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Lessons In Pandemic Preparedness For Africa By Abdulwarees Solanke

Is there any crime called self-plagiarism? This is what I will be deliberately committing in my discourse today.

Using Brunei Darussalam as a case study on how it contended with Avian Influenza pandemic several years ago, my intention is to explore the Pandemic Preparedness of any country at critical times or emergencies like current global lock down arising from the Corona Virus infection that was first reported December last year in Wuhan China.

My ideas are derived from a term paper I wrote way back in 2007 during my graduate study in Public Policy at the Faculty of Business, Economic and Policy Studies Universiti Brunei Darussalam.

For the term paper, our course lecturer in the Study of Public Policy, Dr. Shafruddin Hashim, then an Associate Professor, grouped the class made up students of Master of Public Policy and Master of Health Policy and Management into five or six and assigned each to identify a policy area in the country to explore its intervention. From the group investigation, each student was to produce an individual report.

My group considered the country’s health sector, and investigated the policy response to the Avian Influenza pandemic which in 2003 swept through Asia. My report from which much of the content of my discourse is sourced is titled Responding to Avian Influenza Pandemic: A Policy Challenge for Brunei Darussalam.

One of the materials that assisted our understanding of the issues involved in pandemic preparedness was the November 2004 edition of a WHO publication, WHO Influenza Pandemic Preparedness Checklist.

In that 36 page, two-part document, I found a pungent and instructive observation that Pandemic preparedness is not a quick process:
It would be unrealistic for any country, unless it as a very small population with a centralized infrastructure and bureaucracy, to prepare that it could prepare a detailed and comprehensive pandemic plan in weeks, or even months. Two of the reasons is plan take time and that there is need for multisectoral approach and the need to involve the community.

Multisectoral approach means involvement of many levels of government and people with different areas of skill, including policy development, legislative review and drafting, animal health, human population health, patient care, laboratory diagnosis, laboratory test development, communication expertise and disaster management.

Community involvement means making optimal use of local knowledge, expertise, resources and networks. It is the only way to engage people and build the commitment needed for policy decisions.

Now, my Report on how the small oil-rich South East Asian nation responded to the Avian Influenza pandemic when it hit the region in 2003:
As convoluted as Brunei national philosophy and political cum administrative structures are, health care delivery system still portrays the system as organized and functioning, serving public needs and demand, modern, adequately funded, cheap and accessible.

But it is best understood within policy goals enunciated in the country’s national development plans as well as the elaborate 10year plan of action produced by the country’s ministry of health.

Under the 8th national development plan, the ministry of health was allocated almost B$134 million to carry out 21 projects (ministry of health, 2002). In June 2000, the ministry came up with a 10-year strategic framework of action, titled national health care plan 2000-2010.

This at best is the policy document that has been guiding healthcare delivery in Negara Brunei Darussalam.

The plan of action set for the ministry the following as vison and mission (MOH, 2000):
The ministry of health will strive to become a highly reputable health service organization which is comparable to the best in the world and which will enable every citizen and resident of the nation to attain a high quality of life by being socially, economically and mentally productive throughout the life span.

The mission of the ministry of health is to improve the health and wellbeing of the people in Brunei Darussalam through a high quality and comprehensive health care system which is effective, efficient, responsive, affordable, equitable and accessible to all in the country.

In the framework of action, the ministry also set for itself seven action points covering:
*Consistent provision of health for all
*Continuous improvement in standard
*Active cooperation and collaboration with relevant agencies
*Enhancement of community participation in disease prevention and healthy promotion
*Containing rising cost of healthcare
*Striving to achieve excellence in healthcare management
*Conduction of efforts in caring and supportive manner in consistence with the national guiding philosophy.

In the plan, the ministry acknowledged thus;
‘Public policy makers and senior public managers in Brunei face new and difficult challenges. Government agencies are expected to manage the public services efficiently and effectively amidst rapid environmental changes with all its attendance complexities and uncertainties.

Coronavirus (Photo credit: China News)

It identified six major challenges, namely financial problems faced by the country recently, the epidemiological transition or changing pattern of diseases, the paradigm shift or a change in perspective of healthcare services and the demographic transition of population.

