The members of the PPHSN Coordinating Body (CB) met for the tenth time in Noumea, New Caledonia, 2–4 June 2004, before the second Regional EpiNet Workshop.
Below is a brief summary of the main issues discussed at the meeting.
CB membership renewal in 2004
The procedure to name new CB members will be followed in 2004 in order to have new members on board in 2005 (as was done in 2003 for 2004). For the two sub-regional seats:
- Melanesia: it has already been agreed between the Melanesian countries that Papua New Guinea should take the seat.
- Polynesia: the seat is available to be occupied by a new nominee. The CB focal point will follow the same procedure as last time to nominate the new member.For the three “at large” core member positions, numbers from 1 to 3 had to be randomly allocated as agreed during the PPHSN-CB 8 meeting. The result is: 1 Fiji Islands; 2 Solomon Islands; 3 New Caledonia. The number 3 position, currently filled by New Caledonia, is the one due for renewal this year.
A letter will also be circulated to all allied members asking if they are interested in being represented on the CB. The sitting CB will choose one allied member from among nominees, for a three-year term.
It was also proposed that the Fiji School of Medicine become a permanent allied member in the CB, as are WHO and SPC.
CB communication
The CB members agreed to improve communication among members. Following discussion, the Communicable Disease Network Australia (CDNA) approach (teleconference and letters) was adopted as an option in addition to a discussion list and the usual emails.
Research and surveillance inventory
The CB members agreed that an inventory of all the existing and planned projects research and surveillance projects carried out in the PICTs should be made.
IHR regulations and the role of the PPHSN
The CB members agreed that PPHSN should play a role in the implementation of International Health Regulations (IHR) mechanisms in the PICTs. Taking into account that this initiative should be endorsed by all the PICTs at the highest political level, they decided that a proposal should be submitted to the Meeting of Ministers and Directors of Health in Samoa in March 2005. A working group drafted a proposal for further discussions at the second Regional EpiNet workshop.
It was also agreed that the IHR focal points should be part of the National EpiNet Teams. A letter should be written to all Ministers of Health in order to receive their feedback and endorsement.
Regional EpiNet Team
The CB members agreed that a Regional EpiNet Team should be set up as soon as possible. Many aspects need to be considered before starting the process (identification of the resource persons, agreement at the PICT level, funding, etc.), and this issue was referred to a working group and further discussed at the Second Regional EpiNet Workshop.
Training and accreditation
Following Dr Narendra Singh’s presentation, the CB members acknowledged the importance of accreditation. They also agreed that new opportunities and initiatives such as the Data for Decision Making (DDM) training programme are very useful. The WHO Pacific Open Learning Health Net initiative was mentioned as a good example of a distance training opportunity, having the advantage of training the health professionals on the ground without taking them away from their country for a long period.
PopGIS for presenting data and selling ideas
Following a demonstration from SPC’s population geographic information system (GIS) project, the CB members highlighted two key issues:
- PopGIS could be difficult to use for dynamic data during an outbreak.
- The importance of confidentiality of some data and ownership by the country.
Directory of PPHSN resources
The CB members agreed that the proposed directory of PPHSN resources, including LabNet “instructions for use”, to be produced by the CB focal point, would be very useful.
Discussion and planning of PPHSN extension, to include the following activities:
- HIV/AIDS & STI Surveillance
The CB members agreed that HIV/AIDS is a major public health problem and that it should be incorporated into PPHSN activities now.
- Foodborne surveillance
Dr Jan Pryor and Dr Narendra Singh presented a proposal, on behalf of a working group from the WHO/FAO/SPC Meeting on Future Action on Food Safety in the Pacific held in Malaysia at the end of May, for the establishment of a regional strategy for Pacific foodborne disease (FBD) surveillance within the framework of the PPHSN. The CB members agreed that FBD surveillance is important in the region (two of these diseases, typhoid and cholera, are already part of the PPHSN priorities). Nevertheless, they thought that the proposal needed to be more specific, and a working group was established to look further into at the question: What can PPHSN do to improve foodborne disease surveillance in the PICTs?
- Expanded programme for immunisation and measles surveillance
Dr Richard Duncan updated the CB on the WHO/WPRO Regional Committee meeting on measles and hepatitis B held in September 2003. WPRO will move towards measles elimination. To achieve this, countries will need to focus on achieving high measles immunisation coverage, with good measles surveillance and laboratory confirmation of suspected cases. Opportunities exist for WPRO and PPHSN to work jointly in the area of measles surveillance, in coordination with other partners and donors involved in immunisation in the Pacific through the Pacific Immunization Programme Strengthening (PIPS). One area identified was to boost the current Monthly Active Surveillance system for AFP (acute flaccid paralysis), AFR (acute fever and rash) and neonatal tetanus, and further integrate it with the country surveillance systems and PacNet. - Other communicable diseases
The CB members agreed that resources and funds needed to be identified before taking on board new diseases, except if a new priority arises such as SARS. Dr Jan Pryor updated the CB on the development of NCD-STEPS initiative. As there had been no progress regarding the suggested integration of NCDs to the PPHSN, it was decided that the previously suggested discussion list be created to facilitate communication in this area.
More laboratory issues
Following the TWB meeting’s debriefing, the CB members identified a few more laboratory issues that need to be addressed, as follows.
- Funding for transport
The proposed revolving fund was mentioned as a possible source of funds to pay for the transport of specimens. SPC’s Dr Tom Kiedrzynski said that it should be easy to set up a process at the level of agencies such as SPC and WHO. SPC has some funds that could be accessible in case of emergency. Dr Hitoshi Oshitani added that WHO has also “emergency” funds. There is no rule or limit for these funds; however, countries have to put in a request.
It seems that problems with specimen referrals and shipment with airlines are experienced everywhere, not only in the PICTs. WHO Headquarters is trying to solve this problem at the global level.
- Laboratory safety
Laboratory safety is a real issue; bio-safety cabinets are not always properly maintained in the PICTs.It was reported that the US affiliated countries in the North Pacific received assistance for laboratory services improvement through bio-terrorism funds. The CB members asked if the PPHSN could assist the other countries on this issue also. The Global Fund project, ADB and WHO Department of Communicable Disease Surveillance and Response (CSR) were mentioned as possible sources of funds.
- Confidentiality
Confidentiality was also highlighted during the CB meeting. All CB members agreed that confidentiality must be preserved between the laboratories and the countries. All the laboratory results should be presented to Ministry of Health or Department of Health from where the specimen originates, and further utilisation should only be done with appropriate permission from the concerned country or territory. - Bioethics
There was extensive discussion regarding bioethics issues and the capacity of countries in the region to assess research proposals in terms of bioethics. The CB members concluded that there should be training in the area of bioethics and also suggested that a PPHSN/PHRC technical working group might be established to further address this subject. It was noted, however, that although advice can be given from a regional body like the PHRC, the ultimate decisions in this area must be made by the countries.
Funding issues
The CB members agreed that establishment of the revolving fund was needed urgently, in relation to the Regional EpiNet Team operations and as a matter of regional security. The Revolving Fund Working Group was asked to draft a letter in this regard and send it to the PICT health authorities.
Workplan
At the end of the meeting, the CB members developed a tentative workplan to facilitate the implementation of these new initiatives. It is available for consultation on the PPHSN website: http://www.spc.int/phs/PPHSN.