The International Association of National Public Health Institutes (IANPHI) is a member organization of government agencies working to improve national disease prevention and response. IANPHI is made up of 100+ members, located in approximately 90 countries. An important goal of IANPHI is to improve health outcomes by strengthening or creating NPHIs.
The IANPHI Secretariat is based at the Institute for Public Health Surveillance (InVS) of France, and the US Office is located at the Emory University Global Health Institute in Atlanta, GA. The IANPHI Foundation is located in Finland at THL. Coordinated by Secretary General Jean Claude Desenclos, the IANPHI team is responsible for member relations and programs, policy, communications and NPHI development projects (USA), and the annual meeting scientific program (France).
At its inception, IANPHI received seed funds from the Rockefeller Foundation and a one-year planning grant from the Bill & Melinda Gates Foundation (BMGF). BMGF subsequently awarded multi-year funds for IANPHI's development and to support projects to build NPHIs in low- and middle-income countries. Resources have since been contributed by the U.S. CDC A recent role for IANPHI has been to work with the Child Health and Mortality Prevention Surveillance project.
The National public health institutes (NPHI) model, exemplified by the U.S. Centers for Disease Control and Prevention (CDC), China CDC, Public Health Agency of Canada and others, is an effective and cost-efficient way to systematically develop and sustain national public health systems. NPHIs, including China CDC, INSP in Mexico, FIOCRUZ in Brazil and others in over 90 countries around the world, have been major contributors to reductions in morbidity and mortality from infectious and noncommunicable conditions. Many, including the CDC and the National Institute for Health and Welfare (Finland), have developed over several decades, while others, including NPHIs in Liberia and Canada, were created following poorly managed threats such as Ebola and SARS, in recognition that a coordinated system with a specialized institution is needed to effectively respond to disease threats.
NPHIs usually lead national efforts for disease surveillance and outbreak investigation (to monitor population health trends and detect and resolve outbreaks), laboratory services (to identify and confirm disease threats), health programs (including recommendations for immunizations and maternal and child health initiatives), and public health workforce development and research (including new treatments and technologies). NPHIs are designed to give governments the ability to assess and address major acute and long-term disease threats in a country using scientific, evidence-based policies and strategies, as well as create a career home for public health researchers and scientists, thereby fostering the evidence-based approaches necessary to ensure that government policies are based on scientific evidence rather than politics.
In 2002, the directors of nearly 30 NPHIs met in Bellagio, Italy to share best practices and discuss opportunities for collaboration. In 2004, the group reconvened in Helsinki and declared its intention to forge an alliance.
IANPHI was formally launched at the first General Assembly in Brazil in January 2006, with 39 founding members and a one-year grant from the Gates Foundation. Under a subsequent five-year grant from the Gates Foundation awarded in late 2006, the membership has expanded to 100 institutes in 88 countries around the world.
IANPHI's activities fall into three areas:
One of IANPHI's distinctive features and strengths is a peer-assistance approach that facilitates sharing of expertise and experience among member NPHIs. The model clearly benefits the recipient NPHI by identifying strategies to address priority needs and raising standards of performance for organizing and conducting public health functions. But it rewards the contributing institute as well - by sharing skills and assets to benefit others while also linking resources and solutions to address regional and global health threats and opportunities.
For the network of IANPHI members, the model provides unique opportunities for NPHIs to link with others that are geographically or linguistically similar or are struggling with similar technical or programmatic issues, such as information system development or pandemic preparedness. This collaborative approach also provides a platform for developing research or programs to address shared issues, whether laboratory safety or avian influenza, tobacco use or injury.
Current peer-to-peer partnerships include:
The IANPHI Heymann Mentorship Program aims to encourage public health leadership growth by facilitating one-on-one relationships between established public health leaders and less-experienced counterparts in low-resource countries. It is part of an ongoing IANPHI effort to build human capacity and provide a career path for public health professionals through training in strategic leadership and management. Part of this commitment involves providing current and future NPHI leaders with the tools, training, and support they need to develop their full potential.
The Heymann Mentorship Program provides each mentee ("fellow") an opportunity to develop an ongoing relationship with a mentor with career experience as a public health expert and leader. The program focuses on current and future leaders of NPHIs in IANPHI project sites and strategically targets persons interested in guidance, coaching, counseling, and professional development.
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IANPHI is managed by an executive board and secretariat. Executive board members consider and vote on issues of strategic direction and policy and on project and funding recommendations. There are currently 9 active members on the executive board:
IANPHI offices, are located at the Secretariat in Paris, France, and the US Office in Atlanta, U.S. are responsible for the day-today activities of the organization.
IANPHI's long-term projects help public health systems in low-resource countries respond to modern public health challenges, improve outcomes, and support healthy populations and strong economies. These intensive multi-year engagements develop and strengthen national public health institutes (NPHIs), moving them forward on a continuum from those least developed to those with a comprehensive and coordinated scope of public health responsibilities. Currently, IANPHI has ongoing long-term projects in Bangladesh, Ethiopia, Ghana, Guinea-Bissau, Malawi, Morocco, Mozambique, Nigeria, Tanzania, and Togo.
