**6. Logistics management**

266 Health Management – Different Approaches and Solutions

any anti-viral tablets. Follow up was done daily by health care workers to detect influenzalike illness, which was defined as fever, cough and respiratory distress. Suspected cases were reported to the Institute of Epidemiology, Disease Control & Research (IEDCR) and

Other human-health related approaches to managing Avian Influenza include laboratorybased research, such as pharmaceutical development and testing. For example, a drug trail based in Kamalapur has been evaluating the effectiveness of treatment with Oseltamavir on interrupting the transmission of influenza (May 2008- December 2010). Oseltamavir is the generic version of Tamiflu, an anti-viral that slows the spread of the influenza virus between

Hospital-based influenza surveillance has been increasing. In 2007, twelve hospitals participated in surveillance efforts. Six of the 12 hospitals were run by the government, and six were privately-run hospitals. The hospitals were distributed among six divisions in Bangladesh. By 2010, fourteen hospitals distributed in all seven divisions of Bangladesh

Population-based surveillance has involved collecting both epidemiological and biological data. Samples were collected from cullers and poultry workers to examine the seroprevalence of antibodies for H5N1. Additionally, there has been a longitudinal assessment of the effect of influenza on the cognitive development of urban poor children in Bangladesh. For this surveillance, a certain amount of laboratory capacity is necessary to analyze the samples and data. IEDCR has been a WHO-accredited lab since 2007, and

It is important to note that Avian Influenza is not easily transmitted to humans. If we were able to prevent and/or manage the disease among the live birds, many of the human-health related aspects of disease management would not be needed. As such, efforts should focus on capacity building, logistics management, and communication for behavior change that

Capacity building is crucial for disease management strategies at all levels. If the necessary human resources, infrastructure, and commodity supplies are not in place, behavioral change for Avian Influenza disease management and prevention will not be sustainable, or

Community-level capacity building includes training and education for community members and local disease surveillance. Capacity building at live bird markets is one of the most crucial aspects of disease prevention. For capacity building at the live bird market, it is crucial that the management and ground-level workers be trained in and implement biosecurity measures. In order for that to happen, there needs to be a supply of hygiene and cleaning commodities, such as soap, clean towels and sprayers, as well as a supply of clean water, which requires government assistance. Thus, the infrastructure and capacity for

Similarly, manpower and logistics management of the Veterinary Service need to be further developed to carry out surveillance and respond to outbreaks of Avian Influenza. Additionally, illness surveillance centers and active surveillance measures among high risk groups need to be developed. This will involve training workers and volunteers, as well as

logistics management, which is discussed later in this chapter, must be built-up.

increasing community awareness of Avian Influenza.

participated in the influenza surveillance program (USAID/Bangladesh 2010).

will help prevent, manage, or even eradicate Avian Influenza in live birds.

necessary follow-up steps were taken (USAID/Bangladesh 2010).

IEDCR regularly participates in activities involving H5N1.

cells.

**5. Capacity building** 

in some cases even be able to occur.

In addition to building capacity and infrastructure support for disease management, it is important to take into the account the logistics of implementing the various aspects of disease management. Logistics management considers issues pertinent to implementing disease management strategies such as space and equipment availability, staffing and human resource skills, supplies of relevant commodities, recordkeeping and reporting, and transportation.

In the case of Avian Influezna in Bangladesh, USAID's DELIVER Project has aimed to coordinate plans to "meet the challenges presented by existing and emerging pandemic threats by establishing and operating a secure, reliable global mechanism to store, transport, rapidly deliver, and track in-country distribution of current and future USAID Avian Influenza International Stockpile (AIIS) and outbreak response assets." To achieve these objectives, it has been necessary to work in close partnership with stakeholders from the planning process to implementation, develop a sustainable project design, emphasize the ownership of the stakeholders, gradually phase in the project and stakeholder involvement, and prepare stakeholders to take over by building capacity in private sector to sustain the project (USAID/Bangladesh 2010).

In conjunction with various stakeholders, DELIVER has been able to create a dedicated storage floor in the Department of Livestock Services (DLS), introduce warehousing best practices as well as a uniform logistics recording and reporting system, and design, develop and introduce a digital livestock management system. Additionally, DELIVER has trained personnel on logistics management, computer inventory management, and online reporting. As a result, they have been able ensure proper warehousing, distribution and in-country stock of Avian Influenza commodities (detergent, sprayers, decontamination kits, flu detection kits). Similarly, they have cooperated with Directorate General of Health Services (DGHS) and WHO to ensure proper storage and supply of H1N1 vaccines. Sufficient inventory is kept at a central warehouse and commodities are positioned in proximity to potential outbreak areas. DLS has the ability to respond quickly within a few hours to a reported outbreak in any upazila (district). Additionally, DLS can see the current report and inventory online at any time and use it to make supply decisions (USAID/Bangladesh 2010). DELIVER was able to establish a regular field logistics monitoring system for problem solving, capacity building, and troubleshooting. Sustaining the inventory management and web-based reporting system within DLS is challenging though because DLS is an environment of frequent staff turnover. Another challenge is using the available data in forecasting, procurement, and supply decisions. The goals for the future are all focused on sustaining and continuing to build the capacity to sustain and strengthen these efforts (USAID/Bangladesh 2010).
