BOBO-DIOULASSO, Burkina Faso, May 16, 2012 — Nearly 100 civilian and military representatives from seven African nations, the United States and three United Nations organizations met in Bobo-Dioulasso, Burkina Faso, May 14, 2012 for a week-long exercise to conduct a baseline review of the current capability of the government of Burkina Faso to respond to a potential severe pandemic disaster.

The Burkina Faso Government Pandemic Disaster Response Tabletop Exercise is hosted by the government of Burkina Faso, organized by U.S. Africa Command (AFRICOM), funded by the U.S. Agency for International Development (USAID) and implemented by the Center for Disaster and Humanitarian Assistance Medicine (CDHAM). The tabletop exercise will assist the government of Burkina Faso in assessing their pandemic disaster preparedness and response plan as well as identify and validate how the country’s military can assist the civilian authorities in the “Whole of Government” pandemic disaster response.

“The organization of this exercise aims to reinforce the existing capacities, structures and actors that are responsible for disaster management in Burkina Faso, specifically civil protection in order to mobilize and engage responders, streamline the decision making process and identify the gaps in our plans,” said Abel Toussaint Coulibaly, delegate minister, representing the Ministry of Territorial Administration, Decentralization and Security.

Special Assistant to the Commander of U.S. Africa Command, Brigadier General Stayce Harris, spoke about how “…health and security issues are closely linked. As a result, the U.S. Government has committed specific resources to helping our partner militaries in Africa.”

Harris went on to say, “The role of Africa Command’s Pandemic Response Program, as part of this USAID funded initiative, is to assist in strengthening African partner military nation’s capacities to respond to a pandemic in support of civil authority national pandemic preparedness and response plans.”

PRP is funded by USAID as part of its umbrella program Humanitarian Pandemic Preparedness Initiative. Implemented by the U.S. military, PRP is structured like a traditional USAID project with a focus on long-term sustainable results through the whole of government approach.

PRP’s objectives are to train senior and mid-level military leaders, government agencies and international aid organizations in cooperative disaster management and humanitarian assistance situations with a particular focus on pandemic preparedness. It aims to ensure military, government agencies and international organizations in participating “pandemic preparedness” nations have developed detailed plans of action directly supporting national plans and to conduct exercises to stress test the implementation of these plans and identify deficiencies.

“Pandemics are worldwide epidemics. They have happened before and are not fiction,” said Colonel (Retired) Vincent Anami, director of Kenya’s National Operations Center. According to Anami, a pandemic in 1920 is reported to have killed 40 million people, but some estimates put the death toll as high as 100 million. Anami went on to say that seasonal influenza viruses kill year approximately 500,000 people a year.

Harris reiterated U.S. Africa Command and the U.S. government’s dedication to helping African partner nations build pandemic response capability. “As noted by Africa Command’s deputy commander for Civil-Mil Activities, at our program introduction conference in 2009, ‘Dealing with a pandemic, from planning to post operation phases, is a high priority for the United States Government.’ Consequently, one of Africa Command’s strategic objectives is ‘assisting partner nations with protecting populations from deadly contagions.’”

The five session tabletop exercise is being closely monitored by the Burkina Faso government. The tabletop portion of the exercise began May 15 and will end on May 18.

“Emergency Management means strategy, leadership, planning and closing the gap in disasters,” said Hon. Maj General Julius F. Oketta, Director of the National Emergency Coordination Operation Center (NECOC) at the Office of the Prime Minister. He noted the importance of civil-military coordination, nothing that “cohesiveness [and a sense of partnership] can only be achieved if there is a plan of action for Uganda.” Even the Ugandan Constitution, he added, notes that response is “partly” the responsibility of the military. Maj. Gen. Oketta thanked the US Government ‘for its commitment to train the Ugandan people to effectively plan for, manage and respond to disasters,” concluding that he is “proud of the work that the Government of Uganda has done, especially with the development of the national policy document; however, more needs to be done for Uganda to prepare for disasters to come.”

Dr. Charles Beadling, CDHAM Director, thanked the attendees for dedicating their professional life to helping their country to better prepare for emergency situations. He said the only certainty in disaster management is that disasters will ocurr, regardless of the time and the place, hence the importance of preparedness. He praised the workshop for the important work it does in creating a roadmap in disaster management for the people of Uganda, and encouraged participants to use their strengths and their knowledge to create a product that will help Uganda be better prepared for the future.

