Business Continuity Plan (BCP) for Emergencies like Ebola Virus Diseases for Health sectors

Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
1 |
Preparedness
Ebola Virus Outbreak
Business Continuity Plan (BCP)
Generic Presentation
Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA
Public Health Specialist
Disclaimer: This presentation is developed with a view of advocating a need of
development of Business Continuity Plan (BCP) as part of preparedness or
readiness/response plan for emergencies like Ebola Virus Diseases or any other
emergencies, where the response may have to compromise the essential and critical
functions.

2 |
Outline
 Difference between Contingency Plan and Business Continuity Plan (BCP)
 Impacts of Ebola (socio-economic and others)
 Potential impacts on health and non –health sectors
 Rationale for BCP
 Planning assumptions
 BCP Planning and Steps
 Lack of Preparedness: Example

3 |
Difference between CP and BCP
BCP is part of CP
A Contingency Plan
Protects life safety in the event of
an incident and is geographically
based, meaning that your office’s
plan should be specific to its
location. In other words, what will
you do in case of an immediate
emergency- where will you go, what
should go with you, how will you
account for everyone, etc.
A Business Continuity Plan
Protects the job that you do, and
should outline how you will
continue do essential tasks in the
event of an incident that may
affect operations. For example,
how will you provide the
immunization if there health care
workers are sick? Or how will you
do your job if you can’t use your
office space for a week

4 |
Socio-Economic Impact
EVD
outbreak

5 |
Potential Impact on Ebola Outbreak
 Projections show a possible $32.6 billion loss to West Africa over the next
two years (only in West Africa) – source: WB
 Deaths, absenteeism and attempts to avoid infection have consequences
for supply and demand side of economy
– Markets close, utilities unreliable, telecoms break, cash in short supply
– Mining and production reduces
 Threats to Rule of Law and Security (recently established peace after
decade long conflict

6 |
Potential Impacts on Health Sectors
Deaths/ Illnesses Quarantine
Care Fear
Absenteeism
Decreased Supply
Reduced Services
Disrupted
transportation and
services
Cross Sectoral
Activities
Increased Demand
Care of Ebola/Fever
Water & Sanitation
Communication
Banking services
Mortuary & Burial
Electricity/Power
Routine Health Care
Security
Logistics
Breakdown of Health Services
 Changed Demands
 Lack of BCP
Potential Impacts on
Health Sectors

7 |
Potential Impacts on Non-Health Sectors
Deaths/ Illnesses Quarantine
Care Fear
Absenteeism
Decreased Supply
Reduced production
Disrupted
transportation
Trade of
commodities
Cross sectoral
interdependencies
Increased Demand
Logistic support
Water & Sanitation
Communication
Banking services
Mortuary & Burial
Electricity/Power
Health Care
Security
Breakdown of Services
Economic and Social Disruption
 Changed Demands
 Lack of BCP
Decreased Demand
Retail Trade
Transportation
Leisure Travel
Gastronomy

8 |
Other Risk and Impact
Livelihoods
Human Health
Governance &
Security
Social &
Humanitarian Needs
Economic Systems
• Food and income loss from loss of mining
and production and other source of
incomes
• High illness & potentially higher death rates
• Overstretched health facilities
• Disproportionate impact on vulnerable
• Increased demand for governance & security
• Higher public anxiety
• Reduced capacity due to fear, illness & death
• Deterioration of coping & support
mechanisms
• Interruption in public services
• Quarantine policies
• Trade & commerce disruptions
• Degraded labour force
• Interruption of regular supply systems
Categories of Risk

9 |
Rationale for BCP
 During emergencies our health system will be overwhelmed and
challenged by various factors:
– Demand of Outbreak Response is High
• 30% of required ETC beds are only available (1188 available vs
requirement 4167)
• INSERT: Number of health Care required for the effective response
– Absenteeism
• More than 600 health care workers are affected
• More than half of them died
• Sickness of Health Care workers
• Fear Factors (we don’t know the exact number)

