Joint External Evaluation of IHR Core Capacities of the Democratic Socialist Republic of Sri Lanka Mission report: June 19-23, 2017
Joint External Evaluation of IHR Core Capacities of the Democratic Socialist Republic of Sri Lanka Mission report: June 19-23, 2017
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Contents Acknowledgements-------------------------------------------------------------------------------------------------v Executive summary ------------------------------------------------------------------------------------------------ 1 Sri Lanka scores----------------------------------------------------------------------------------------------------- 3 PREVENT 5 National legislation, policy and financing----------------------------------------------------------------------- 5 IHR coordination, communication and advocacy-------------------------------------------------------------- 7 Antimicrobial resistance------------------------------------------------------------------------------------------- 9 Zoonotic diseases--------------------------------------------------------------------------------------------------12 Food safety----------------------------------------------------------------------------------------------------------15 Biosafety and biosecurity-----------------------------------------------------------------------------------------17 Immunization-------------------------------------------------------------------------------------------------------20 of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka DETECT 22 National laboratory system---------------------------------------------------------------------------------------22 Real-time surveillance---------------------------------------------------------------------------------------------25 Reporting------------------------------------------------------------------------------------------------------------28 Workforce development------------------------------------------------------------------------------------------30 RESPOND 33 Preparedness-------------------------------------------------------------------------------------------------------33 Emergency response operations---------------------------------------------------------------------------------35 Linking public health and security authorities-----------------------------------------------------------------38 Medical countermeasures and personnel deployment-------------------------------------------------------40 Risk communication-----------------------------------------------------------------------------------------------42 OTHER IHR-RELATED HAZARDS AND POINTS OF ENTRY 46 Points of entry -----------------------------------------------------------------------------------------------------46 Chemical events----------------------------------------------------------------------------------------------------48 Radiation Emergencies--------------------------------------------------------------------------------------------50 Appendix 1: JEE Mission Background--------------------------------------------------------------------------53 iii
ACKNOWLEDGEMENTS The WHO JEE Secretariat would like to acknowledge the following, whose support and commitment to the principles of the International Health Regulations (2005) has ensured a successful outcome to this JEE mission: The government and national experts of Sri Lanka for their support of, and work in, preparation for the JEE mission (the Ministry of Health, Nutrition and Indigenous Medicine and its departments and units; the ministries of Defence, Foreign Affairs and Disaster Management; the departments of Animal Production and Health, Agriculture and Fisheries; the Sri Lankan Security Services; the Civil Aviation Authority of Sri Lanka; Aviation Sri Lanka; the Disaster Management Centre; the Central Environment Authority; the Sri Lanka Atomic Energy Regulatory Council; and the Sri Lanka Ports Authority). of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka The governments of Bhutan, Sweden and the United States of America, for providing technical experts for the peer review process. The World Organisation for Animal Health, for their contribution of experts and expertise. The government of the United States of America, for their financial support to this mission. The following WHO entities: the Country Office for Sri Lanka, the Country Office for Uzbekistan, The Regional Office for South East Asia and the WHO headquarters Department of Country Health Emergency Preparedness and IHR, for providing technical experts and supporting the mission. Global Health Security Agenda for their collaboration and support. v
Executive summary Findings from the joint external evaluation Sri Lanka is to be commended for volunteering to host a Joint External Evaluation. This shows tremendous commitment, foresight and leadership from the government. The country team should also be congratulated on bringing together a large number of key individuals, from a variety of organizations and departments, to contribute to the evaluation. This ensured the participation of colleagues from for example the Ministries of Agriculture, Defence and Foreign Affairs and the departments of animal health and atomic energy, in addition to the participation of numerous colleagues from the public health sector. Their contributions greatly enriched the preparation and delivery of the mission. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka During the JEE mission, the external team developed three cross-cutting recommendations which require urgent high-level commitment. These are as follows: Strengthen multisectoral engagement and foster a true One Health approach Sri Lanka established a Steering Committee for the International Health Regulations (IHR) in 2016. This provides an opportunity significantly to increase collaboration and information exchange between ministries, sectors and disciplines, and thereby to improve the health and health security of humans and animals. The planned formalization of the committee with high-level membership and an annual work plan will make it an important body for coordination and collaboration among ministries at the national level. To complement this development, it is recommended that Sri Lanka: Establishes or enhances mechanisms to promote systematic collaboration between the human health, animal health and other