In an analysis of pandemic influenza plans in Asia-Pacific countries in 2006, Coker found that although all countries recognised the importance of pandemic planning, operational responsibility particularly at the local level, remained unclear; most plans relied on specialised flu hospitals, while few developed the possibility of caring for patients at home [75] . (The study made no reference to primary health care or the private practice sector). In his analysis of public health emergencies in developing countries, Quarantelli identified relatively poor adaptive capabilities to be the key barrier to effective responses at the central and local levels [76] . Possible reasons included poorer public health infrastructures and human and financial resources, organisational structures that functioned mainly in a top-down manner with a strong emphasis on structures more than functions, and lack of planning initiatives the further away one moved from central level [76] .