kong flu) took the lives of many victims. According to WHO
estimates, if the same case occurs now, it could cause the deaths of 2-7 million people and
the UN estimates that it could cause the deaths of 5-150 million people. Because of that an
integrated national strategy on controlling bird flu is extremely important.
2. Best possible care for human victims of bird flu and animals
Human patients/victims of bird flu and animal need to be cared for as well as possible -
correctly and proportionally - as they cannot be handled separately from each other. That
means that caring for human victims is prioritized to guarantee the continuance of human
life. Nevertheless simultaneous care of animal cases must also be handled because animals
are the source of infections in humans.
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3. Minimizing damage caused by the development of bird flu
Handling bird flu means saving people and their economic activities in order to ensure the
continuance of their lives. Because of that the handling bird flu must pay attention to the
sustainability of farmers’ lives and farming, both upstream and downstream businesses.
What is even more important is that poultry products free of bird flu are an element that
guarantees food security, which is not only important for domestic food safety but also for
the safety of exported animal products. With the above widespread socio-economic impact
of bird flu, efforts must be done to minimize damages in various fields.
4. Managing sustainable bird flu control.
Controlling bird flu must be sustainable as one source of bird flu infections that is difficult
to control are wild birds that freely migrate and are capable of spreading the virus between
countries. In relation to that other than quick steps to handle the effects of bird flu when
they occur, what is needed even more is the strengthening of the human and animal
healthcare systems. By strengthening both systems, then the ability to control bird flu
sources, prevent infections in humans and care for victims can be continuous. Sustainable
control of bird flu hopefully can repress the emergence of cases or outbreaks in the future.
5. Effective national preparedness for human pandemic influenza
Preparedness for human pandemic influenza is achieved by facilitating and making
effective a national response which is coordinated among all administrative levels through
prevention and control activities to reduce morbidity, mortality and social-economic
impacts.
6. Developing local, national and international networks on AI control and pandemic
Influenza Preparedness
4.
Basic Principles
Based on the above common goals then the policy of the national strategic plan for avian
influenza control and preparedness for human pandemic influenza is formulated and conducted
according to five basic principles, which are:
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1. Prioritizing Human Safety.
The principle of prioritizing human safety is followed as sustaining human life is most
important.
2. Considering economic factors.
Economic factors need to be considered given the socio-economic impact that arises, the
various policy choices and steps available and the limited resources available.
3. Emphasizing integrated efforts of all components: government, private sector, community,
professional organizations, and international organizations.
This strategic plan will in the end be applied at the community level, farming and farm
product companies as well as human healthcare providers, which are mostly conducted by
the private sector. For that, community and private awareness and active participation in the
implementation will be the key. In the era of decentralization, the role of local governments
as the main actor of this strategic plan is vital. Local government transparency on avian
influenza events in their areas is greatly needed and combined efforts of all local
governments at all level is a must. The role of professional organizations and international
organizations in supporting community and private involvement is also large.
4. Compliance with National and International agreements and standards.
The strategy chosen was formulated in reference to international standards set by
international organizations such as the WHO in human healthcare services, and the FAO
and OiE in animal healthcare services.
5. Preparedness and alertness in anticipating human pandemic influenza must be maintained
and sustainable and this document will be treated as a living document which at any time
can be adjusted according to need.
5. Pandemic Phases
According to the WHO, there are six phases to a global human pandemic influenza
based on a number of epidemiological factors in humans before a pandemic is declared. Those
six phases are divided into three large time groups: inter-pandemic, pandemic alert, and
pandemic.
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Inter-pandemic Period
Phase 1: No new influenza virus subtypes are detected in humans. An influenza virus subtype
that can cause an infection in humans may exist in animals. If it exists in humans the
risk of infection or illness in humans is low. In Indonesia this phase occurred before
July 2003.
Phase 2: No new influenza virus subtypes are detected in. But, an influenza virus subtype
circulating in animals has the risk of infecting humans. In Indonesia this phase began
in August 2003 when the virus subtype H5N1 was detected in poultry.
Pandemic alert Period
Phase 3: Infection in humans with a new subtype, but no infection from humans to humans, or
in very rare events in close contact. In Indonesia this phase began in July 2005 when
infection by subtype H5N1 was confirmed in humans.
Phase 4: Clusters with limited human to human infection but much localized spread, signaling
that the virus is not adapting well to humans. In Indonesia as of September 2005, this
phase hadn’t begun yet.
Phase 5: Larger clusters, but human to human infections are still localized, signaling that the
virus has adapted better to humans , but may not fully be able to spread easily
(substantive pandemic risk).
Pandemic Period
Phase 6: Pandemic period: increasing and continuity of infections in the general public.
Post-pandemic Period
Return to inter-pandemic period.
6. Strategic Plan Framework
Handling viruses at source is the key to success in controlling, and preventing the
emergence of various animal diseases, especially those that can infect humans (zoonosis).
Therefore, the strategy that needs to be undertaken is:
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1. Avian Influenza Control;
2. Self-preparedness and alertness for a possible human pandemic influenza.
COMMON GOALS
AVIAN INFLUENZA
1. Preventing AI from developing into the next
CONTROL
stage.
STRATEGY
2. Best possible care for human victims and
animals.
3. Minimizing damage caused by bird flu
HUMAN
development
PANDEMIC
4. Managing sustainable bird flu control
INFLUENZA
5. Effective national preparedness for human
PREPAREDNESS
pandemic influenza
STRATEGY
6. Developing networks on AI control and PI
Preparedness
Picture 1. Strategic Plan Framework
Controlling bird flu needs to be conducted in accordance with international standards.
Compliance to these international regulations/standards is very important so that the impact on
animal health, possible infections in humans and its spreading to unaffected areas and countries
can be avoided (externalities/trans-boundary). Therefore, this national strategic plan shows the
responsibility of the people and nation of Indonesia as a member of Asia and the international
world. In accordance to this, steps to control bird flu is a concerted effort that needs to be
integrally implemented as a one country program, as well as a regional, and international
program for controlling avian influenza.
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PART II
NATIONAL STRATEGY FOR CONTROLLING AVIAN INFLUENZA
1. Goals
The common goals of the national strategy for controlling avian influenza are:
1. Maintaining bird flu-free areas and controlling bird flu in infected areas
2. Lowering morbidity and mortality from bird flu
3. Lowering the socio-economic impact of bird flu
4. Increasing Indonesia’s contribution in solving the bird flu problem globally
2. Target
The targets to be achieved in controlling bird flu are:
1. Controlling bird flu in animals:
a. Maintaining bird flu-free areas
b. Eliminating bird flu from sector 1 and sector 2 in 2008
c. Reducing bird flu cases in sector 3 and sector 4 in 2008
d. Preventing the spread of bird flu from poultry to other domesticated animals in 2008
2. Preventing and controlling extraordinary events/outbreaks in humans:
a. Preventing the spread of bird flu from animals to humans in 2008
b. Preparedness for human pandemic influenza by the end of 2008
3. Strategy
1. Highly Pathogenic Avian Influenza (HPAI) Control in Animals
2. Management of Human Cases of AI
3. Protection of High-Risk Groups
4. Epidemiological Surveillance on Animals and Humans
5. Restructuring the Poultry Industry System
6. Risk Communication, Information and Public Awareness
7. Strengthening Supporting Laws
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8. Capacity Building
9. Action Research
10. Monitoring and Evaluation
4. Interrelationship among Strategies
Bird flu control strategy will be focused on the effort to control disease in animals,
managing cases in humans and protecting high-risk groups. This focused strategy is
supported by surveillance and epidemiology in animals and humans, increasing capacity,
action research, communication information and education, as well as monitoring and
evaluation. The continuation and effectiveness to that strategy needs to be supported by the
strengthening of laws and the restructuring of the poultry industry system.
Epidemiological surveillance
on animals and humans
Controlling disease in animals
Action research
Managing cases in humans
Capacity
building
Protecting high-risk groups
Risk Communication,
Monitoring
Information and Public
and Evaluation
Awareness
Restructuring the poultry
Strengthening Supporting
industry system
Laws
Picture 2. Interrelationship between Avian Influenza control strategies
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5.
Details of Strategy
5.1. Strategy 1 : Highly Pathogenic Avian Influenza (HPAI) Control in Animals
Goal:
Decreasing cases of animal death and preventing the spread of AI to a wider area
Target:
1. Maintaining AI-free areas
2. Freeing AI in sector 1 and 2 of the poultry industry by the end of 2008
3. Reducing AI in sector 3 and 4 of the poultry industry by the end of 2008
4. Preventing the spread of AI to animals other than birds
Main Activities :
1. Stamping out in newly infected areas
2. Increasing bio-security
3. Increasing quarantine control of Highly Pathogenic Avian Influenza
4. (HPAI) medium traffic and tracing back
5. Provision of vaccine and increasing vaccination coverage of animals, especially
at sectors 3 and 4
5.2. Strategy 2: Management of Human Cases of AI
Goals:
1. Prompt and accuracy of disease diagnosis
2. Managing cases according to standards
Target:
1. Detection of AI within 3 days at the latest in 9 regional laboratories and 1 national
reference laboratory
2. All cases are handled in accordance with service standards
3. Decreasing death from bird flu
Main Activities
1. Provision of antiviral medicine
2. Reference of cases
3. Provision of facilities and infrastructure for case handling in hospitals
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4. Formulating Standard Operating Procedures (SOP) for managing cases
5. Training healthcare workers
5.3. Strategy 3: Protection of High-Risk Groups
Goal:
Protecting high-risk groups from AI infection
Target:
The protection of high-risk groups from AI infection, they are:
1. Animal farmers and farm workers, and poultry merchants
2.