relevant sectors on technical and policy areas. Enhance surveillance Sri Lanka has demonstrated its commitment to strong surveillance systems for national priority diseases in the human and animal health sectors, as well as to systems for detecting antimicrobial-resistant microbes, adulterated food and counterfeit medicines. These systems will be invaluable for providing early warnings of potential threats to human and animal health, monitoring priority diseases, and informing implementation measures. However, it is recommended that to ensure the effectiveness of these systems, Sri Lanka: Integrates the surveillance efforts of the human and animal health sectors, across all levels of government and especially at the national level Improves the quality and management of data, considering the use of enhanced electronic reporting tools and registries to facilitate the rapid collection, exchange, analysis and use of health data. New information technology has enabled the development of electronic patient registries covering clinical and laboratory data from all levels and sectors of the healthcare system. This allows real-time surveillance and reporting activities, as well as linkages with other sources of data. Ensure sustainable and scalable health security through improved documentation Sri Lanka has high levels of expertise and operational capacity for dealing with public health threats and emergencies. The country also benefits from teams of experienced public health professionals who are trusted by the public. However, it is recommended that Sri Lanka: Develops, finalizes and formally approves national plans, memoranda of understanding, standard operating procedures and other administrative mechanisms that facilitate and formalize implementation, 1
2Joint External Evaluation communication and coordination across sectors, while maintaining the flexibility to adapt to situations as they develop Implements these administrative mechanisms to empower all relevant sectors and ensure a One Health and multi-hazard approach, contributing to business continuity and Sri Lanka s ability to respond to unexpected events and large-scale emergencies. The JEE team would like to express its appreciation for the considerable work and effort Sri Lanka dedicated to the JEE process, including both the self-evaluation and the external evaluation. The professionalism, transparency, and willingness of the Sri Lankan team to seek solutions together with the JEE team was instrumental to the mission s success. The team now hopes the evaluation can serve as a platform from which to develop a country action plan for the way forward.
Sri Lanka scores Technical areas Indicators Score National legislation, policy and financing IHR coordination, communication and advocacy Antimicrobial resistance Zoonotic diseases Food safety Biosafety and biosecurity Immunization National laboratory system Real-time surveillance Reporting Workforce development Preparedness 1 FETP: Field epidemiology training programme P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government instruments in place are sufficient for implementation of IHR (2005) 4 P.1.2 The State can demonstrate that it has adjusted and aligned its domestic legislation, policies and administrative arrangements to enable compliance with IHR (2005) 3 P.2.1 A functional mechanism is established for the coordination and integration of relevant sectors in the implementation of IHR 2 P.3.1 Antimicrobial resistance detection 3 P.3.2 Surveillance of infections caused by antimicrobial-resistant pathogens 3 P.3.3 Health care-associated infection (HCAI) prevention and control programmes 3 P.3.4 Antimicrobial stewardship activities 3 P.4.1 Surveillance systems in place for priority zoonotic diseases/pathogens 3 P.4.2 Veterinary or animal health workforce 3 P.4.3 Mechanisms for responding to infectious and potential zoonotic diseases are established and functional 2 P.5.1 Mechanisms for multisectoral collaboration are established to ensure rapid response to food safety emergencies and outbreaks of foodborne diseases 3 P.6.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities 2 P.6.2 Biosafety and biosecurity training and practices 1 P.7.1 Vaccine coverage (measles) as part of national programme 5 P.7.2 National vaccine access and delivery 5 D.1.1 Laboratory testing for detection of priority diseases 4 D.1.2 Specimen referral and transport system 2 D.1.3 Effective modern point-of-care and laboratory-based diagnostics 3 D.1.4 Laboratory quality system 3 D.2.1 Indicator- and event-based surveillance systems 3 D.2.2 Interoperable, interconnected, electronic real-time reporting system 4 D.2.3 Integration and analysis of surveillance data 4 D.2.4 Syndromic surveillance systems 4 D.3.1 System for efficient reporting to FAO, OIE and WHO 3 D.3.2 Reporting network and protocols in country 2 D.4.1 Human resources available to implement IHR core capacity requirements 4 D.4.2 FETP 1 or other applied epidemiology training programme in place 4 D.4.3 Workforce strategy 3 R.1.1 National multi-hazard public health emergency preparedness and response plan is developed and implemented 1 R.1.2 Priority public health risks and resources are mapped and utilized 1 of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka 3
4Joint External Evaluation Emergency response operations Linking public health and security authorities Medical countermeasures and personnel deployment Risk communication Points of entry Chemical events Radiation emergencies R.2.1 Capacity to activate emergency operations 1 R.2.2 EOC operating procedures and plans 2 R.2.3 Emergency operations programme 3 R.2.4 Case management procedures implemented for IHR relevant hazards. 4 R.3.1 Public health and security authorities (e.g. law enforcement, border control, customs) are linked during a suspect or confirmed biological event 4 R.4.1 System in place for sending and receiving medical countermeasures during a public health emergency 2 R.4.2 System in place for sending and receiving health personnel during a public health emergency 1 R.5.1 Risk communication systems (plans, mechanisms, etc.) 2 R.5.2 Internal and partner communication and coordination 5 R.5.3 Public communication 3 R.5.4 Communication engagement with affected communities 4 R.5.5 Dynamic listening and rumour management 5 PoE.1 Routine capacities established at points of entry 3 PoE.2 Effective public health response at points of entry 4 CE.1 Mechanisms established and functioning for detecting and responding to chemical events or emergencies 2 CE.2 Enabling environment in place for management of chemical events 2 RE.1 Mechanisms established and functioning for detecting and responding to radiological and nuclear emergencies 1 RE.2 Enabling environment in place for management of radiation emergencies 3
