National Strategy for prevention and control of Brucellosis in humans and animals 2018-2023

NATIONAL STRATEGY FOR PREVENTION AND CONTROL OF BRUCELLOSIS IN HUMANS & ANIMALS 2018-2023 April 2018 i TABLE OF CONTENTS List of Tables ............................................................................................................... iii List of Abbreviations .................................................................................................. iv Excutive Summary ..................................................................................................... v Aknowledgement ....................................................................................................... vi CHAPTER ONE ........................................................................................................... 1 1. Introduction ........................................................................................................... 1 1.1 Situation Analysis ............................................................................................ 1 1.2 Socio-Economic Impact and Justification for Control ....................................... 3 1.3 National Policies/Strategies and Legal Framework ........................................... 4 1.4 Stakeholders’ Mapping ................................................................................... 5 1.4.1 Major stakeholders – line Ministries/partners ......................................... 5 CHAPTER TWO .......................................................................................................... 7 2. Strength, Weakness, Opportunities and Challenges (SWOC) Regarding Brucellosis Prevention and Control .................................................................... 7 CHAPTER THREE ....................................................................................................... 13 3. Guiding Principles of Brucellosis Prevention and Control Strategy ................ 13 3.1 Vision ............................................................................................................. 13 3.2 Mission ........................................................................................................... 13 3.3 Goal ................................................................................................................ 13 3.4 General objective/Objective of the Strategy .................................................... 13 3.5 Key strategic objectives for brucellosis control ................................................ 13 3.5.1 Prevent and Control of brucellosis in human ........................................ 13 3.5.2 Prevention and control of brucellosis in food animals ........................... 14 3.5.3 Strengthen institutional capacity to control brucellosis .......................... 14 3.5.4 Promote and coordinate research and innovation in brucellosis interventions ........................................................................................ 14 3.5.5 Enhance awareness and knowledge on brucellosis for proffesionals, policy makers, community and public .................................................. 14 3.5.6 Enhance Partnerships and One Health Approach/Multi-Sectoral Collaboration ....................................................................................... 14 3.5.7 Streamline and harmonise appropriate legal and policy framework and institutional arrangement for the implementation of strategy .......... 15 CHAPTER FOUR ........................................................................................................ 16 4. Implementation Plan of the Strategy ................................................................. 16 ii CHAPTER FIVE ........................................................................................................... 17 5. Institutional and Financial Arrangement ........................................................... 17 5.1 Institutional Arrangement ................................................................................ 17 5.2 Financial Arrangement .................................................................................... 18 CHAPTER SIX ............................................................................................................. 19 6. Monitoring and Evaluation .................................................................................. 19 7. References ........................................................................................................... 20 8. Appendices .......................................................................................................... 21 iii LIST OF TABLES Table 1: Brucellosis seroprevalences by livestock production system, species and tests used .................................................................................................. 2 Table 2: Brucellosis seroprevalences by ecosystem species and tests used ............ 2 Table 3: Brucellosis seroprevalences by occupational group, febrile presenting patents and tests used ............................................................................... 2 Table 4: Stakeholders invovled and their corresponding area of intervention ............ 6 Table 5: Strengths, weaknesses, opportunities and challenges ................................ 8 Table 6: Road Map for the Progressive control of Brucellosis ................................... 16 Table 7: Institutional responsibilities and roles .......................................................... 17 iv LIST OF ABBREVIATIONS AU-IBAR African Union- International Bearau of Animal Resource CBO Community Based Organization COSTECH The Tanzania Commisison for Science and Technology CUHAS Catholic University of Health and Allied Sciences DTRA Defense Threat Reduction Agency DVS Director of Veterinary Services FAO Food and Agriculture Organisation FBO Faith Based Organization ICT Information Communication and technology IDSR Intergrated Disease Surveillance and Response IEC Information Education and Communication IHI Ifakara Health Institute KCRI Kilimanjaro Clinical Research Institute LITA Livestock Institute Training Agency MoLF Ministry of Livestock and Fisheries MOHCDGEC Ministry of Health Children Development Gender Elderly and Children MOU Memorandum of understanding MUHAS Muhimbili University of Health and Allied Sciences NGO Non-Governmental Organization NIMR National Institute for Medical Research NM-AIST Nelson Mandela-African Istitute of Science and Technology OIE World Organization for Animal Health PAHSP Private animal health Service Provider PMO-OHU Prime Ministers Office – One Health Unit PO-RALG President’s Office – Regional Adminstration and Local Government PPR Peste Petit des Ruminants RVF Rift Valley Fever SPS Sanitary and Phytosanitary SUA Sokoine University of Agriculture TALIRI Tanzania Livestock Research Institute TAWIRI Tanzania Wildlife Research Institute TFDA Tanzania Food and Drug Authority TVI Tanzania Veterinary Institute TVLA Tanzania Veterinary Laboratory Agency USAID United State Agency for International Development VCT Veterinary Council of Tanzania VPO Vice President’s Office WHO World Health Organization ZVC Zonal Veterinary Centres v EXCUTIVE SUMMARY Brucellosis is a contagious bacterial zoonotic disease, which affects humans, livestock and wildlife. Brucellosis is a highly prevalent disease in many areas of Tanzania, however very limited data is available regarding its distribution, affected host species and impact. Studies indicates that the disease causes significant production loss and potential public health problems. In Tanzania, most patients presenting at hospitals with febrile illness tend to be clinically diagnosed as malaria or enteric fever, largely because of the high endemic nature of these two infections but also due to similarity with clinical presentations of other infections prevalent. In livestock, brucellosis results in reduced productivity, abortions and weak offspring and is a major impediment for trade. Prevention of human brucellosis depends a great deal on control of the disease in domestic livestock. Effective