Animal health care, medical workers, paramedics and animal quarantine
personell
3. Medical and paramedical workers in hospitals and labs
4. Owners of pet birds and communities around animal-farms
5. Closed contact person with AI patient
Main Activities:
1. Provision of personal protection equipment (PPE) to workers at animal farms,
hospitals and laboratories
2. Improving sanitation in farm areas, poltry market and poultry slaughter house
3. Increasing ways of living healthily with birds
5.4. Strategy 4: Epidemiological Surveillance on Animals and Humans
Goals:
1. Developing an AI surveillance and early warning system for humans and
animals
2. Strengthening surveillance capacity at all health service facilities
3. Preparing surveillance in case of a pandemic
4. Knowing disease epidemiology and dynamics
5. Establishing disease zoning
Target:
1. Establishment of an integrated AI surveillance system for humans and animals
by the end of 2006 at the latest
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2. Identification of pandemic risk factors and the quick dissemination of
information
3. Availability of sufficient resources (labor, facilities, infrastructure, funds) to
conduct surveillance at all levels by the end of 2008
4. Development of a pandemic surveillance system by the end of 2007
5. Availability of an AI disease map and virus mutation data
Main Activities:
1.
Formulation and implementation of an integrated surveillance system including
surveillance of high-risk groups
2.
Formulation and implementation of an early warning system (EWS)
3.
Provision of surveillance facilities and infrastructure
4.
Increasing quantity and quality of surveillance human resources
5.
Formulating a pandemic surveillance system
6.
Post-vaccination monitoring
7.
Surveillance on potential AI reservoir
8.
Conducting molecular epidemiological surveillance on animals and humans
9.
Monitoring homologous/ heterogous vaccine effectiveness on farm animals by
using the sentinel birds/ DIVA method
10. Formulation and implementation of an AI control and HPI preparedness system
with an integrated database using Geographical Information System Technology
11. Developing intergrated information system for animal health surveillance
5.5. Strategy 5: Restructuring the Poultry Industry System
Goal:
Improving the poultry industry structure and system
Target:
Improving the structure and system for raising local poultry, angonan ducks, and pet
birds, by the end of 2008
Main Activities:
1. Evaluation of the poultry farming system
2. Formulate regulation reorganizing the poultry farming system including poultry
laughter houses and poultry markets
3. Implementating formulated poultry farming system
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5.6. Strategy 6: Risk Communication, Information and Public Awareness
Goals:
1. Disseminating knowledge about AI to the community and health personell
2. Empowering communities to actively participate in surveillance and network
development in AI control, especially small- and middle-scale animal farmers
3. Formulating risk comunnication stretegic including advocation to dicision marker on
AI control
4. Advocating policy-makers to control AI
5. Developing Indonesia’s image in the international community on the efforts that have
been done
Target:
1. Increased community knowledge and awareness on AI
2. Establishment of a community network for conducting disease surveillance and
prevention in every village, sub-district, and district
3. Establishment of small- and medium-scale farmers organization in each province
4. Increasing publication and communication on AI through printed and electronic
media during ordinary and extraordinary events
Main Activities:
1. Establishment of an organization for small- and mid-scale animal farmers
2. Development of public communication to disseminate methods of bird flu prevention
and control
3. Counseling and training the community on the surveillance and prevention of bird flu
4. Public awareness campaign, training, and education for health personell
5. Maintaining a positive environment for special groups (legislators, students,
educators, NGOs, poultry community, community leaders, medical/veterinary,
merchant and animal farmer communities)
5.7. Strategy 7: Strengthening Supporting Laws
Goals:
1. Strengthening laws on AI control
2. Developing Veterinary Authorities in related institutions
3. Strengthening institutions in the field of animal farming and animal health in every
province and district/city
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4. Strengthening institutional health service in protecting against AI
Target:
1. Revision of Law 6/1967 on Animal Farming and Health by the end of 2006
2. Establishment of Government Regulations on Zoological Disease Control, including
AI, by the end of 2007
3. Establishment of departmental relationship system between the center and areas,
including the private sector and the community, in AI control
4. Establishment of animal farming and health agencies/sub agencies in certain
districts/cities
Main Activities:
1. Finalization of Law no 6/1967
2. Formulating Government Regulations on Zoonotic disease Control, including AI
3. Developing standard and accreditation for hospitals and referral labs
4. Formulating rules and rugulation on local livestock services
5.8. Strategy 8: Capacity Building
Goals:
1. Improving national system for AI control
2. Institutional strengthening on veterinary and animal quarantine services
3. Strengthening riset institutes
4. Increasing AI diagnosis laboratory capacity
5. Increasing hospital capacity
6. Increasing field veterinary services capacity
7. Strengthening of biological products, assay and sertification institutions
Target:
1. Establishment and functioning of an AI control system by 2006
2. Establishment and functioning of a quick response team at the center and areas in
2006
3. Establishment of a Bio Safety Level 3 (BSL 3) laboratory for animals and humans in
2006
4. Functioning of 8 regional laboratories for humans and 7 animal health labs, and the
addition of 2 new type A animal health labs and 33 animal labs type B
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5. Functioning of animal quarantine laboratories in 40 technical execution units (TEUs)
in 2008
6. Increasing promotion of biological product and sertification animal drugs
7. Establishment of laboratory network for animals and humans in 2006
8. Phased establishment and functioning of animal health posts in AI infected areas by
2008
9. Functioning of 44 reference hospitals in 2006
10. Placement of 1500 veterinary field workers by a contract system in 2008
Main Activities:
1. Establishment of expert panel and institution for integrated AI control
2. Increasing capacity of veterinary authority
3. Establishment of an integrated surveillance team at the center and areas
4. Establishment and functioning of a BSL 3 lab for animals and humans
5. Provision of equipment of regional and national reference laboratories, including
human resources
6. Building 2 animal health laboratories of type-A
7. Provision of equipment of existing 7 type-A animal health laboratories
8. Provision of equipment of existing 33 type-B animal health laboratories
9. Improving facilities and infrastructue of the Research Institute
10. Improving facilities and infrastructure of Pusetma
11. Improving facilities and infrastructure of BBMSOH
12. Provision of facilities and infrastructure, including human resources of animal
quarantine laboratories
13. Regular meeting and intensive communication among laboratories
14. Development of animal health posts and provision of equipment and human resource at
animal health post and type-C laboratories
15. Recruitment of veterinary field workers
16. Training for veterinarian, quarantine personnel and researcher
17. Acreditation of veterinary laboratories
18. Strengthening the function of Community Health Centers (Puskesmas) in surveillance,
socialization, case discovery and AI reference system
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5.9. Strategy 9: Action Research
Goals:
1. Increase the effectivity of AI vaccine and vaccination
2. Conducting AI vaccine research and development
3. Developing specific and sensitive diagnostic kits
4. Recognizing epidemiology of AI virus
5. Developing diagnostic method and AI reagents
Target:
1. Indentified of AI virus strain for human by the end of 2008
2. Indentified of AI virus strain for animal by the end of 2008
3. Availability of accurate diagnostic criteria by 2006
4. Fast and accurate diagnostic kits by the end of 2007
5. Identification of AI vaccine candidates by the end of 2008
Main Activities:
1. Conducting epidemiological research, genotyping, and diagnose
2. Development and testing of human vaccine
3. Antigen development
4. Development of bird flu research lab network model
5. Conducting research on effectiveness of vaccine and vaccination program
6. Research and development of diagnostic reagents and kits
7. Research and development of bird vaccine
5.10. Monitoring and Evaluation
Goal:
Monitor and evaluate the progress and the impact and indentify problems
Target:
Formulation of regular AI monitoring and evaluation reports (monthly, quarterly,
biannually, and annually) and the existence of functional feedback for the
improvement of the system/implementation
Main Activities:
1. Formulation of AI protection monitoring and evaluation plan
2. Monitoring, evaluation and regular reporting on AI control development
3. Coordination and feedback
Avian Influenza Control Strategy Matrix (See Appendix 1)
21
PART III
NATIONAL HUMAN PANDEMIC INFLUENZA PREPAREDNESS STRATEGY
1. Goals
1.1 General Goal
The Human pandemic influenza Preparedness Strategy is a coordinated national
response, effective at all administration levels, to face human pandemic influenza, through
prevention and control activities to reduce pain, death, and socio-economic impacts.
1.2 Specific
Goals
1. Reducing viral infections and the possibility of infection in humans.
2. Strengthening early warning surveillance for an early coordinated response to
extraordinary events.
3. Breaking the influenza virus’s chain of infection and spread.
4. Reducing the impact of a pandemic on pain and death, as well as minimizing the
socio-economic impact (social chaos).
5. Monitoring and evaluating response that is currently and has already been done
towards the pandemic.
This plan covers:
1. Ensuring quick, timely, and coordinated response to a pandemic, including the latest
information from authorities for professional health workers, the general public and the
media at all stages.
2. Specializing the roles and responsibilities of the Health Department and other sectors,
local health workers, community health providers and community organizations,
professionals etc.
