Executive Summary: Evaluation of the National Emergency Stockpile System (NESS)
This report presents the findings from the Evaluation of the National Emergency Stockpile System (NESS). It is based on research conducted by Evaluation Services, Public Health Agency of Canada.
The National Emergency Stockpile System (NESS) is a system of 11 warehouses and 1,300 pre-positioned sites containing medical equipment and supplies, pharmaceuticals, social service supplies, and various "modules or kits" such as casualty collecting units, mini-clinics and reception centre kits. The current value of NESS supplies is estimated by the program to be $300 million.
The NESS program provides emergency supplies to provinces and territories when requested. This "surge capacity" means that when provinces and territories have exhausted their own emergency supplies, they may make a request to the Public Health Agency to access NESS supplies.
The NESS supplies are used for the provision of critical medical services in the event of a natural or manmade disaster, for example: terrorist incidents, global disease outbreaks (including pandemics), floods, fires or earthquakes. These supplies have been deployed in response to a variety of events domestically and internationally. Over the past 25 years, supplies from the NESS warehouses have been deployed for 128 domestic events and at least 22 international events.
Since the NESS program was created almost 60 years ago, there have been significant changes in the emergency management context in Canada, including the broader range of public health threats that have emerged in the 21st century. Its original mandate in the 1950s was to enable a medical and social services response to a nuclear disaster. Shortly afterwards, it was then tasked to assist with responses to natural disasters (1960s). This remained consistent until the terrorist events on September 11, 2001, when growing attention was then paid to chemical, biological and radio-nuclear threats and the need to stockpile countermeasures. In 2003-04, the SARS outbreak triggered preparations for another global threat, pandemic influenza, with the subsequent initiation of substantial NESS stockpiling of pandemic response supplies.
Recognizing these changes, numerous reviews/audits and research reports over the past 10 years have focused on "modernizing" the NESS program. The majority of findings and recommendations from these reports have been consistent, as reflected in the latest report, the 2010 Audit of Emergency Preparedness and Response:
"The mandate of the National Emergency Stockpile System (NESS) requires renewal in order to more appropriately reflect its current emergency response role. In addition, program management attention is required to address issues related to NESS acquisition practices, supply and equipment maintenance processes, inventory valuation, control and record keeping systems and processes, inventory obsolescence processes and information management capabilities."[Link to footnote 1]
Evaluation purpose and methodology
This evaluation of the NESS program was initiated in response to a recommendation in the 2010 Public Health Agency of Canada Audit of Emergency Preparedness and Response to assess the relevance of the program.
The purpose was to gain an understanding of the extent to which the NESS program was still relevant and to provide guidance for program realignment and refinement. It focussed on an exploration of the program's scope, its alignment with federal and Public Health Agency of Canada roles and responsibilities, as well as its congruence with Government of Canada and Public Health Agency priorities. There was also an opportunity to explore challenges faced by the program and examine how public health stockpiles were managed in other jurisdictions.
This evaluation analyzed information from multiple sources. First, key internal documents were examined including previous audits and reviews of the NESS program as well as internal NESS records, correspondence and communication. Second, feedback was solicited from provincial/territorial representatives and selected other government departments. Finally, interviews were conducted with key senior managers, external issue experts and with a selection of experts in other countries involved in the management of public health stockpiles.
Findings and recommendations
In many ways, the NESS is an insurance policy. Because disasters will continue to happen, Canada has to be prepared. As a result, there is a clear need for a stockpile of public health supplies managed by the federal government. However, what needs to be contained in the stockpile has to be clearly defined and communicated.
Focusing the domestic role of the NESS
A strategic long term plan is needed to guide the acquisition and management of assets that are relevant to current risk assessments and that align with the Agency's current mandate. The Centre for Emergency Preparedness and Response should consider the Agency's role in:
- pandemic preparedness and a review of the stockpile of anti-virals in the NESS warehouse in light of any decisions regarding the size and composition of the National Antiviral Stockpile[Link to footnote A]
- surge capacity to provinces and territories for (a) planned mass gatherings of national significance, such as the Vancouver Winter Olympic Games in 2010 and (b) medical and/or pharmaceutical responses to unplanned events such as natural or manmade disasters
- preparing for national security threats, such as a chemical, biological or radio-nuclear event (in collaboration with Health Canada).