Bangladesh: Strengthen disease surveillance and outbreak response in Bangladesh
Bangladesh has limited ability to get accurate data quickly from its 400-plus local disease reporting sites and integrateit at the sub-national and national levels. This three-year project is addressing that deficit, so that the country's Institute of Epidemiology, Disease Control and Research (IEDCR) can track potential outbreaks and emerging threats that typically show up first in far-flung locations. IEDCR is enhancing its capacity for real-time disease intelligence by expanding its innovative web-based information gathering and evaluation system to the local level. The project will lay the foundation for noncommunicable disease surveillance and a national laboratory network. Given IEDCR's strong leadership and capacity, substantive relationships with national and international partners, and potential for linkages with its new Field Epidemiology and Laboratory Training Program (FELTP), this project will be a model for countries in Asia and Africa with pressing needs to expand evidence-based decision making.
Ethiopia Establish Ethiopia NPHI
IANPHI supports the creation of an emergency operations center and enhanced laboratory capacity to detect disease outbreaks in Ethiopia. Project partners and collaborators include WHO, which has offered expertise on emergency response preparedness planning; the U.S. CDC, which has based its FELTP at EHNRI and is providing technical assistance on emergency preparedness; and the Association of Public Health Laboratories, which is actively involved in strengthening laboratory components. IANPHI's member from Norway has expressed interest in providing technical assistance. Perkins+Will, a U.S.-based architectural firm, is designing the new emergency operations center.
Ghana: Establish Ghana CDC
Ghana has worked for several decades to build a national primary health care network and has developed substantive capacity at the Ghana Health Service and the School of Public Health in research, surveillance, monitoring and evaluation, and other public health functions. IANPHI is working to develop and fund a strengthened and streamlined public health system through a new "Ghana CDC" that will better respond to health threats and address the major causes of death and disability in the country. It will link and strengthen maternal and child health, surveillance, vaccine and immunization coverage, lab capacity, health promotion, environmental and occupational health, and training. IANPHI will assess current public health capacity, facilitate development of a strategic framework for health, and help implement and fund a redesigned, expanded public health system.
Guinea-Bissau: Transform the national public health system by creating a new NPHI
IANPHI, with technical assistance from Brazil's Oswaldo Cruz Foundation, led efforts to bring together Guinea-Bissau's disjointed public health system into a new NPHI that links its National Laboratory of Public Health, the Bandim Health Project (field epidemiology), the Ministry of Health's epidemiology unit, and the National School of Public Health. With IANPHI support, the ministry has renovated the partially destroyed headquarters and national lab. The new institute in Guinea-Bissau will strengthen core public health functions including laboratory science, data collection and analysis, disease outbreak monitoring, and training. As the first donor to the new institute, IANPHI has leveraged funds from the World Bank, WHO, and the governments of Brazil, China, and Portugal, which have provided lab equipment, phones, computers, generator fuel, library materials, and human resource consultation.
Mozambique: Establish Mozambique NPHI
Following discussions with IANPHI, Mozambique intends to transform the country's National Institute of Health (NIH) into a comprehensive NPHI focusing on collecting data to inform public health decisions. That will require significant organizational, human resource, and infrastructure changes. Without a central reference lab or adequate human resources, NIH cannot quickly identify major disease threats or outbreaks nor contain them. IANPHI is partnering with Brazil's FIOCRUZ, and architects HDR CUH2A's Design 4 Others to help Mozambique strengthen disease monitoring and outbreak investigation, create a formal system to collect and analyze health data to promote evidence-based decision making, and build a coordinated system of public health laboratories, linked to a new NPHI facility. The U.S. CDC in Maputo will oversee $9 million in budgeted PEPFAR funding.
Morocco: Establish the Morocco NPHI
Morocco faces multiple public health burdens: infectious diseases, high maternal mortality rates, a growing incidence of noncommunicable diseases, and risks posed by environmental toxins. Inadequate laboratories and surveillance as well as a lack of technical and research expertise hinder evidence-based decision making. Based on input from IANPHI-funded workshops and public health experts from the U.S. and Norway, Morocco's National Institute of Hygiene is exploring creation of a new NPHI that would monitor, assess, and respond to health threats. Envisioned is an institute responsible for environmental health, non-communicable diseases, poison control, pharmacovigilence, maternal child health, and research. The NPHI would coordinate public health functions, enhance technical expertise (including new laboratories and training), and strengthen surveillance and health information. Pilot surveillance projects under consideration include assessments of environmental hazards, maternal mortality, and tobacco and other NCD health risks. Morocco also is exploring several partnerships: a twinning program to help build applied research capacity, laboratory design by architecture firm Perkins+Will, and creation of an FELTP by the CDC.