control of these, needs cooperation between human and animal health sectors with regard to research and actions directed to disease control. Furthermore, there is a lack of harmonized protocol for the diagnosis, prevention and control of the disease in humans and animals. Therefore, a comprehensive One Health strategy for prevention and control of the disease in humans and animals is desirable. The present National Strategy for Prevention and Control of Brucellosis articulates measures for prevention and control of Brucellosis in Tanzania mainland. The strategy provides guidance on early warning to enable rapid detection, reporting and response. This strategy took into consideration existing legislation guiding prevention and control of animal and human diseases as well as guidelines and recommendations of International Organizations such as the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE), and the World Health Organization (WHO). vi AKNOWLEDGEMENT The development of the National Strategy for Prevention and Control of brucellosis is a great achievement in ensuring systematic mechanism of addressing priority zoonoses in the country. This is a multi-sectoral strategic document to guide prevention and control of brucellosis in human and animal in Tanzania and has been prepared in line with the National One Health Strategic Plan (2015), National Integrated Surveillance Guidelines and the recommendations drawn from Joint External Evaluation (JEE) and Global Security Health Agenda (GHSA). The development process was coordinated by the Prime Minister’s – One health Coordination Unit under the Disaster Management Department in collaboration with Ministry of Livestock and Fisheries, Ministry of Health Community Development Gender Elderly and Children and Ministry of Natural Resources and Tourism. Other contributors include technical backstopping from PREDICT, P&R, FAO and WHO. The contributions made through stakeholders’ consultative meeting are highly appreciated as they shaped the Strategy significantly. Preparation of this strategy was made possible with the support of the FAO’s component of the Emerging Pandemic Threats Phase II (EPT-2) project, which is financed by the United States Agency for International Development (USAID). We highly appreciate such contributions Dr Mpoki M. Ulisubisya Prof. Elisante Ole Gabriel Permanent Secretary Permanent Secretary MoHCDGEC MoLF 1 CHAPTER ONE 1. INTRODUCTION Brucellosis is a contagious bacterial zoonotic disease, which affects humans, livestock and wildlife. It is considered by the Food and Agriculture Organisation (FAO), the World Health Organisation (WHO) and the Office International des Epizooties (OIE) as one of the most widespread zoonoses in the world. The disease is caused by bacteria in the genus Brucella. Three species including B. melitensis, B. abortus and B. suis are of great zoonotic potential and are the ones known to be prevalent in Tanzania. Human brucellosis is characterized by awide range of symptoms marked by non-specific recurring fever, headache, chills, joint pains, undue fatigue, anorexia, night sweats, among others (John et al., 2010), which make the diagnosis difficult. The disease also requires prolonged treatment with a combination of antibiotics (Seleem et al., 2010). In animals mainly cattle, the disease is characterized by late term abortion, infertility and reduced milk, calf crop production as a result of retained placenta and secondary endometiritis. Bulls suffer orchitis, epididymitis, seminal vesiculities, hygroma particularly at carpal joints. The major ways of Brucella transmission to people are through direct contact with infected fetus and fetal membranes during parturition and consumption of unpasteurized milk and milk products. The disease can also be transmitted through consumption of raw blood and meat. Farmers and people working with animals (butcherers, animal health attendants, animal attendant’s, lab attendants etc) can also be infected through direct contact with infected animals, aborted fetuses and discharges and accidentally through needle injection during mass vaccination and during laboratory manipulation. Transmission through inhalation and consumption of contaminated dairy products has been widely documented in many parts of the world (John et al., 2010). Wildlife may be the source of the diseases to humans especially those living in proximity to wildlife due to intense overlap of these species, including game meat handling. Brucella has traditionally been considered a biological weapon. It was the subject of extensive offensive research in the past, and still belongs to category B pathogens on most lists. Its propensity for airborne transmission and induction of chronic debilitating disease requiring combined antibiotic regimens for treatment, its abundance around the world and its vague clinical characteristics defying rapid clinical diagnosis are some of the characteristics that apply to the pathogen’s weapons potential. 1.1 Situation Analysis The global burden of human brucellosis remains enormous; it causes more than 500,000 infections per year worldwide (Dean et al., 2012). The annual impact of Brucellosis to smallholders across sub-Saharan Africa and South Asia is estimated at USD $500 million per year (GalvMed, 2017). Brucellosis has been reported from almost all countries in Africa (Mangen et al., 2002). In Africa, the prevalence varies from 5-55% in humans and 8-46% in animals (Mangen et al., 2002). Brucellosis is a highly prevalent disease in many areas of Tanzania. Brucella spp that have been isolated in the country include B. abortus, B. melitensis and B. suis (Bouley AJ et al 2 2012, Swai et et al 2005,) however very limited data is available regarding their distribution, affected host species and impact. Available studies indicate Brucella sero-positivity between 0.5-15% (Table 1) among wildlife, pigs, cattle and small ruminants. Similarly, prevalence rates of brucellosis ranging from 0.6% to 23% have been reported in cattle reared in different production and ecosystems in Tanzania (Table 2). In fully susceptible spp abortion rates may vary from 30% to 80%. Several free-ranging wild animal species, such as the African buffalo (Syncerus caffer), hippopotamus (Hippopotamus amphibius), impala (Aepyceros melampus), blue wildebeest (Connochaetes taurinus), zebra (Equus burchelli) and eland (Tragelaphus oryx), have been consistently reported to be seropositive, indicating possible persistent foci of infection in these animals. Due to this, brucellosis has been a problem in wildlife and domestic ruminants in the selected animal-human interface areas. There are few reports of clinical brucellosis in Tanzania (John et al 2010). Much of the published work on human brucella infections are based on sero-survey of occupational high risk groups such as livestock herders, farmers, butchers and other abattoir workers, and veterinarian and febrile presenting patients at hospitals (Table 3). Our observations, based on these few previous sero-epidemiological reports, suggest that the magnitude of human brucella infections may be greater than has been appreciated and the disease can easly be misdiagnosed with other febrile illnesses. Table 1: Brucellosis seroprevalences by livestock production system, species and tests used Production system Spp Tests Prevalence Source 1 Agro pastoral northern Tanzania cattle, sheep, goats RBPT/c-ELISA 4.2-8.7% Mtui-Malamsha 2001, Shirima 2005 2 Agro pastoral northern Tanzania cattle RBPT 12% Swai et al 2005 3 Agro pastoral lake zone Tanzania cattle RBPT 10.8% Jiwa et al 1996 4 Agro pastoral southern Tanzania cattle RBPT 15.2% Ottaru et al 1985 5 Agro pastoral northern eastern Tanzania cattle RBPT 0.6-7.9% Swai et al 210 6 Pastoral northern Tanzania cattle, sheep, goats RBPT/c-ELISA 4.9-6.5% Shirima 2005 7 Dairy and Pastoral Eastern Tanzania cattle RBPT 10.6-12.3% Swai, 1997, Weihupl et al 2000 8 Slaughter stocks Pigs RBPT &Riv T 0.7% Simon et al 2016 9 Dairy and Pastoral Tanzania Cattle, small ruminants RBPT/c-ELISA 8.2% Alonso et al 2016 3 Table 2: Brucellosis seroprevalences by ecosystem species and tests used Ecosystem/Interface Spp Tests Prevalence Source 1 NCCA Cattle, sheep, goats RBPT/MAT 6-23% Mellau et al 2009 2 Serengeti Buffalo, zebra, wildbeest RBPT 1-24% Fyumagwa et al 2009 3 Mikumi-Selous RBPT 0.6% Temba 2012 4 Katavi-Rukwa Cattle, sheep, goats RBPT, ELISA, PCR, Riv T 1.6-7.9% Assenga et al 2015 Table 3: Brucellosis seroprevalences by occupational group, febrile presenting patents and tests used Groups Spp Tests Prevalence Source 1 Febrile patients, Moshi, Tanzania Human SAT 3.5% Bouley et al 2012 2 Occupational group, Tanga Human RBPT 5.5% Swai et et al 2005 3 Livestock keepers(Pastoralist) Serengeti Human c-ELISA ?