Abstract
Background: The International Health Regulations (IHR) contain obligations for the routine prevention, control, and response measures to events at designated airports meet the criteria of being declared a Public Health Event of International Concern. In order to minimize the spread of disease across borders through travel and trade, countries that are signatory to IHR are required to designate their international ports or airports to develop and maintain capacities to ensure that airports are a safe environment for travellers. These include safe water, flight catering facilities, eating establishment, public bathrooms and the disposal of both liquid and solid waste. In order to monitor and review the progress in capacity implementation, an assessment tool for the requirements at designated Points of Entry is available for use by the respective countries. It is mandatory under the regulations for airports to have developed the capacities as set out in IHR. There however are no reports available to indicate that evaluation has been carried out in Zimbabwe for IHR implementation at airports. There is limited research on evaluation of the implementation of these interventions in Zimbabwe, with a particular focus on airports as points of entry. This study assessed the effectiveness of the IHR implementation at the three international airports in Zimbabwe.
Objective: To evaluate the effectiveness of the implementation of the IHR at Zimbabwe’s three International Airports.
Methods: This was a cross-sectional descriptive study with a sample size of 430 participants. This study was carried out at Robert Mugabe, Victoria Falls and Joshua Mqabuko Nkomo International Airports in Zimbabwe through the application of the World Health Organisation instruments for assessment of capacities at airports. Participants were randomly sampled using a list-based sampling frame using the email addresses of the staff working at the three airports. A web-based questionnaire was administered to multiple stakeholders at the sites, and documentation from the sites were also used in this study. The data from this study was analysed through the use of the Statistical Package for Social Science (SPSS). Logistic regression then followed for each objective, because there was one dependent variable (Training in IHR) and several independent variables (Socio-demographic characteristics, respondent information, Point of Entry details, Knowledge of the IHR, perception of respondents, Routine Implementation, and implementation of IHR during Public Health Emergencies).
Results: While Zimbabwe has adopted the 2005 international regulations at the airports, operational level staff are not fully aware of them, despite the regulation being incorporated into their work. Participants were not aware of IHR (OR 0.02, 95%CI 0.003 – 0.13). Airport staff lack adequate training in IHR (OR6.38, 95%CI 2.82 – 14.08), were not aware that implementation of the IHR is mandatory (OR 0.39; 95% CI 0.23-0.66), and were unaware of the IHR competent authority. Responses suggested that the competent authority was Civil Aviation Authority of Zimbabwe (CAAZ) as the (OR 0.31; 95% CI0.16-0.59) and Immigration (OR 4.25, 95% CI 2.19-8.22), programmes to were in place to maintain a safe facilities for travellers ; and the airport staff did not know if contingency plans for unexpected public health existed at the three airports (OR0.33, 95% CI 0.13-0.85). There were no preparedness and response plans at the three airports (OR0.34, 95%CI0.17-0.71).
Conclusions: While Zimbabwe adopted IHR, and some of the competencies are being implemented at the three airports, not all the required competencies have been implemented at the three designated airports because of the lack full awareness at operational level. Training of multisectoral staff and cooperation is required among the airport stakeholders for achieving and maintaining the routine and emergency capacities.
Keywords: International Health Regulations; World Health Organisation; pandemics; airports; Points of Entry.