RDML (Ret) James Hart, J5, Deputy Director Programs, speaking on behalf of USAFRICOM Commander General Carter Hamm, thanked the government and staff at OPM for coordinating such an important event, adding that “the ability to form relationships and understanding roles in preparedness is critically  important” in disaster management. RDM Hart said, “Recent activity highlights the importance of understanding the whole of government approach, which involves: preparedness activities; command and control during response; legal and administrative framework; and using military assets in civil response.

USAFRICOM conducted a review of Uganda’s domestic emergency management capabilities in early March 2012. This onsite peer review of Uganda’s Disaster Management Program consisted of a series of interviews conducted by a team of experienced emergency management professionals. The team reviewed documentation and conducted thorough interviews with National Ministries, District representatives, local authorities, private agencies, NGOs, and other key stakeholders and implementing partners to gain a comprehensive view of Uganda’s disaster management capabilities. The review was designed to provide assistance to the country in identifying areas of focus for planning, preparedness, and response capabilities and to establish a baseline for the May workshop, resulting in a national work plan for use in building capacity for Uganda to respond to disasters. To achieve this, building partnerships and trust is an utmost goal of this workshop, in addition to seeking out best practices, and developing plans and training activities.

Hon. Minister Musa Francis Ecweru, Minister of State, Relief Disaster Preparedness and Refugee, officially kicked off the workshop, emphasizing that as a community and as global citizens, “our destiny is in our own hands.” He added that the Ugandan people must be prepared and ready to respond appropriately to a disaster using a comprehensive approach. He commended the Ugandan people for working to ensure that different components of the plan are working well, adding that NECOC has been put in place as a result of several recent disasters. The Minister emphasized the importance of the role of the military, saying that they are critical to any disaster, because of their training, good health and fast response ability, concluding, “A structured and comprehensive approach to disaster response is critical to any nation but cannot be achieved without coordinating with all key players.”

In closing, Mr. Ecweru said all disasters require harmonization of all regional players and that only an integrated approach and a well-balanced policy can allow labor efficiency in a coordinated framework. “Being here signals a willingness to contribute to the development of a work plan and marks the beginning of a process that marks a commitment to disaster planning and preparedness for Uganda.” He encouraged the organizing team to leave no strategy or tactic unexplained in the process.

DP3 uses a whole-of government approach in its program design, building partnerships and capacity with various African partner nations. Initiation of activities under this program includes a review of national emergency management systems using proven methodologies such as the Emergency Management Standards, developed by the Emergency Management Accreditation Program. U.S. Africa Command uses the work plan that will result from this workshop to develop capacity building activities in support of country goals. The end-state of DP3 is for African partner nations to strengthen their capacity to respond to a disaster and mitigate threats to their stability and security.

CDHAM attended the ASIA-PACIFIC MILITARY MEDICINE CONFERENCE (APMMC), co-hosted by the United States Army and the Royal Thai Army, from April 30-May 4, 2012, in Bangkok, Thailand. On day 1, CDHAM Disaster Psychiatry Fellow, Major (Dr.) Geoff Oravec, co-moderated a panel on “Military Responses in Humanitarian Assistance and Disaster Relief.”  On day 2, USUHS President, Dr. Charles Rice, gave a plenary talk on “Military Medicine: Life Saving Support and Stability.”  Later that day, CAPT Trueman Sharp, Chair of the Department of Military and Emergency Medicine, co-moderated a panel on “Military Medical Education: Not Just a Doctor in a Uniform.”  On that panel, CDHAM Director, Dr. Charles Beadling, gave a presentation on “Military Medicine Education: A US Perspective.”

CDR Glendon Diehl, PhD and CDHAM Deputy Director Dr. Kevin Riley, PhD also offered a poster presentation on the Center and USUHS’ effort on the development of the Global Health Engagement Framework for the Department of  Defense. This poster was based on the efforts of  Dr. Beadling, Dr. Carlos Williams, Dr. Diehl, Dr Riley and Ms. Sharon Jankosky respectfully.