% Shirima and Kunda 2016 4 Agriculture/livestock keepers(agro pastoralist)-northern, Tanzania Human RBPT, ELISA, 8.3% Shirima 2005 5 Livestock keepers(Pastoralist) Katavi Human RBPT, ELISA, Riv T 0.6 % Assenga et al 2015 6 Fever presenting outpatients, Kilosa Human RBPT, ELISA (B. abortus) (B. Melitensis) 7% 15.4% Chipwaza et al 2015 Effective prevention and control of brucellosis rely mainly on vaccination and test and slaughter policy of positive reactor animals. Moreover, broad use of vaccine is constrained by several factors related to delivery system, pathogen factors (Brucella spp is not host spp specific and varied brucella pathogens), host factors (affecting multiple animal spp) and varied production system (pastoral, agropastarol, intensive) complicating vaccine uptake and participation in vaccination program. Vaccines and vaccination campaign is lacking and where available it is only one type (S.19) that has been in use in cattle, which may not confer protection across the species. Combinations of all these technical, policies and operational challenges are among of the factors that impede effective disease control. 1.2 Socio-Economic Impact and Justification for Control Brucellosis is endemic in Tanzania with studies indicating a significant production loss and potential public health problems. Brucellosis causes severe debilitating disease that may result to permanent disabling sequel, and considerable medical expenses in addition to loss of income due to loss of working hours in human. In Tanzania, most patients presenting at hospitals with febrile illness tend to be clinically diagnosed as malaria or enteric fever, largely 4 because of the high endemic nature of these two infections but also due to similarity with clinical presentations of other infections prevalent in Tanzania. Symptoms and signs are non specific, and several other febrile illnesses may be simulated, for example glandular fever, toxoplasmosis, influenza and other enteric infections. Also, when an unusual complication is present, it may be overlooked. Clinical diagnosis of brucellosis is therefore difficult to establish leading to it being misdiagnosed, mismanaged and underreported. In livestock, brucellosis results in reduced productivity, abortions and weak offspring and is a major impediment for trade. Prevention of human brucellosis depends a great deal on control of the disease in domestic livestock. Effective control of brucellosis in Tanzania, like in other endemic countries, needs cooperation between human and animal health sectors with regard to research and actions directed to disease control. Despite of few research reports available, detailed disease information covering wide geographical areas and multiple susceptible host spp are missing. Furthermore, there is a lack of harmonized protocol for the diagnosis, prevention and control of the disease in humans and animals. Therefore, a comprehensive One Health strategy for prevention and control of the disease in humans and animals is desirable. 1.3 National Policies/Strategies and Legal Framework There are a number of legislation and regulations guiding the prevention and control of brucellosis in Tanzania. These include; • National Livestock Policy of 2006 The policy gives provision for control of zoonotic diseases including brucellosis in view of safeguarding the public health • Animal Disease Act No. 17, 2003 make provision for certification, animal disease outbreak investigation, control, notification and compensation • Public Health Act -2009: -This is an Act to provide for the promotion preservation and maintanance of public health with a view to ensuring the provision of comprehensive functional and sustainable public health services to the general public. Th serves for controlling diseases including zoonoses, Act provide provision guiding outbreak notification and investigation. • Tanzania National Health Policy 2003-the policy puts emphasis on the provision of equitable, quality and affordable basic health services, reduction of disease burden, maternal and infant mortality and increase life expectancy; availability of drugs and equipment; availability of health services to all people (urban and rural); as well as human resource capacity development. • Tanzania National eHealth Strategy 2013- the strategy recognizes the potential of information and communication technology (ICT) it can offer in transforming healthcare delivery by enabling information access and supporting healthcare operations, management, and decision making 5 • National Action Plan for Health Security 2017 • URT One Health Strategy Plan 2015 - 2020 Other laws/acts that regulate the prevention and control of brucellosis in Tanzania include; • Presidential Circular No 1 2002: Restricts movement of animals from disease infected area The Food, Drugs and Cosmetic Act No 1 of 2003: Food Hygiene Regulations 2006 TFDA • The Animal Welfare Act No 19 of 2008 • Livestock Registration, Identification, and Traceability Act No 12 of 2010 • The Local Government (District) Authorities Act No 7 of (1982) • Local Government (Urban Authorities) Act (1982) • Disaster Act No 7 of 2015: Provides for risk management of disasters including outbreaks of infectious diseases International policies/guidelines/regulations • OIE /FAO/WHO – provide broad guidance and protocols on disease surveillance, contingency planning, preparedness and response to zoonotic diseases • World Organization for Animal Health (OIE) terrestrial animal health code that set standards for the improvement of animal health and welfare and veterinary public health worldwide; OIE manual for diagnostic tests and vaccines for terrestrial animals. • WHO: World Health Organization (WHO) is the body of the United Nations (UN) responsible for directing and coordinating human health, main function includes; providing leadership on matters critical to health and engaging in partnerships where joint action is needed; shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; providing technical support, catalysing change, and building sustainable institutional capacity and monitoring the health situation and addressing health trends • FAO/OIE: Proggesive Control Pathway (PCP) for Brucellosis • AU IBAR: Integrated regional coordination mechanism sets mechanism for prevention and control of zoonoses 1.4 Stakeholders’ Mapping 1.4.1 Major stakeholders – line Ministries/partners A number of stakeholders will join forces to address specific interventions. Interventions and correlating stakeholders are summarised in table no. below. 6 Table 4: Stakeholders invovled and their corresponding area of intervention Area of Intervention Stakeholders involved Policies, standards and regulations development and implementation resource mobilization MoLF, MNRT, MOHCDGEC VPO-Environment Technical backstopping, capacity buiding and resource mobilization for disease for prevention and control FAO WHO OIE UNICEF NGO’s Reinforcement of policies and laws and control intervention implementations PO-RALG, Home Affairs and other relevant NGO’s and private sector and livestock keeping community Biosafety and Biosecurity MoLF, MNRT, MOHCDGEC, PO-RALG, and other relevant NGO’s and private sector, Institute (e.g. Universities and colleges – SUA, UDSM, LITA. MATI, etc) Research, training, consultancy and vaccine production National: Tanzania Veterinary Laboratory Agency (TVLA), DVS, COSTECH, NIMR, TAWIRI, TALIRI, IHI SUA, NM-AIST, UDSM, LITA International: Glasgow, University of Minesota, Pennystate University, Washington University, University of Edinburgh among others Advocacy and Ethical standards Professional bodies: TVA, MAT, MCT, VCT, Pharmacies, Nurses, allied Association, Tanzania Public Health Association (TPHA) Public awareness and prevention and control MALF, MNRT, MOHCDGEC, PO-RALG, and other relevant NGO’s PMO-DMD (OHCU), Community and private sector, FAO, WHO Implementers MoLF: Director of Veterinary services (DVS), Tanzania Veterinary Laboratory Agency (TVLA), Veterinary Council of Tanzania (VCT)) MoHCDGEC: DPS, PO RALG: RAS, Local Government Authorities (LGAs) MNRT: TAWIRI, TANAPA, TAWA NGOs: BRAC Tanzania, and other private NGO or CBO such as World Vision, CARE, Catholic Relief Services, Global Services Corps. 