Public Health Emergency Operations Centers: From Malaria Surveillance to COVID-19 Response in Laos

By Kemi Tesfazghi, GEMS Program Director and Bram Piot, Senior Surveillance & Monitoring Officer, PSI

Once established, a Public Health Emergency Operations Center (or PHEOC) functions as a nerve center for disease surveillance and response. This is critical to the management of an outbreak—or the elimination of a disease altogether.

From 2015 to 2019, PSI led the Bill and Melinda Gates Foundation-funded GMS Elimination of Malaria through Surveillance (GEMS) project across Cambodia, Lao People’s Democratic Republic (PDR), Myanmar and Vietnam.  A core objective of the project was the strengthening of malaria elimination surveillance in these four countries; this mission provided the catalyst for standing up and strengthening PHEOCs in the region to better track the disease.

Under the GEMS project, PSI worked with the National Center of Malariology, Parasitology, and Entomology (CMPE) of Lao PDR and the World Health Organization (WHO) to automate reporting of malaria data from the private sector into national surveillance systems. This initiative makes Lao PDR one of the few countries where malaria surveillance data from the private sector directly feeds into the national Health Management Information system (HMIS).

This automated data integration is possible because of quality malaria surveillance strengthening programming, implemented in close collaboration with CMPE, ensuring that private sector reporting mechanisms are aligned with the national program. PSI worked with the private providers and sub-national public health staff to improve data quality overall. On a systemic level, we:

  • Mapped out and adapted the way in which data flows from the private to the public sector to achieve greater efficiency
  • Improved processes through data integration and eliminated manual data entry using state-of-the-art DHIS2 reporting tools
  • Increased the precision of surveillance data by reporting individual case data instead of aggregated figures

PSI’s close collaboration with CMPE at the national and subnational levels laid a foundation that could be leveraged for the implementation of a PHEOC strengthening project.

In Lao PDR, the vision for a strengthened PHEOC was born from a desire to establish a ‘war room’ where the national malaria response could be effectively coordinated by putting the right people in the right room with the necessary resources and infrastructure to respond. Any efforts in this direction also pave the way for alignment of public health data on disease outbreaks with all-hazards emergency response including natural disasters and other emergencies, handled by an overarching national Emergency Operations Center (EOC).

In 2014, the Lao PDR Ministry of Health established a national PHEOC within its Department of Communicable Diseases Control (DCDC) with a mandate to be a central point for key decision-makers and response team personnel in times of public health emergencies.

At the inception of the PHEOC strengthening project, an assessment identified the following key weaknesses which limited the ability to efficiently and effectively respond to public health emergencies:

  • Lack of dedicated EOC staff and absence of adequate PHEOC funding
  • Absence of a comprehensive all-hazards emergency response plan
  • Lack of standard operating procedures for PHEOC watch, alert, and response operations
  • Limited use of surveillance data to inform strategic planning and decisions

The PHEOC was also suffering from the following limitations:

  • An absence of malaria as a notifiable disease
  • Delayed identification of disease outbreaks and delayed response to alerts of potential outbreaks due to an outdated and inefficient disease surveillance system
  • Inefficient supply chain management functions, including logistics contingency plans for stockouts and emergency response

And finally, there was a need for critical infrastructure, such as improved internet connectivity at the subnational levels and equipment to support a PHEOC for constant monitoring and analyzing surveillance data, providing the national and provincial PHEOCs with adequate infrastructure to build out modern communication and surveillance systems.

With visionary funding from the Bill and Melinda Gates Foundation, PSI is working with CMPE, the Clinton Health Access Initiative (CHAI) and the WHO to strengthen the PHEOC in Lao PDR. The premise of the project is that strengthening the PHEOC will help Lao PDR prepare and respond to all public health emergencies. This includes stemming outbreaks and accelerating malaria elimination by elevating it to a notifiable disease that warrants a coordinated and decisive response in the event of a disease-specific outbreak. The inclusion of malaria as a notifiable disease essentially provides the PHEOC with the required mandate to work with CMPE to accelerate malaria elimination by playing a crucial coordination role.

Strengthening the PHEOC has been a mutually beneficial initiative. This investment is expected to accelerate malaria elimination while also improving the overall capacity of the PHEOC, enhancing the efficiency and effectiveness of outbreak response and driving timely course correction and coordination at the national and sub-national levels. The physical infrastructure needed for the overall PHEOC has also been improved. In addition to optimizing disease surveillance systems, PSI and its implementation partners have also improved data visibility on stock consumption levels, built the capacity of personnel and established mechanisms to ensure sufficient and flexible funding for rapid response activities and for conducting simulations and after-action reviews.

Since the start of 2020, the PHEOC has played a central role in preparing, coordinating and responding to the COVID-19 outbreak in the country. Key COVID-19 response activities conducted by government entities have been coordinated through the PHEOC, which holds daily meetings to assess ongoing needs and creates daily situation reports for the Prime Minister’s office. The swift and highly coordinated response to COVID-19 in Lao PDR is partly due to the existence of a strong PHEOC with a clear mandate to coordinate the country’s response to the pandemic.

What’s next? PSI is taking the initial lessons learned in Lao PDR and is applying them in both Myanmar and Cambodia, with funding from the Australian Department of Foreign Affairs and Trade (DFAT). We will continue to report on these efforts throughout 2020 and beyond: please visit our blog to continue to learn about our efforts in strengthening health systems across the region!

Banner image credit: Justin Kong, PSI/GEMS

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