PREVENT National legislation, policy and financing Introduction The International Health Regulations (IHR) (2005) provide obligations and rights for States Parties. In some States Parties, implementation of the IHR (2005) may require new or modified legislation. Even if a new or revised legislation may not be specifically required, states may still choose to revise some regulations or other instruments in order to facilitate IHR implementation and maintenance in a more effective manner. Implementing legislation could serve to institutionalize and strengthen the role of IHR (2005) and operations within the State Party. It can also facilitate coordination among the different entities involved in their implementation. See detailed guidance on IHR (2005) implementation in national legislation at http://www.who.int/ihr/legal_issues/legislation/en/index.html. In addition, policies that identify national structures and responsibilities as well as the allocation of adequate financial resources are also important. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka Target Adequate legal framework for States Parties to support and enable the implementation of all their obligations, and rights to comply with and implement the IHR (2005). New or modified legislation in some States Parties for implementation of the IHR (2005). Where new or revised legislation may not be specifically required under the State Party s legal system, States may revise some legislation, regulations or other instruments in order to facilitate their implementation and maintenance in a more efficient, effective or beneficial manner. States Parties ensure provision of adequate funding for IHR implementation through the national budget or other mechanism. Sri Lanka level of capabilities In Sri Lanka, the Quarantine and Prevention of Disease Ordinance (1897) governs the prevention of the spread of disease, and measures relating to quarantine. The Ordinance allows ministers to introduce regulations to prevent the introduction of disease to Sri Lanka and prevent the spread of disease both within and outside the country s borders. In 2014 the government completed an assessment of the extent to which Sri Lanka s existing legislation was sufficient for IHR implementation. In 2016, following this assessment, Sri Lanka s cabinet approved several amendments to the Ordinance in order to bring it in line with IHR requirements. Other laws, including those relating to animal health, have been updated to better reflect IHR requirements. Sri Lanka has clear regulations on activities that should be carried out at local level to follow up on events. Reporting used to be paper based but is now web based, and covers both the public and private sectors. Sri Lanka does not have specific agreements in place for collaboration with other countries. WHO mechanisms can be used when needed. Following the 2004 tsunami, the government set up a national disaster commission that can provide funding during disasters. The country has extensive experience in disaster management, clear procedures in place, and a collaborative approach to preparedness. There are compensation schemes for farmers affected by disasters. 5
PREVENT 6Joint External Evaluation Sri Lanka has had mixed experiences with receiving aid from other countries. The country has established a mechanism and registration process for receiving foreign professionals, but this process is not always followed. Sri Lanka is currently updating its animal health legislation, which covers zoonotic diseases. The World Organization for Animal Health (OIE) has recommended a review of this legislation. Recommendations for priority actions Update the Quarantine and Prevention of Disease Ordinance with amendments that were recently approved by Sri Lanka s cabinet, in order to bring the legislation up to date with IHR requirements. Formalize, through regular meetings and established terms of reference, coordination between IHR focal points within the various line ministries as an administrative requirement for IHR implementation. Establish a multisectoral technical working group to assess the legal system and administrative arrangements in relation to the IHR across the whole of government, and, where necessary, adjust laws, regulations and administrative practices in order to enable IHR implementation. Document and publish the administrative arrangements and policies from various sectors in order to encourage cross-sectoral collaboration. Indicators and scores P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government instruments in place are sufficient for implementation of IHR (2005) Score 4 Sri Lanka has legislation in place that provides the necessary basis for IHR implementation, including a disease prevention ordinance from 1987 and a disaster management act from 2005. Additional regulations on specific diseases and on border issues are in place. Similar legislation exists for the animal health sector. In recent years, many acts and laws have been amended, and structures have been established, to facilitate the implementation of the IHR. This includes the establishment of a directorate for quarantine. Areas that need strengthening/ challenges There is a need to assess the need for changes in other parts of national legislation in order to have capability across government to implement the IHR. More formal structures are needed to improve coordination among different parts of the government. P.1.2 The State can demonstrate that it has adjusted and aligned its domestic legislation, policies and administrative arrangements to enable compliance with the IHR (2005) Score 3 Sri Lanka has carried out two assessments of its laws and administrative arrangements with regard to supporting the IHR. Several adjustments have been made to laws and regulations following these assessments. There is a need to establish a multisectoral group to suggest further adjustments to laws and regulations to comply fully with the IHR.