7 CHAPTER TWO 2. STRENGTH, WEAKNESS, OPPORTUNITIES AND CHALLENGES (SWOC) REGARDING BRUCELLOSIS PREVENTION AND CONTROL Brucellosis is a complex infectious zoonosis with economic importance in livestock world wide and is endemic in Tanzania.Prevention and control approaches are challenged by several factors including its complex epidemiology, policies related to its control, vaccine complexities, surveillance and diagnostic challenges, husbandry practices and social cultural values of the community. However, generally there are strengths and opportunities that could be harnessed to facilitate prevention and control with eventual eradication of brucellosis in the country. In addition, there are weaknesses and challenges, which must be addressed for effective prevention and control of the disease. Critical issues to be considered includes: 1. Frameworks in support for brucellosis prevention and control (political will) 2. Skilled and motivated human resource to support brucellosis control 3. Institutional organization 4. Financial resources 5. Tools for brucellosis surveillance and control (vaccines, reporting system, feedback and response system) 6. Research, training and development 7. Knowledge about brucellosis among public (advocacy, communication and social mobilization) 8. Partnership and multi-sectoral collaboration 9. Monitoring and evaluation 8 Ta b le 5 : S tr e n g th s , w e a k n e s s e s , o p p o rt u n it ie s a n d c h a lle n g e s Is s u e S tr e n g th s W e a k n e s s e s O p p o rt u n it ie s C h a lle n g e s F ra m ew o rk s in s u p p o rt f o r b ru ce llo si s p re ve n tio n a n d co n tr o l ( p o lit ic al w ill ) E xi st en ce o f n at io n al s ec to ra l p o lic ie s, s tr at eg ie s an d le g al fr am ew o rk s e. g . N at io n al L iv es to ck P o lic y o f 2 0 0 6 , an d A n im al D is ea se s A ct , 2 0 0 3 P u b lic H ea lth P o lic y 2 0 1 6 P u b lic H ea lth A ct , 2 0 0 9 N at io n al H ea lth S ec u rit y P la n ,2 0 1 7 S ec o n d fi ve y ea r D ev el o p m en t P la n (2 0 1 6 2 0 2 0 ) Ta n za n ia N at io n al e H ea lth S tr at eg y, 2 0 1 3 P re si d en tia l s ec u la r N o 1 o f 2 0 0 2 , T h e F o o d , D ru g a n d C o sm et ic s A ct , 2 0 0 3 (F o o d b o rn e su rv ei lla n ce sy st em ) O cc u p at io n al S af et y an d H ea lth A d m in is tr at io n (O S H A ) L iv es to ck R eg is tr at io n , Id en tifi ca tio n an d T ra ce ab ili ty A ct N o 1 2 o f 2 0 1 0 L o ca l G o ve rn m en t A u th o rit y A ct N o 7 o f (1 9 8 2 ) O n e H ea lth S tr at eg ic P la n o f 2 0 1 6 L is t o f n at io n al p rio rit y zo o n o tic d is ea se s In vo lv em en t o f o th er la w e n fo rc er s, ex am p le P o lic e, J u d ic ia ry e tc . L im ite d L aw e n fo rc em en t In ad eq u at e en fo rc em en t o f d is ea se c o n tr o l a n d li ve st o ck m o ve m en t la w s. L ac k o f p o lic y g u id el in es G en er al ly lo w a w ar en es s am o n g st ak eh o ld er s (h ig h a w ar en es s in s o m e co m m u n iti es w h er e b ru ce llo si s h as b ee n w id el y st u d ie d e g n o rt h er n T an za n ia (r ef Z h an g e t al ., 2 0 1 6 ) A va ila b ili ty o f g lo b al g u id el in es an d s ta n d ar d s fr o m in te rn at io n al b o d ie s lik e FA O , O IE , W H O P re se n ce o f G lo b al H ea lth S ec u rit y A g en d a 2 0 1 7 P re se n ce o f I n te rn at io n al P u b lic H ea lth R eg u la tio n s D el ay in p o lic y re vi ew an d im p le m en ta tio n to s u p p o rt re p ro g ra m m in g w h er e n ec es sa ry 9 Is s u e S tr e n g th s W e a k n e s s e s O p p o rt u n it ie s C h a lle n g e s S ki lle d h u m an re so u rc e A va ila b le s ki lle d h u m an r es o u rc e at va rio u s le ve ls . (h u m an , an im al a n d en vi ro n m en ta l h ea lth e xp er ts a n d la b o ra to ry t ec h n o lo g is ts ) In su ffi ci en t n u m b er o f tr ai n ed p er so n n el (h u m an , ve te rin ar y, en vi ro n m en ta l h ea lth e xp er ts an d la b t ec h n o lo g is ts ) In ad eq u at e co n tin u o u s p ro fe ss io n al d ev el o p m en t p ro g ra m m es A va ila b ili ty o f tr ai n in g in st itu tio n s /f ac ili tie s Te ch n ic al b ac ks to p p in g f ro m p ar tn er s (F A O , W H O a n d O IE ) F u n d in g t o s u p p o rt b u ild u p h u m an re so u rc e In st itu tio n al o rg an iz at io n P re se n ce o f h u m an a n d a n im al h ea lth s tr u ct u re s an d f ac ili tie s in cl u d in g O H C o o rd in at io n U n it (u n d er P rim e M in is te r’s O ffi ce ) P re se n ce o f re le va n t m in is tr ie s an d d ep ar tm en ts /A g en ci es (e g T F D A E xi st en ce o f o th er c o n tr o l p la n s (e .g . fo r R ab ie s, A vi an in flu en za , R V F a n d P P R ) W ea k co m m u n ic at io n /s h ar in g o f in fo rm at io n t o e n su re d et ec tio n an d r es p o n se O ve rla p o f th e im p le m en ta tio n o f ac tiv iti e In te g ra te d D is ea se S u rv ei lla n ce an d R es p o n se (I D S R ) f o r h u m an d o es n ’t c ap tu re b ru ce llo si s O H , co o rd in at io n f ra m ew o rk s/ n et w o rk s P re se n ce o f In te rn at io n al o rg an iz at io n s (F A O , W H O , O IE ) W ea k sh ar in g o f d at a an d in fo rm at io n ; b ro ke n c h ai n o f co m m an d f o r an im al an d h u m an h ea lth ) F in an ci al r es o u rc es to s u p p o rt b ru ce llo si s p re ve n tio n a n d co n tr o l A n n u al b u d g et ar y al lo ca tio n f o r d is ea se s u rv ei lla n ce a n d c o n tr o l In ad eq u at e fu n d in g P ar tn er sh ip s w ith d ev el o p m en t an d b ila te ra l p ar tn er s, d ev el o p m en t in iti at iv es / p ro g ra m m es a t n at io n al , re g io n al a n d in te rn at io n al le ve ls e. g D ef en ce T h re at R ed u ct io n A g en cy (D T R A ), W el co m e Tr u st , B ill a n d M el in d a G at es fo u n d at io n , U S A ID P re se n ce o f se ve ra l c o n so rt ia ad d re ss in g b ru ce llo si s e. g . A fr iq u e O n e A S P IR E , Z E L S T h er e is n o s in g le b as ke t fu n d f o r zo o n o se s co n tr o l in cl u d in g b ru ce llo si s W ea k sh ar in g o f re so u rc es b et w ee n se ct o rs (w ea k co lla b o ra tio n a n d co o rd in at io n ) 10 Is s u e S tr e n g th s W e a k n e s s e s O p p o rt u n it ie s C h a lle n g e s To o ls f o r b ru ce llo si s su rv ei lla n ce a n d co n tr o l ( d ia g n o st ic s, va cc in es , re p o rt in g sy st em , fe ed b ac k re sp o n se s ys te m ) P re se n ce o f lo ca lly m ad e va cc in es fo r an im al s A va ila b ili ty o f la b o ra to ry d ia g n o st ic ca p ac ity P re se n ce o f g u id el in e fo r su rv ei lla n ce o f p rio rit iz ed z o o n o tic d is ea se s (in p ip e lin e) A va ila b ili ty o f ep id em io lo g ic al d at a o n a n im al s ec to r (s ev er al r es ea rc h es g o in g o n ) In co n si st en t an d f ra g m en te d re se ar ch d at a (n o n at io n al w id e re p re se n ta tiv e d at a b ia se d d at a) L ac k o f va cc in at io n in s m al l ru m in an ts (o n ly in c at tle ) L o w v ac ci n at io n c o ve ra g e as so ci at ed w ith a va ila b ili ty a n d ac ce ss ib ili ty – (d is tr ib u tio n c o ld ch ai n ) o f va cc in e T h er e is n o n at io n al s ta n d ad is ed an d v al id at ed d ia g n o st ic t es ts P re se n ce o f re fe re n ce la b o ra to rie s fo r d ia g n o si s, re se ar ch a n d t ra in in g (A n im al , P