Nigeria: Build ability to rapidly identify and treat MDR-TB
The Nigerian Institute for Medical Research (NIMR)--one of the first to conduct national surveys using the new WHO-approved Hain Assay--found that 6.1% of patients had organisms resistant to both INH and rifampin. Partners, including the U.S. CDC, South Africa's National Institute of Communicable Diseases, Hain Lifescience, and the Harvard School of Public Health, have donated instruments to perform liquid cultures, a power generator, a vehicle to transfer samples, lab expansion, and training. In the third year of IANPHI funding, NIMR will continue to strengthen its public health capacity through collaborative efforts to expand MDR-TB surveillance and training. The project is a model for other developing countries and has attracted the interest of WHO, resulting in Green Light Committee approval for Nigeria to obtain second-line antituberculosis drugs at reduced cost for treatment of MDR-TB.
Nigeria: Study the Factors Influencing Community Attitudes Toward Timely Perinatal Care
Nigerian Institute of Medical Research (NIMR) will study the factors influencing community attitudes toward timely perinatal care with the goal of improving maternal and neonatal outcomes. More than 140 women die each day in Nigeria from pregnancy and childbirth complications--the world's second highest number of maternal deaths. The project, which is expected to be a model for all of Nigeria, will use a 10-step community participation process that has improved perinatal health and outcomes in other developing countries.
Tanzania: Transform NPHI by adding NCD capacity.
The burden of noncommunicable diseases (NCDs) is increasing, but in the past, there has been limited information about NCDs and risk factors such as tobacco use. IANPHI is working with the National Institute for Medical Research (NIMR) in Tanzania to help NIMR take on major new responsibilities in NCD surveillance and control and layer NCD surveillance onto existing infrastructure for infectious diseases. A pioneer in Africa in establishing the national Integrated Disease Surveillance and Response System for infectious diseases, NIMR now plans to be a forerunner on the continent in the field of chronic disease surveillance. IANPHI's efforts--and good timing--kick started the project, which is now underway on several levels. IANPHI's grant included funding for two FELTP fellows and work on STEPS and vital statistics. AFENET and the University of Copenhagen are providing training at the community level. IANPHI is funding district and regional surveillance and, with the U.S. CDC, analysis of vital statistics. A prevention component will also be developed. NIMR leaders expect to gain valuable experience through this project that can be applied to other NPHIs hoping to add NCD functions. Project partners also include Finland's THL and Columbia University.
Togo: Create Togo NPHI
Togo has seen dramatic declines in its economy, living standards, and health outcomes since the early 1990s. Despite many challenges--minimal donor presence, fragile infrastructure, human resource deficits, and underfunded public health sector--the country's leaders, including the president, believe that a comprehensive national public health institute is needed to meet the nation's many health challenges. After an initial assessment, IANPHI recommended some immediate actions to improve and modernize l'Institut National d'Hygiene (INH)--the government's designated agenda for public health leadership--as a foundation for development into an NPHI. These first steps focus on improving the quality of laboratory services for disease surveillance and outbreak response and integrating laboratory and epidemiologic efforts. In addition to strengthening core public health functions at the national and sub-national levels, the project provides an opportunity to increase Togo's visibility among international donors and partners and integrate Togo into regional and global public health initiatives. The Institute Pasteur of Morocco is an active partner, providing technical assistance on site as well as training opportunities in Morocco. Partners include Germany's international cooperation agency (GTZ) and France's Institut de Veille Sanitaire, which may use Togo's experience as a model project for a new global assistance initiative.
Uganda: Research the Ecology, Behavior and Genetic Variability of Aedes Africanus Arbovirus Vector.
The Uganda Virus Research Institute (UVRI) will research the ecology, behavior and genetic variability of Aedes africanus arbovirus vector in order to predict the risks of arboviral outbreaks and design more effective disease control strategies such as insecticide spraying and vaccinations. One of the larger goals of the grant is for UVRI to create a mosquito specimen and DNA repository that will provide baseline information for larger research studies relevant to the control of Ae africanus species. Several diseases in Uganda have been traced to Aedes africanus arbovirus spread by mosquitoes including epidemics of yellow fever, Rift Valley fever, dengue, and West Nile virus.
Vietnam: Use Molecular Methods to Study and Identify the cagA Gene in H. pylori Infected Gastric Cancer Patients
Vietnam National Institute of Hygiene & Epidemiology (NIHE) will use molecular methods to study and identify the cagA gene in H. pylori infected gastric cancer patients. H. Pylori has been shown to be associated with gastric cancer, and NIHE is hoping to determine the role of the cagA gene in H. Pylori. NIHE hopes to get a better understanding of the biological mechanism for gastric cancer in order to provide better diagnosis and treatment options for people in Vietnam, where gastric cancer is the second most common cancer found in men and the third most common in women.