Ability to Respond by Health Ability to Respond by Health Services Plan before an Services Plan before an

eventual Pandemiceventual Pandemic

CHILE MINISTRY OF HEALTH

Dr María Brito

April 2006

Components Considered in the PlanComponents Considered in the Plan

1.- Organization:

• Organizational Chart• Flows and Coordination Systems• Parties Responsible• Incorporation of other Players

2.- Functions:

• Definition of the functions of each one of the actors during the different Phases of the Pandemic

I.- Organization and Functioning

EMERGENCY COMMITTEEEMERGENCY COMMITTEE

Public HealthSub Secretary

NetworkSub Secretary

Communications Legal

DPI DIGERA

Sanitary Coordination in PandemicNorth

Sanitary Coordination in Pandemic South

Sanitary Coordination in PandemicCenter

RRHH

Components Considered in the PlanComponents Considered in the Plan

1.- Outpatient Care

II.- Installed Capacity, Assignment of Resources:

•Number of establishments

•Assignment of available Human Resources

•Social, private organizations etc.

•Availability of :

•Drugs

•Supplies

•Equipment

Components Considered in the PlanComponents Considered in the Plan

2.- Hospital Care

II.- Installed Capacity, Assignment of Resources:

•Number of establishments (public and private)•Number of total beds available (public and private)•Number of critical beds available (public and private)•Availability of equipment to support critical activity•Availability of RRHH to support critical activity•Hospital management indicators•Availability of:

DrugsSuppliesEquipment

Components considered within the en el Components considered within the en el PlanPlan

1.- Outpatient Care

• Out fitting of additional services• Availability of extra RRHH

2.- Hospital Attention

• Number of possible beds to reconvert

• RRHH that supports the increase in activity

• Installed physical capacity that allows an increase of beds

• Ability to establish strategic reserves (storage and distribution)

II.- Potential Capacity

Theoretical Impact StudyTheoretical Impact Study

General Assumptions

• Attack Rate • Population to be considered• Lethality • Corresponding periods and percentages

(consultations and/or hospitalization)

Assumptions Outpatient Care

• Percentage of consultations to be carried out• Number of consultations per patient• Output of consultations per hour

III.- Establish the assumptions

Theoretical Impact ExerciseTheoretical Impact Exercise

3.- Hospital Care Assumptions

• Hospitalization percentages according to groups• Average length of stay of patients in critical beds• Percentage of patients in critical beds• Percentage of less complex hospitalizations

III.- Establish the Assumptions

Bed requirementsBed requirements

88% of beds requested are for Special Care

• 12% of required beds are for Critical Care.

SCU88%

ICU6%

UTI6%

• Of the total critical beds 50% correspond to intensive care beds (Mechanical Ventilator and Invasive Monitoring)

Example….Example….

ATTACK RATE 20%TOTAL CHILDREN ADULTS

COUNTRY TOTAL 15,116,435 3,890,126 11,226,309

NUMBER OF CASES 3,023,287 778,025 2,245,262

HOSPITALIZATIONS 0.5% (<65) y 1% (>65) 16,334 3,890 12,444

REQUIRED BEDS 4,840 1,153 3,687

MORTALITY 1%(<65) y 30% (>65) 870 39 831

ATTACK RATE 40% TOTAL CHILDREN 15-64 YEARS

TOTAL COUNTRY 15,116,435 3,890,126 11,226,309

NUMBER OF CASES 6,046,574 1,556,050 4,490,524

HOSPITALIZATIONS 0.5% (<65) y 1% (>65) 32,667 7,780 24,887

REQUIRED BEDS 9,679 2,305 7,374

MORTALITY 1%(<65) y 30% (>65) 1,739 78 1,661

General Results of the Exercise

Components Considered in the PlanComponents Considered in the Plan

1.- Outpatient Care

• RRHH Gap• Gap supplies, medicine and equipment• Valuation of the estimated Gaps

2.- Hospital Care

Gap RRHHGap supplies and reactiveGaps medicineGap in equipment that provides critical activity supportValuation of the Gaps

IV.- Gap Analysis

Total hired Hours

Total hired hours

Total consulations to carry out

1° Pick of consulations

with an attack rate

of 20%

Number of patients per

hour(10) Gap in hours

2° Pick of consultation

s with an attack reate

of 20%

Number of patients per

hour(10)

Gap in hours measured

con 20% funcionarios

enfermos

50% del Total

70% de consultas

horas requeridas

no hay brecha

30% de consultas

horas requeridas

no hay brecha

401.812 321.450 1,511,644 1,058,150 105,815 215,635 453,493 45,349 276,100

REQUIMENT OF MEDICAL HOURS FOR OUTPATIENT CARE RATE 20% Attack Rate 20% Total Country

Estimate of the Gaps in Outpatient CareEstimate of the Gaps in Outpatient Care

Estimate of Gaps in Hospital Care (Beds)Estimate of Gaps in Hospital Care (Beds)

Children Adults

Children Adults Children Adults Children Adults

1,014 3,245 146 468 148 128 2- 351-

2,006 6,416 300 959 148 128 151- 830-

Total Critical Beds Required (12%)

Total Number of Beds Required in Special Care

(88%)

Adjusted offer of Critical Beds

Gap in critical beds according to attack rate

•Special care beds were counted as new

• For the gap in critical beds, a real availability of adult critical beds of 10%, and 30% for pediatric was considered.

In conclusionIn conclusion

• Information must be available

• Information must be analyzed

• Indicators about the management of beds must be included as part of the analysis process

• Expert consensus is required

Components to be implementedComponents to be implemented

• Make the Health Services and Establishment’s Plan operational.

• Responsibly design the carrying out of preparatory exercises for a Pandemic at the local level

• Simulation exercises

• Inform authorities about the required adjustments for the implementation of the plan

THANK YOU