Health system analysis to support capacity development in response to the threat of pandemic influenza in Asia

Supported by The European Commission and The Rockefeller Foundation

Operational planning to implement strategic pandemic influenza plans remains a major challenge. This project analysed how resources can be deployed effectively and efficiently in countries in Asia in the event of a pandemic. To date, an important challenge has been that there is no universally accepted, organised method for evaluating preparedness.

This research project builds upon and extends an innovative pilot research project in Thailand by LSHTM and IHPP that linked coherently quantitative analyses of resource gaps with qualitative assessments of governance constraints given different epidemiological scenarios.

The goal of the project, funded by the European Commission was to provide a framework to evaluate health system operational capacity and, in 4 settings (Vietnam, Indonesia, Thailand, Taiwan), systematically determine operational capacity gaps in order support containment and mitigation of pandemic influenza. With additional support from the Rockefeller Foundation, the study was expanded to cover two additional countries: Lao PDR and Cambodia.

Operational capacity gaps were determined under four hypothetical pandemic scenarios. Resources available were determined in order to address containment and mitigation outcomes. Resources were mapped at two levels (the enabling environment and the organisational environment tasked with implementation). Governance arrangements were evaluated according to the same pandemic influenza scenarios. The scenarios were drawn upon in evaluations of each setting to ensure lessons learned are coherent.

With ministerial support across the sites, the results from this work inform revisions of strategic and operational pandemic influenza plans, provide a critical resource for the war room in the event of a pandemic, and inform decisions about future resource allocation.

AsiaFluCap – Final Evaluation Report

Articles produced from the AsiaFluCap project:
๐ Krumkamp R, Mounier-Jack S, Ahmad A, Reintjes R, Coker R. Evaluating health systems’ preparedness for emerging infectious- diseases: A novel conceptual and analytic framework. Health Policy 98(2010) 91 – 97

๐ Krumkamp R, Kretzschmar M, Rudge J W, Ahmad A, Hanvoravongchai P, Westenhoefer J, Stein M, Putthasri W, Coker R. Health service resource needs for pandemic influenza in developing countries: a linked transmission dynamics, interventions and resource demand model. Epidemiol. Infect., 2010, 1-9

๐ de Sa J, Mounier-Jack S, Darapheak C, Ly Khunbun N, Phetsouvanh R, Chanthakoummane N, Touch S, Phommasack R, Coker R. Responding to Pandemic Influenza in Cambodia and Lao PDR: Challenges in Moving from Strategy to Operation. Southeast Asian J Trop Med, 48(2010)

๐ Hanvoravongchai P, Adisasmito W, Chau P N, Conseil A, de Sa J, Krumkamp R, Monier-Jack S, Phommasack B, Putthasri W, Shih CS, Touch S, Coker R. Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries. BMC Public Health, 2010 10:322

๐ Adisasmito W, Hunter BM, Krumkamp R, Latief K, Rudge JW, Hanvoravongchai P, Coker RJ. Pandemic Influenza and Health System Resource Gaps in Bali: An Analysis Through a Resource Transmission Dynamics Model. Asia Pac J Public Health. 2011 Nov 14

๐ Yu-Chen Hsu, Yi-Ta Yang, Shih-Yan Yang, Shu-Mei Chou, Jen-Hsiang Chuang. Analysis on District Medical Resources and Preparedness Gap on the Health Outcomes of the 2009 H1N1 Influenza Pandemic in Taiwan. Taiwan Epidemiology Bulletin. 2011 Nov 22/Vol.27/No.22

๐ James W. Rudge, Piya Hanvoravongchai, Ralf Krumkamp, Irwin Chavez, Wiku Adisasmito, Pham Ngoc Chau, Bounlay Phommasak, Weerasak Putthasri, Chin-Shui Shih, Mart Stein, Aura Timen, Sok Touch, Ralf Reintjes, Richard Coker. Health System Resource Gaps and Associated Mortality from Pandemic Influenza across Six Asian Territories. PlosONE, 2012 7(2): e31800

๐ Stein ML, Rudge JW, Coker R, van der Weijden C, Krumkamp R, Hanvoravongchai P, Chavez I, Putthasri W, Phommasack B, Adisasmito W, Touch S, Sat le M, Hsu YC, Kretzschmar M, Timen A. Development of a resource modelling tool to support decision makers in pandemic influenza preparedness: The AsiaFluCap Simulator. BMC Public Health. 2012 Oct 12;12:870

๐ Hanvoravongchai P, Chavez I, Rudge JW, Touch S, Putthasri W, Chau PN, Phommasack B, Singhasivanon P, Coker R; iaFluCap Project Consortium. An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion. Int J Health Geogr. 2012 Dec 14;11:53. doi: 10.1186/1476-072X-11-53.


Collaborators include:

London School of Hygiene & Tropical Medicine
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Mahidol University, Faculty of Tropical Medicine
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 RIVM infectieziektebestrijding
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Centers for Disease Control, Taiwan
Taiwan CDC logo




Hamburg University of Applied Science

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National Institute of Public Health, Cambodia
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Communicable Disease Control Department , Cambodia
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Ministry of Science & Technology, Vietnam
MST Vietnam




University of Indonesia
Faculty of Public Health Indonesia




University of Health Sciences, Laos
University of Health Sciences Laos




International Health Policy Programme, Thailand


Vietnam Military Medical University

National Avian and Human Influenza Coordination office, Laos

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