la n t H ea lth A g en t (A P H A ) U K a n O IE r ef er en ce la b f o r B ru ce lla ) A va ila b ili ty o f te ch n ic al b ac ks to p p in g (F A O , W H O , O IE ) F in an ci al r es o u rc es In ad eq u at e en g ag em en t L G A s S tr ai n t yp in g (a p p ro p ria te v ac ci n es ) H u sb an d ry p ra ct ic es R es ea rc h , tr ai n in g an d d ev el o p m en t P re se n ce o f R es ea rc h a n d T ra in in g In st itu tio n s (S U A , M U H A S , TA W IR I, N IM R , IH I, T V L A , N M A IS T, C U H A S , K C R I, N H L Q A ) R es ea rc h r eg u la tio n C O S T E C H P o lit ic al w ill f o r al lo ca tin g 1 % o f to ta l b u d g et f o r re se ar ch (G o ve rn m en t co m m itm en t) P re se n ce o f p o o l o f lo ca l e xp er ts o n b ru ce llo si s P re se n ce o f n et w o rk s w ith o n g o in g re se ar ch a ct iv iti es o n b ru ce llo si s W ea k co o rd in at io n o f re se ar ch in iti at iv es A b se n ce o f n at io n al r es ea rc h ag en d a fo r p rio rit y zo o n o tic d is ea se s P re se n ce o f re fe re n ce la b o ra to rie s fo r d ia g n o si s, re se ar ch a n d t ra in in g C o lla b o ra tio n w ith in te rn at io n al re fe re n ce la b o ra to ry (U K ) a n d p ar tn er s (D T R A , W el co m e Tr u st , B ill a n d M el in d a G at es F o u n d at io n , W H O , FA O ) a n d U n iv er iti es in t h e U K , U S A , A u st ra lia , Ja p an e tc B ru ce lla b ei n g b io a g en t in cr ea se li ke lih o o d o f g et tin g ex te rn al r es ea rc h f u n d s In ad eq u at e fu n d in g In ad eq u at e re se ar ch fin d in g s es p ec ia lly o n ci rc u la tin g s tr ai n s 11 Is s u e S tr e n g th s W e a k n e s s e s O p p o rt u n it ie s C h a lle n g e s K n o w le d g e ab o u t b ru ce llo si s am o n g p u b lic E xi st en ce o f el ab o ra te a d m in is tr at iv e st ru ct u re s d o w n t o g ra ss r o o t le ve l (fr o m t h e M in is tr y to t h e vi lla g e) t h at ca n s u p p o rt e xt en si o n s er vi ce s P re se n ce o f va rio u s m ed ia o u tle t G o o d c o ve ra g e o f m o b ile n et w o rk s an d s o ci al m ed ia g ro u p s In ad eq u at e kn o w le d g e am o n g fa rm er s (o n ly 2 0 % o f fa rm er s ac ce ss e xt en si o n s er vi ce s) L ac k o f ad vo ca cy m at er ia ls , (p o st er s, fl ar es , an d p ro to co ls ) at a ll le ve ls in a n im al a n d h u m an h ea lth w o rk er s D is jo in t co m m u n ic at io n d u rin g an d a ft er a b o rt io n in a n im al s) G lo b al ly , b ru ce llo si s fa ct s h ee ts an d p ro to co ls a re a va ila b le S o ci o c u ltu ra l v al u es an d b el ie fs P ar tn er sh ip a n d m u lti s ec to ra l co lla b o ra tio n P re se n ce o f O H C o o rd in at io n U n it O H T ec h n ic al w o rk in g g ro u p s O n e h ea lth s tr at eg ic P la n (2 0 1 6 ) T h e N at io n al S tr at eg y fo r In co m e G ro w th a n d P o ve rt y R ed u ct io n 2 0 1 0 (N S G R P M K U K U TA ) It em p h as iz es m u lti s ec to ra l c o lla b o ra tio n in d is ea se c o n tr o l S u rv ei lla n ce g u id el in es f o r p rio rit y zo o n o tic d is ea se (i n t h e p ip e lin e) W ea k m u lti s ec to ra l co lla b o ra tio n (T h er e is li tt le co o rd in at io n a n d c o lla b o ra tio n b et w ee n t h e h u m an a n d a n im al h ea lth s ec to rs a n d o th er r el ev an t se ct o rs f o r b ru ce llo si s co n tr o l) L ac k o f si g n ed M O U b et w ee n se ct o rs L ac k o f fo rm al c o m m u n ic at io n st ra te g y A va ila b le O H n et w o rk s/ fo ru m s/ o rg an iz at io n s b o th g lo b al ly a n d re g io n al ly F ea r am o n g in d iv id u al s D iff er en t p rio rit ie s an d co n ce rn s re su lt in to la ck o f tr u st a m o n g te am m em b er s P o o r co m m u n ic at io n an d la ck o f co m m o n u n d er st an d in g a m o n g co lla b o ra to rs 12 Is s u e S tr e n g th s W e a k n e s s e s O p p o rt u n it ie s C h a lle n g e s M o n ito rin g a n d ev al u at io n P re se n ce o f su rv ei lla n ce g u id el in es fo r p rio rit y zo o n o tic d is ea se s (in t h e p ip e lin e) U n d er re p o rt in g a n d in ad eq u at e fe ed b ac k in t h e an im al h ea lth s ec to r F ew la b o ra to rie s fo r d is ea se co n fir m at io n L ac k o f n at io n al r ef er en ce la b f o r b ru ce llo si s d ia g n o si s • U se o f m o b ile t o o ls t o p ro m o te r ep o rt in g • Te ch n ic al b ac ks to p p in g fr o m p ar tn er s (F A O , W H O ) • P re se n ce o f in te rn at io n al re fe re n ce la b o ra to rie s fo r d ia g n o si s, r es ea rc h a n d tr ai n in g (O IE r ef er en ce la b in U K ) F u n d in g t o s u p p o rt ac tiv e an d p as si ve su rv ei lla n ce L ac k o f in fr as tr u ct u re an d m o tiv at io n a m o n g an im al a n d h u m an h ea lth w o rk er s L ac k o f lin k b et w ee n re se ar ch a n d p ra ct ic e to g u id e ef fe ct iv e m o n ito rin g B io se cu rit y an d b io sa fe ty a t va rio u s le ve ls P re se n ce o f re le va n t re g u la tio n s (r ef er c rit ic al is su e n o 1 a b o ve ) P re se n ce o f b io s af et y fa ci lit ie s an d to o ls a t va rio u s le ve ls (fi el d , la b , o n tr an si t) In ad eq u at e b io se cu rit y an d b io sa fe ty f ac ili tie s at f ar m le ve l In ad eq u at e kn o w le d g e o n b io se cu rit y an d b io sa fe ty is su es fo r ex p er ts a n d f ar m er s L im ite d b io se cu rit y an d b io sa fe ty g u id el in es • P re se n ce o f g u id el in es fr o m in te rn at io n al r ef er en ce la b o ra to rie s • Te ch n ic al b ac ks to p p in g (O IE sa n ita ry a n d p h yt o sa n ita ry (O IE S P S ), W T O , W H O ) • P re se n ce o f ex p er ts o n b io sa fe ty is su es A n im al h u sb an d ry (m an ag em en t an d c ar e o f an im al s) (d iffi cu lt to e n fo rc e an im al m o ve m en t co n tr o l, va cc in at io n e tc ) 13 CHAPTER THREE 3. GUIDING PRINCIPLES OF BRUCELLOSIS PREVENTION AND CONTROL STRATEGY 3.1 Vision To have the nation that is free from brucellosis 3.2 Mission Ensuring the wellbeing of people by improving safety of animal source products and livestock productivity through an integrated brucellosis control strategy. 3.3 Goal To control and eventually eradicate brucellosis in the country through an integrated intervention strategy. 3.4 General Objective/Objective of the Strategy To reduce the burden and socio-economic impact caused by brucellosis in human and animal populations in Tanzania. 3.5 Key Strategic Objectives for Brucellosis Control 1. To enhance awareness and knowledge on brucellosis for professionals, policy makers, community and the general public 2. To initiate a national vaccination programme for livestock using public private partnership 3. To streamline and harmonise appropriate legal /policy framework and institutional arrangement in the implementation of the plan 4. To institutionalise Brucellosis testing among the febrile human cases in public and private health facilities 5. To support implementation of functional and quality integrated surveillance and diagnostic activities using One Health Approach 6. To promote and coordinate research and innovation in Brucellosis interventions 7. To facilitate and support application of bio-security and bio-safety targeting risk groups 8. To advocate and mobilize resources for supporting implementation of the plan 3.5.1 Prevent and Control of brucellosis in human The prevention and control of human brucellosis hinges on elimination of contacts between people and infected animals or their products as well as avoiding risk behavioural practice. Measures for brucellosis should include public education on the risks, transmission avoidance and control of brucellosis. Among the commonly used approaches to prevent brucellosis in human include; personal hygiene, protection of the environment and food hygiene (adequate boiling of fresh milk intended for drinking or making other milk products). Adoption of safe working practices including use of PPE is highly encouraged in high risk occupations when handling potentially infected materials, eg aborted foetus, placenta, gravid uterus etc will be promoted. Other measures include employing good animal husbandry and management practices. 