one health workforce
Post on 11-Apr-2022
2 Views
Preview:
TRANSCRIPT
One Health in Vietnam from Training & Research to Policy
Phuc Pham-Duc1, Fred Unger2, Hung Nguyen2 1Center for Public Health & Ecosystem Research (CENPHER), Vietnam One Health University Network (VOHUN), Vietnam 2International Livestock Research Institute, Hanoi, Vietnam
Regional workshop of the ComAcross project, 25-27 November 2015, Bangkok, Thailand
Outline
• One Health Training in Vietnam
• One Health Research – examples
• From evidences to decisions
• Challenges and way forwards
2/1/2016 2
Hanoi (Network Secretariat): • Hanoi School of Public Health • Hanoi Medical University • Vietnam National University of Agriculture
Thai Nguyen University of Medicine and Pharmacy Thai Nguyen University of Agriculture & Forestry
Thai Binh University of Medicine and
Pharmacy
Hai Phong University of Medicine and
Pharmacy
Bac Giang Agriculture and Forestry University
Nam Dinh University of
Nursing
Hue University of Medicine and Pharmacy Hue University of Agriculture and Forestry
Dak Lak: Tay Nguyen University - Faculty of Medicine and Pharmacy - Faculty of Veterinary and Animal Science
Can Tho •University of Medicine & Pharmacy •Faculty of Applied Biology and Agriculture
Hochiminh City: • HCMC University of Medicine and Pharmacy • HCMC University of Agriculture & Forestry
2/1/2016
VOHUN (Vietnam One Health University Network)
Vinh Medical University
3
OHW Objectives Objective 1 – to participate with government, academia, and other key partners in defining
OH workforce needs
(Talking to government and private sector regarding training and research needs) (University-Government-Private Sector engagement on training and other needs)
Objective 2 –to assist government ministries to train the future “One Health” workforce (Translating these needs into creating a new ‘graduate species’ to transform public health)
Objective 3 – to assist government ministries to train the current “One Health” workforce (Supporting governments and private sector by creating new in-service training initiatives)
Objective 4 – Support universities in strengthening faculty capacities for One Health teaching, research, and community outreach
(Strengthening faculties to train the new workforce)
Objective 5 – Provide organizational development support to One Health networks
(Strengthening networks for support of all initiatives and for sustainability)
2/1/2016
Academic Curricula
(pre-service)
One Health Competencies
(Core & Technical)
Learning Objectives
Modules
Professional Development “Short
Course”
(in-service)
How to Make Your Curriculum a One Health Curriculum
• A strategic planning and MoU were agreed & signed (OHW: 2015-2019)
• One week field trip for International Veterinary Medicine students – OH clinical practices
• 60 students & 10 lecturers from 10 countries
• Seminars to introduce OH concept/approach • 17 universities/schools
• 150 lecturers & researchers
• 1,500 students (Preventive Medicine, Public Health & Vet.)
2/1/2016 7
Achievements
Development of OH training program (1)
1. Developed the training packages for OH elective
modules for Public Health student at the HSPH
11 lessons / 2 credits
4 case study: Streptococcus suis,
Leptospirosis, Rabies, Liver flukes
3. Developed a OH & Health Programs module at the Hai
Phong UMP
11 lessons / 2 credits
2. Developed the test evaluation for OH elective modules for Preventive Medicine student at the HMU
12 lessons / 3 credits
40 questions/lesson x 12 lessons
80% MCQ and 20% True/False questions
2/1/2016 8
4. Developing a training program for International Masters of Public Health – OH orientation
7 core modules : 24 credits
7 Elective modules: 8 credits
6. Developing a zoonotic disease module for Veterinary
Medicine student at the UAF
3 credits
7. Developing a OH field-based training program for human and animal health professionals
1 week (48 hours) in class
4 weeks field practices
2/1/2016 9
Development of OH training program (2)
5. Developing a training program for International Masters of Public Health majoring Environmental Health
International Masters of Public Health (OH orientation) • Program: 1 year • Core modules: 24 credits • Elective modules: 8 credits • Thesis: 8 credits • Students: Vietnam, Lao PDR, Cambodia, Indonesia,
Malaysia, Thailand
2/1/2016 10
One Health & Zoonosis Modules
• 3 Credits
• Faculties of Animal Science & Veterinary Medicine (7 Universities)
• Lesson 1: One Health concepts & approaches
• Lesson 2: Fundamentals of zoonotic diseases & ecosystem health
• Lesson 3: Zoonoses (bacteria & virus)
• Lesson 4: Zoonoses (parasites)
• Lesson 5: Using One Health approach in management and surveillance of zoonoses
2/1/2016 11
One Health & Zoonosis Modules (2 -3 credits)
OH field-based training course
2/1/2016
No Subject Number of hours
Theory Assignment Practice Total
I In class: 5 days
1 Basic concepts of One Health
Systems Thinking
4 4 0 8
2 Zoonoses fundamental 4 0 0 4
3 Zoonoses risk analysis 4 4 0 8
4 Applied epidemiology in investigation, detection,
organization, prevention and control zoonoses
3 5 0 8
5 Sampling 0 0 4 4
6 Planning, monitoring, evaluating and reporting 4 4 0 8
7 Cooperation interdisciplines 2 1 0 3
8 Guidance in writing research proposal 1 0 0 1
9 Communication 2 2 0 4
Total 24 20 4 48
II In Field: 4 weeks
III In class: 1 week
Result report 0 0 12 12
TOTAL 24 20 16 60
Strengthening University-Government Partnerships
1. Strengthening Universities-Government agencies
• Ministry of Health (MOH) / GDPM
• Ministry of Agriculture & Rural Development (MARD) /DAH
• Ministry of Education & Training (MOET)
• OH Partnerships / PAHI,
• Institutes: NIHE, NIVR, One Health Research
2. Strengthening Universities – International organizations
• USAID, WHO, CDC, ILRI, FAO, IDRC, WSC, OIE, etc.
