guide for acceleration of ihr implementation in states parties
TRANSCRIPT
Guide for acceleration
of IHR implementation
in States Parties
Enhanced Desk Review of National IHR Core
Capacities, Action Plan Development, and
Stakeholder Mobilization
February 2013
WHO/HSE/GCR/LYO/2013.1
2
© World Health Organization 2013
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Table of Contents Acronyms ................................................................................................................ 5
List of References .................................................................................................... 6
Glossary of Terms ................................................................................................... 7
I. Introduction ....................................................................................................... 10
1.1. IHR Background .......................................................................................... 10
1.2. Status of IHR Implementation.................................................................... 10
1.3. The deadlines for meeting IHR core capacity requirements and request for
an extension ...................................................................................................... 11
1.4. Recommendations of the IHR Review Committee on strengthening IHR
implementation ................................................................................................ 12
1.5. Current tools available to support IHR assessment, implementation, and
monitoring ........................................................................................................ 12
II. Purpose and scope of this guide ....................................................................... 13
III. Capacities for review ........................................................................................ 13
IV. Sectors to be involved at country level in the review and planning process .. 14
V. Process and timelines to accelerate IHR implementation ............................... 14
5.1. Planning phase ........................................................................................... 15
5.2. Desk review and selected specific site visits (enhanced desk review) ...... 16
5.3. Plan of Action Development ...................................................................... 18
5.4. Follow up to the desk review and planning ............................................... 19
5.5. Advocacy for IHR implementation ............................................................. 20
5.6. Resource mobilization ............................................................................... 21
VI. Monitoring the implementation of IHR plans ................................................. 23
VII. Appendices: ................................................................................................... 24
Appendix 1. Schedule and follow-up agenda ................................................... 24
Appendix 2.2. Details of attributes to be addressed within each core capacity
by desk review and planning exercise based on IHRMT ................................... 26
Appendix 4.1. Examples of SWOT analysis templates ...................................... 30
Appendix 4.2. Enhanced SWOT Analysis .......................................................... 30
Appendix 4.3. Example of output of SWOT analysis by core capacity ............. 31
Appendix 5. Example of a Plan of Action template .......................................... 32
Appendix 6. Proposed Report template ........................................................... 33
Appendix 7. Sample agenda and list of participants for stakeholder meeting 34
Appendix 8. Sample summary advocacy plan .................................................. 35
Appendix 9.1. Samples of donor proposal template ........................................ 36
Appendix 9.2. Example of IHR donor and activity mapping ............................. 38
Appendix 10. Specific attributes that need strengthening based on 2010 Data
from States Parties questionnaire .................................................................... 39
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Acknowledgements
The production of this document was coordinated by Dr Stella Chungong,
Coordinator of Monitoring, Procedures and Information (MPI), Department of
Global Capacities, Alert and Response (GCR), World Health Organization (WHO),
Geneva.
WHO HEADQUARTERS
Dr Stella Chungong, Dr Rajesh Sreedharan, Dr Jun Xing, and Ms Sophia Desillas.
WHO REGIONAL OFFICES
WHO Regional Office for Africa: Dr Florimond Tshioko, Dr Peter Gaturuku, Dr
Nathan Bakyaita, and Dr Zabulon Yoti.
WHO Regional Office for the Eastern Mediterranean: Dr John Jabbour
WHO Regional Office for Europe: Dr Thomas Hoffman and Dr Markus Kirchner.
WHO INTERCOUNTRY SUPPORT TEAM (IST)
Dr Fernando da Silveira and Dr Adama Berthe.
WHO COUNTRY OFFICE
Dr Fatorma Bolay, Dr Harry Opata, and Dr Aka Tano-Bian.
WHO MEMBER STATES
Belarus, Georgia, Saudi Arabia, Sudan, Tajikistan, Zambia, and Zimbabwe.