14 3.5.2 Prevention and control of brucellosis in food animals The prevention and control in animals will focus on managing and altimately eradicate B. abortus and B. melitensis infections in cattle and goats to reduce economic losses and protect general public fro the disease The main prevention and control will include i. Vaccination of female calves and goats. ii. Strengthen brucellosis surveillance using One Health Approach iii. Awareness and sensitizing livestock keepers on proper disposal of aborted fetuses, placenta and placenta fluid iv. Promote good husbandry practices including bio-security measure v. Test and slaughter of the positive animals in targeted farms 3.5.3 Strengthen institutional capacity to control brucellosis • Surveillance and diagnostics capacities for prioritized zoonoses including Brucellosis will be strenhthened at national and subnational levels through training of field and lab personel to support brucellosis surveillance • Equip laboratories for brucellosis diagnosis. Efforts will be made to introduce testing schemes in targeted farms and incorporate brucellosis in existing surveillance systems, such as Integrated Disease Surveillance and Response (IDSR). • Quality vaccine production capacity at Tanzania Vaccine Institute – Kibaha will be strengthened to support vaccination programmes (including vaccines for small ruminants). 3.5.4 Promote and coordinate research and innovation in brucellosis interventions OH, stakeholders comprising of animal health, medical, public and environmental health, anthropologist and other experts to identify and undertake interventional research, eg. Efficacy of current vaccines, vaccine delivery model, pathogen/infection dynamics, Knowledge, Attitude and Practices (KAP) studies, system’s research etc In addition, research focusing development and validation of rapid field and laboratory confirmatory tests. 3.5.5 Enhance awareness and knowledge on brucellosis for proffesionals, policy makers, community and public Awareness raising and sensitizing various stakeholders (Livestock keepers, consumers, policy makers, FBO/CBO leaders) using different avenue including but not limited to schools, Churches, Mosques, mass media (Radio, TV, Brochures, social media) and meetings at different levels will be enhanced. Livestock keepers will be made aware on risks related to improper disposal of aborted fetuses, placenta and placenta fluid and good husbandry practices including bio-security measure will be promoted. 3.5.6 Enhance Partnerships and One Health Approach/Multi-SectoralCollaboration Establish a way to allow sharing of disease reports, other information and discussions among 15 the animal health and human health departments at various administrative levels. This may include joint implementation where applicable 3.5.7 Streamline and harmonise appropriate legal and policy framework and institutional arrangement for the implementation of strategy. Legal/ policy framework will be streamlined and harmonised to support zoonoses control. In addition, law enforcers will be engaged to raise awareness to all stakeholders regarding legal aspects providing for animal disease control including brucellosis. This will facilitate compliance to application of control measures. 16 CHAPTER FOUR 4. IMPLEMENTATION PLAN OF THE STRATEGY Progressive (step-wise) approach for the control of brucellosis is adopted as suggested by OIE (FAO, 2013)., The approach entails to progressively move from one stage to the stage immediately after and is based on four different stages each with a situation analysis, expected outcome and summarized key activities as indicated in table 5. Stage 1 is where the epidemiological situation is being assessed and stage 4 is when the evidence is provided that there is no bacteria circulation either at zonal or national level and is ready to apply for the OIE official country status of brucellosis freedom. Table 6: Road Map for the Progressive control of Brucellosis Stage 1 Stage 2 Stage 3 Stage 4 Situation • Brucellosis is known to be present but with limited information • No structured control plan Known situation of the disease with a control programme underway Brucellosis at low levels within susceptible livestock and human population No evidence of brucellosis in livestock No human cases Outcome Better understanding of the disease situation. Brucellosis prevalence/ incidence rates in livestock and human reduced by 20% by 2020 Reduced impact of brucellosis in livestock and humans by 50% by 2025 Self –declared free from brucellosis with/without vaccination 17 CHAPTER FIVE 5. INSTITUTIONAL AND FINANCIAL ARRANGEMENT 5.1 Institutional Arrangement A national Strategy for Prevention and Control plan of brucellosis will be implemented through the existing structures that include the line Ministries, Local Government Authorities and stakeholders including development partners. At the regional, district and village levels the respective Primary Health Care Committee (PHC) will be responsible in their respective areas. However, at the levels of MoLF and MoHCDGEC in the Directorates of Veterinary Services and Preventive Services respectively, there shall be a coordinator for overseeing the day-to-day activities of the control strategies. The One Health Coordination Unit – at the Prime Minister’s office shall be the coordinator of multi-sectoral activities pertinent with brucellosis control. It is expected that the control measures will involve all the areas with animals known to be important in the epidemiology of the disease in the country. Table 7: Institutional responsibilities and roles Institution Roles/Responsibility Ministry responsible for Finance Provision of funds and other resources Oversees budget preparation and execution • Ministry responsible for Livestock • and Fisheries • Ministry responsible for Health • Ministry responsible for wildlife Formulation and harmonisation of policies and strategies Information and data collection Provision of technical support and implementation of activities President’s Office, Regional Administration and Local Government(PORALG) Implementation of Vaccination activities Creation of brucellosis awareness Participate in brucellosis surveillance VPO – Environment Enforcement of government laws Surveillance Ministry of Home Affairs Enforcement of government laws Ministry responsible for Justice and Constitution Affairs Interpretation and custody of government laws Prime Ministers Office – One Health Coordination Unit Coordination of multi-partners and multi-sectorial activities related to One-Health and resource mobilization TFDA To ensure quality, safety and effectiveness of medicines by evaluating and registering of quality vaccines, control the importation of vaccines and conducting post marketing surveillances for vaccines TVLA, TVI Diagnosis, research and vaccine production, vaccine quality control TANAPA Coordination of wildlife related activities and control of brucellosis in wildlife buffer zones 18 ZVCs, Health facilities Surveillance in humans and animals Academic and Research Institutions (e.g: NM-AIST, KCMC, SUA, MUHAS,IHI, TAWIRI, NIMR etc) Research, training, diagnosis, consultancy and vaccine manufacture PAHSP (Private Animal Health Service Providers) Surveillance, provision of veterinary services and reporting NGOs both local and International Provides technical support, public awareness, funding and linkages with communities and outreach activities Food processors (eg Abattoirs, Milk plants etc) Surveillance Development Partners (e.g, B&MGF, WHO, OIE, FAO, UNICEF, USAID, CDC etc) Support of brucellosis vaccination activities, funding of outreach activities 5.2 Financial Arrangement Funding will be sourced from the Tanzania central government ministries (Ministry of Livestock and Fisheries (MoLF) and Ministry of Health, Community Development, Gender, Elderly and Children, Ministry of Natural Resources and Tourism, President’s Office, Regional Administration and Local Government (PO-RALG), Prime Minister’s Office, Development Partners and NGOs, CBOs and FBOs. Private sector will be engaged to support activities. Community own resources will be requested to support local activities. 