OH continuing education course = OH field-based + FETP + AVET (VOHUN) (MOH) (MARD)
2/1/2016 13
What did we think?
• Agricultural intensification had closed relationship with ecosystem and human health.
• Livestock: advantages and disadvantages
• Livestock waste management, reuse.
• Any innovative changes are needed to develop the agricultural & livestock systems to increase production, at the same time preserving and enhancing natural resources.
• Using ecohealth approach to manage animal and human wastes
Better Human and Animal Waste Management in Hanam Province,
Vietnam – using Ecohealth / One Health Approach
What we did so far: (NCCR North-South program) 1. Community engagement (Local authorities) 2. Research ( PhD, MSc) But more focus on “Diseases”: Health Status, Diseases..
Focal Issue Sanitation & Health
Kim Bang district, Hanam, Vietnam
•Human, animal health & well-being •Environment •Social- economics
Understand the real situation of Agriculture intensification
Issues
Stakeholderworkshop Issues identified
•Design •Implement •Intervention •Dissemination
Communicate with
Stakeholders
engagement Community engagement
Researchers stay with
community (none-scientists)
What do we need?
Some research activities were carried out
• PRA: to identify emerging problems of local communities and issues related to agricultural and human waste managements.
• Baseline survey: 461 households • to explore the relationship between waste management practices and rural
household health status in the study sites
• to identify the current animal waste treatment methods
• Health risk assessment related to biogas-wastewater • Exposure assessment: 451 pig farms; Samples: 150
• Quantify the microbial and chemical indicators: E. coli, Salmonella, Giardia, Cryptosporidium, BOD & COD, pH, temperature
• Estimate the risk of infections and diarrhea by the specific pathogens
• Community-based intervention • Village regulation; good practice pig farm; behavior change communication.
2/1/2016 16
Risks of diarrhoea related to biogas wastewater
Increasing livestock production (MARD, 2013)
Environmental pollution caused by livestock waste becomes more severe (Đ.T.T.Sơn, 2011)
Biogas is commonly used for treatment of livestock waste (H.K.Giao, 2010)
2/1/2016
Biogas if not properly used -> the efficiently destroyed pathogens is low (V.T.Y.Phi, 2009; Jirina, 2012)
Most pig farms discharge biogas wastewater direct to public drainage (79%), irrigation (43%) (L.Q.Hương, 2014)
February 1, 2016 Monday seminar 18
Dose-response models (Sources: Haas et al., 1999, Howard et al., 2006)
Estimated single risks of infection
Exponential model (Giardia & Cryptosporidium)
Pinf(d) = 1 – exp(-rd)
β-Poisson model (E. coli)
Pinf(d) = 1 – [1+ (d/ID50)(21/α – 1)]-α
Where are:
- Pinf(d) : risk of infection in an individual exposed to a single pathogen dose (d)
- α: infectivity constants (E. coli: 0.1778)
- ID50: pathogen dose at which 50% of a population will be infected (E. coli: 8.6 x 107)
- r: infectivity constants (Giardia: 0.02 and Cryptosporidium: 0.00467)
- d (dose ingested) = μ x m
μ: concentration of organism/100mL
m: amount of water accidental ingested
Quantitative Microbial Risk Assessment (QMRA) (Hazard identification – Dose-response analysis – Exposure assessment
– Risk characterization)
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Maintaining biogas
Cleaning drainage
Irrigating corn crop
Irrigating fruit tree
Irrigating vegetable
Estimated single risk of diarrhoea Estimated single risk of diarrhoea
Estimated single risk of diarrhoea
Probability of diarrhea risk by E. coli
(12%), Crypto (25%), Giardia (5%)
Estimated average single risk of diarrhea
Community-based Intervention
2/1/2016 20
Reduce the health risks related to biogas-wastewater (human,
animals)
• Decreasing the frequency exposure to biogas-wastewater
• Reduction of pathogens in the biogas-wastewater (E. coli, Sal)
• Safe use of wastewater-irrigated products (vegetables, fish)
• Properly treatment of animal wastes by biogas system
Good Practice Pig-Farm (GPPF) in Vietnam
• understand the biogas operation and maintenance process
• aware the health risks related to biogas-wastewater (human & animals)
Good enforcement
the village regulation on
environmental sanitation
Effective behavior change communication
Increase skills for monitoring & prevention
of animal diseases
Village core group members (local authority, head of village, village health workers & para-vet.; pig holders) & Researchers
Community-Based Intervention
2/1/2016 21
Good Practice Pig-farm • Saving time, water,
electricity, money • More gas for cooking • Less smell, flies • Improving personal
hygiene practice • More friendly • Increasing productivity
Project framework Risk profiling
Risk assessment
Microbial Risk Assessment
Chemical Risk Assessment
Economics (eg health, CBA)
Value chain
Rapid assessment
Economic assessment
Animal Health Risk Assessment
…
….