3. Reducing pain and death from influenza, both during pandemics and inter-pandemic
periods.
4. Ensuring essential services function well during a pandemic.
5. Minimizing possible social chaos and economic loss from human pandemic influenza.
6. Providing counseling for local health authorities to firm up local human pandemic
influenza plans.
22
7. Strengthening facilities for surveillance, case management, lab capacity and response to
influenza and other infectious diseases.
8. Strengthening multidiscipline response to main extraordinary events that cause social
chaos.
9. Helping the response to the media and other communication requests.
10. Strengthening communication systems including networks and perfecting community
communication and alertness services.
11. Increase improvement fundraising and resource mobilization.
12. Investigating all laws and regulations needed in each phase.
13. Strengthening regional and international cooperation.
14. Modernizing scientific and technological capacity related to human pandemic influenza.
15. Building medical company capabilities and capacities to produce medicines and
vaccines to fight pandemic “strains”.
16. Strengthening supply logistics and capacity.
2. Target
1. Maintaining bird flu-free areas and freeing infected areas as well as preventing
transmission to other livestock.
2. Strengthening integrated surveillance, including early warning on a community basis in
every village, on a lab-basis by developing one national reference lab and 8 or 10
regional labs around Indonesia.
3. Strengthening and developing capacity from 44 to 100 reference hospitals.
4. Preparing the availability of trained workers in controlling human pandemic influenzas.
5. Developing anti-viral medicine and vaccine stockpiling or production capacity.
6. Conducting a national bird flu prevention and control campaign and preparing the
community to face human pandemic influenza to avoid panic.
3. Strategy
1. Strengthening sustainable management (planning, activating, organizing, coordinating,
monitoring and evaluating).
2. Strengthening surveillance on animals and humans (including early warning,
investigation and control actions).
3. Prevention and Control (high-risk protection, vaccination, bio-security, etc).
23
4. Strengthening health service response capacity (availability of medicines, medical tools,
vaccines, labs, human resources, case management, etc).
5. Communication, Information and Education (Risk communication).
4. Interrelationship among Strategies
Strengthening
Surveillance
Strengthening
on Animals
Strengthening
Health Service
and Humans
Sustainable
Response
COMMUNITY
Management
Capacity
Prevention
and Control
Communication, Information, and Education (Risk Communication)
Picture 3.Relationship between Human pandemic influenza Preparedness Strategies
5. Strategy Details
5.1. Strengthening Sustainable Management
Goals:
1. Developing integrated bird flu control and human pandemic influenza
preparedness management systems and mechanisms.
2. Mobilization of resources from various domestic and international sources.
Target:
Establishment of an integrated, effective, and efficient management for bird flu control
and human pandemic influenza preparedness
Main Activitiess:
1. Formulation of a framework for conducting bird flu control and human pandemic
influenza preparedness, including preparing guidelines and policies.
24
2. Assessment of preparedness status and identification of necessary actions
ASAP.
3. Establishment of a National Human pandemic influenza Committee (NIPC) and
Command Post (CP) along with their mechanisms.
4. Monitoring and evaluation of national contingency plan implementation.
5. Coordination with neighboring countries, the region and international bodies for
information sharing and emergency response net working.
6. Planning post-pandemic reconstruction, in the event of a pandemic.
5.2. Strengthening Surveillance on Animals and Humans
Goals:
1. Strengthening comprehensive surveillance and early warning systems including
the role of laboratories.
2. Firming up epidemiological investigation (extraordinary events response team)
and contact management.
3. Increasing surveillance of Influenza Like Illnesses (ILI) with a focus on bird flu
and during influenza pandemics
Target
1. Strengthening integrated surveillance, including community based early warning
in every village, and laboratory based surveillance by developing one national
reference laboratories (BSL-3) and 8 or 10 regional laboratories around Indonesia.
2. Strengthening animal health institutions such as labs at the center and areas to
support surveillance and early warning.
Main Activitiess
1. Implementing clinical surveillance systems of Influenza like Illnesses (ILI) and
AI, covering: a) Surveillance guidelines; b) Sentinel-hospital based
surveillance; c) Laboratory based surveillance; d) Rumor verification
surveillance; e) Community based surveillance; f) Animal Influenza
surveillance.
2. Conducting epidemiological and viral (molecular) studies on new influenza
virus subtypes with pandemic potential.
3. Establishing a national and international reference lab network.
25
4. Conduction investigation and response to bird flu control and human pandemic
influenzas.
5. Monitoring the development of resistance to anti-viral medicine.
6. Disseminating information to leaders and related sectors including the WHO
and other international institutions for decision-making and action.
5.3. Prevention and Control
Goals:
1. Preventing infection and breaking the chain of AI and HPI transmission as soon as
possible (ASAP).
2. Conduction AI and HPI control actions in infected areas.
3. Providing and developing the production of antiviral medicines and vaccines from
Indonesian virus seeds.
Target:
1. Maintaining AI-free areas and freeing infected areas as well as preventing the
infection of other livestock.
2. Developing anti-viral medicine and vaccine stockpiling and production capacity.
Main Activitiess:
1. Protection of high-risk groups.
2. Increasing bio-security in areas with a high risk of AI infection and/or influenza
pandemic.
3. Strengthening the monitoring of poultry and poultry product traffic as well as
human traffic.
4. Providing antiviral medicine and bird flu vaccines for AI and HPI (new subtype
strains)
5. Developing the capacity to domestically produce antiviral medicines and
vaccines for AI and HPI (new influenza viral-subtypes)
6. Action research on the management of animal AI cases and human pandemic
influenza.
26
5.4. Strengthening Health Service Response Capacity
Goals:
1. Improved human and animal health service systems at the center and areas in
protecting against AI and HPI.
2. Increased capacity (HR, tools and methods) of appointed reference hospitals and
other health facilities.
Target:
1. Strengthening and developing capacity from 44 to 100 reference hospitals.
2. Preparing trained worker capacity in controlling AI and HPI.
3. Equipping facilities and infrastructure including human resources at animal
quarantine laboratories.
Main Activitiess:
1. Improving capacity of animal health services
2. Development of AI and HPI case management, including the prevention of
nosocomial infection.
3. Provision of reagents, diagnostic tests, tools, isolation/ICU rooms, and other
medical and diagnostic supports.
4. Health Services and References in Hospitals
5. Training Healthcare and Animal Healthcare workers.
5.5 Communication, Information and Education
Goals:
1. Provision of risk information, education, and communication to all layers of the
community so that they are alert and they don’t panic when dealing with
extraordinary bird flu events and the possibility of human pandemic influenza
occurring.
2. Raised risk communication capabilities of PR technician, councilors, mass and
electronic media.
27
Target:
1. Raised community knowledge in anticipating extraordinary bird flu events and the
preparedness for the possibility of human pandemic influenza occurring.
2. A national campaign on the prevention and control of bird flu and preparing for
the possibility of human pandemic influenza.
Main Activities:
1. Formulation of risk communication strategy.
2. Establishment of a National Information Center (NIC).
3. Establishment of communication, information and education (CIE) media: print
and electronic.
4. Establishment of a communication network among all partners and
international institutions (WHO, FAO, OIE, etc.).
5. Mass public communication (general public).
6. Communication and Information to high-risk and strategic groups.
5. 6. Human pandemic influenza Contingency Plan
Basis for consideration:
There are still many unknowns pertaining to a possible human pandemic influenza but
such a pandemic must be anticipated in order to reduce its impact. Indonesia may be
hit by a pandemic, weather in a limited or wide area.
Goals:
1. To maintain preparedness
2. To conduct responses according to the size of the human pandemic influenza
challenge.
Strategy:
1. Maintaining preparedness (If Indonesia is not hit)
2. Establishing the size of the infected area (If Indonesia is hit):
Scenario 1 : limited to the village / kelurahan level in a limited number of
provinces
28
Scenario 2 : limited to the sub-district level in a limited number of provinces
Scenario 3 : limited to the district level in a limited number of provinces
Scenario 4 : epidemic/outbreak on a national scale
3. Response to:
Scenario 1 : Especially by isolation (Outbreak Law), if there are antiviral
medicines (tamiflu) 80 % of the population is treated.
Scenario 2 : Conduct an investigation and extraordinary event response
Scenario 3 : Declare an outbreak/epidemic and establish law enforcement
(Outbreak Law). Central government mobilizes funds and forces to
prevent spread of outbreak and reduce its impact.
Scenario 4 : National Scale Epidemic. Mobilization of national forces and
resources including funds and reserve forces (volunteers, etc.) as
and if ordered by the President as the Commander-in-Chief so long
as the emergency lasts in Indonesia.
4. Analyzing the epidemiological situation and responding according to continually
changing situations.
Human pandemic influenza Preparedness Strategy Matrix (See Appendix 2)
Human pandemic influenza Contingency Plan (See Appendix 3)
29
PART IV ORGANIZATION
By nature, AI is a disease that can easily cross national borders. It can easily spread from
island to island, and spread even more easily within a single island. Consequently, all
stakeholders in the fields of health and animal farming, under the coordination of the local
governments must: a). Establish transparency in their respective areas, and b). Quickly act in
accordance to the National Strategic Plan, by mobilizing all elements in their respective areas
as well as by seeking support from other sources. The isolation of one area only is not
sufficient for prevention of AI spread. Instead, it results in uncontrolled development that will
eventually create financial and socio-economic impacts on a greater numbers of human
victims. Therefore the concerted effort of all stakeholders in all areas under the coordination of
the local government is a necessity.