10 |
Rationale for BCP – Absenteeism e.g. Liberia
 46 percent of those working at the start
of the Ebola crisis are no longer
working as of early November 2014
 Self-employed and wage workers have
been the hardest hit, while agriculture
is beginning to see returns to work as
the harvest approaches
 Food insecurity is worsening, especially
for the poorest, due to rising rice prices,
falling incomes, and transportation
restrictions
Source: World Bank Group: The Socio-Economic Impacts of Ebola in Liberia

11 |
Rationale for BCP…Contd
 During emergencies our health system will be overwhelmed and
challenged by various factors:
– Other requirements
• Safe burial team and trained manpower in place
• Logistic Demands for the outbreak response
 To over come the demands of response
– Other sectors will be compromised by mobilizing
• Health Care workforce
• Logistics
• Facilities
• Finance (Money)

12 |
 During emergencies our health system has to operate other essential
functions in absence of that for instance may lead to following situation
– immunization rates have been dropping with loss of health care workers and
reluctance of the population to visit health facilities.
– The long planned measles campaign in one of the country has been
postponed until after the Ebola epidemic is over.
– Some evidence has shown collapse of routine health care as both patients and
providers have avoided clinics for fear of infection.
– It has also highlighted that the malaria control effort has been impacted and
likely to linger long after the outbreak ends.
– Achievements so far made (malaria deaths have fallen by about 30% in African
countries since 2000) are at stake in these countries.

13 |
 During emergencies our health system has to operate other essential
functions in absence of that for instance may lead to following situation
– Locally endemic disease surveillance and laboratory confirmation have been
challenged and case reporting is already going down.
– Similar situation prevails in the area of maternal health services, where
pregnant women cannot get assistance delivering babies. In some places due
to ignorance, some of the pregnant mothers are visiting Ebola treatment center
with a view of receiving better services.
– Patients who need lifesaving emergency surgeries like appendectomy, C-
sections and others are at risk due to limitation of surgical capacity as well as
the risk of being turned away if they have signs of vomiting or fever.

14 |
Rationale for BCP…Cont
 In absence of BCP may lead to:
– Disruption of essential services like immunization, maternal and child health care;
– Disruption of control of locally endemic diseases and other emergency care and
services.
 Inability to provide these services not only impacts health of people but also
impact on overall development of the country,
– Can compromise achievements made for MDGs;
– Other goals of sustainable development and
– Put these countries at stake, where peace has established after decade long
conflict and this kind of situation may lead to newer form or revival of the conflict.

15 |
Plan and Planning
 Plans alone are nothing; planning is everything.
 Vital element is to involve stakeholders in the planning process and
identify their roles and responsibilities

16 |
Planning assumptions
 EVD outbreak can overwhelm the health services
 Health Care Workers’ Absenteeism due to one of the four causes
 Saving life, reducing morbidity and mortality and decreasing impact on socio-economy are high
priorities.
 Maintaining critical and essential services during EVD outbreak is a priority
 Adequate training is delivered and is made aware of its existence and their and responsibilities
during outbreak.
 During outbreak, health care workers are considered essential staff and can be mobilized to EVD
response and to other essential services.
 Sharing the resources between departments, hospitals, and other partners are essential on the
success of responding the EVD outbreak.

17 |
Core Business Continuity Actions
 Identify the critical functions
 Identify the personnel, supplies and equipment vital to maintain
essential functions
 Consider how to deal with the anticipated level of staff absenteeism
 Provide clear command structures, delegations of authority and orders
of succession
 Stockpile strategic reserves of supplies and equipment
 Determine the ability of the organisation to continue operations if
critical infrastructure services and/or supplies become unavailable

18 |
Core Business Continuity Actions….Contd
 Agree on a system of communication with staff, partners, HQs, suppliers and
customers
 Identify units/departments that could be downsized or closed to reallocate
resources
 Assign and train alternates for critical posts
 Plan for security risks to operations and supply chains
 Consider alternative methods of working, e.g. changes to shift patterns, working
from home
 Consider the implications of travel restrictions and develop procedures to follow if
such restrictions are imposed