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Acronyms
AFR WHO Africa Region
AFRO WHO Regional Office for Africa
AMR WHO Americas Region
AMRO WHO Regional Office for the Americas
AMR Americas Region
APSED Asia-Pacific Strategy for Emerging Diseases
CO Country Office
DPC Disease Prevention Control
EID Emerging Infectious Diseases
EMR WHO Eastern Mediterranean Region
EMRO WHO Regional Office for the Eastern Mediterranean
ESR Electron Spin Resonance
EUR WHO European Region
EURO WHO European Regional Office
EUR European Region
GLEWS Global Early Warning System for major animal diseases,
including zoonoses
IDSR Integrated Disease Surveillance and Response
IHR International Health Regulations (2005)
IHRMT International Health Regulations Monitoring Tool
INFOSAN International Food Safety Authorities Network
IPC Infection Prevention and Control
MDG Millennium Development Goals
MoH Ministry of Health
MoU Memorandum of Understanding
NFP National IHR Focal Point
NGO Non-governmental Organization
PAHO Pan-American Health Organization
PoA Plan of Action
PoE Points of Entry
RO Regional Office
SEAR South East Asian Region
SEARO WHO Regional Office for South East Asia
SOP Standard operating procedure
SP States Parties
SWOT Strengths, weaknesses, opportunities, and threats analysis
WHA World Health Assembly
WHO World Health Organization
WPR Western Pacific Region
WPRO WHO Regional Office for the Western Pacific
WR WHO Representative
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List of References
Balachandran, A. Global Polio Eradication Initiative Advocacy Toolkit. Geneva,
World Health Organization, Global Polio Eradication Initiative, 2011.
Core Capacities Assessment Handbook for Use in the WHO African Region. A
guide for Assessment Consultant (not published). Brazzaville, World Health
Organization, Regional Office for Africa, 2011.
IHR (2005) 2nd
Edition 2008. Geneva, World Health Organization, 2008.
http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf
IHR Core Capacity Monitoring Framework: Checklist and Indicators for
Monitoring Progress in the Development of IHR Core Capacities in States Parties.
Geneva, World Health Organization, 2011.
IHR Monitoring (States Parties) 2011 Questionnaire for Monitoring Progress in
the Implementation of IHR Core Capacities. Geneva, World Health Organization,
2011.
IHR Core Capacity Monitoring Framework: Checklist and Indicators for
Monitoring Progress in the development of IHR Core Capacities in States Parties:
Processes and Outputs. Geneva, World Health Organization, 2010.
Last JM, ed. A Dictionary of Epidemiology. New York, Oxford University Press,
2001.
Protocol for Assessing National Surveillance and Response Capacities for the
International Health Regulations (2005) in Accordance with Annex 1 of the IHR. A
Guide for Assessment Teams. Geneva, World Health Organization, December
2010 (WHO/HSE/IHR/2010.7).
Report of the Review Committee on the Functioning of the International Health
Regulations (2005) and on Pandemic Influenza A (H1N1) 2009. Geneva, World
Health Organization, May 2011.
Resource Mobilization for the African Region. In draft. AFRO and Geneva HQ,
World Health Organization, 2011.
Resolution WHA 64.1. Implementation of the International Health Regulations
(2005). In: Sixty-fourth World Health Assembly, Geneva, 16-24 May 2011.
WHO Communications Toolkit. Geneva, World Health Organization, 2007.
http://www.who.int/nuvi/advocacy/communications_toolkit.pdf.
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Glossary of Terms
core capacity essential public health capacities that States Parties are required to
have in place throughout their territories by the year 2012, pursuant to
Articles 5 and 12 and Annex 1A of the IHR (2005). Eight core capacities
are defined in this document.
desk review an administrative review that consists of collection, collation, analysis,
and interpretation of available information in a country. It is essentially
a review of documentation regarding IHR core capacity development.
The Desk Review in the context of this document and based on the need
to appropriately monitor progress in development of the IHR core
capacities in countries could be followed by a visit to a few selected
sites (e.g. points of entry, laboratories at national and sub-national
levels), if deemed appropriate.
evaluation a process that attempts to determine as systematically and objectively
as possible the relevance, effectiveness, and impact of activities in light
of their objectives. This could include evaluation of structures,
processes, and outcomes (adapted from Last JM, ed. A Dictionary of
Epidemiology, New York, Oxford University Press, 2001).
event a manifestation of disease or an occurrence that creates a potential for
disease, as a result of events including, but not limited to those that are
of infectious, zoonotic, food safety, chemical, radiological, or of nuclear
origin or source.
feedback the regular dissemination of surveillance data from analyses and
interpretations to all levels of the surveillance system to ensure that
everyone involved is kept informed of trends and performance.
focus group a group of people who engage in a roundtable discussion on a relevant
topic. A focus group discussion is typically directed by a moderator who
guides the discussion to gather the groups' opinions or more knowledge
on the topic.
goods tangible products, including animals and plants, transported on an
international voyage, including for utilization on board a conveyance
(IHR (2005)).
health hazard a factor or exposure that may adversely affect the health of a human
population. Health hazards may be of biological (infectious, zoonotic,
food safety, and other), chemical, radiological, or nuclear origin or
source.
