Since June 2022, Pakistan has been experiencing an unprecedented monsoon season that triggered the most severe flooding in the country’s recent history. These floods resulted in the washing away of villages, roads, and buildings. According to the National Disaster Management Authority’s (NDMA) situation report, 84 districts have been declared as “calamity-hit” areas and 33 million people were affected.  

Families living in open areas with a short supply of safe drinking water and food were exposed to a wide range of post-flood related hazards, including infectious diseases, waterborne diseases, and other health concerns such as, Acute Diarrhea, Typhoid, Malaria, Dengue, Viral Hepatitis, and Leishmania, amongst others.

Accordingly, many provinces requested the National Institute of Health (NIH) to train their Field surveillance and data management staff. Additionally, two teams from Pakistan Field Epidemiology and Laboratory Training Program (FELTP) were sent to the flood affected areas of Sindh and Balochistan on October 9, 2022, to train. The field surveillance staff were trained to collect data, samples, and implement public health response, while data management staff were trained on compiling and entering data using the DHIS-2 tool.

Since obtaining data properly from the field was challenging, a senior scientific team from the NIH and FELTP residents and graduates held coordination meetings with disease surveillance focal persons, district health officers, IT specialists, and Director General Health Services to identify the gaps and issues in the surveillance system and DHIS-2 platform that were solved shortly.

Moreover, Pakistan FELTP residents and graduates have been supporting epidemiological and lab investigations in their country, through ensuring proper diagnostics and sample taking procedures.

In order to achieve these goals, FELTP graduates conducted meetings with NIH and the District Health Officer to arrange the training of laboratory technicians to work on mobile diagnostic laboratories. A total of six technicians were trained and started working in October 2022 in collecting different samples for SARS-CoV-2, influenza, Respiratory Syncytial Virus (RSV), and Dengue fever which were all found negative. They were also engaged in field sampling and transporting the samples to the public health reference laboratories, with case investigation support.

Furthermore, Pakistan FELTP graduates have been supporting provincial and district health departments through a rapid needs assessment plan developed by Pakistan FELTP, WHO, in addition to local health authorities to strengthen and expand disease surveillance, outbreak response, and ensure preventive and control measures are being taken through robust coordination.

Besides taking part in risk communication and community engagement (RCCE) activities, FELTP teams have been  supporting community leaders in developing and disseminating awareness messages about communicable disease and routes of transmission, as well as conducting health awareness sessions on waterborne and vector-borne diseases, as well as other infectious diseases.

They are also engaged in facilitating routine immunization along with COVID-19 vaccination, as well as monitoring of the vaccination activities and reporting data of adverse effects following immunization (AEFI) to health authorities.

In addition to their previous contributions, Pakistan FELTP residents and graduates have also been assisting health departments, the Provincial Disaster Management Authority (PDMA), and the NDMA in establishing emergency control rooms and medical camps at the provincial and district levels, along with providing onsite training sessions to the healthcare staff and laboratory personnel, and engaging in community outreach support in Inter Provincial Coordination (IPC), risk communication, and Water, Sanitation and Hygiene (WASH).

Moreover, and to ensure an effective multi-sectoral coordination for proper response across the country, the National Flood Response Coordination Centre (NFRCC) has been established under the NDMA. Pakistan FELTP Director nominated an FELTP graduate for coordinating disease surveillance that is led by the NIH and presenting a daily situational report in the NFRCC meetings.

Also, the World Health Organization (WHO) country office in Pakistan is hosting a daily Health Cluster meeting in collaboration with the Ministry of National Health Services, which is attended by representatives from UN agencies, non-governmental organizations, and provincial departments of health to improve collaboration for effective response.

Pakistan FELTP Coordinator is co-chairing the cluster meetings and monitoring disease situation in the flood affected districts. Disease surveillance data is presented in the meeting after being collected and analyzed at Provincial Disease Surveillance Units (PDSRUs).

Physical access to flood affected areas has also been another challenge due to many roads being destroyed, and routes sub-merged in the flood water. However, Pakistan FELTP residents and graduates are taking measures to reach every flood affected locality and monitor the trends of communicable diseases in these areas and apply measures accordingly.

The role of Pakistan FELTP has been crucial during this crisis, and as always proved to be essential in strengthening the national public health preparedness, surveillance, and response.