IHR coordination, communication and advocacy Introduction The effective implementation of the IHR requires multisectoral/multidisciplinary approaches through national partnerships for efficient and alert response systems. Coordination of nationwide resources, including the designation of a national IHR focal point, which is a national centre for IHR communications, is a key requisite for IHR implementation. Target Multisectoral/multidisciplinary approaches through national partnerships that allow efficient, alert and responsive systems for effective implementation of the IHR (2005). Coordinate nationwide resources, including sustainable functioning of a national IHR focal point a national centre for IHR (2005) communications which is a key requisite for IHR (2005) implementation that is accessible at all times. States Parties provide WHO with contact details of national IHR focal points, continuously update and annually confirm them. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka PREVENT Sri Lanka level of capabilities Sri Lanka s Ministry of Health, Nutrition and Indigenous Medicine is the main body responsible for implementing the IHR. The ministry performs this role in collaboration with stakeholders from a variety of other ministries and departments. The Quarantine and Prevention of Disease Ordinance, first introduced in 1897 and revised in 1962, is the principal law governing the prevention of the spread of diseases. The second section of the ordinance provides the Minister of Health with the authority to introduce regulations for the purpose of preventing the introduction into Sri Lanka of any disease, and also of preventing the spread of any disease outside Sri Lanka. In 2008, the Director of the Quarantine Unit and the Chief Epidemiologist at the Ministry of Health, Nutrition and Indigenous Medicine were nominated as the joint National Focal Points for the IHR. In 2016, Sri Lanka established a National IHR Steering Committee under the chairmanship of the Director General of Health Services. The committee includes the following individuals and organizations: Public Health Services, Quarantine Unit, Epidemiology Unit, Decision Making Unit (Ministry of Health, Nutrition and Indigenous Medicine) Civil Aviation Authority of Sri Lanka Chief Executive Officer of Bandaranaike International Airport Commanding officer of Bandaranaike International Airport Airport Aviation Sri Lanka Airline authorities Ports Authority Deputy Inspector General, Sri Lanka Police Sri Lanka Customs 7
PREVENT 8Joint External Evaluation Department of Immigration and Emigration Department of Animal Production and Health Department of Agriculture Ministry of Disaster Management Atomic Energy Regulatory Council and the Atomic Energy Regulatory Board Central Environment Authority Security authorities. Recommendations for priority actions Draft and formalize terms of reference for the National IHR Steering Committee, including roles and responsibilities and frequency of meetings; and formulate an action plan for the committee. The National IHR Steering Committee should participate fully in completing the IHR annual questionnaire. Hold an annual meeting of the National IHR Steering Committee to inform members about IHR updates. Indicators and scores P.2.1 A functional mechanism established for the coordination and integration of relevant sectors in the implementation of IHR Score 2 Sri Lanka has established a directorate of quarantine, identifying National IHR Focal Points and providing necessary finances for the function of these mechanisms. A National IHR Steering Committee was established in 2016 to improve the coordination of IHR-related activities. During a public health emergency of international concern, the Director General of Health Services coordinates activities with all relevant stakeholders. IHR strengthening activities were included in the Ministry of Health, Nutrition and Indigenous Medicine s Master Plan 2017-2025. A multisectoral avian influenza committee was established in 2009 and convenes every month. This provides an effective platform through which to discuss influenza and other emerging health threats. The Advisory Committee on Communicable Diseases was formed three years prior to the JEE mission and convenes every two months to take high-level policy decisions related to communicable diseases. This committee includes representation from experts from many different disciplines. The National IHR Steering Committee requires strengthening through more regular meetings and defined plans of action. The IHR annual questionnaire should be completed with the full participation of all stakeholders. IHR updates should be disseminated to all relevant stakeholders through an annual meeting. Sectoral coordination focal points for IHR activity need to be established.