IHR Monitoring Tool
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a framework and process for States Parties to monitor the development
of their core capacities at the national, intermediate and
community/primary response levels in accordance with the
requirements for core capacity development in Annex 1 of the IHR
(2005)
IHR (States Parties) Monitoring Questionnaire
a questionnaire that is based on the IHR monitoring framework and
designed so that State Parties can provide standardized information on
the progress of implementation of IHR across all regions of the world,
and which allows reporting on progress with IHR implementation
annually to the World Health Assembly.
indicator a variable that can be measured repeatedly (directly or indirectly) over
time to reveal change in a system. It can be qualitative or quantitative,
allowing the objective measurement of the progress of a programme or
event. The quantitative measurements need to be interpreted in the
broader context, taking other sources of information (e.g. supervisory
reports and special studies) into consideration and they should be
supplemented with qualitative information.
Member States Currently, 193 Member States of the WHO, in accordance with Chapter
III of the WHO Constitution, and any States Parties which may hereafter
become a Member State of the WHO in accordance with the
Constitution.
point of entry a passage for international entry or exit of travellers, baggage, cargo,
containers, conveyances, goods, and postal parcels as well as agencies
and areas providing services to them on entry to or exit from (IHR
(2005)) a country.
public health the science and art of preventing disease, prolonging life, and
promoting health through organized efforts of society. It is a
combination of sciences, skills, and beliefs that is directed to the
maintenance and improvement of the health of all people through
collective or social actions. The goal is to reduce the amount of disease,
premature death, and disease-produced discomfort and disability in the
population (Last, 2001).
public health emergency of international concern
an extraordinary event which is determined, according to the IHR, (i) to
constitute a public health risk to other Member States through the
international spread of disease and (ii) to potentially require a
coordinated international response.
public health risk
the likelihood that an event may adversely affect the health of human
populations, with an emphasis in the IHR for events that may spread
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internationally or may present a serious and direct danger to the
international community (IHR (2005)).
published in the context of this document, published means available on a publicly
accessible domain with a reference or URL provided.
States Parties the States Parties to the IHR (2005) include 193 WHO Member States,
the Holy See, and Liechtenstein, currently identified at
http://www.who.int/ihr/legal_issues/states_parties/en/ and any State
which may hereafter accede to the IHR (2005) in accordance with the
terms of the Regulations and the WHO Constitution.
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I. Introduction
1.1. IHR Background
The International Health Regulations 2005 (IHR) is an international legal agreement that
is binding on all 195 States Parties to the IHR/the Regulations. The IHR (2005) entered
into force on 15 June 2007.
The purpose and scope of the IHR (2005) is:
to prevent, protect against, control and provide a public health response
to the international spread of disease in ways that are commensurate
with and restricted to public health risks, and which avoid unnecessary
interference with international traffic and trade.
The Regulations include much more than a list of specific infectious diseases and cover a
wide range of public health risks of potential international concern which could include:
� biological, chemical, or radiological and nuclear events in origin or source, or
� diseases potentially transmitted by:
o persons (e.g. SARS, influenza, polio);
o goods, food, animals (e.g. Rift Valley fever);
o vectors (e.g. plague, yellow fever, West Nile fever); or
o the environment (e.g. radiological and nuclear releases, chemical spills,
or other contamination).
The successful implementation of the IHR requires a strong national public health
system that is critical for response to public health emergencies of national and/or
international concern. States Parties should be able to maintain active surveillance of
diseases and public health events, rapidly investigate reports, assess public health risk,
share information, and implement public health control measures. At the international
level, it is essential to establish an effective system that supports disease control
programmes for the containment of specific public health threats and continuously
assesses global public health risks while being prepared to rapidly respond to
unexpected internationally spreading events.
