Table 1. Scoring system used for assessing level of Ebola virus preparedness in the joint review of countries of the World Health Organization South-East Asia Region, February to November 2015.
| Task, by key component | Aspect of readiness assesseda | Level of functionalityb |
|||
|---|---|---|---|---|---|
| Not addressed (score 0) | Planned but not implemented (score 1) | Low functionality (score 2) | Complete response (score 3) | ||
| A. Emergency planning for risk management | |||||
| A1. Ebola virus disease preparedness plan implemented | Surge capacity | No plan | Ebola virus disease preparedness planned | Plan written, but incomplete implementation | Costed, risk-based approach, in line with WHO’s pandemic influenza preparedness plan |
| A2. Guidelines disseminated | Surge capacity | Not available | All Ebola virus disease-related WHO guidelines checked and read | WHO guidelines adapted and disseminated, but incompletely | WHO guidelines adapted and disseminated |
| A3. Funds release mechanism established | Operational readiness | No plan | Planned | Detailed procedures in place | Tested by past experience or simulation |
| A4. Staff bonus pay system in place for high-risk assignments | Operational readiness | No plan | Planned | Detailed procedures in place | Tested by past experience or simulation |
| A5. Contingency planning encouraged when appropriate | Surge capacity | No plan | Planned, with lists of agencies needing plan | Some contingency plans prepared | Tested by past experience or simulation |
| B. Risk assessment processes | |||||
| B1. Country-specific risk assessments conducted and capacity operational | Currently functional activities | No risk assessment conducted | At least one risk assessment reported produced | Risk assessments conducted, with regular updates, and disseminated | Risk assessment, with risk-based scenarios and recommendations documented |
| C. Leadership and coordination in place and with surge capacity (multilevel and multisectoral) | |||||
| C1. Ebola task force or Ebola committee established and operational | Operational readiness | Not mentioned | Strategies briefly mentioned | Multilevel and multisectoral approach established | Detailed strategies identified |
| C2. Membership of Ebola task force clearly described in plan, and updated | Operational readiness | Not mentioned | Mentioned | Terms of reference clear and reviewed | Tested by past experience or simulation |
| C3. Incidence management structure in place and operational | Operational readiness | Not in place | Mentioned in plan | Terms of reference clear and reviewed | Tested by past experience or simulation |
| C4. Emergency operation centre in place and operational | Operational readiness | Not in place | Roles and responsibilities to be defined | Detailed roles and responsibilities and communication and procedures in place | Tested by past experience or simulation |
| D. Surveillance alert warning system | |||||
| D1. Early warning system in place for haemorrhagic fever or Ebola virus disease cases | Currently functional activities | Not in place | Planned | Only indicator- or event-based surveillance enhanced | Indicator- or event-based surveillance enhanced for Ebola virus disease |
| D2. Indicator-based surveillance enhanced | Currently functional activities | Not enhanced | Planned | Instructions sent to hospitals and all health-care facilities | Staff trained extensively |
| D3. Event-based surveillance enhanced | Currently functional activities | No | Planned | Instructions sent to hospitals and all health-care facilities | Staff trained extensively |
| D4. Early warning reporting is timely and sensitive | Currently functional activities | Unknown | Limited surveillance infrastructure for timely reporting | Electronic data management system, but not timely and sensitive | Efficient, immediate reporting and analysis |
| D5. Rumours’ surveillance ready to operate | Currently functional activities | Not planned yet | Planned | Responsible department identified | Staff trained and tested |
| E. Laboratory diagnosis | |||||
| E1. Reference laboratories identified | Currently functional activities | No | At least one national reference laboratory identified | Staff trained for diagnostics | Quality assurance conducted |
| E2. Stand-by arrangements in place to ship samples from suspected Ebola cases for confirmatory testing | Operational readiness | No | With WHO collaborating centre and relevant airlines in place | Mechanism tested for other emergency infectious diseases in the past | Mechanism tested for Ebola virus disease as a drill |
| E3. Instructions on procedures for handling of infectious substances | Currently functional activities | Not distributed | Protocols online and readily available. Websites shared with all hospitals | Reference hospital laboratory staff trained | Hospital laboratory staff extensively trained |
| E4 Surge of public-health and clinical laboratories to meet planned needs | Surge capacity | No | Planned, but with no details | Planned, with some details | Detailed plan |
| F. Rapid investigations, efficient contact tracing and containment | |||||
| F1. Several rapid response teams on investigation identified | Operational readiness | No | Call-down list of rapid response team leaders available | Multisector team members identified and some trained | Rapid response team trained with drills |
