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Table 1 Standardized checklist and scores for 61 indicators grouped across seven categories

From: Pandemic influenza preparedness in the WHO African region: are we ready yet?

INDICATORS RATIONALE SCORES
Additional assessment guide Number of countries
Yes No
PREPARATION
 1 Does the country have a national pandemic influenza plan? Is it publicly available? 35 0
 2 Does the national influenza plan target human or avian influenza subtypes? Human influenza subtype e.g. H1N1 and animal subtype e.g. H5N1 32 3
 3 Does the national pandemic influenza plan meet the international (WHO/IHR etc) guidance on preparedness? Is the plan based on the six phases of planning and response? 22 13
 4 Are the responsibilities and actions in the plan defined phase by phase? This is required for capacity setting, planning and command based on WHO recommendations. 21 14
 5 Are there local plans at district and regional level? See if are there any arrangements in place 9 26
 6 Are business continuity plans available across the non-health sectors at national and regional levels? Or are these mentioned in the plans? Check this among institutions (UN organization and churches etc). Do these plan mention how they will cope with an influenza pandemic and continue to provide other essential health services. 7 28
 7 Are the plans flexible? Does the plan have a severity index or are they able to adjust whether to mild or severe nature of the pandemic? 13 22
 8 Do the response and inter-wave planning phases have their own courses of action and budgets which would be implemented? These tasks should have financial and human resource with a budget provision for a year. Also see question 4 24 11
 9 Is the plan sustainable for a longer term? Influenza funding and development of command structures should not heavily rely on external funding. 0 35
 10 Does the plan have a national committee(s) or advisory body in place to oversee preparedness? Check who drafted the plan and if they were part of the committee. 32 3
 11 Does the plan have any assumptions on which the plan is based? Does the plan mention the expected range of cases and percentage of staff off sick? Check for detailed assumptions and planning principles such as case scenarios that will trigger responses and guide effective implementation of the plan. 14 21
 12 Are there a national command and control structure? This is where data or information is aggregated for the country. The national command centre exercise authority and can designate responsibilities at the local or regional levels. 25 10
 13 Are there health services command and control structure? Check for hospital and clinic plans 8 27
 14 Does the pandemic plan regularly and systematically get tested at all levels and across all sectors i.e. national level health sector exercises or drills? Check if they carry out simulations and tabletop exercises- this is important because it can feedback in the planning as lessons learnt. 8 27
 15 Have the legal implications of travel restrictions and other interoperability issues been determined? Are there any discussions or agreements on a list of issues such as cross-border management and quarantine? 15 20
 16 Do interventions proposed in the plan have exit strategies? What are the exit options? When should the pandemic be outbreak declared over? 4 31
COORDINATION AND PARTNERSHIPS
 17 Are there any regional or local arrangements in place on how to respond? Do plans engage local people, families and medical personnel to ensure local services are running smoothly during the pandemic period? 24 11
 18 Are there a regional/local planning and coordination structure? Check for leadership roles and designation of responsibilities among the coordinating structures. 24 11
 19 Is the health sector well connected to other sectors such as businesses and civil society? Private and public partnership necessary to continue providing essential services such as water, energy and safe transport. 12 23
 20 Are there joint cooperation and partnership with the neighboring countries on mutually relevant influenza policy areas? A pandemic outbreak has no borders- check how transborder problems related to pandemic influenza will be resolved or if it is a priority in the plan. 10 25
 21 Does the partnership or coordination involve financial and technical support? This is important for planning continuity purposes and future responses. 16 19
RISK COMMUNICATION
 22 Are they a national communication strategy or is it publicly available? Has the national communication strategy been published? 22 13
 23 Does the national communication strategy sufficiently stress the likely nature or duration of the pandemic, its spread, its peak and decline, nor does it sufficiently inform the public on these issues? Is the national communication strategy committed to public awareness including communicating the nature, spread, peak and decline of influenza (seasonal and pandemic? 11 24
 24 Are there any Information Education and Communication (IEC) material or IEC in place or available? Check if the plan use or intend to use multi-media communication i.e. newspapers, radio, TV, posters, magazines and social networking sites such as Facebook and Twitter 31 4
 25 Are there any definitions of key target groups for specific preventive messages and protection such as health and emergency personnel within the communication plan? Are there any public hygiene campaigns to highlight the personal public health measures during normal influenza seasons or outbreaks? 23 12
 26 Are there effective programmes in place to change public attitudes and perceptions about influenza? To avoid problems due to poor messages on preventive measures and general hygiene etc. 12 23
 27 Are churches or religious groups mentioned in the plan to help communicate preparedness messages? People are more likely to listen to a religious leaders than from health personnel. 8 27
 28 Are there a nation-wide influenza guidance ‘intranet’ for health authorities respond quickly to an influenza outbreak? Web reporting systems? 9 26
 29 Is information exchanged with stakeholders? Are conferences, meetings and forums mentioned for information exchange and sharing? 17 18
SURVEILLANCE AND MONITORING
 30 Are there surveillance systems in place for collecting and sharing of virological and epidemiological data with the WHO and other partners? Check for Integrated Disease Surveillance Response (IDSR) and check if such data is shared? 18 17