1.2. Status of IHR Implementation
The status of IHR core capacity development is monitored by the World Health
Organization (WHO) through the annual IHR (States Parties) Monitoring Questionnaire
(hereafter referred to as the Monitoring Questionnaire), which is self-reported data. The
IHR monitoring process involves assessing, through a checklist of 20 indicators
specifically developed for monitoring each core capacity, the following:
• status of implementation of eight core capacities
• development of capacities at points of entry (PoE)
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• development of capacities for five IHR-relevant hazards (infectious, zoonotic,
food safety, chemical, and radiological and nuclear)
The Monitoring Questionnaire was completed by 128 States Parties in 2010 (66%) and
by 161 States Parties in 2011 (83%). All regions had submission rates above 70%, and
AMR, EUR, and SEAR had submission rates above 85% in 2011. Overall, regions are
making good progress on specific attributes related to surveillance, the function of
National IHR Focal Points (NFP), response, and laboratory services, while there have
been relatively lower achievements in terms of capacity development in the areas of
PoE, chemical and radiological and nuclear hazards, and human resources.
The data analysis of the results of the questionnaire show the specific attributes that
need to be strengthened and are available in the country profiles on the IHR portal,
which are accessible to NFPs.
1.3. The deadlines for meeting IHR core capacity requirements and
request for an extension
All States Parties should have developed and begun implementing plans of action (PoAs)
to ensure that the core capacities required by the IHR are present and functioning
throughout their territories by the deadline, 15 June 2012. However, some States
Parties have not yet assessed the ability of existing national structures and resources to
meet the minimum requirements described in the IHR, some have not developed plans
of action to address gaps, and others have not reported on progress made in developing
or maintaining the IHR core capacities.
Following a review of the national capacities listed in Annex 1, States Parties may obtain
a two-year extension to the 20121 deadline for fulfilling these capacity obligations on
the basis of a justified need and an implementation plan to be reported to WHO
(Articles 5, 13). Accordingly, "the State Party that has obtained an extension shall report
annually to WHO on progress made towards the full implementation." The extension
request and relevant reports should be sent by the NFP to the WHO IHR Contact Point at
the appropriate WHO Regional Office (RO). After receiving the request, accompanied by
the justification and implementation plan, the Secretariat will inform the State Party
through the NFP if the extension has been obtained and indicate the new target date for
the completion of the capacities. Extensions will be for a period of two years starting
from 15 June 2012.
The IHR put the responsibility for initiating and fulfilling the procedure on the State
Party. WHO is not mandated to make any determinations regarding which States
require an extension, the WHO Secretariat therefore encourages all States Parties
wishing to obtain an extension to complete the extension request process before 15
June 2012, to avoid falling out of compliance with the Regulations in relation to the
national capacity obligations.
1 There are exceptions to this target date, arising from the dates on which the Regulations
entered into force for the States Parties concerned. These exceptions are: India, current
target date 8 August 2012; Liechtenstein, current target date 28 March 2017; Montenegro,
current target date 5 February 2013; and the United States of America, current target date
18 July 2012.
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1.4. Recommendations of the IHR Review Committee on
strengthening IHR implementation
In January 2010, at the 126th session of the Executive Board, the Director-General of
WHO proposed to convene a Review Committee to review the experience gained in the
global response to the influenza A (H1N1) 2009 pandemic in order to inform the review
of the functioning of the IHR. Following the analysis of the Review Committee, a number
of recommendations were made. Among others, the Review Committee recognized that
“while the IHR have helped to make the world better prepared to cope with public
health emergencies, the core national and local capacities called for in the IHR are not
yet fully operational and are not now on the path of timely implementation worldwide”.
Notably, Recommendation 1 of the 15 recommendations of the Review Committee
states:
Accelerate implementation of core capacities required by the IHR. WHO and
States Parties should refine and update their strategies for implementing the
capacity building requirements of the IHR, focusing first on those countries that
will have difficulty meeting the 2012 deadline for core capacities. One possible
way to support and accelerate implementation would be for WHO to mobilize
appropriate agencies and organizations that would be willing to provide
technical assistance to help interested countries assess their needs and make the
case for investment. Making the case for investment in IHR capacity building and
subsequent resource mobilization would increase the likelihood that more States
Parties could come into compliance with the IHR. Donor countries and
organizations could take advantage of the IHR Annex 1A as a priority list for
development support and also seize opportunities to share specialized resources,
such as laboratories, across countries. WHO should also update the 2007
guidance on NFP functions, and include examples of good practice to reinforce
the value of the IHR.