19 |
Core Business Continuity Actions CONTD
 Train staff on infection control and communicate essential safety messages
 Consider ways of reducing social mixing (e.g. working from home, reducing
meetings and travel) and test these in advance
 Consider the need for family and childcare support for essential workers
 Consider the need for psychosocial support services to help staff remain
effective
 Consider and plan for the recovery phase

20 |
Business Continuity Planning
(Organizations, facilities, departments)
Step 2
Business Impact Analysis
(Identifying Essential
Services/Functions)
Step 1
Governance and Leadership
and establishment of BCP
Committee
Step 3
Identifying required skills sets and
staff allocation and reallocation.
Step 4
Step 5
Documentation for each
Essential Service/Function
Step 6
Compare to the
“preparedness checklist”
Maintain
essential services
Business
Continuity
Identifying relevant issues and/or
Implications for Implementation
Step 7
Review,Test the Plan and
Revise

21 |
Step 1: Governance and Leadership
Establishment of BCP Committee
 Public Health Agency/institute’ senior management team is responsible
for overseeing BCP process.
– Having policy by determining how the agency/institute will manage and control
EVD outbreak and its risk
– Resourcing qualified personals and sufficient resources to apply BCP.
– Ensure the BCP is tested and reviewed; staff are trained and are aware of their
roles and responsibilities.
– Monitor and evaluate the application of BCP and make adjustment accordingly

22 |
Step 2: Business Impact Analysis
(Identifying Essential Services/Functions)
 Business Impact Analysis: The process lead on identifying and
prioritization of essential functions.
 Essential Services is defined as follows:
– A service and/or function that when not delivered creates an impact on the
health and safety of individuals.
– A service and/or function that may lead to the failure of a business unit if
activities are not performed in a specified time period.

23 |
Step 3: Identify Required Skill Sets and Staff Allocation
 Identify the number of staff (by classification) required to maintain the
essential services/functions. Include essential services/functions
created or increased by the “surge activity”.
 Mapping of Human Resource Capacity of the agency/institute.
 Identify any special requirements necessary to perform the essential
services/functions.

24 |
Step 4: Identify any Relevant Issues and Implications
for Implementation
 Recognizing vital issues and implications that may have consequences in any
essential service reduction, modification, and/or elimination is an important
procedure.
 Each should be discussed and any relevant comments/solution should be
documented.
 It is recommended that part of this process include documentation and a planned
response for each essential service/function.
– Activation of Plan
– Planning
– Policies and Procedures
– Surveillance and Attendance
– Delivery of Services
– Human Resources
– Communications
– Testing of Plan

25 |
Step 5: Documentation for Each Essential Service/Function
 Identified essential services/functions
 Identified any relevant issues/implications that may arise when the level
of service/function is modified and/or reduced
 This part of the plan explains how each of the essential service/function
is maintained, reduced, modified and/or eliminated, who makes the
decision, what are the solutions are in place, any other necessary
actions to follow and any communication strategy.

26 |
Step 6: Compare to the “Preparedness Checklist”
 Review the Emergency Preparedness of your agency/institute to
safeguard that all issues have been addressed such as the decision-
making process and authority for implementing service modification,
reduction and/or elimination.
 To review, additional documentation may be necessary to ensure that
all critical elements have been addressed.
 Compare the checklist with preparedness checklist of agency/institute;

27 |
Step 7: Review, Test the Plan and Revise
 Circulate the plan for information and training purposes within the agency/institute
once the Business Continuity Plan is ready.
 Conduct annual review, test the plan and revise the Business Continuity Plan as
necessary. .
 Finally, conducting an emergency exercise to test the plan will help staff
understand the Business Continuity Plan, how and when it’s activated, who is
responsible for what, and how it fits with agency/institute strategy to deal with a
EVD outbreak.
Plans alone are nothing; planning is everything; however, if we
don’t use and test it then planning alone is nothing too.