| F2. Several rapid response teams on sampling procedures and on transport identified | Operational readiness | No | Call-down list of rapid response team leaders available | Multisector team members identified and some trained | Rapid response team trained with drills |
| F3. Several rapid response teams on personal protective equipment identified | Operational readiness | No | Call-down list of rapid response team leaders available | Multisector team members identified and some trained | Rapid response team trained with drills |
| F4. Several rapid response teams on Ebola case management identified | Operational readiness | No | Call-down list of rapid response team leaders available | Multisector team members identified and some trained | Rapid response team trained with drills |
| F5. Rapid response team ready for contact tracing | Operational readiness | No | Adapted strategy for contact tracing planned | Described | Rapid response team trained with drills |
| G. Infection control and clinical management | |||||
| G1. General awareness enhanced about hygiene and how to implement infection control in hospitals | Surge capacity | Planned | Instructions sent out | Training conducted | Tested or training with drills |
| G2. Isolation units and triage system for suspected Ebola cases in hospitals | Operational readiness | No | Planned, with call-down lists | Identified and equipped, with triage system | Training provided to all staff on infection control and prevention measures and waste management |
| G3. Surge increase in isolation rooms planned | Surge capacity | No | Planned | Procedures in place | Procedures tested |
| G4. Adequate capacity for clinical management of Ebola cases with haemorrhagic fever | Operational readiness | No | Planned | Planned but no procedures described | Detailed strategies and procedures |
| H. Communication (dissemination mechanism, public information, social mobilization and risk communication) | |||||
| H1. Communication coordination mechanism functional, involving all government sectors and other stakeholders | Operational readiness | No | Planned | In place, with partners and stakeholders identified | Tested |
| H2. Risk communication plan in place and operational in ministry of health | Operational readiness | No | Plan or strategy developed (centralized, different audience, partnership) | Experienced team or unit in place, with clear roles and responsibilities for Ebola risk communication materials | Training provided with simulation or drills conducted for Ebola virus disease |
| H3. Communication with the public and feedback mechanisms established | Surge capacity | No | Critical information materials planned (messages on Ebola virus disease available or functional procedures for review and validation) | Critical communication for use of information materials planned, with plan to engage community leaders | Mechanism in place to communicate with community leaders, and information materials readily available |
| H4. Procedures for information dissemination to all levels planned | Operational readiness | No | Mentioned but not implemented | Online websites developed but incomplete | Online websites developed and complete |
| H5. Advice to travellers to affected areas provided | Currently functional activities | No | Planned | Available from travel services | Available online and elsewhere (private and government agencies) |
| H6. Communication under International Health Regulations (IHR) | Operational readiness | No | IHR past experience | Trained | Exercises conducted |
| H7. Social mobilization planned | Surge capacity | No | Planned | Experience in engaging community leaders | Detailed plan made and experienced staff in place |
| I. Points of entry | |||||
| I1. Health emergency plan at airports ensured | Currently functional activities | No, but planned | In place | Training conducted extensively | Drills and simulations conducted or already tested, with updating |
| I2. Airport’s isolation room adequately equipped | Currently functional activities | No | Partially equipped | Fully equipped | Fully equipped in at-risk points of entry |
| I3. Airport's health teams on 24-hour 7-day stand-by, to assist travellers and ensure correct isolation | Currently functional activities | No | Procedures in place | Training provided | Procedures reviewed or tested |
| I4. Stand-by agreement with referral hospitals in place | Currently functional activities | No | Planned | Procedures described | Procedures reviewed or tested |
| I5. Communication procedures in place between health and airport authorities | Currently functional activities | No | Planned, with detailed mechanism described | In place | Tested |
| I6. Follow-up in place for at-risk travellers from Ebola-affected countries | Currently functional activities | No | Planned, with detailed mechanism described | In place | Monitoring system tested with at-risk travellers |
WHO: World Health Organization.
a Aspects of preparedness assessed by tasks were as follows: currently functional activities: activities currently operational in the country for Ebola virus disease detection; operational readiness: whether the country was ready for introduction of an Ebola virus disease case; surge capacity: how prepared the country was to face a wider Ebola virus outbreak.
b Functionality of tasks was scored as follows: no structure in place or activities not addressed (score 0); activities planned but not implemented (score 1); activities in place but low evidence of functionality (score 2); or complete response, i.e. evidence of fully functional activities and readiness or planning for surge capacity (score 3).