This recommendation acknowledges and underscores the critical need to accelerate IHR
implementation in countries and for urgent action on the part of States Parties and
WHO.
1.5. Current tools available to support IHR assessment,
implementation, and monitoring
To support States Parties, WHO, in collaboration with its technical partners, has
developed global and regional-specific tools addressing the assessment, implementation,
and monitoring of the IHR capacities. The International Health Regulations website
(http://www.who.int/ihr) provides access to publications and guidelines that may be
useful to countries in this regard.
With regards to assessment and monitoring tools specifically, WHO has developed a
number of generic and core-capacity specific guidance for IHR. These include, among
others, in-depth assessment protocols, specific assessment tools (Points of Entry,
Laboratory, Risk Communications, Legislation, etc.), monitoring checklists, IHR (States
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Parties) Monitoring Questionnaires, and other guidance. WHO regional offices also have
regional strategies, such as the Integrated Disease Surveillance and Response (IDSR),
Emerging Infectious Diseases (EID) and Asia-Pacific Strategy for Emerging Diseases
(APSED), on which countries need to build in developing the IHR core capacities.
To better address the recommendations of the Review Committee, there is a need to
develop a methodology, using the existing tools that would allow countries to rapidly
assess their status, develop plans, and mobilize resources to implement and monitor
IHR core capacity development within a very limited timeframe. Some countries would
like to carry out in-depth assessments spanning a longer period of time, while others
would like to use the annual self-reported Monitoring Questionnaire. Several States
Parties would like this intermediary guidance that identifies gaps and strengths and
permits development of robust plans, while validating the quality of the self-reported
data through the IHR monitoring tool, with a shorter duration than the time currently
required for an in-depth assessment.
Given the time left for meeting the national core capacity development requirement,
the scarce human and financial resources in countries, this guidance is being proposed
to countries.
II. Purpose and scope of this guide The purpose of this guide is to support States Parties in assessing their current capacity
in relation to the requirements of the IHR and in planning the development of their
national IHR core capacities through a range of accelerated activities. The scope includes:
1. Desk review to determine current status and gaps complemented by very
specific selected site visits as needed (e.g. designated PoE, Laboratory, Health
facility, institutions in capital city). The limitations of the modified desk review
may be that data collected would be mainly qualitative, and site visits would be
very limited both in number and geographical location (within the capital city),
which may not accurately reflect the realities in the periphery.
2. Updating / developing the plan of action to strengthen existing IHR capacities
and address gaps.
3. Intensified advocacy for involvement of partners and stakeholders.
4. Resource mobilization to raise additional funds and other resources for action.
This guide can be used by countries that have not conducted an assessment of existing
national structures and resources to meet the minimum requirements using the
protocol document, the IHR Monitoring Tool (IHRMT), or other equivalent tools.
This guidance does not replace the IHRMT, but should help to improve the quality of
data collected and reported, strengthen partnerships within and between sectors,
mobilize resources, and promote in-country sensitization and advocacy for IHR
implementation.
III. Capacities for review Based on the WHO checklist and indicators for monitoring IHR national core capacity
development, eight core capacities (Legislation, Coordination, Surveillance,
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Preparedness, Response, Risk Communications, Human Resources, Laboratory) should
be reviewed across the five IHR relevant hazards (Infectious, Food safety, Zoonotic,
Chemical, and, Radiological and Nuclear) and the PoEs. A summary of attributes to be
addressed within each core capacity by desk review and planning exercise based on the
IHRMT may be found in Appendix 2).
Figure 1: IHR core capacities and hazards
CORE CAPACITIES
}
}
Legislation
Coordination HAZARDS
Surveillance
Preparedness Infectious Points of Entry
Response Food Safety
Risk Communication Zoonotic
Human Resources Chemical
Laboratory Radiological/Nuclear
IV. Sectors to be involved at country level in the review and
planning process For effective national and global health security, the IHR should be a national
responsibility, not just that of the Ministry of Health (MoH) or the NFP. The
implementation of the IHR involves and has an impact on functions and responsibilities
across many ministries, sectors, and governmental levels and the participation of these
partners should be considered during the review. Some of these sectors may include:
• environment
• public health
• international ports, airports, ground crossings (including quarantine)
• customs
• food safety
• agriculture (including animal health)
• radiation safety
• chemical safety
• transportation (including dangerous goods)
• risk communication (collection, use, and disclosure of public health information)
• public health activities of authorities or other relevant entities at the
intermediate (state, provincial, or regional) and local levels
• national security
• other
V. Process and timelines to accelerate IHR implementation This guidance outlines a five working day schedule and a follow up agenda (see
Appendix 1 for an overview of activities) comprising six components, notably: a planning
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phase; an enhanced desk review; development of a PoA; stakeholder advocacy;
resource mobilization; and monitoring implementation.