 31 Are there a national laboratory or national influenza centre (NIC) or Influenza assessment centres (IAC) for collecting epidemiological data on Influenza Like Illness (ILI) and Severe Acute Respiratory Infections (SARI) The national laboratory capacity is important to provide timely, high quality, validated routine and diagnostic influenza data. ILI and SARI are indirect measures for influenza- and there are good indicators for pandemic preparedness. 18 17
 32 If yes in 31, does the national laboratory have the capacity to perform: Virus isolation? Influenza typing? Influenza s Check these at the national and administrative regional level. 13 22
 33 Are there a PCR machine for testing/sequencing of seasonal and pandemic influenza viruses? Relevant for monitoring viruses and for estimating additional resources that might be required to tackle pandemic influenza problem. 9 26
 34 Are there a national “Early Warning” systems or Event Based Surveillance (EBS) Are they a computerised hospital system that can readily give age-specific mortality data in real time? 6 29
 35 Is the virological and epidemiological data shared with partners/WHO? Are they an influenza web reporting system? Check if they have a FluNet and FluID reporting systems. 4 31
 36 Are they a surveillance working group(s)? A team of specialized expertise/epidemiologists to advise on the planning and response etc. See also question 10. 16 19
PREVENTION AND CONTAINMENT
 37 Are non-pharmaceutical intervention plans in place? i.e. closure of schools, ventilators, PPEs, quarantine, isolation, hygiene and sanitation. Are prevention and cluster control plans in place (i.e. for border and stamping influenza out prior to widespread in the country. 26 9
 38 Are pharmaceutical interventions in place? i.e. use of vaccines, antivirals and antibiotics for secondary infections Check for vaccine strategy if in place? 29 6
 39 Are there a procurement strategy of pharmaceutical (vaccines) and non-pharmaceutical products (PPEs)? Check for political intervention to improve pharmaceutical logistics in acquiring vaccines and other drugs. 17 18
 40 Are there contracts and agreements with pharmaceutical companies for the supply of equipment and drugs for influenza preparedness capacity? Check if there are vaccine and antiviral drug contracts and agreements with the pharmaceutical companies. 2 33
 41 Are there a pharmaceutical (vaccine) strategy If a pandemic vaccine is planned to be used when will the vaccines arrive in health centres? Is it within six months of the start of the pandemic? 12 23
 42 Are there accelerated regulatory approvals of influenza vaccines for quick deployment? Or are there a national regulatory capacity in place so that vaccines, diagnostic tests and antiviral medicines for influenza can be deployed quickly? Some countries deploying influenza vaccines are required to meet the preconditions for supply of vaccines through the WHO Deployment Initiative. 3 32
 43 Are there any additional (surge) capacity to improve responses through training and increasing human resource capacity? Are there a standardised national educational materials for all health care workers? 21 14
 44 Are there effective hospital control policies? Do hospitals or health centres have their own plans? 5 30
 45 Are there plans for recruiting volunteers from local communities? This is necessary in case of staff absenteeism during the pandemic period. 2 33
 46 Are there a reserve list of health professionals? Necessary in case of staff absenteeism during the pandemic period. 4 31
CASE INVESTIGATION AND TREATMENT
 47 Are there any scientifically-based estimates of the numbers of people likely to be affected by pandemic influenza and needing medical and social care? These estimates contributes to the planning of resources and for efficient and equitable deployment of vital supplies for pandemic influenza. 8 27
 48 Are there a list of critical information that is needed early in a pandemic (e.g. attack rates by age and locality, strain type, likely antiviral sensitivity, response to antivirals and public health measures, etc)? What is the proportion of the population that may need treatment i.e. target groups for prophylaxis? 9 26
 49 Are there criteria for the types and amounts of antivirals to be used? Does the plan have priorities on the types of antivirals or drug combinations? 18 17
 50 Are there a local distribution channel to deliver these antivirals and vaccines? Hotlines e.g. telephone lines for requests and local influenza centres to deliver. 13 22
51 Are there any consideration of mechanisms to monitor the usefulness of vaccines, effectiveness, side-effects and resistance of antivirals through real time surveillance? Necessary for efficient and timely decision-making 8 27
 52 Are border screenings in place and will the cases be followed-up? Contact tracing e.g. interviewing patient cases and carrying out surveys for possible sources? 15 20
 53 Are isolation or quarantine rooms provided at the port of entry? Rooms to hold suspected cases. 16 19
 54 Are there a national annual seasonal influenza vaccination programme in place? Necessary if countries will be able to vaccinate timely during the pandemic period. 0 35
 55 If yes it is achieving > 75% uptake in over 65 s and increasing uptake in occupational and clinical risk groups? Vaccinating the elderly and at risk adults, for example, is unlikely to establish indirect protective effects because these groups represent a small percentage of the population among whom the virus spreads. 0 35
 56 Are there vaccine uptake figures or are these published annually? If the vaccine uptakes are low, are there plans in educating the public on attitudes and perceptions? 0 35
ETHICAL CONSIDERATIONS
 57 Is there an ethical framework in place? Necessary to avoid ethical problems that might arise 1 34
 58 Are there any ethical consideration for appropriate use of quarantine procedures, treatment of patients with vaccines and antiviral drugs? Are there priority setting and equitable access to therapeutic and prophylactic measures? What are the core governmental responsibilities on this? 4 31
 59 During implementation of the plan, are there consideration to balance public health and human rights? During a pandemic influenza emergency, policymakers experience tension and disputes, and that they struggle to balance public health decisions between what is best for the individual and society as a whole. 6 29
 60 Are there evidence base for public health measures on which decisions will be based or are based? Check in the plans if policymakers use science 6 29
 61 Are there transparency, public engagement and social mobilization in the plan? Is there a list that shows the beneficiaries for the interventions or how the beneficiaries were selected as eligible candidates for the interventions or limited resources? 7 28