APMMC provides a forum for U.S. military health-care providers to discuss topics, issues, and concerns of military medical significance with allied and friendly countries in the Asia Pacific region. The conference provided an opportunity to discuss military medical topics such as influenza viruses, pandemic influenza, HIV, emerging infectious diseases, malaria, preventive medicine, deployment health for peacekeeping operations (PKO) and other contingency operations (OCO), military medical aid to civil agencies, health service support, combat medicine, triage and casualty evacuation, medical readiness, behavioral health, Wounded Warrior Care, medical technology, medical training, simulation training, research and medical interoperability.

The theme of APMMC XXII was “Diversity is Our Strength: Regional Security through Collaboration.”  Topics were presented in lecture forum, small group sessions, and poster board presentations.  Conference participation was estimated at approximately 450 delegates.

Quality healthcare, biosurveillance, situational awareness and medical disaster response are data-driven activities. Having the right information to make critical decisions requires a dynamic, robust capability to exchange data while enforcing privacy policies. The Federal government has provided strategies, frameworks and architectures to enable the development of many systems within homeland security, public health, emergency response and now healthcare. While significant progress has been made with investments over the last decade, challenges still exist.

CDHAM will be involved in testing the Health Resilience Exchange (H-ReX) information sharing pilot, which directly addresses this need for separate systems and networks to interoperate across and between government entities and their partners. It is the realization of an interoperable network of systems as envisioned in the Pandemic and All Hazards Preparedness Act and leverages the processes and methodologies of the federal information sharing environment. As a true information sharing service, H-ReX supports many federal, state and local initiatives including the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act of 2009 under Title XIII. The pilot supports these efforts through the use of existing standards and technologies while also enhancing current production capabilities:

• Health exchange, biosurveillance, situational awareness, medical response and decision support standards and interoperability can be evaluated for effectiveness
• State and local health and health information exchanges can immediately support HITECH and refocus on use and application of data
• Medical and healthcare participants will achieve certification for population and public health reporting Meaningful Use for Stage 1 while also addressing mandated reporting burdens
• Health is international with bi-directional impacts that will be researched to define information sharing needs

The pilot will focus on minimal data sets to test out the entire data lifecycle and across multiple initiatives to avoid duplicating existing efforts to expand and harmonize multiple standards. The Health Resilience Exchange is the culmination of a decade-long effort to deploy a national interoperable network of systems to support information exchange across medical, healthcare, public health, health security and homeland security sectors. The pilot is a project under the Henry Jackson Foundation and a federal Cooperative Research and Development Agreement.

CDHAM is involved in an exciting initiative to develop a standardized process for measuring the effectiveness of Global Health Engagements (GHE)/Medical Stability Operations (MSO) to be used across the Military Health System. Each GHE/MSO mission will have unique aspects and may have different measures of effectiveness. However, the more we use standardized terminology and processes, the better we can compare how effective each engagement was in meeting intended goals.

It is important to be able to measure progress toward strategic desired end states, rather than just productivity or performance metrics. By collecting data over time, and using a standardized process, comparisons can be made about the cost-effectiveness of various types of health engagements. Eventually, we will be able to determine the optimal duration and frequency of health engagements. In the current severely constrained fiscal environment, this information is critical for our decision makers.

This initiative was endorsed by the Assistant Secretary of Defense for Health Affairs in April 2011 during the Strategic Health Engagement Forum. CDHAM is partnering with the Center for Excellence in Disaster Management and Humanitarian Assistance and coordinating with the offices of the Joint Staff Surgeon, Undersecretary of Defense for Policy, International Health Division and the Combatant Command Surgeons. Valuable input has been solicited from a wide variety of stakeholders, including the US Agency for International Development, Peace Keeping Stability Operations Institute and Naval War College.

The current model is being called the Global Health Engagement Measures of Effectiveness (GHE-MoE) framework, and is a hybrid of the Logical Framework and Results Framework tools. The proposal is to use a baseline assessment of the Host Nation healthcare system which can be repeated periodically, perhaps at three-year intervals, to measure long-term improvement. The GHE-MoE framework can provide a standardized process to measure the effectiveness of our strategic health engagements.

Charles W. Beadling, MD, FAAFP, IDHA, DMCC
Col (ret), USAF, MC, CFC
Director

CDHAM, in partnership with United States Northern Command and the Armed Forces Health Surveillance Center, is organizing the Environmental Health Considerations for Global Emerging Infections Conference, June 12-14, 2012 in Denver, Colorado. The purpose of the conference is to strengthen Biosafety, biosecurity and readiness for outbreaks of dangerous and emerging pathogens outbreaks.