Other challenges are the revolution in information and communication technologies and the paradigm shift or modernization pf public service management.

Bruneians therefore can be said to be lucky for the country or nation to have a focused ministry of health, and as well as the benefit of enjoying the following
*Free medical and health care
*Flying medical services for inaccessible remote areas
*Free standard government in each of the four districts
*Military hospitals
*Excellent facilities at RIPAS (the country’s main referral hospital) built at a cost of $162 million in 1984
*Patients with specialized treatment can be sent abroad on government account

When the world health organization in December 2003 sent out an alarm of the new strain of influenza sweeping through many parts of the world with documented evidences from Hong Kong, Thailand, Vietnam parts of Africa and Europe, the response of Brunei can be said to be encouraging.
Falling back on its experience in responding to SARS outbreak earlier, it was not difficult for the country to pursue the next line of action: VIGILANCE AND PRECAUTION, according to a senior official at the health ministry.

To understand in depth policy practice in Brunei Darussalam, the study group, identified Brunei’s ministry of health response to the avian influenza pandemic as to a good case.
The members held series of meetings with senior officials of the ministry, and conducted as in-depth interview with a key actor involved in crafting the ministry of health influenza pandemic preparedness plan.

From the interactions and interviews, the following were observed in the process of understanding how Brunei rose to the situation.

Health security of Bruneians cannot be isolated from that of her neighbors, so the country cannot pretend to be blind to the health security situation of her neighbors too.

Information vital to national security, hence the country cannot afford to treat information from the rest of the world with levity
International agencies like world health organization have strong inputs into the policy direction of Brunei.

In health or emergency policy formulation, Bruneian government and the public service is very sensitive, therefore takes preventive and precautionary measures as policy option
Compared to other countries, Brunei’s wealth is a contributory factor to her ability to respond to situations qualitatively

The size of her population is also a determinant in hoe rapid her policies can be implemented and evaluated.

Aware of the gravity of the pandemic, and with the country surrounded by some neighbours already recording serious cases of the flu as the WHO alert indicated, it was necessary that Brunei did a SWOT analysis of the situation to determine its response, assess the policy response impact, and see ways of involving all the necessary stake holders, after all, as admitted by our source at the health ministry, “the most important thing is to understand the issue at hand and who will be involved.”

In the case of the avian influenza pandemic, Brunei’s immediate policy goal as set by the ministry of health is to formulate the first line of defence based on the SWOT analysis of the situation and the information provided by the Manilla-based WHO western pacific region under which Brunei is grouped, because for precautionary purposes, information is very important.

Fortunately, as acknowledged by the health ministry, WHO has a very good system of information dissemination, but the limitation is if a country does not provide information which WHO would disseminate. Brunei also relies on the bilateral/multilateral cooperation as with ASEAN or the border help conference members.

Each ministry of health within the region has its focal point, and it is to this point that WHO directs all information. When an emergency as the outbreak of the flu happens, the director of public health who is the focal point will brief the minister of health.

The minister immediately convenes a meeting of all the heads of department who will decide on the formation and composition of the relevant committees to address the issue at hand.

But the immediate policy concern of the ministry was identified as follow:
What to do to protect the Bruneian population
How to evolve a plan that is flexible, open, and amendable to change as much is yet to be known about the influenza
How to address the impact in all dimensions: social, financial, security (especially food security) and economic impact.

As acknowledged by our source in the health ministry, all the issues and dimensions- political, social, religious, economic, and medical and security have to be addressed. Not just the health ministry, all other agencies and ministries would have to be engaged the issue is a wide one.

He admitted that to prepare for such a plan is a great challenge as not many countries can boast of foul proof plans, more so, any plan is useless without putting it into practice. As he said, plans are based on assumptions, but assumptions may be wrong.

Drawing from its experience on how it handled the earlier Severe Acute Respiratory Syndrome, the ministry did not look far to determine what is the net line of action following the information on the avian flu. It revived the SARS committee.

