Disease Overview | My Assignment Tutor

Republic Of Zachistan Diagnostics capacity assessment for Dunyamwera disease Disease Overview: Dunyamwera is an infectious disease that has been classified as a pandemic by all major global health agencies. Since the outbreak was first reported three months earlier, almost 3 million cases have been confirmed globally, with many more unconfirmed cases expected to manifest in the near future. In Zachistan, a large African country with a population of 50 million, 380 cases have been confirmed over the past month, and the government has assembled a team of key officials, research institutions, development partners, and pharmaceutical company leaders to tackle the challenge of the pandemic. Testing, tracking and tracing is essential to the government’s strategy for action, and the government hopes to undertake a rapid assessment of the diagnostics capacity of the country. CHAI has been tasked with supporting the government in conducting this analysis, which is expected to inform key policy decisions. Current diagnostics scenario: Presently, the diagnostic procedure for identifying Dunyamwera virus involves the collection of Buccal Swabs from suspected patients. Phlebotomists (experts in patient sample collection) visit the suspected patients and collect the samples using buccal brushes from inside the mouths of the patients, from the cheek tissue. The procedure does not require collection of blood specimens. The buccal swab is then transported to the diagnostic labs in a secure, temperature-controlled carrier. Presently, there are 200 labs spread across the country, and each lab has 1 RT-PCR machine. At the lab, the lab technicians use RT-PCR machines to confirm the presence of the Dunyamwera virus in the samples. The DNA from the swab is extracted using a manual extraction method by the lab technicians, and the process is time consuming. For running the diagnostic tests in the RT-PCR machines, screening test kits are used, which contain a mix of chemicals and control samples. The extracted DNA is mixed with the reagents in the testing kits, and this mixture is loaded in one of the slots in the RT-PCR machine. One test kit is required per sample. The test kits are supplied by a number of local and international manufacturers. Due to the global demand, orders for test kits have to be placed much in advance, as the lead times for procurement are substantial. The national guidelines presently recommend that for each tested sample which shows a positive presence of the virus in the screening test, a confirmatory test be conducted. Due to this reason, some capacity of the RT-PCR machines is allocated to confirmatory tests in each batch, thus reducing the available capacity for screening tests. Planned interventions to improve diagnostics capacity: Ever since the beginning of the Dunyamwera-23 outbreak, the government of Zachistan has been continuously working with the manufacturers (pharma companies), research institutions, and development partners to identify specific solutions for increasing the diagnostic capacity of the country. Last week, one pharmaceutical company made a breakthrough in the technology for test kits. They have produced a new combination test kit, which can conduct both the screening and confirmatory tests simultaneously from the same sample. This is expected to remove the requirement of conducting confirmatory tests, freeing up capacity for additional tests in each cycle of the RT-PCR machine. The government of Zachistan understands that this is a significant opportunity to increase the overall testing capacity, and hopes to place procurement orders for these. The procurement lead times for the combination testing kits are unclear, and the government presently estimates that sufficient testing kits will be made available for 50 labs each in four tranches of procurement. Further, research by global players has led to the development of an automated DNA extraction equipment, which became available last week. Since the manual DNA extraction process is time consuming, the new machines are expected to decrease the cycle time of testing, and hence enable more number of cycles per machine per day. The government of Zachistan placed an order for automated extraction machines immediately, and 20 such machines have arrived in the country over the past week, and have been dispatched to 20 different labs. Zachistan hopes to make the automated DNA extraction machines available at all 200 labs over the coming months, and has placed orders for the same. Zachistan has agreed with the manufacturers to cover the remaining 180 labs in tranches of 30, 60, and 90 labs over this period. As before, because the global demand for these machines is high, procurement lead times may vary substantially from those presently agreed with the manufacturers. The daily test capacities for all types of RT-PCR machines are present in the Appendix. The Challenge: The challenge being faced in all African countries is that presently the visibility into diagnostic capability of the countries is limited, and hence policy decisions are being made on inaccurate estimates of testing capacity. The government of Zachistan has declared a lockdown of routine businesses, and has mandated enforcement of social distancing measures to prevent the transmission of the infection. CHAI is working with the Ministry of Health of Zachistan to estimate the testing capacity of the country over the next 6 months (180 days), supported by strong quantitative analysis, to enable the ministry in making sound data based decisions. Further, orders for test kits need to placed with different manufacturers, who are asking for advance payments to confirm orders. This will ensure supply security of test kits over the next few months. Since procurement lead times may vary, the government has asked CHAI to create a flexible capacity assessment model, which the decision makers can use to compare various alternate scenarios, by varying the inputs related to procurement lead times of combination testing kits and automated extraction machines. Requirements: Create a flexible diagnostics capacity assessment excel model which lets the decision makers vary the inputs (coverage of interventions, and days of switch for automated extraction machines and combination testing) to compare various scenarios of daily and cumulative testing capacity for the next six months (180 days) in Zachistan. Use this model to calculate the cumulative testing capacity for Zachistan with intervention details as listed in Appendix B and Appendix C. Estimate the quantity of combination test kits and non-combination test kits required over the next 6 months (180 days), assuming all machines are utilized to their full capacity. Present this analysis in 3-4 slide PowerPoint which is to be used by CHAI to present to the Ministry of Health officials from Zachistan. Please make reasonable assumptions wherever required, and mention them within the excel file. B. Please also write a 500-word (1-page, Calibri font size11) essay on following topic: In India, what is wrong with the public health system, despite numerous efforts by government? Provide a comprehensive overview of the situation using information such as % income spent on healthcare by lower middle class and care-seeking behaviour in rural India etc. Suggest in a paragraph on top 3-4 ways to tackle the problem. Please focus on practical and easy to implement solutions. Appendix: Daily Testing Capacity by machine type S. No.Type of RT-PCR MachineNumber of machines of type on Day 0Daily Test Capacity per machine (In number of tests)1Basic (Manual extraction with non-combination kits)180362Automated extraction with non-combination kits201083Manual extraction with combination kits0454Automated extraction with combination kits0135 Intervention 1 – Switch to Combination Testing S. No.TrancheCoverage of Intervention (Number of labs switching to combination testing)Day of Switch (Assuming today to be Day 0)1Tranche 150332Tranche 250763Tranche 3501084Tranche 450144 Intervention 2 – Switch to Automated DNA Extraction S. No.TrancheCoverage of Intervention (Number of labs switching to Automated Extraction)Day of Switch (Assuming today to be Day 0)1Tranche 130262Tranche 260483Tranche 39084