Antimicrobial resistance Introduction Bacteria and other microbes evolve in response to their environment and inevitably develop mechanisms to resist being killed by antimicrobial agents. For many decades, the problem was manageable as the growth of resistance was slow and the pharmaceutical industry continued to create new antibiotics. Over the past decade, however, this problem has become a crisis. Antimicrobial resistance is evolving at an alarming rate and is outpacing the development of new countermeasures capable of thwarting infections in humans. This situation threatens patient care, economic growth, public health, agriculture, economic security and national security. Target Support work coordinated by FAO, OIE and WHO to develop an integrated global package of activities to combat antimicrobial resistance, spanning human, animal, agricultural, food and environmental aspects (i.e. a One Health approach). Each country has: (i) its own national comprehensive plan to combat antimicrobial resistance; (ii) strengthened surveillance and laboratory capacity at the national and international levels following international standards developed as per the framework of the Global Action Plan; and (iii) improved conservation of existing treatments and collaboration to support the sustainable development of new antibiotics, alternative treatments, preventive measures and rapid point-of-care diagnostics, including systems to preserve new antibiotics. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka PREVENT Sri Lanka level of capabilities Sri Lanka has identified antimicrobial resistance (AMR) as an important area for public health action. In May 2017, Sri Lanka published its first National Strategic Plan for Combating AMR, which was developed with input from multiple sectors and is aligned with the WHO Global Action Plan on AMR. Sri Lanka has an extensive and well-established healthcare system, including more than 60 microbiology labs across the country. These labs can conduct AMR surveillance (with varying levels of capability) for WHO priority pathogens. Additional support is provided by a national reference lab. For animal health, 24 district-level veterinary labs provide a limited level of AMR surveillance capability. A multisectoral steering committee is responsible for providing national AMR policy guidance and support. Over the next few years, Sri Lanka is planning to increase the number of laboratories (both human and veterinary) that submit AMR data, expand healthcare acquired infection surveillance beyond MRSA bacteraemia, and develop robust hospital-based AMR stewardship programmes. Sri Lanka has demonstrated much progress on AMR since 2009, when AMR surveillance was first implemented. Given its well-trained and dedicated workforce, the country is well positioned to improve on its scores at the next JEE. Recommendations for priority actions Conduct systematic awareness programmes on AMR among target groups in the human health, veterinary, fisheries, and agriculture sectors. 9
Joint External Evaluation Establish and expand the national AMR surveillance system to cover all priority pathogens for AMR in human health and relevant AMR pathogens (such as Salmonella, E.coli, and S. aureus) in animal health. Expand surveillance of healthcare acquired infections (HCAI) to include at least one additional HCAI (such as surgical site infections or ventilator-associated pneumonia). Establish antibiotic stewardship programmes and strengthen legislation against unauthorized prescriptions in the human and animal health sectors. Indicators and scores P.3.1 Antimicrobial resistance detection Score 3 Sri Lanka has an accessible, countrywide human and veterinary laboratory network. PREVENT More than 60 human microbiology laboratories have the capability to detect resistance in WHO priority pathogens. Sri Lanka has a national reference laboratory for human health (at the Medical Research Institute), and specialized national reference laboratories for N. gonorrhoea and M. tuberculosis. Three multisectoral, national-level committees support AMR (a steering committee, a quality assurance committee, and an infection control and prevention committee). Develop a system for multisectoral coordination between human and animal health. Expand capability for AMR surveillance at veterinary laboratories. P.3.2 Surveillance of infections caused by antimicrobial-resistant pathogens Score 3 The National Strategic Plan has identified AMR as a priority public health issue. AMR surveillance is currently being conducted routinely at 15-20 laboratories. Sri Lanka participates in the WHO Gonococcal Antimicrobial Resistance Surveillance Programme. Projects on AMR pathogens are underway in the animal health sector (including on mastitis in animals and surveillance of S. aureus, Streptococcus, and E.coli). Encourage participation of all hospitals (at base hospital level A or higher) in AMR surveillance activities. Start to collect AMR data on Shigella infections. Broaden surveillance for AMR infections by including other sectors such as animal health and agriculture. P.3.3 Health care-associated infection (HCAI) prevention and control programmes Score 3 Sri Lanka has a National Advisory Committee on Infection Prevention. All hospitals have an infection control unit and an infection control committee. Infection control has been included in some curricula for healthcare workers (for example in postgraduate training). 10