In relation to that, with the current momentum for AI control, veterinary services and
human health system must be revitalized and strengthened completely and comprehensively. In
this regard the Department of Agriculture and the Department of Health are technically
responsible for the management and implementation, and - together with the Heads local of
Governments - make functional both of these systems in all areas of the Republic of Indonesia.
With the functioning of these two systems, monitoring the community, early detection and
response can be done. Moreover, with the support of various institutions and related parties as
spelled out in detail in strategies, control of the bird flu problem can be conducted.
The challenge faced in the implementation of the National Strategic Plan in this
decentralization era is that the role of Local Government Heads in the application of this
Strategic Plan in each autonomous area is very big. Responsibility, cooperation and
togetherness in the implementation in each area and territory are the key to success in
achieving the goals of this Strategic Plan. For that, Local Government Heads are the ones
mainly responsible for the implementation of the Strategic Plan in their respective areas and
territories. Because of the number of stakeholders/parties involved, there needs to be a clear
chain of command, especially in urgent and emergency situations. A command system such as
this is already arranged in Law no. 4/1984 on Outbreaks and Law no. 40/1991 on Infectious
Diseases Control. In local level, a command system is arranged at the Governor and District
Head levels.
30
In responding and containing Avian Influenza planned in the National Strategy, two
committees are needed to be established:
o National Committee on Avian Influenza Control. This committee is responsible for
coordinating the implementation of National Strategic Plan on AI Control and Influenza
Pandemic Preparedness at national and local level. The committee is responsible directly
to the President. The committee also serves as the country’s focal point for effort of AI
control at national, regional and global level.
o National Task Force or Committee for Influenza Pandemic Control. This committee is
responsible for coordination of implementation of Pandemic Influenza Contingency Plan.
This committee will be established provided the AI phase has moved to pandemic
influenza (Phase 6 referring to WHO pandemic staging).
Both these two committee will not be established concurrently, since the second
committee will be functional only if the pandemic influenza phase occurs.
A.
National Committee on Avian Influenza Control
The committee is chaired by Coordinating Minister of Social Welfare who has direct
administrative responsibility to the President of republic of Indonesia. In his activities, the
chairman will be assisted by Chief Operational Officer and a Committee of Communication
and Public Information. For administration, the chairman will be assisted by a Secretariat and
Divisions of Planning, Budgeting and International Cooperation. There are also 4 groups that
are focus on Research and development, AI Animal Control in, AI in Human Control, and
Vaccine and Anti Viral. A group of experts from academics and professional association will
also assist the chairman.
31
The structure of National Committee on Avian Influenza Control
Chairman
Expert Group
Operation Officer
Secretariat
Communication
& Public
Information
Planning
Budgeting
International
Group
Cooperation
Research and
AI in Animal
AI in Human
Vaccine and
Development
Control Group
Control Group
Anti Viral
Group
Group
Provincial AI Control Committee
District AI Control Committee
B.
National Task Force or Committee for Influenza Pandemic Control
In the case of emergency, that is if the pandemic influenza taking place, the mechanism
of command is coming directly from the President of Republic of Indonesia, and subsequently
from the Governors and Bupatis/Mayors at Provincial and District Level, respectively. At
national level, the Committee will be chaired by the Coordinating Minister of Social Welfare
and involving related ministries especially Minister of health and Minister of Agriculture. In
the meanwhile, respected ministerial roles have been prescribed in the Contingency Plan.
32
The Structure of National Task Force / Committee on Influenza Pandemic Control
National Task Force
PRESIDENT
Provincial Task
Force
GOVERNOR
City/District Task
District Head/
Force
Mayor
33
PART V. CLOSING
This National Strategic Plan is formulated comprehensively by integrating simultaneous
and sustainable animal and human healthcare aspects. The National Strategic Plan covers 2
things: (1) National Avian Influenza Control Strategy, and (2) National Human pandemic
influenza Preparedness Strategy. The AI Control Strategy is aimed at eliminating bird flu at its
source - that is in animals - and increasing healthcare in humans, especially those at high risk.
The National Human pandemic influenza Preparedness Strategy is aimed at preparing
mechanisms, actors, instruments and resources to prevent and anticipate human pandemic
influenza, and therefore the formulated national policies and plans are for anticipating
readiness of an event that hopefully will never happen.
Participation and togetherness of all components of society in controlling bird flu and
preparing for human pandemic influenza need to be increased. The government is clearly not
the only one responsible for controlling bird flu, because all components of society have roles
and function which are equally important. In the decentralization era, the role of local
governments as the main implementers of this national strategy in their respective areas is the
key to success.
In accordance with the complexity of the problem faced, the success of this National
Strategic Plan needs comprehensive technical and operational cooperation, both horizontally at
all levels of government and other stakeholders, as well as vertically with the active
participation of the whole society as explained in Part IV Coordination. With the cooperation
and responsibility of all parties and the firmness of local government decision-makers, this
Strategic Plan can be conducted to protect the Republic of Indonesia from the bird flu as well
as preventing human pandemic influenza.
34
GLOSSARY
Avian Influenza
: Shortened to AI, often called avian flu, bird flu or flu burung, can
infect quickly, and can cause mortality in poultry of up to 100%.
This disease is caused by influenza type-A virus, sub type H5 and
H7. All poultry such as chickens, ducks, turkeys, pigeons and wild
birds can be infected although AI often attacks chickens and turkeys.
Bio-safety Level (BSL 3): A level considered sufficient to prevent the transmission of an agent
through the respiratory system, causing a serious infection. BSL-3
Laboratories are laboratories that fulfill international requirements in
laboratory safety measures for examining live bacteria or viruses to
ensure the safety of humans and the environment
Bio-security
: All actions that form a first line of defense against outbreaks and are
done to prevent the possibility of contact/infection from infected
entities and the spread of disease.
Confirmed case
: Someone showing the symptoms of bird flu, that is someone with
respiratory difficulties, fever (>38oC), cough and/or sore throat or
runny nose, supported by a laboratory check: positive H5N1
influenza virus culture, positive influenza (H5) PCR, or an increase
in H5 antibodies of 4 times normal
Culling
: The extermination of animals infected with AI virus by butchering or
burning.
Depopulation :
Or
selective
extermination, is acting to reduce the poultry population,
which is the source of infections. This step is done at all infected
farms which are established through clinical and pathological
anatomic diagnosis on all poultry infected as well as on healthy
poultry which share their living space.
Epidemiology
: The study of distribution, determinants and frequency of disease
(including other events related to health) in populations
FAO
: Food and Agriculture Organization
Bird Flu/Flu Burung
: Term often used for Avian Influenza (see Avian Influenza definition)
35
H5N1
: A type-A influenza virus subtype/strain that in 1997 jumped from
chickens to humans.
ILI :
Influenza like illness are diseases that have symptoms similar to
influenza that is fever, cough, cold, sore throat, headaches and
muscle pains.
Nosocomial Infection : Infection from bacteria or virus in hospitals, disease infection from
patients treated in hospitals to other patients or hospital employees.
Extraordinary Event
: The appearance or increase of occurrences of pain/death that means
that affects an area or group of society during a certain time, and is
an event that could lead to the occurrence of an outbreak.
High-Risk Group
: Group of citizens defined according to their collective exposure
which epidemiologically indicated an increasing risk of infection of a
disease. In the case of bird flu, high-risk groups are animal farmers,
animal-farm workers, poultry merchants, medical staffs and
paramedics of animal healthcare, hospitals, labs and other medical
facilities; owners of pet birds and communities near poultry farms.
Risk Communication : Communication activities specialized for socializing various risks
associated with Bird Flu and the possibility of human pandemic
influenza in the future so that communities will be alert and won’t
panic.
Type-A Health Laboratories: Regional animal laboratories whose function is conducting
investigations on animal diseases, which at this time are named Balai
Penyidikan Penyakit Veteriner Regional (BPPVR) (Regional
Veterinary Disease Investigation Hall). The number of BPPVR at
this time is 7 labs, located in Medan, West Sumatera, Lampung,
Yogyakarta, Sulawesi Selatan, Denpasar, and South Kalimantan.
OIE
: Office International des Epizooties (World Animal Health
Organization) is an intergovernmental body on animal health that
was established in 1924 and whose members now number 167
countries
Human pandemic influenza (HPI)
: A condition where influenza is prevalent in several
countries in the world.
36
PPE :
Personnel Protection Equipment, equipment that must be worn by
high-risk groups such as health workers, laboratory staff, those who
regularly contact poultry/birds and animal-farm workers to prevent
bird flu infection.
Poskeswan
: Pos Kesehatan Hewan (Animal Health Post) is an animal healthcare
service institution at the field level located in sub-districts. This
institution’s function is to provide animal health services and
artificial insemination.
Genetic Re-assortment : An event whereby there occurs a mixing of influenza genes in animal
and humans which creates a new virus subtype
Reservoir animals
: Non-poultry animals which can be a source of AI virus development.
Poultry Industry System Sector 1, 2, 3 and 4: The poultry farming system is divided into 4
sector categories based on type of business and bio-security level.