While there continues to be a need during public health events for a social service response, the capacity of the provinces and territories, and non-governmental organizations (such as the Canadian Red Cross and a variety of other response agencies), to assist with the provision of these supplies at the local level has increased. Other countries, as well as some provinces and territories in Canada, are already primarily working with non-governmental organizations for social services support during an emergency.
While the threats and effects from localized disasters are still prevalent, the roles and responsibilities for responding to those types of events do not necessarily lie with the Public Health Agency.
Retain some but not all of the current NESS asset mix. Focus on an appropriate public health role when planning for and determining the future strategic mix of assets rather than on a more general social services role in responding to events.
- a. Continue to ensure the following stock is available for provincial/territorial surge:
- pandemic preparedness supplies
- medical and pharmaceutical supplies for planned mass gatherings of national significance and unplanned natural or manmade disasters
- chemical, biological and radio-nuclear (CBRN) countermeasures.
- b. Consider eliminating social service supplies from the NESS asset mix while ensuring their continued availability.
For stock being acquired and retained, attention should also be paid to its life-cycle management – such as methods of procuring and storing supplies. (see Appendix A)
Disposal of supplies
It is estimated by the program that a significant proportion of the supplies and equipment in the current NESS stockpile is out of date and/or is not in accordance with current medical standards or practices. This equipment may be unusable or use technology that is no longer relevant to modern medical practice.
Provincial and territorial representatives are aware of this issue and feedback indicated that this situation has to some extent eroded confidence in the overall value of the entire complement of NESS supplies. An Agency commitment to clearing the NESS warehouses of outdated supplies will help to rebuild confidence among provinces and territories in the overall program.
Disposal of outdated supplies is a critical activity. There are supplies that no longer meet current medical standards and/or are no longer deemed strategic or appropriate for a Public Health Agency stockpile. Disposing of such a large number of assets may be costly and will take time to complete.
Develop, resource and implement a disposal strategy to allow for the disposal of:
- a. equipment and supplies that are outdated, no longer meet current medical standards, or are of poor quality (i.e. emergency hospitals, casualty collecting units, etc.)
- b. individual social services items (i.e. cots and blankets) and social services units (i.e. mobile feeding units, reception centre kits, etc.) (contingent on the outcome of recommendation 1b).
Supporting an integrated response
Information about the NESS is not routinely shared within the federal government and across jurisdictions. Provinces/territories and other federal government departments have expressed concern that there is not a universal understanding about the current scope of what the NESS program is and does, its potential and its links with other public health related stockpiles.
The Agency needs to develop a strategy to clarify processes, affirm responsibilities and raise awareness of the stockpile, ensuring that knowledge and expertise on stockpiling are shared within the federal government and across Canadian jurisdictions. This effort will help build confidence in the stockpile and allow others who rely on this service to better understand what the stockpile can and cannot provide.
Develop, implement and monitor a strategy to help communicate the Public Health Agency of Canada's role in stockpiling supplies for public health responses, considering the following target groups:
- Other federal government departments and agencies
- Provinces/territories, including specialized areas:
- End users (health practitioners)
- Materiel management specialists
- Logistical teams.
Reflecting PHAC's international role
While international deployment of supplies is not the primary objective of the NESS, the stockpile has been used in the past to respond to international events. However, there are no ongoing authorities for deploying the stockpile internationally and there are no established processes and protocols.
Include specific consideration of the NESS in the Agency's broader discussions of its international role.
Should an international role be determined for the NESS, to plan for this type of deployment, the Public Health Agency should consult and establish ongoing points of contact with other federal government departments to better prepare for future requirements.
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