All infection control doctors and nurses undergo in-service training on infection control after being appointed to the infection control unit. MRSA bacteraemia surveillance is conducted at select hospitals. Develop national-level infection control policies. Establish a comprehensive healthcare acquired infection surveillance system and incorporate it into the national notifiable diseases system. Expand healthcare acquired infection surveillance to include all human health hospitals as well as farms. Establish negative-pressure isolation rooms in all tertiary care level hospitals, according to international standards. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka P.3.4 Antimicrobial stewardship activities Score 3 Sri Lanka has national guidelines on empirical antibiotic therapy for select clinical conditions (such as leptospirosis and dengue). PREVENT Red Light antibiotics require approval prior to prescription. The Drug Act covers the animal health sector. Local antibiotic stewardship programmes are available in some hospitals. The National Medicines Regulatory Authority aims to ensure that all medicines and medical devices available in Sri Lanka are efficacious, safe and of acceptable quality, and to ensure uninterrupted supply and rational use. Continue to develop AMR awareness programmes in all relevant sectors, including for the public. Develop legislation to ensure strict oversight and enforcement of unauthorized, over-the counter sale of antibiotics in both human and animal health sectors. Strengthen the existing mechanism for monitoring prescription policies. Develop comprehensive AMR stewardship programmes for healthcare personnel. 11
Joint External Evaluation Zoonotic diseases Introduction Zoonotic diseases are communicable diseases that can spread between animals and humans. These diseases are caused by viruses, bacteria, parasites and fungi carried by animals, insects or inanimate vectors that aid in its transmission. Approximately 75% of recently emerging infectious diseases affecting humans is of animal origin; and approximately 60% of all human pathogens are zoonotic. PREVENT Target Adopted measured behaviours, policies and/or practices that minimize the transmission of zoonotic diseases from animals into human populations. Sri Lanka level of capabilities Sri Lanka has a number of strengths in zoonotic diseases. These include a network of qualified veterinarians and para-professionals across the country, and a network of district-level veterinary investigation centres. Mechanisms are not yet in place, however, for a true One Health approach based on an effective collaboration between the human health and animal health workforces. Until recently, activities related to zoonotic diseases have been primarily the responsibility of the Ministry of Health, Nutrition and Indigenous Medicine. Now, the Department of Animal Health and Production has the mandate (but not the budgetary authority) to perform activities such as rabies vaccinations for dogs. The department has also requested the establishment of a Veterinary Public Health division, which would come under its management. Zoonotic diseases of importance in the country include: rabies; leptospirosis; salmonellosis; brucellosis; bovine spongiform encephalopathy; avian influenza; Japanese encephalitis; and tuberculosis. Zoonotic diseases with parasitic agents are not identified as priorities, although they are likely to be of significance. In addition to the priority actions identified below, it is recommended that Sri Lanka implements all relevant recommendations of the World Organization for Animal Health s PVS Evaluation, and requests a follow-up evaluation. Recommendations for priority actions Establish a veterinary public health team within the Department of Animal Health and Production, with an appropriate allocation of human, physical and operational resources at both the central and field levels. Establish a formal One Health platform, bringing together the four key ministries and agencies (Health, Animal Health and Production, Fisheries and Environment/Wildlife) with local government and private stakeholders to deliver a national zoonotic disease control strategy. Design, implement and annually evaluate zoonotic disease control plans for rabies, brucellosis, tuberculosis and leptospirosis, among others. 12
Indicators and scores P.4.1 Surveillance systems in place for priority zoonotic diseases/pathogens Score 3 There is a network of qualified veterinarians and para-professionals that covers the whole country. The district level-veterinary Investigation Centre network comprises 25 regional laboratories, which are manned with veterinarians and para-professionals who can perform bacteriology, haematology and parasitology. There is a Veterinary Research Institute, equipped to a satisfactory standard, within the Central Veterinary Investigation Centre. The National strategy on zoonotic disease control requires finalization and approval. A mechanism is needed to institutionalize One Health surveillance activities that link all relevant sectors. All ongoing surveillance programmes should be streamlined, including through the upgrade of surveillance in slaughterhouses and strengthened collaboration with private veterinarians and the wildlife sector. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka PREVENT Diagnostic facilities at all levels should be upgraded. The infrastructure, logistics and implementing mechanisms for veterinary public health activities should be improved. P.4.2 Veterinary or animal health workforce Score 3 Sri Lanka has well-trained veterinary staff. Half of graduates on internship programmes have at least a masters level qualification. Staff and para-professionals are provided with continuous professional development opportunities, both in Sri Lanka and abroad. Sri Lanka should ensure that there is an adequate workforce within the Department of Animal Health and Production. Adequate numbers of public health veterinary surgeons should be appointed. A mechanism is required to implement veterinary public health activities at the divisional level. Vacancies for veterinary surgeons and para-professionals should be filled as soon as possible. P.4.3 Mechanisms for responding to infectious and potential zoonotic diseases established and functional Score 1 Veterinary Investigation Officers and the Central Veterinary Research Institute are able to connect rapidly and respond in the event of an outbreak. There is continuous monitoring after outbreaks. The Department of Animal Health and Production and the Ministry of Health, Nutrition and Indigenous Medicine share specimens for tuberculosis testing. 13
Joint External Evaluation Epidemiology capacity should be strengthened for outbreak investigation, disease reporting, surveillance and emergency response. Laboratory capacity for disease diagnosis should be strengthened. Standard operating procedures are required for laboratory and field activities PREVENT 14
Food safety Introduction Food- and water-borne diarrhoeal diseases are leading causes of illness and death, particularly in less developed countries. The rapid globalization of food production and trade has increased the potential likelihood of international incidents involving contaminated food. The identification of the source of an outbreak and its containment is critical for control. Risk management capacity with regard to control throughout the food chain continuum must be developed. If epidemiological analysis identifies food as the source of an event, based on a risk assessment, suitable risk management options that ensure the prevention of human cases (or further cases) need to be put in place. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka Target Surveillance and response capacity among States Parties for food- and water-borne disease risks or events by strengthening effective communication and collaboration among the sectors responsible for food safety, and safe water and sanitation. PREVENT Sri Lanka level of capabilities Sri Lanka s health authorities, including the Food Control Administration, have long-standing experience in food safety issues. The Ministry of Fisheries and Aquatic Resources Development has also gradually upgraded its capacity regarding aquatic food so that its standards comply with those of the European Union and United States Food and Drug Administration. However many challenges remain concerning food consumed in Sri Lanka, whether imported or locally produced. These challenges include the need to develop a food safety strategy and to improve hygiene practices in establishments handling, preparing or producing products of animal origin. Sri Lanka s strengths in food safety include the nationwide network of officials of the Ministry of Health, Nutrition and Indigenous Medicine, and the country s laboratories and regulations. A key recommendation is to develop and formalize collaboration between the Ministries of Health, Rural Economy, Agriculture and Fisheries in order to assess and manage risks throughout the food chain continuum. Some operational links between agencies have been established, but there is a lack of formalized collaboration on many aspects of food safety for example, on salmonella. Recommendations for priority actions Strengthen collaboration between Sri Lanka s various agencies and ministries, aspiring to a farm-tofork approach. Carry out a risk profiling assessment and use the results to revise interagency responsibilities and the overall food safety strategy. Upgrade capacities and guidelines, and particularly laboratory capacity in areas such as on-site testing and testing on chemical residues. 15
Joint External Evaluation Indicators and scores P.5.1 Mechanisms for multisectoral collaboration established to ensure rapid response to food safety emergencies and outbreaks of foodborne diseases Score 3 There is a good regulatory framework. A single agency, the Food Control Administration (part of the Ministry of Health, Nutrition and Indigenous Medicine) has the lead role in food safety. Food control laboratories are managed by the Ministry of Health, Nutrition and Indigenous Medicine. The Food Act and 30 other regulations provide legislative backing for food safety activities. More than 1600 officers regularly sample food for laboratory analysis. PREVENT The Ministry of Health, Nutrition and Indigenous Medicine has four food laboratories across the country. These laboratories are now being upgraded to face present day threats. Define a food safety strategy and amend regulations accordingly. Ensure annual action plans are agreed upon between human health and animal health authorities, and that those annual reports are produced and shared. Improve and enforce hygiene practices in establishments handling, preparing or producing products of animal origin. Upgrade laboratories with the capacities to (for example) test for heavy metals and pesticides. Ensure that the workforce related to food safety is larger and better trained. Implement all relevant recommendations of the World Organization for Animal Health s PVS Evaluation and/or request a follow-up evaluation. 16