19 CHAPTER SIX 6. MONITORING AND EVALUATION The National Strategic Plan for Prevention and Control of Brucellosis will be implemented through Ministries responsible for Livestock, Health and Wildlife. Other Ministries are those responsible for Local Government Authorities and other stakeholders. A national Brucelosis control task force will be established to report to the ministries responsible for animal and human health. At regional, district and ward-levels, representatives of One Health Committees will be responsible for their respective areas. Designated officer (at DVS and DPS) shall be coordinators responsible for overseeing day-to-day activities of the programme. The One Health Coordination Unit – at the Prime Minister’s office shall be coordinator of multi-sectorial activities within a One Health framework. Monitoring and Evaluation (M&E) of the anthrax prevention and control strategic plan will be critical to measure the effectiveness of interventions. Indicators will be used to determine whether the interventions are making progress towards achieving objectives and goals of the anthrax prevention and control strategic plan. Each activity bears a monitoring indicator to be measured in the process of its implementation. Monitoring and evaluation frameworks will incorporate both process and outcome indicators. Individual Ministries/institutions/ bodies will have responsibility for monitoring and evaluating relevant identified activities and feeding information, findings and recommendations into the overall M&E process. A mid term review will be done after three years to monitor the implementation of the plan. End-of term evaluation will be conducted in 2023. 20 7. REFERENCES Alonso, Silvia; Dohoo, Ian; Lindahl, Johanna; Verdugo, Cristobal; Akuku, Isaiah; et al. (2016). Prevalence of tuberculosis, brucellosis and trypanosomiasis in cattle in Tanzania: a systematic review and meta-analysis. Animal Health Research Reviews; Cambridge 17.1 16-27. Bouley AJ, Biggs HM, Stoddard RA, Morrissey AB, Bartlett JA, et al. (2012) Brucellosis among hospitalized febrile patients in Northern Tanzania. Am J Trop Med Hyg. 87: 1105–1111. pmid:23091197. Chipwaza B, Mhamphi GG, Ngatunga SD, Selemani M, Amuri M, Mugasa JP, et al. (2015) Prevalence of Bacterial Febrile Illnesses in Children in Kilosa District, Tanzania. PLoS Negl Trop Dis 9(5): e0003750. https://doi.org/10.1371/journal.pntd.0003750. Dean AS, Crump L, Greter H, Schelling E, Zinsstag J. (2012). Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 6(10):e1865. doi: 10.1371/ FAO 2003a. A step wise approach for progressive control of Brucellosis in animals. Rome. http//www.fao.org/ag/againfo/programmes/en/empress/news 250113b.html (accessed 14 April 2014) Galvmed (2017) Brucellosis outbreak in India highlights need for greater disease control. https://www.galvmed.org/news/brucellosis-outbreak-india-highlights-need-greater disease-control/ (Accessed on, February 13, 2018). Fyumagwa R.D, Wambura P.N., Mellau L.S.B. and Hoare, R. (2009). Seroprevalence of Brucella abortus in buffaloes and wildebeests in the Serengeti ecosystem: A threat to humans and domestic ruminants. Tanzania Veterinary Journal 26(2): 62-67. John K, Fitzpatrick J, French N, Kazwala R, Kambarage D, Mfinanga GS, MacMillan A, Cleaveland S. (2010). Quantifying risk factors for human brucellosis in rural northern Tanzania. PLoS One. 1; 5(4):e9968 Mangen, M. J., Otte, J., Pfeiffer, D., Chilonda, P. (2002). Information and Policy Branch, AGAL, Food and Agriculture Organization Rome, Italy, Livestock policy discussion paper, 8:12-18 in De La, Societe De Pathologic Exoticque, 89(5): 353-357. Seleem, M.N., S.M. Boyle, and N. Sriranganathan, 2010: Brucellosis: A re-emerging zoonosis. Veterinary Microbiology 140, 392–398. Shirima, G. M. (2005). The epidemiology of brucellosis in Animals and humans in Arusha and Manyara regions of Tanzania. PhD thesis, University of Glasgow. Swai ES and Schoonman L (2009) Human Brucellosis: Seroprevalence and Risk Factors Related to High Risk Occupational Groups in Tanga Municipality, Tanzania. Zoonoses Public Health. 56: 183–187. pmid:18811674. Swai ES, Schoonman L. The use of rose bengal plate test to asses cattle exposure to Brucella infection in traditional and smallholder dairy production systems of Tanga region of Tanzania. Vet Med Int. 2010;2010. doi: 10.4061/2010/837950. WHO, 2006: Brucellosis in human and animals. World Health Organization (WHO), 20 Avenue Appia, 1211 Geneva 27, Switzerland. WHO Press, WC310. pp. 89. 21 8. APPENDICES Appendix 1: LOGICAL FRAMEWORK MATRIX Outcome Objectives Activity Indicator Data source/ Means of Veri fication Baseline Better under standing of the disease situation To enhance awareness and knowledge on brucellosis for professionals, policy makers, community and the public • Conduct knowl edge, Attitude, Practice (KAP) studies in different social, policy and professional group • Develop/review communication and advocacy strategy for the brucellosis diseases (cross cuting) • Develop, produce and disseminate IEC materials. • Conduct advocacy, communication and social mobilization on brucellosis • Carry out baseline survey and epidemi ological investigation and undertake risk mapping • Number of, KAP studies conducted and shared • Comunication and advocacy strategy in place • IEC materials put in place and dissem inated to the target groups at different levels. • Number of meeting for advocacy con ducted • Surveys and investigations and risk map ping undertak en Baseline survey report, post in tervention survey reports Derived from pre-existing Published data Vaccination of livestock using public private partnership To initiate a national vaccination programme for livestock using public private partnership • Develop national vaccination plan • Production/procure of vaccine • Conduct monitor ing of vaccination programme • To conduct vacci nation campains at National and subnational levels • National vac cination plan document • Number of Vac cine produced/ procured and consumed • Number of vaccination campaign/ monitoring visits Availability of Reports and document on the activities conducted No Existing data 22 Outcome Objectives Activity Indicator Data source/ Means of Veri fication Baseline Institutio na-lised brucellosis testing among febrile human cases in public and private Institutionalise brucellosis testing among febrile human cases in public and private health facilities • Procure diagnostic reagents, • Train personnel (Epi-Laboratory on biosafety and biose curity) • Develop SOP for testing of human febrile cases guided by evidence / research • Orient professionals on SOP, biosafety and biosecurity • Availability of materials and health cen ters/facilities involved. • Number of training and trained individuals by districts. Availability of SOP document Training and ori entation reports No pre-ex isting Supported and implemented functional and quality integrated surveillance and diagnostic activities using One Health Approach To support im plementa-tion of functional and quality integrated surveillance and diagnostic activities using One Health Approach • Train personnel and equip Epidemiolgy Unit for brucellosis surveillance. • Train personnel and equip Lab Unit for brucellosis detec tion. • Train clinicians for proper case man agement • Train and equip field staff/health officers for data collection and reporting. • Develop joint out break investigation protocol in animals • Undertake active surveillance in ani mals • Reports of number of supplies and, equipments. Number of trainings and surveillance. • Number of dis tricts equipped with data collection and reporting tools. • Joint investi gation protocal developed Reports and documents No pre-ex isting data Streamlined and harninised appropriate legal/policy framework and institu tional arrange ment for im plementation of the plan To streamline and harmonise appropriate legal /policy framework and institutional arrangement in the implemen tation of the plan • To carry out legal