5.1. Planning phase
Given the short timeframe, preparation is critical for the success of the review and
planning exercises and includes a number of activities, which are summarized in
Appendix 1 and defined in the following paragraphs.
Advocacy. Acceleration of IHR implementation at the country level will require focussed
advocacy. This needs to be done at the senior political, decision-making levels of the
MoH and other relevant ministries or agencies to facilitate the process for technical staff.
The WHO country office (CO) should support the process.
Proposal development. A proposal for the desk review and a PoA needs to be
developed by the NFP in collaboration with the WHO CO and should present a realistic
timeline and budget for the proposed activities.
Requesting a desk review. Based on the proposal, an official request from the national
authorities should then be made to WHO, confirming the country's interest in
conducting a desk review and developing a PoA.
Administrative and logistical arrangements. Once a country decides to carry out a
review, the NFP or persons deemed appropriate by the country will be responsible to
set up a coordinating mechanism with the WHO CO and other key partners. The NFP, in
close collaboration with the WHO CO, should rapidly begin work on administrative and
logistical requirements (transportation, finances, personnel, meeting facilities, supplies,
etc.) for the review.
Identifying the review team and key informants. The NFP, in collaboration with WHO,
should assemble a review team. This team will be responsible for identifying the focal
points responsible for strengthening IHR core capacities across the various hazards,
conduct interviews with the focal points/key informants, and review documents as
necessary.
Where feasible, the key informants should be drawn from various levels in the country
(national, intermediate, and peripheral/community levels) and from various disciplines,
such as:
• health services, including laboratory services and all major disease control
programmes;
• chemical, nuclear, food safety, and zoonotic hazards sectors (including
laboratory);
• representative(s) responsible for implementing the IHR at PoE;
• those responsible for IHR-relevant human resource development in the country;
• non-governmental organizations (NGOs), technical partners, and private sector
institutions;
• donors; and
• others as deemed necessary by the State Party.
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Meetings with stakeholders. Led by the NFP, a coordination meeting should be held
with those stakeholders who responsible for the implementation of the IHR as a means
to provide an opportunity for the experts to gain a common understanding of the
review process and the expected outputs. This meeting also serves the dual purpose of
sensitizing stakeholders about the IHR. Such a meeting could cover the generalities of
the IHR and updates, States Parties and WHO obligations under the IHR, and an
overview of relevant IHR tools such as the IHRMT, as well as current status of IHR
implementation by the State Party, if data are available.
Identify and collect relevant documents. The focal points/key informants from the
various sectors should be responsible for identifying and collecting relevant documents.
This process should be guided by the 13 core capacities and hazards outlined in the
IHRMT (see Section III, Figure 1). These relevant documents may include current
situation reports, policy and legislation documents, strategic plans, certification
documents (e.g. for PoE, laboratories, etc.), standard operating procedures (SOPs),
guidelines, etc. These documents should be pre-assembled for easy reference during the
desk review. (See Appendix 3 for examples of relevant documents.)
Distribution and completion of the Monitoring Questionnaire. The NFPs are
responsible for distributing the core capacity IHRMT questionnaires to the relevant
thematic focal point (e.g. surveillance questionnaire to relevant surveillance focal point)
for completion. It is recommended that countries complete the IHRMT questionnaire, if
not already done, before the review. This then could be further refined during the
review. The NFPs should be responsible for collating the data from all the 13 capacities
and hazards and checking the questionnaire for completeness. The Monitoring
Questionnaire is available to all NFPs through the IHR-Portal at
https://extranet.who.int/ihrportal .
Site visits and data validation (enhanced desk review). Sites for potential visits,
particularly in the central part of the country, for the purposes of validating data should
be identified. This activity constitutes an enhanced desk review and is discussed in
greater detail in Section 5.2.