CDHAM is set to begin a series of courses similar to the “Global Health Strategies for Stability Course,” developed by CDHAM in partnership with various stakeholders. For more on these courses, contact us at education@cdham.org or refer to our GHSS website at http://ghss.cdham.org.

The Global Health Strategies for Stability (GHSS) Course was designed to increase public health capacity by providing a comprehensive set of skills for understanding and improving the health sector of a nation or region. In this course, students learn how to use health as a stabilizer in global health engagements, covering elements that are critical to understanding the health sector of a nation and designing sustainable solutions for meeting needs and increasing capacity.

The GHSS course, developed by CDHAM in partnership with Johns Hopkins School of Public Health and the Defense Medical Readiness Training Institute, was designed to provide USG personnel (DOD, HHS, USAID, DOS and FDA) as well as private sector personnel working in support of USG programs, with the knowledge and skills to successfully assess, design, execute and manage health sector interventions under the overarching subject matter of Global Health/Medical Stability Operations. CDHAM is currently accepting applications to attend the first installment of the GHSS course, which will be conducted in Washington, DC from August 6-30, 2012. Interested parties can apply through CDHAM’s website at http://ghss.cdham.org. Participants in the course will also be eligible to receive a minimum of 20 hours of continuing education units to attend the course. The GHSS course aims to develop a cadre of health personnel, both military and civilian participants, with a solid understanding of global health issues in the context of US and host nation national security.

The GHSS also aims to:

• Develop professionals who function as effective mentors and health diplomats in a globalized health environment.
• Develop a cadre of health professionals, both military and civilian partners, with a solid understanding of global health issues within the context of US and partner nation national security.
• Develop professionals who can recognize health destabilizers and develop, implement and evaluate programs that address and mitigate their effects.
• Improve the quality of health missions and programs with partner nations through the knowledge and skills taught in this course.

As part of our continued commitment to internal capacity building, CDHAM fellow under the Master in Healthcare Administration and Policy (MHAP) program at the Uniformed Services University of the Health Sciences (USUHS), Ms. Sharon Jankosky, just finished attending a Humanitarian Rights and Humanitarian Law course in Geneva, Switzerland. The course is offered by the Center for International Humanitarian Cooperation (CIHC) and is part of a series of courses that  aim to prepare humanitarian workers and members of international relief agencies to perform more effectively while in conflict and post-conflict areas.

According to the CIHC, the course investigated the origins and principles of both Humanitarian Law and Humanitarian Rights, introduced applicable conventions and protocols, explored ways where the law can enhance humanitarian assistance, and gave students an opportunity to analyze case studies and develop a thorough understanding of the applicability of Human Rights and Humanitarian Law to their daily work. The aim of the course is to enhance students’ ability to monitor violations of respective rights and determine effective ways of advocacy, while also integrating international norms and standards into their own field of work.

Topics covered include:  Human Rights Law (Introduction, history, concepts, (non-) state actors; civil, cultural, economic, political and social rights, child rights); Tools for Humanitarian workers (Natural Disasters and Human Rights); Humanitarian Law (Introduction, history, Geneva Law, The Hague Law, rules of engagement, combatant status, determining conflicts); The Human Rights based approach (integrating a human rights based approach into programming and projects), Human Rights monitoring and advocacy; The Right to Humanitarian Assistance (legal concepts and current developments); Humanitarian Intervention and the responsibility to protect; International Criminal Law (History, concepts, tribunals and the ICC, practical implications for humanitarian workers); International Disaster Response Law.

For more information, refer to the CIHC website at: http://www.cihc.org/

The course combines engaging lectures, student activities, and discussions designed to intellectually challenge students on the application of both hard and soft power in the context of medical support to stability operations. Students get the opportunity to speak with Subject Matter experts with experience in a broad range of activities, learning about concepts and lessons learned from DoD missions around the world.

MSOC is open to all DoD Active Duty/Reserve/Guard, US Public Health Service and US Coast Guard Medical Officers (O3-O6), senior enlisted medical professionals, and Interagency/Intergovernmental partners. MSOC also offers students the opportunity to receive credit for their work: AMA PRA/CME Cat I; CNE; Cat II non- ACHE (15-20 credits).