Sector 1 is a comprehensive poultry system. This poultry industry
group implements high-level bio-security and its products are
commercially sold in urban areas or exported. Sector 2 is poultry
business groups that enter the commercial poultry production system
and implements mid- to high-level bio-security systems. Products are
sold in urban and rural areas. Sector 3 is the group of poultry farm
businesses which are almost identical to sector 2 but with low-level
bio-security systems. Sector 4 is the group of poultry farms which
still use the backyard system and lack bio-security systems. This
type of poultry business is centered in rural village areas and is often
a side-business for extra income or self consumption.
Single farm system
: System of farm business that raises one type of livestock (un-mixed
farming), for example poultry that is not mixed with a pig farm in
one farming location/area.
Stamping out
: Extermination of all poultry/animals suspected of (potentially) being
infected by AI in newly AI-infected areas
Strain
: A group in one species or type. For example the influenza strain that
has been circulating lately are type-A (H1N1), type-A (H3N2), and
type B (H3N2)
37
Stockpiling
: Provision of medicine in large numbers to anticipate the possibility
of a pandemic occurring
Surveillance
: Activities to establish the source of infection in a newly-infected
area, its spread, disease zoning and virus behavior dynamics
Epidemiological Surveillance: Systematic and continuous analysis of a disease or health
problem and conditions that affect the occurrence, increase and
spread of said disease or health problem, so that effective and
efficient actions for handling it can be undertaken, through the
process of collecting data, processing and spreading epidemiological
information to health providers.
Sentinel Poultry
: Healthy poultry that are not AI-vaccinated and placed in a vaccinated
group/flock/stable/village of poultry in infected areas
Outbreak
: The spread of an infectious disease that occurs in relatively large
numbers with the number of victims increasing at a rate greater than
normal in a certain time and place that can also cause disaster
WHO
: World Health Organization
Disease Zoning
: Classifying areas into free areas, threatened areas and infected areas.
Free areas are provinces or island areas that have not been infected
by or areas where the existence of avian influenza has not been
reported. Threatened areas are areas without reported cases, but with
a direct land border with infected areas without natural barriers in
between and which also import poultry production facilities from
those infected areas. Infected areas are areas with avian influenza
cases that have been diagnosed clinically, anatomical pathologically,
epidemiologically and confirmed by laboratories.
38
APPENDIX 1
NATIONAL AVIAN INFLUENZA CONTROL STRATEGY MATRIX
Strategy 1: Highly Pathogenic Avian Influenza (HPAI) Control in Animals
Goal:
Decreasing cases of animal death and preventing the spread of AI to a wider area
Target:
1. Maintaining AI-free areas
2. Freeing AI in sector 1 and 2 of the poultry industry by the end of 2008
3. Reducing AI in sector 3 and 4 of the poultry industry by the end of 2008
4. Preventing the spread of AI to animals other than birds
Institution
Cost (Rp. billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2007
2008
Conducting selective depopulation of
Proportion of animals
Deptan
255 516.7 802.2
infected areas and emergency vacination
depopulated
Stamping out in newly infected areas
Number of animals stamped out
Deptan
135.5
191.6
304.4
Implementation of bio-security
Increasing bio-security
Deptan 5.0 6.4 7.8
SOP
Increasing quarantine control of Highly
Monitoring of HPAI carrier
Pathogenic Avian Influenza
Deptan 25.6 30 35
medium
(HPAI) medium traffic and tracing back
Provision of vaccine and increasing
vaccination coverage of animals,
Protection of the population at
Deptan 225.6
355.1
438.8
especially at sectors 3 and 4
risk
TOTAL
646.7
1099.8
1588.2
40
Strategy 2: Management of Human Cases of AI
Goals:
1. Prompt and accuracy of disease diagnosis
2. Managing cases according to standards
Target:
1. Detection of AI within 3 days at the latest in 9 regional laboratories and 1 national reference laboratory
2. All cases are handled in accordance with service standards
3. Decreasing death from bird flu
Institution
Cost (Rp billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2007
2008
Provision of antiviral medicine
Availability of antiviral medicine
Depkes
40
40
40
Reference of cases
Carrying out of reference
Depkes
6.75
9
11.25
Provision of facilities and infrastructure
44 AI infectious disease
Depkes 221.15
280.82
0.82
for case handling in hospitals
reference hospitals
Availability of case management
Formulating Standard Operating
SOP in all hospitals and
Procedures (SOP) for managing cases
Depkes 5 - -
community health centers
(puskesmas)
The training of medical workers
Training healthcare workers
and paramedics at 44 regional
Depkes 86.39
0.315
82.915
and refererral hospitals and labs
TOTAL
359.29 330.135 134.985
Notes: 9 regional laboratory : (1) North Sumatera University; (2) Provincial Health Laboratory : Palembang, Surabaya, Bandung; (3) Human Virology and
Cancer Biology Institute, University of Indonesia; (4) Micorbiology Laboratory University of Diponegoro; (5) Microbiology Laboratory University of
Hasanuddin, Makasar, South Sulawesi and ; (6) Microbiology Laboratory University of Udayana, Bali
41
Strategy 3: Protection of High-Risk Groups
Goal:
Protecting high-risk groups from AI infection
Target:
The protection of high-risk groups from AI infection, they are:
1. Animal farmers and farm workers, and poultry merchants
2. Animal health care, medical workers, paramedics and animal quarantine personell
3. Medical and paramedical workers in hospitals and labs
4. Owners of pet birds and communities around animal-farms
5. Closed contact person with AI patient
Institution
Cost (Rp. billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2007
2008
Provision of personal protection
Use of personal protection
Depkes,
equipment (PPE) to workers at animal
0.7 0.8 0.8
equipment by all workers
Deptan
farms, hospitals and laboratories
Improving sanitation in farm areas,
Depkes,
Maintenance of sanitation
poltry market and poultry slaughter
Deptan,
5.6 6.5 7.5
facilities at farms
house
Pemda
Increasing ways of living healthily
Depkes,
Increase of clean living behavior
15.6
15.1 20.7
with birds
Deptan
TOTAL
21.9
22.4
29.1
42
Strategy 4: Epidemiological Surveillance on Animals and Humans
Goals:
1. Developing an AI surveillance and early warning system for humans and animals
2. Strengthening surveillance capacity at all health service facilities
3. Preparing surveillance in case of a pandemic
4. Knowing disease epidemiology and dynamics
5. Establishing disease zoning
Target:
1. Establishment of an integrated AI surveillance system for humans and animals by the end of 2006 at the latest
2. Identification of pandemic risk factors and the quick dissemination of information
3. Availability of sufficient resources (labor, facilities, infrastructure, funds) to conduct surveillance at all levels by the end of
2008
4. Development of a pandemic surveillance system by the end of 2007
5. Availability of an AI disease map and virus mutation data
Institution
Cost (Rp billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2008
2009
Formulation and implementation of an
Availability and implementation of
Deptan,
184.08
48.96 19.21
integrated surveillance system
an integrated surveillance system
depkes
including surveillance of high-risk
groups
Formulation and implementation of an
Availability and implementation of
Deptan,
69.86 64.76 31.41
early warning system (EWS)
an EWS
depkes
43
Strategy 4: Epidemiological Surveillance on Animals and Humans… (Continued)
Institution
Cost (Rp. billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2008
2009
Provision of surveillance facilities and
Availability of surveillance facilities
Deptan,
29.6 31.1 35.4
infrastructure
and infrastructure
depkes
Availability of a minimum of 1
Increasing quantity and quality of
Deptan,
surveillance worker each for humans
26.9 27.7 27
surveillance human resources
Depkes
and animals in every sub-district
Formulating a pandemic surveillance
The formulation a pandemic
Deptan,
6.64 6.56 6.54
system
surveillance system
Depkes
Post-vaccination monitoring
Knowing vaccine
protectiveness
Deptan 2.8 3.3 3.8
Surveillance on potential AI reservoir
Knowing AI reservoir animals
Deptan
1.0
1.2
1.3
Conducting molecular epidemiological
Knowing AI virus serotypes and
Deptan,
12.0 8.9 9.9
surveillance on animals and humans
genotypes
Depkes
Monitoring homologous/ heterogous
vaccine effectiveness on farm animals
Knowing the existence of the AI
Deptan 0.1 0.1 0.1
by using the sentinel birds/ DIVA
virus in the area
method
Formulation and implementation of an
Availability of a Geographical
AI control and HPI preparedness
information system that can monitor
Bakosurtana
system with an integrated database
15 10 10
the spread of AI and the possibility
l
using Geographical Information
of HPI to overcome AI and HPI
System Technology
Developing intergrated information
Function comprehensive information
Deptan 5.6 2.2 2.5
system for animal health surveillance
system of animal health surveillance
TOTAL
353.58 204.78 147.16
44
Strategy 5: Restructuring the Poultry Industry System
Goal:
Improving the poultry industry and management
Target:
Improving the structure and system for raising local poultry, angonan ducks, and pet birds, by the end of 2008
Institution
Cost (Rp. billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2008 2009
Evaluation of the poultry farming
Formulation of evaluation results
system
of the poultry farming system
Deptan 0.2
0.2
0.2
reformation
Formulate regulation reorganizing the
poultry farming system including
Establishment and socialization of
poultry laughter houses and poultry
Deptan 0.2
0.2
0.3
laws on the poultry farming system
markets
Implementating formulated poultry
Establishment of farm animal
Deptan 0.7
0.8
0.9
farming system
development areas
TOTAL
1.1
1.2
1.4
45
Strategy 6: Risk Communication, Information and Public Awareness
Goals:
1. Disseminating knowledge about AI to the community and health personell
2. Empowering communities to actively participate in surveillance and network development in AI control, especially small-