The following are the subcommittees in the larger SARS response committee:
Therapeutic sub-committee which prepares the hospital
Epidemiology sub-committee which gathers information from other parts of the world on the influenza trend.
Equipment sub-committee which is responsible for assessing and accessing necessary equipment and facilities, namely respirators, ventilators, masks, gloves, gowns etc.
Financial sub-committees, responsible for preparing the inventory and negotiating or liaising with the ministry of finance.

While experts in the ministry of health prepare the ground plan in the direction of action, the plan is validated at a higher level of authority. This is the national committee on pandemic preparedness headed by the crown price, with all the members of the cabinet as members.

It is to this committee that the response committee set up within the ministry of health reports. The deputy minister of health is the chairman of the main committee within the ministry of health.

Generally, therefore, policy crafting and decision making is more of committee work, and once policy with terms of references, each member or subcommittee will have its responsibility.

Ultimately, the person who ensures everything go on as planed is the chairman, the deputy minister of health who reports to the national committee on pandemic/zoonotic preparedness.

In this emergency situation, as our source admitted, deciding what to do can be a bit problematic because the nature of the disease is not fully known.

Secondly, there is a limitation on access to essential preventive drugs and flu relief items. Not only are they in short supply, there is a high competition in them.

Even if the resources to purchase them are available, the items, may not be available because of the hot demand from all over the world. The policy planners deciding what to do would therefore have to prioritize what must be done in the defensive-preventive overall policy strategy.

This policy is three-fold:
Information: providing transparent, fast, accurate and balanced information to all citizens so that they can understand the full dimension of the outbreak and take precautionary measures on their own volition.

Prevention: in the defensive-preventive strategy, who to protect becomes the first priority. While acknowledging that all Bruneians must be protected, the first line of action is to stop both human and animal importation. Here, the ministry closely collaborates and share information with the immigration department and the ministry of industry a primary resource under which agricultural department falls. Secondly, the major line of protection is the health workers who will be dealing with the situations directly.
So much of the resources will have to be concentrated in providing protective materials for them.

Capacity- Building: the nature of the pandemic demands that capacity-building strategy must be embedded into the overall policy strategy so that managers of the situation will be constantly be updated on the trend by attending conferences, specialized workshops and meetings.

In a nutshell, Brunei’s policy response can be summed up as follows:
Prevention
Detection
Quick and rapid action
Impact mitigation

The set of actions comes with specific objectives, demanding the involvement of the whole government machinery, the banks and the private sector, the civil society, the media and the religious authorities, who have strong influence on the people.

Because of the nature of Bruneian society, it is difficult to exclude anyone or any issue in the effort to prevent the avian influenza outbreak in Brunei.

Brunei is lucky in several respects: the country is rich, hence can afford the needed equipment and preventive items and it has encouraging information and communication infrastructure. Considering her size and population, the country looks prepared to combat such emergency as avian flu. Things look tightly fitting, and any policy is not considered good or bad until the situation that warrants the crafting of such policy truly unfolds.

And that is why any policy should be flexible to accommodate new realities. For Brunei therefore, the avian influenza pandemic preparedness policy is yet to be tested, but it looks solid.

Looking at the way the pandemic was addressed in Brunei, the pattern of the public policy that unfolds is that issues generated from without the country (input) and of security implication to the nation have a neat order of being addressed by experts and professionals in government who report to the authoritative decision makers.

It gives an impression of domineering role of bureaucrats and professionals in decision making. Neat as it is, not all policy issues will take this form in Brunei because of the prevailing traditional and political culture which is top-down or hierarchical in nature, patently exclusive and not given to open debate and contestation of ideas.

Therefore, it can be argued that policy response to avian influenza pandemic cannot serve as a perfect test of policy process and richness of Negara Brunei Darussalam. Any lesson for us in Africa?

Abdulwarees, a fellow of the Chartered Institute of Public Diplomacy and Management, is Assistant Director, Strategic Planning & Corporate Development at Voice of Nigeria and volunteers for the Muslim Public Affairs Centre MPAC Nigeria Director, Media & Strategic Communications 08090585723, [email protected]

Opinions expressed in this article are solely the writer’s, not ALEDEH’S

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