28 |
Lack of Preparedness: Maternal Health Services
Pregnant
mother goes
to health care
facility for
delivery
Health Care
workers
absent and
some
mobilized to
ETC
Complication
of Pregnancy
and delivery
Increased in MMR
and IMR

29 |
Lack of Preparedness: Logistic or Energy Department

30 |
Operational Status
Human Resources - Operation and maintenance of
Wards/Departments. E.g ICUs
Full Operational
Capacity,
24 hours services
No. of available
qualified health care
workers: 11-13 people
(Full Human Resources
Reserve)
No. of available
qualified health care
workers:
< 8 people
Reduced
Operational
Capacity,
24 hours services no
longer possible
No. of available qualified
health care workers:
9-10 people
(Limited Human
Resources Reserve)
No. of available qualified
health care workers:
8 people
(Minimum Required
Human Resources – No
Reserve)
Health Care Workers:All types of workers from doctors, nurses,
technicians, cleaning team and other ICU operational staff.

31 |
Human resources: Qualified
Health Care workers
24 hours service capacity
13 – 10 Full capacity with sufficient reserve
10 - 9 Operation possible with limited reserve
8
(Minimum to run
24 - hour operation)
Critical – Unable to maintain operation if one more
staff is absent
< 8 Continuity of operation impacted
Operational Status Coding

32 |
Institutional body (Ministry / Specific Team or Committee)
to monitor operational status of all facilities
“Network Planning and Management
Facility A Facility B Facility C

33 |
Role of Ministry of Health
 MoH should provide advice to businesses on business continuity
planning and maintaining essential services despite worker
absenteeism
 MoH should work with the private sector to ensure business continuity
planning is coordinated and integrated

34 |
Business continuity plans
 Be specific
 Identify who is going to do what when and how
 Identify what actions need to be undertaken in each phase of pandemic
 List emergency contacts
 Plan around 2 scenarios: rapid onset pandemic with wide impact and slow onset
pandemic with moderate localised impact
 Discuss plans with staff, suppliers and banks

35 |
Test
 Test contingency plans
 Simulation exercises
 Scenario planning
 Tabletop exercises
 Learn lessons from tests
 Identify areas that need improvement

36 |
References and Acknowledgement
 Nirmal Kandel. Presentation on Whole of Society Approach for Pandemic Preparedness in National
Training of Trainers on WHOLE-OF-SOCIETY APPROACH on Pandemic Preparedness, Dhulikhel, Nepal,
29-30th June 2010
 WHO. Whole of Society of Pandemic Readiness. WHO Guidelines for pandemic preparedness and
response in the non health sector. Geneva, July 2009
 UN. Socio economic impact of Pandemic Influenza. United National System for Influenza Coordination,
2009
 World Bank. The Economic Impact of the 2014 Ebola Epidemic: Short and Medium Term Estimates for
West Africa. Accessed on 29th November 2014 (http://www.worldbank.org/en/region/afr/publication/the-
economic-impact-of-the-2014-ebola-epidemic-short-and-medium-term-estimates-for-west-africa
 World Health Organization: Ebola Response Roadmap Situation Report. Geneva: WHO 7 Nov 2014. 11 p
(Accessed on 11 Nov 2014 http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141107)

37 |
References and Acknowledgement
 Nirmal Kandel. Draft Business Continuity Planning Tool Kit for Ebola Virus Disease Outbreak. Unpublished.
2014
 World Health Organization. Ebola and Marburg virus disease epidemics: preparedness, alert, control, and
evaluation. Interim version 1.2. Geneva: WHO/HSE/PED/CED/2014.05. 2014
 Loose VW, Vargas VN, Warren DE, Starks SJ, Brown TJ, Smith BJ: Economic and Policy Implications of
Pandemic Influenza. USA: Sandia National Laboratories; Mar 2010. 28 p. Sandia Report SAND2010-1910.
 ACAPS Briefing Note. Ebola Impact on Health. Geneva: ACAPS; 26 Sep 2014. 10 p. Accessed on 18 Nov
2014 http://acaps.org/img/documents/b-acaps_briefing_note_ebola_impact_health_26_sept_2014.pdf)
 Hayden EC. Ebola obstructs malaria control. Nature; 2 October 2014. Vol 14; Pg 15
 Images used in the presentations are downloaded from Google Image search option using best available
title for the image topic. Access in 29th November, 2014: https://www.google.com/imghp?gws_rd=ssl
(these images are used for orienting purpose only and not for commercial any use)

38 |
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