and middle-scale animal farmers
3. Formulating risk comunnication stretegic including advocation to dicision marker on AI control
4. Advocating policy-makers to control AI
5. Developing Indonesia’s image in the international community on the efforts that have been done
Target:
1. Increased community knowledge and awareness on AI
2. Establishment of a community network for conducting disease surveillance and prevention in every village, sub-district, and
district
3. Establishment of small- and medium-scale farmers organization in each province
4. Increasing publication and communication on AI through printed and electronic media during ordinary and extraordinary
events
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006
2007 2008
The number of organizations
Establishment of an organization for small-
for small- and mid-scale
Deptan 1.3
1.4
1.7
and mid-scale animal farmers
animal farmers
Development of public communication to
Kominfo,
Frequency of communications
disseminate methods of bird flu prevention
Deptan,
78.6 79.3 77.7
undertaken
and control
Depkes
The number of AI cases
Deptan,
Counseling and training the community on
discovered by the community
Depkes,
0.5 0.2 0.3
the surveillance and prevention of bird flu
and number of people trained
Kominfo
46
Deptan,
Public awareness campaign, training, and
The number of trained health
Depkes,
47,46
50,55
50,81
education for health personell
personell
Depdiknas
Maintaining a positive environment for
special groups (legislators, students,
Deptan,
Number of special groups
educators, NGOs, poultry community,
Depkes,
0.3 0.4 0.4
counseled
community leaders, medical/veterinary,
Kominfo
merchant and animal farmer communities)
TOTAL
128.16
131.85
130.91
47
Strategy 7: Strengthening Supporting Laws
Goals:
1. Strengthening laws on AI control
2. Developing Veterinary Authorities in related institutions
3. Strengthening institutions in the field of animal farming and animal health in every province and district/city
4. Strengthening institutional health service in protecting against AI
Target:
1. Revision of Law 6/1967 on Animal Farming and Health by the end of 2006
2. Establishment of Government Regulations on Zoological Disease Control, including AI, by the end of 2007
3. Establishment of departmental relationship system between the center and areas, including the private sector and the
community, in AI control
4. Establishment of animal farming and health agencies/sub agencies in certain districts/cities
Institution
Cost (Rp. billion)
Main Activities
Indicators of Accomplishment
Responsible
2006
2007 2008
Finalization of Law no 6/1967
Revised Law No.6/1967
Deptan
10
-
-
Formulation of Government
Formulating Government Regulations
Regulations on Zoonotic disease
Depkes,
on Zoonotic disease Control, including
0.2 - -
Control, including bird flu by the
Deptan
AI
end of 2007
Developing standard and accreditation
The number of accredited hospitals
Depkes 0.5
0.5
-
for hospitals and referral labs
and labs
Formulating rules and rugulation on
Formulation of local laws on
Deptan,
local livestock services
animal farming and animal health
0.3 - -
Pemda
agencies/sub agencies
Total
11
0.5
-
48
Strategy 8: Capacity Building
Goals:
1. Improving national system for AI control
2. Institutional strengthening on veterinary and animal quarantine services
3. Strengthening riset institutes
4. Increasing AI diagnosis laboratory capacity
5. Increasing hospital capacity
6. Increasing field veterinary services capacity
7. Strengthening of biological products, assay and sertification institutions
Target:
1. Establishment and functioning of an AI control system by 2006
2. Establishment and functioning of a quick response team at the center and areas in 2006
3. Establishment of a Bio Safety Level 3 (BSL 3) laboratory for animals and humans in 2006
4. Functioning of 8 regional laboratories for humans and 7 animal health labs, and the addition of 2 new type A animal health
labs and 33 animal labs type B
5. Functioning of animal quarantine laboratories in 40 technical execution units (TEUs) in 2008
6. Increasing promotion of biological product and sertification animal drugs
7. Establishment of laboratory network for animals and humans in 2006
8. Phased establishment and functioning of animal health posts in AI infected areas by 2008
9. Functioning of 44 reference hospitals in 2006
10. Placement of 1500 veterinary field workers by a contract system in 2008
49
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006 2007
2008
Functioning expert panel and
Establishment of expert panel and institution
integrated institution of AI
Deptan 2.2
2.5
2.9
for integrated AI control
control
Capacity and function of
Increasing capacity of veterinary authority
veterinary authorized
Deptan 0.5
0.6
0.7
institution
Establishment of an integrated surveillance
Functional integrated
Depkes,
1 1 1
team at the center and areas
surveillance
Deptan
Establishment and functioning of a BSL 3 lab
Functioning BSL 3 labs for
Depkes,
136.9
118.9 27.0
for animals and humans
animals and humans
Deptan
Provision of equipment of regional and
Functioning regional and
national reference laboratories, including
Depkes
1.69 1.44 1.44
national reference laboratories
human resources
Establishment of 2 new
Building 2 animal health laboratories of type-
animal health laboratories of
Deptan 100
0
-
A
type-A
Provision of equipment of existing 7 type-A
Functioning of 7 type-A
Deptan 32.0
36.8
42.3
animal health laboratories
animal health laboratories
Provision of equipment of existing 33 type-B
Functioning of 33 type-B
Deptan, Pemda
9
10,4
11,9
animal health laboratories
animal health laboratories
Improving facilities and infrastructue of the
Functioning of Research
Deptan 4.6
5.3
6.1
Research Institute
Institute
50
Improving facilities and infrastructure of
Improved facilities of Pusetma
Deptan
7.0
8.0
9.2
Pusetma
Improving facilities and infrastructure of
Improved facilities of
Deptan 3.1
3.6
4.1
BBMSOH
BBMSOH
Equipping facilities and infrastructure,
Functioning animal quarantine
including human resources of animal
Deptan 9.8
11.2
12.9
laboratories
quarantine laboratories
Regular meeting and intensive communication
Depkes,
Frequency of regular meetings
0.5 0.5 0.5
among laboratories
Deptan
Development of animal health posts and
Functioning animal health
provision of equipment and human resource at
Deptan 8.1
294,4
173,2
posts (poskeswan)
animal health post and type-C laboratories
Placement of contract system
Recruitment of veterinary field workers
Deptan 3.0
3.0
3.4
veterinary workers
Training for veterinarian, quarantine personnel
Improved capacity of
Deptan 5
5.8
6.6
and researcher
quarantine personnel
Number of veterinary lab
Acreditation of veterinary laboratories
Deptan 0.3
0.4
0.4
accredited
Strengthening the function of Community
Functioning community health
Health Centers (Puskesmas) in surveillance,
centers in case discovery and
Depkes 10
10
10
socialization, case discovery and AI reference
AI reference system
system
Total
334.69
209.04
128.54
51
Strategy 9: Action Research
Goals:
1. Increase the effectivity of AI vaccine and vaccination
2. Conducting AI vaccine research and development
3. Developing specific and sensitive diagnostic kits
4. Recognizing epidemiology of AI virus
5. Developing diagnostic method and AI reagents
Target:
1. Indentified of AI virus strain for human by the end of 2008
2. Indentified of AI virus strain for animal by the end of 2008
3. Availability of accurate diagnostic criteria by 2006
4. Fast and accurate diagnostic kits by the end of 2007
5. Identification of AI vaccine candidates by the end of 2008
Cost (Rp. billion)
Institution
Main Activities
Indicators of Accomplishment
Responsible
2006
2007
2008
Conducting epidemiological research,
Depkes,
Completion of 20 research projects
23.8 22.7
24.9
genotyping, and diagnose
Deptan
Development and testing of human vaccine
Indonesian vaccine candidate
Depkes
45 18,7
10,7
Availability of serological check
Antigen development
Depkes
2 2 2
antigen
Development of bird flu research lab
Development of 8 lab network
Depkes
10 10 10
network model
nodes
Conducting research on effectiveness of
Increased vaccine quality and
Deptan
0.5 0.2 0.2
vaccine and vaccination program
safety
52
Research and development of diagnostic
Production of diagnostic reagents
Deptan
0.2 0.2 0.2
reagents and kits
and kits
Research and development of bird vaccine
Identification of bird vaccine
Deptan
0.2
0.2
0.2
TOTAL
81.7 35.3 37.5
53
Strategy 10: Monitoring and Evaluation
Goal:
Monitor and evaluate the progress and the impact and indentify problems
Target:
Formulation of regular AI monitoring and evaluation reports (monthly, quarterly, biannually, and annually) and the existence
of functional feedback for the improvement of the system/implementation
Cost (Rp. billion)
Institution
Main Activities
Indicators of Accomplishment
Responsible
2006
2007
2008
Formulation of AI protection monitoring
Depkes,
Availability of plan documents
1.6 1.7 1.8
and evaluation plan
Deptan
Monitoring, evaluation and regular
Depkes,
Monitoring, evaluation and report
2.7 2.4
2.7
reporting on AI control development
Deptan
Frequency of coordination and
Depkes,
Coordination and feedback
3 3 3
feedback
Deptan
TOTAL
7.3 7.1 7.5
54
SUMMARY OF STRATEGY AND BUDGETING REQUIRED FOR AI CONTROL (in million rupiah)
2006 2007 2008
STRATEGY
Highly Pathogenic Avian Influenza (HPAI) Control in Animals
646.7
1099.8
1588.2
Management of Human Cases of AI
359.29
330.135
134.985
Protection of High-Risk Groups
21.9
22.4
29.1
Epidemiological Surveillance on Animals and Humans
353.58
204.78
147.16
Restructuring the Poultry Industry System
1.1
1.2
1.4
Risk Communication, Information and Public Awareness
128.16
131.85
130.91
Strengthening Supporting Laws
11
0.5
-
Capacity Building
334.69
209.04
128.54
Action Research
81.7
35.3
37.5
Monitoring and Evaluation
7.3
7.1
7.5
1,945.42
2,042.11
2,205.30
55
APPENDIX 2
NATIONAL HUMAN PANDEMIC INFLUENZA PREPAREDNESS
POLICY MATRIX
56
Strategy 1: Strengthening Sustainable Management
Goals:
1. Developing an integrated management systems and mechanisms for controlling bird flu and human pandemic influenza
preparedness
2. Mobilization of resources from various domestic and international sources
Target:
Formulating integrated and effective management to control bird flu and prepare for human pandemic influenza..