and policy analysis, spot some weak ness and amend accordingly • To carry out advoca cy and operational ize legal frameworks • To carry out stake holder’s engage • Report of Revised docu ment • Number of ad vocacy meeting conducted • Number of stakeholders meeting con ducted Reports and documents from activities Existing policies/le gal frame works 23 Outcome Objectives Activity Indicator Data source/ Means of Veri fication Baseline ment meeting es pecially for the low enforcers and DEDs to involve them in disease control • Facilitate Interminis trerial arrangement through develop ment of MoUs • To establish linkage mechanism for research between line ministries and research institutions to support the con trol of brucellosis • To develop com munity base policy institutional and legal frameworks to support community engagement in the control of brucellosis • To develop appro priate regulations for the control of brucellosis and other disease of importance • Availability of MoU • Established linkage between line ministries and research institution to support control of brucellosis • Established policy • Availability regulations Cordinated research and innovation on Brucelosis intervantion Promote and coordinate research and innovation on brucellosis interventions • Conduct innovative Brucellosis research to inform legislation and intervention planning • Research on Policy and coordination structure which sup port implementation and interventions • Research on dis ease epidemiology in wildlife, livestock and humans • Research on inter actions which lead • Number of research GAPs identified • Number of proposals developed and sent for funding • Reports/pub lications and documents Reports Proposal docu ments Existing publica tions and reports on brucellosis 24 Outcome Objectives Activity Indicator Data source/ Means of Veri fication Baseline into outbreaks btn the compartments • Research in new technology on rapid detection, identifica tion and differentia tion of species. • Validation of existing vaccines • Conduct research on making new vac cine materials and antigen for vaccines • Research on other options for Brucello sis control • Research on other susceptible groups and groups at risk of getting disease • Research on socio cultural drivers on Brucellosis transi mission, prevention and control Improved application of biosecurity and biosafety targeting risk groups Facilitate and support application of bio-security and bio-safety targeting risk groups • Review, update and disseminate the biosafety and biosecurity policy and curricula • Creation of aware ness to the first re sponders - farmers, extension officers • Train and equip biosafety officers including meat inspectors and market staff • Inventory of lab research and detec tion • To designate labo ratories for handling and identification of Brucellosis • Brucellosis out break response plan. • Number of staff trained. • Number of equipments procured. • Availability of lab research and detection • Availability of designed lab for handling and identifica tion of Brucelo sis • Availability of SoPs Presence of PPE, Presence of safety cabinet in the laboratory Not exist ing 25 Outcome Objectives Activity Indicator Data source/ Means of Veri fication Baseline • Development and dissemination of SOP’s on biosafety and biosecurity on suspected cases of Brucellosis to avoid contamination Advocate and mobilize resources for supporting implementation of the plan • Development of bru cellosis proposals to support implemen tation of the plan • Conduct develop ment partners map ping for resource mobilization within and outside Tanza nia. • Number of brucellosis proposals developed. • An inventory of funding agen cies available Reports of im plementation. Funding propos als. Not exist ing 26 Appendix 2: DETAILED PREVENTION AND CONTROL STRATEGY FOR BRUCELLOSIS STRATEGIC OBJECTIVES KRAs ACTIVITIES Target year for initiating output / activity . 1 2 3 4 5 To enhance aware ness and knowledge on brucellosis for professionals, policy makers, community and the public Conduct knowledge, Attitude, Practice(KAP) studiesin different social, policy and professional group Develop/review commu nication and advocacy strategy for the brucellosis diseases (cross cuting Develop, produce and disseminate IEC materials Conduct advocacy, communication and social mobilization on brucellosis Carry out baseline survey and epidemiological in vestigation and undertake risk mapping To initiate a national vaccination pro gramme for livestock using public private partnership Develop and implement national vaccination plan Production/procure of vaccine To conduct vaccination campains at National and subnational levels Conduct monitoring of vaccination programme Institutionalise brucel losis testing among febrile human cases in public and private health facilities Procure diagnostic re agents, Train personnel (Epi-Lab oratory on biosafety and biosecurity) Develop SOP for testing of human febrile cases guided by evidence / research Orient professionals on SOP, biosafety and bios ecurity Procure diagnostic re agents, 27 STRATEGIC OBJECTIVES KRAs ACTIVITIES Target year for initiating output / activity . 1 2 3 4 5 To support implemen tation of functional and quality integrated surveillance and diag nostic activities using One Health Approach Train personnel and equip Epidemiolgy Unit for bru cellosis surveillance. Train clinicians for proper case management Train and equip field staff/ health officers for data collection and reporting. Develop joint outbreak investigation protocol in animals To streamline and harmonise appro priate legal /policy framework and insti tutional arrangement in the implementation of the plan To carry out legal and policy analysis, spot some weakness and amend accordingly To carry out advocacy and operationalize legal frameworks To carry out stakeholder’s engagement meeting especially for the low enforcers and DEDs to involve them in disease control Facilitate Interministrerial arrangement through development of MoUs To establish linkage mechanism for research between line ministries and research institutions to support the control of brucellosis To develop community base policy institutional and legal frameworks to support community engagement in the control of brucellosis To develop appropriate regulations for the control of brucellosis and other disease of importance 28 STRATEGIC OBJECTIVES KRAs ACTIVITIES Target year for initiating output / activity . 1 2 3 4 5 Promote and coor dinate research and innovation on brucel losis interventions Conduct innovative Bru cellosis research to inform legislation and intervention planning Research on Policy and coordination structure which support implemen tation and interventions Research on disease epidemiology in wildlife, livestock and humans Research on interactions which lead into outbreaks btn the compartments Research in new technol ogy on rapid detection, identification and differen tiation of species. Validation of existing vaccines Conduct research on making new vaccine materials and antigen for vaccines Facilitate and support application of bio-se curity and bio-safety targeting risk groups Review, update and disseminate the biosafety and biosecurity policy and curricula Creation of awareness to the first responders farmers, extension officers Train and equip biosafety officers including meat in spectors and market staff Inventory of lab research and detection To designate laboratories for handling and identifi cation of Brucellosis Development and dis semination of SOP’s on biosafety and biosecurity on suspected cases of Brucellosis to avoid con tamination 29 STRATEGIC OBJECTIVES KRAs ACTIVITIES Target year for initiating output / activity . 1 2 3 4 5 Review, update and disseminate the biosafety and biosecurity policy and curricula Creation of awareness to the first responders farmers, extension officers Advocate and mo bilize resources for supporting implemen tation of the plan Development of brucello sis proposals to support implementation of the plan Conduct development partners mapping for re source mobilization within and outside Tanzania.