Biosafety and biosecurity Introduction It is vital to work with pathogens in the laboratory to ensure that the global community possesses a robust set of tools such as drugs, diagnostics, and vaccines to counter the ever-evolving threat of infectious diseases. Research with infectious agents is critical for the development and availability of public health and medical tools that are needed to detect, diagnose, recognize and respond to outbreaks of infectious diseases of both natural and deliberate origin. At the same time, the expansion of infrastructure and resources dedicated to work with infectious agents have raised concerns regarding the need to ensure proper biosafety and biosecurity to protect researchers and the community. Biosecurity is important in order to secure infectious agents against those who would deliberately misuse them to harm people, animals, plants or the environment. of IHR Core Capacities of Democratic Socialist Republic of Sri Lanka PREVENT Target A whole-of-government national biosafety and biosecurity system with especially dangerous pathogens identified, held, secured and monitored in a minimal number of facilities according to best practices; biological risk management training and educational outreach conducted to promote a shared culture of responsibility, reduce dual-use risks, mitigate biological proliferation and deliberate use threats, and ensure safe transfer of biological agents; and country-specific biosafety and biosecurity legislation, laboratory licensing and pathogen control measures in place as appropriate. Sri Lanka level of capabilities Sri Lanka has identified the importance of ensuring biosafety and biosecurity within human health, animal health and agricultural laboratory facilities. A biosafety manual for medical laboratories provides laboratory staff in the public and private sectors with guidance, information and knowledge on biosafety and biosecurity. The manual has also been distributed to public sector hospitals and laboratories. The Medical Research Institute has an institutional biosafety committee and a biosafety policy document. Infection Control Committees in each hospital have responsibility for monitoring and implementing the basic principles of biosafety and biosecurity. Individual organizations and facilities that store or process dangerous pathogens including the Medical Research Institute, the National Programme for Tuberculosis Control and Chest Diseases, the National STD/AIDS Control Programme and the Veterinary Research Institute maintain up-to-date records and inventories of pathogens, but there is no national inventory for dangerous pathogens. One public sector laboratory and a small number of private sector laboratories have obtained ISO accreditation. The government is encouraging further laboratories to gain accreditation. Training programmes at all facilities have a biosafety component. On-the-job training is mainly conducted at institutional level, according to local protocols. Staff responsible for the shipment of specimens are trained on transport of infectious substances. WHO-sponsored training courses on international shipping regulations are also offered. 17
Joint External Evaluation Recommendations for priority actions Develop a comprehensive, multisectoral biosafety and biosecurity strategy and accompanying legislation. Based on the strategy, develop an action plan for implementation at the national level for both the public and private sectors, including: m m A biosafety and biosecurity training programme that includes professional awareness training Measures to update the inventory of dangerous pathogens and toxins Update the laboratory licensing accreditation process to include biosafety and biosecurity requirements. Identify how sustained funding can be ensured for biosafety and biosecurity programmes. Indicators and scores PREVENT P.6.1 Whole-of-government biosafety and biosecurity system in place for human, animal and agriculture facilities Score 2 The country has identified facilities to store or process dangerous pathogens, consolidating dangerous pathogens into a minimum number of facilities. The Veterinary Research Institute has been identified for the storage of pathogens in the animal health sector. Although Sri Lanka does not have comprehensive national biosafety and biosecurity legislation, guidelines are available at the national level. A biosafety manual has been distributed to public sector hospitals and is available for private sector hospitals. The animal health sector has institutional guidelines and the agriculture sector has a national plant protection act. The country has an accreditation board, and several private sector laboratories and one public sector laboratory are ISO 15189 accredited. The animal health sector has ISO 17025 accredited laboratories. The Medical Research Institute s polio, measles and rubella laboratories are WHO accredited. Sri Lanka does not have national level records or an inventory to monitor the number and type of dangerous pathogens and toxins collected in the country. The country does not have comprehensive biosafety and biosecurity legislation or regulations in place. The laboratory licensing and accreditation process for state sector laboratories should be strengthened. Pathogen control measures, including standards for physical containment and operational handling and containment failure reporting systems, should be strengthened. Oversight, monitoring and enforcement mechanisms should be strengthened. P.6.2 Biosafety and biosecurity training and practices Score 1 Biosafety and biosecurity is included in the training curricula in the human and animal health and agriculture sectors. Institutional level training on biosafety and biosecurity has been provided to staff at all facilities that work with dangerous pathogens and toxins. 18