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006 2007 2008
1. Formulating a framework for conducting bird flu Availability of guideline
Depkes, Deptan
1
0
0
control and human pandemic influenza
books on bird flu control
and Depdagri
preparedness including preparing guidelines and
and human pandemic
policies on animal extermination compensation
influenza preparedness
(stamping out, culling).
2. Assessment of preparedness status
Availability of the latest
Depkes, Deptan
0.3
0.3
0.3
identification of necessary actions ASAP.
and most accurate data
3. Establishing a National Human pandemic
Establishment of NIPCs
MenkoKesra,
1
0
0
influenza Committee (NIPC) and Command
at all government
MenkoPereko-
Post as well as its mechanisms.
administration levels
nomian
(Presidential Decision)
4. Monitoring and evaluation of national
Availability of
Depkes, Deptan
1
1
1
contingency plan implementation.
monitoring and
57
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006 2007 2008
evaluation results data
5. Coordination with neighboring and regional
The existence of a
Deplu,
1
1
1
countries and international bodies for
written commitment
Menkokesra,
information sharing and emergency response
Bappenas,
networking.
Depkes, Deptan
6. Planning post pandemic reconstruction, in the
The existence of a post
Depkes, Deptan,
20
20
20
event of a pandemic.
pandemic reconstruction
Bappenas
master plan
TOTAL
24.3 22.3 22.3
58
Strategy 2: Strengthening Surveillance on Animals and Humans
Goals :
1. Strengthening comprehensive surveillance and early warning systems including the role of laboratories.
2. Strengthening epidemiological research (extraordinary event response team) and contact management.
3. Increasing surveillance of influenza like illnesses (ILI) focusing on bird flu and during human pandemic influenzas
Target
1. Strengthening surveillance, including community based early warning in every village, and laboratory based
surveillance by developing one national health reference (BSL-3 ) and 8 or 10 regional laboratories around Indonesia.
2. Strengthening animal health institutions such as laboratories in the center and areas to conduct surveillance and early
warning.
Cost (Rp. billion)
Indicators of
Institution
Main Activities
Accomplishment
Responsible
2006
2007 2008
1. Conducting clinical surveillance of Influenza
AI and HPI surveillance
Deptan –
Like Illnesses (ILI) and bird flu, covering:
database
Depkes
17.8
27.8
82.8
a. Surveillance Guidelines.
b. Sentinel hospital based surveillance.
c. Laboratory based surveillance.
d. Rumor verification surveillance.
e. Community based surveillance.
f. Animal influenza surveillance.
2. Conducting a study on epidemiological and viral
Information on the
Deptan –
1
1
1
(molecular) surveillance on new influenza viral
development of new
Depkes
subtypes with pandemic potential.
influenza viral subtypes
3. Developing national and international reference
Establishment to refer
Depkes-
1
1
1
laboratory networking.
specimen of human and
Deptan
animal to exchange
information
59
Cost (Rp. billion)
Indicators of
Institution
Main Activities
Accomplishment
Responsible
2006
2007 2008
4. Conducting investigations and responses to AI
Quick response
Deptan -
35
70
105
and HPI countermeasures.
investigation & reporting Depkes
5. Monitoring the development of resistance to
Database on resistance to Deptan –
1
1
1
antiviral medicine.
antiviral medicine
Depkes
6. Disseminating information to leaders and related
Recommendation
Deptan –
0.5
0.5
0.5
sectors including the WHO and other
Depkes
international institutions for decision making and
action.
TOTAL
56.3
101.3
191.3
60
Strategy 3: Prevention and Control
Goals:
1. Preventing infection and breaking the chain of AI and HPI transmission as soon as possible (ASAP).
2. Conducting AI and HPI control actions in infected areas.
3. Developing and providing antiviral medicine and vaccine production from Indonesian virus seeds.
Target:
1. Maintaining bird flu-free areas, freeing bird flu infected areas and preventing the infection of other animals
2. Developing capacity for stockpiling and producing antiviral medicine and vaccines.
Cost (Rp. billion)
Indicators of
Institution
Main Activities
Accomplishment
Responsible
2006 2007 2008
1. Protecting high-risk groups.
80% protection coverage
Deptan,
5.3
5.3
5.3
Depkes,
Depdagri
2. Increasing bio-security in areas with a high-risk
80% bio-security coverage
Deptan,
2
2
2
of AI infection and human pandemic influenza.
Depkes,
Depdagri
3. Strengthening the monitoring of poultry and
Health Certification
Deptan –
35
35
35
poultry product traffic as well as human traffic.
Depkes
4. Providing antiviral medicine and vaccines for
- Human antiviral
Deptan –
112
112
112
bird flu and human pandemic influenza (new
medicine: 0,5% -1 % of
Depkes
subtype strains)
total population
- Human vaccine
61
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006 2007 2008
5. Developing capacity to domestically produce
Domestic capability to
Deptan,
100
150
175
antiviral medicine and vaccines for bird flu and
produce antiviral
Depkes,
human pandemic influenza (new subtype medicines and vaccines
Deperindag
strains)
6. Action research on animal cases of bird flu and
Applicable research results
Deptan, LIPI,
12
12
12
human pandemic influenza.
Depkes,
Menristek,
Universitas/
Depdiknas
TOTAL
266.3 316.3 341.3
62
Strategy 4: Strengthening Health Service Response Capacity
Goals:
1. Continuously increasing the animal health service system.
2. Increasing the health service system at the center and areas in protecting against bird flu and human pandemic influenza.
3. Increasing the capacity (HR, equipment and methods) of appointed reference hospitals and other health facilities.
Target
1. Strengthening and developing capacity from 44 to 100 reference hospitals.
2. Preparing trained worker capacity in managing bird flu and human pandemic influenzas.
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006
2007 2008
1. Improving capacity of animal health services
Number of animal health
Deptan,
6
6
6
post personnel trained
Depdagri
2. Developing AI and HPI management Availability of management
Deptan,
5
1
1
including the prevention of nosocomial
guidelines
Depkes
infection.
3. Providing reagents, diagnostic tests, isolation
Availability of materials,
Deptan,
200
200
200
rooms/ICUs and other medical and tools and medical and
Depkes
diagnostic supports.
diagnostic supports at 100
reference hospitals
4. Health services and references in hospitals
Fulfillment of services to
Depkes
1.2
1.6
2.0
patients
5. Training healthcare and animal healthcare
Certification of skilled
Deptan,
87.5
52.5
52.5
workers
workers
Depkes, PT/
Diknas,
TOTAL
299.7 261.1 261.5
63
Strategy 5: Risk Communication, Information and Public Awareness
Goals:
1. Providing risk information, education and communication to all layers of society to be alert and not panic in dealing
with AI extraordinary events and the possibility of human pandemic influenza.
2. Increasing the risk communication capabilities of PR technical workers, councilors, public relation personell and
jurnalist and community leaders.
Target:
1. Increasing community knowledge in anticipating AI extraordinary events and preparedness for the possibility of human
pandemic influenza.
2. A national campaigned on the prevention and control of bird flu preparedness for the possibility of human pandemic
influenza.
Indicators of
Institution
Cost (Rp. billion)
Main Activities
Accomplishment
Responsible
2006
2007 2008
1. Formulation of risk communication strategy
A national risk
Depkominfo,
1
1
1
communication strategy
2. Establishing a National Information Center
Existence of NIC
1
1
1
(NIC)
3. Establishing CIE media: printed and electronic.
Availability of CIE media
Depkominfo,
26
26
26
4. Establishment of communication network Existence communication
2
2
among all partners and international institutions
cooperation network
2
(WHO, FAO, OIE, etc.).
5. Mass public communication (general public)
CIE Mass & Electronic
Depkominfo,
11
11
media
Depked,
11
6. Communication and information to high-risk
CIE in high-risk and
Deptan,
50
50
and strategic groups.
strategic groups
Menko Kesra,
50
Bappenas
TOTAL
91 91 91
64
SUMMARY OF STATEGY AND BUDGET REQUIRED FOR PI PREPAREDNESS (in million rupiah)
STRATEGY
2006 2007 2008
Strengthening Sustainable Management
24.3
22.3
22.3
Strengthening Surveillance on Animals and Humans
56.3
101.3
191.3
Prevention and Control
266.3
316.3
341.3
Strengthening Health Service Response Capacity
299.7
261.1
261.5
Risk Communication, Information and Public Awareness
91
91
91
TOTAL
738
792
907
65
APPENDIX 3
HUMAN PANDEMIC INFLUENZA CONTINGENCY
PLAN
66
Strategy 6: Contingency Work Plan
SCENARIO 1:
Limited to the village level in limited Provinces
Village isolation conducted based on outbreak laws.