Interventions
Action research 1
Action research 2
Action research 3
…………………
Engaging stakeholders and co-generating evidence, Advocacy, Communication, OM
1
2 3
4
Incentive-based interventions
Randomized Control Trials (RCT)
“Reducing disease risks & improving food safety in smallholder pig value chains in Vietnam” (PigRisk)
Risk assessment: Salmonella in pork production chain - Pig slaughterhouse and pork market.
Pathogen concentration (N)
Pf
Infection risk (P)
Farm Market Slaughter-
house Fork
Consumption
Exposure assessment
Exposure assessment
Risk
Pp Pr
Nf Np Nr
Source: Microbiological Risk Assessment Series No2-2002, No7-2008
RISK OF MICROBIAL CONTAMINATION IN THE CHAIN RISK OF INFECTION FOR CONSUMERS
• Established a Taskforce of risk assessment for food safety: MOH, MARD, Institutes, Universities, Private Sectors...
• Analyses of food safety policy in Vietnam and how research evidence informs policy.
• Stakeholder workshops were conducted to identify the scope of activities and priority issues in food safety.
• Training courses and follow-up along with case studies of risk assessment for food safety were held.
• Developed the guidelines for risk assessment on food safety (both microbial and chemical hazards).
• Dissemination workshops to development of policy on food safety.
Taskforce: Food Safety Risk Assessment
Capacity building
• Training courses for public health & veterinary professionals – MOH, MARD.
• Developed textbooks and guidelines on food safety risk assessment.
• Publication of a special edition of risk assessment in a Vietnamese journal;
• Policy briefs developed
…real situation of policy change
Identified issues
Research Results Policy
makers accepted
? Policy changed
From Evidences to Decisions
• Establish a working group / policy alliance group (PAG)
• Meetings, study site visits, dialogue, forum, etc.
• Mass media, communication event, linking websites
• Provide clear/concrete evidences, goals, targets (policy briefs)
• The message must be designed specifically for the policy makers to better reflect their needs
• The credibility of the “messenger” can be as important as the message itself
• Will & determination to move and wait for opportunities
• Stakeholders analysis – win without fighting
Example: Topics to be discussed
• The government is developing a strategy for developing livestock production;
• How recommendations issued by Ecohealth/One Health project can better be in line with current discussions on the policy?
• How the Working Group can assist CENPHER to design the research results in a message targeting decision makers?
• Who can be the best “messenger” to present Ecohealth project and results to decision makers?
Moving towards a One Health approach in Vietnam
• MARD-MOH joint inter-ministerial circular (16) on coordinated prevention and control of zoonotic diseases (May 2013)
• Establishment of new DAH division on veterinary public health as well as the Emergency Operations Center located in GDPM office
• OH is in the national strategies
• Emerging Pandemic Threats activities, VAHIP, SEA-EU-NET and associated donor commitment
• Recognition of the need to include wildlife in animal health efforts and zoonotic risks
• One Health Communication Network for journalists
• Institutional challenges: acceptance, policy engagement
• Capacity building: One Health Workforce
• Incentives: how to share credits, added values of One Health
• Deeper coordination between sectors on human and animal (and wildlife) health and the environmental agencies
• Improving the translation of evidence and research into policy
Challenges
Summary and conclusion
One Health in Vietnam
- Great attention and support from different level
- Training in good way, but limited research
- Inter-sectoral collaboration and policies: good enabling environment
Challenges and ways forward
- Capacity building: One Health Workforce
- More research & case studies
- Deeper coordination of sectors: further (re)-organization
- Resources
Acknowledgement
top related