Activity Timeframe
Main
Responsibility Additional “Output” Indicator
Cost (Rp. Unfunded
Responsibility
million)
Pandemic
Department of
Local Gov. and all
Reduction in the
All
Phase 6
Health
related sectors, NGOs,
impact of pandemic
religious organizations
and community members
Treating patients in
At Very
DEPARTMENT OF Local governments with
Patients treated and
10,- per
All
reference hospitals and early period
HEALTH: Nearest
local health services
infections minimized
patient
other hospitals.
of Pandemic Reference Hospital.
Phase 6
Isolation of infected
At Very
DEPARTMENT OF Local governments with
Infections Limited
100
All
villages
early period
HEALTH
local health services and
of Pandemic
local pamongpraja police
Phase 6
Increasing
At Very
DEPARTMENT OF Local governments with
Infections Limited
50
All
extraordinary event
early period
HEALTH
local health services
investigation activities of Pandemic
in nearby villages
Phase 6
Treating near contact At Very
DEPARTMENT OF Local governments with
Infections Limited
50
All
with Tamiflu (if
early period
HEALTH
local health services
available)
of Pandemic
Phase 6
67
Conducting risk
At Very
DEPARTMENT OF Local governments with
Infections Limited
50
All
communication
early period
HEALTH
local health services
of Pandemic
Phase 6
Monitoring and
At Very
DEPARTMENT OF Local governments with
Infections Limited
50
All
evaluation
early period
HEALTH
local health services
of Pandemic
Phase 6
Maintaining
At Very
DEPARTMENT OF Local governments with
Infections Limited
100
All
international
early period
HEALTH
local health services
communication and
of Pandemic
cooperation especially
Phase 6
with ASEAN members
and the WHO
68
SCENARIO 2:
Limited to the Sub-District Level in limited Provinces
Perform epidemiological investigation and respond to extraordinary events
Activity Timeframe
Main
Additional
“Output”
Cost (Rp.
Unfund
Responsibility
Responsibility
Indicator
million)
ed
Pandemic Phase 6 DEPARTMEN
Local Gov. and all
Reduction in
All
T OF HEALTH related sectors, NGOs,
the impact of
religious organizations
pandemic
and community
members
Treating patients in reference
At Very early
Department of Local governments
Patients treated
10 per
All
hospitals and other hospitals
period of
Health
with local health
and infections
patient
Pandemic Phase 6
services
minimized
Increasing extraordinary event At Very early
Department of
Local governments
Infections
5.000. All
investigation activities in nearby period of
Health
with local health
Limited
villages
Pandemic Phase 6
services
Treating near contact with
At Very early
Department of
Local governments
Infections
500 All
Tamiflu (if available)
period of
Health
with local health
Limited
Pandemic Phase 6
services
Conducting risk communication At Very early
Department of
Local governments
Infections
500 All
period of
Health
with local health
Limited
Pandemic Phase 6
services
Monitoring and evaluation
At Very early
Department of
Local governments
Infections
50 All
period of
Health
with local health
Limited
Pandemic Phase 6
services
Maintaining international
At Very early
Department of
Local governments
Infections
100 All
communication and cooperation period of
Health
with local health
Limited
especially with ASEAN
Pandemic Phase 6
services
members and the WHO
69
SCENARIO 3:
Limited to District/City Level in limited Provinces.
Central Government mobilizes funds and forces to limit outbreak.
Activity Timeframe
Main
Additional
“Output”
Cost (Rp.
Unfunded
Responsibility
Responsibility
Indicator
million)
Pandemic
DEPARTMENT
Local Gov. and all
Reduction in the All
Phase 6
OF HEALTH
related sectors, NGOs,
impact of pandemic
religious organizations
and community members
Treating patients in
At Very early
DEPARTMENT
Local governments with
Patients treated and
10 per
All
reference hospitals (run period of
OF HEALTH:
local health services
infections
patient
“triage” system) and
Pandemic
Nearest
minimized
other hospitals.
Phase 6
Reference
Hospital.
Treating other patients
At Very early
DEPARTMENT
Local governments with
Patients treated and
0.05 per
All
as off-site patients with period of
OF HEALTH
local health services
infections
patient
symptomatic
Pandemic
minimized
medicines.
Phase 6
Increasing
At Very early
DEPARTMENT
Local governments with
Infections Limited
5.000
All
extraordinary event
period of
OF HEALTH
local health services
investigation activities
Pandemic
in nearby villages
Phase 6
Conducting risk
At Very early
DEPARTMENT
Local governments with
Infections Limited
5.000
All
communication
period of
OF HEALTH
local health services
Pandemic
Phase 6
Mobilizing village
At Later Period DEPARTMENT
Local governments with Suffering of the
50.000 All
volunteers and
of Pandemic
OF HEALTH
local health services and people is reduced;
religious groups.
Phase 6
local pamongpraja police chaos minimized.
Monitoring and
At Later Period DEPARTMENT
Local governments with
Infections Limited
50
All
evaluation
of Pandemic
OF HEALTH
local health services
Phase 6
70
Maintaining
At Later Period DEPARTMENT
Local governments with
Infections Limited
100
All
international
of Pandemic
OF HEALTH
local health services
communication and
Phase 6
cooperation especially
with ASEAN members
and the WHO
71
SCENARIO 4:
National Scale Epidemic
Mobilization of national forces and resources including funds and reserve forces (volunteers etc.) as and if ordered by the
President as Commander-in-Chief for as long as the Country is in a State of Emergency.
Activity Timeframe Main
Additional
“Output” Indicator
Cost (Rp.
Unfunded
Responsibility
Responsibility
million)
Pandemic
President
Local Gov. and all
Reduction in the All
Phase 6
related sectors,
impact of pandemic
NGOs, FBOs and
community members
Treating patients in
At peak
DEPARTMENT
Local governments
Patients treated and
10 per patient *) All
reference hospitals
period of
OF HEALTH:
with local health
infections minimized
(run “triage”
pandemic
Nearest Reference services
system) and other
phase 6
Hospital.
hospitals.
Treating other
At peak
DEPARTMENT
Local governments
Patients treated and
0.05 per patient All
patients as off-site
period of
OF HEALTH
with local health
infections minimized
*)
patients with
pandemic
services
symptomatic
phase 6
medicines.
Increasing
At peak
DEPARTMENT
Local governments
Infections Limited
All
extraordinary event
period of
OF HEALTH
with local health
50.000
investigation
pandemic
services
activities in nearby
phase 6
villages
72
Conducting risk
At peak
DEPARTMENT
Local governments
Infections Limited
50.000
All
communication
period of
OF HEALTH
with local health
pandemic
services
phase 6
Mobilizing village
At peak
DEPARTMENT
Local governments
50.000
All
volunteers and
period of
OF HEALTH
with local health
religious groups.
pandemic
services
phase 6
Mobilizing national
At peak
DEPARTMENT
Local governments
Suffering of the
500.000 All
forces and resources
period of
OF HEALTH and
with local health
people is reduced;
including funds and
pandemic
all related sectors,
services
chaos and other
reserve forces.
phase 6
police, military
negative implications
under the
are minimized.
command of the
President
Monitoring and
At peak
DEPARTMENT
Local governments
Infections Limited
All
evaluation
period of
OF HEALTH
with local health
100
pandemic
services
phase 6
Maintaining
At peak
DEPARTMENT
Local governments
Infections Limited
100
All
international
period of
OF HEALTH
with local health
communication and
pandemic
services
cooperation
phase 6
especially with
ASEAN members
and the WHO
73
Implement Outbreak
At peak
DEPARTMENT
Local governments
Infections Limited
500
All
and Quarantine Laws period of
OF HEALTH and
with local health
and additional
pandemic
all related sectors,
services
regulations (distance, phase 6
police, military
border closings,
under the
restrictions on
command of the
gathering, etc.)
President
Burying bodies
At peak
DEPARTMENT
Local governments
Areas are cleared of 0.25 per body*)
All
period of
OF HEALTH and
with local health
bodies
pandemic
all related sectors,
services and local
phase 6
police, military
pamongpraja police
under the
command of the
President
Notes:
*) Based on incident rate: 11% (NAMRU-2 research results), Mortality rate (WHO): 50% and Total Population of Indonesia:
220,000,000
US $ 1000 per overnight patient
US $ 5 per off-site patient with symptomatic medicines
US $ 25 cost per body buried
Cost of off-site treatment = 11% x 220,000,000 x US $ 5 = US $ 121.000.000
Cost of hospitalization = 44 hospitals x 10 patients x 6 months x 4 turns per patient x US $ 1.000 = US $ 10.560.000
Cost of burying bodies = 50% x 11 % x 220,000,000 x US $ 25 = US $ 302,500,000
Other Costs = US $ 65,070,000
Total Costs during peak of pandemic = US $ 499,130,000
74
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