5.2. Desk review and selected specific site visits (enhanced desk
review)
The aim of the enhanced desk review is to conduct a rapid assessment using
available/current data/documents to determine the current status of the country’s eight
IHR core capacities across the IHR relevant hazards and PoE. A number of activities
should be carried out during this phase as summarized in Table 2. Additionally, see
Appendix 2.1 for an example of how to outline and summarize indicators and functions
requiring an enhanced desk review. Appendix 2.2 provides a list of attributes that
should be addressed within each core capacity, hazard, and PoE during the desk review
and planning exercises. A list of key documents to be assessed and updated during the
desk review is outlined in Appendix 3.
Table 2: Summary of activities to undertake during a desk review
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Timeline Activities
Review and
planning
phase
1. Initial meeting of desk review team
2. Meeting with stakeholders
3. Review of relevant documents and conduct of interviews
4. Focus group discussion and/or site visits (to validate responses to
the IHRMT) as deemed necessary
5. Thematic SWOT Analysis
6. Agreement on gaps identified
7. Identification of priority areas for action
8. Develop plan of action
9. Develop follow up plan with timelines
10. Present to stakeholders (key findings, recommendations, and
priority areas of action)
11. Draft country report (include PoA in report)
An initial meeting of the review team should be held. The team should be briefed on the
administrative and logistical arrangements, scheduling, meeting arrangements, courtesy
calls etc. Using the Monitoring Questionnaire, the team should assign thematic areas (as
defined by the eight core capacities, five hazards, and PoE) for interviews. The review
teams will proceed to conduct interviews with the identified thematic focal points. Visits
can be scheduled to meet with relevant IHR stakeholders in various sectors and
departments, including: those responsible for infectious disease; chemical, radiological,
nuclear, and food safety (this may include municipalities); zoonotic events; and PoE.
Focus group discussions could be held during these visits. Responses will be recorded in
the appropriate section of the Monitoring Questionnaire. Additional questions may be
used to clarify the discussions, statements, or documents.
Where necessary, interviewers should request evidence in the form of additional
documents to validate the answers provided. Relevant documents elicited should be
guided by the 13 capacities and hazards outlined in the IHRMT.
Specific site visits (laboratory, health facility, PoE) may be used to validate data, if
deemed necessary. For this activity, it is important to identify sites that may be reached
within a short time, preferably within the city where the review is taking place. Half a
day is recommended for the completion of site visits. These visits should allow
triangulation and validation of data reviewed on the implementation of core capacities.
At these sites and through interviews with the implementing staff, the existence of
documents and tools may be verified as well as the reality of current practice. Such
information may lead to the modification of the initial choice of answer to questions in
the Monitoring Questionnaire. Other observations that are not specified in the
18
monitoring tool may be noted and used during the analysis of strengths, weaknesses,
opportunities, and threats (SWOT).
The approach at each site visited should be to:
• have an initial meeting to introduce the objectives of the review and ask
relevant questions;
• obtain informal feedback on issues that have already been identified regarding
the IHR capacities and hazards and their development;
• identify examples of good and bad practices;
• consult IHR relevant documents; and
• challenges, strengths, and weaknesses, and IHR capacities should be identified,
documented, and discussed during the site visits.
This qualitative information will contribute to the interpretation of the review.
An analysis should be completed for each thematic group that identifies strengths,
weaknesses, opportunities, and threats using the SWOT analysis template provided for
desk reviews (see Appendices 4.1, 4.2, and 4.3). Each identified area should also include
recommendations for action to be taken to strengthen the capacity or fill the known
gap(s). Working with the thematic stakeholders, gaps should be put into a priority list,
and this should be used to define and prioritize areas of action. Main recommendations
and actions to strengthen country core capacity should be proposed. Some gaps may be
grouped with respect to the possibility of common solutions. Strengths and existing
resources should be built upon. The thematic SWOT analysis and recommendations
should be presented and a consensus should be reached by the review team members
with regard to priorities for the PoA.
At the end of the desk review, the following outputs are expected:
1. Existing capacities within the country should be identified.
2. Areas and gaps that need to be strengthened and filled should be determined.
3. Areas with existing or improved capacities (if applicable) should be identified
and built upon.
4. A SWOT analysis (see Appendix 4.1) should be carried out.
5. Priority areas and recommendations should be identified for further action.
5.3. Plan of Action Development
The PoA should provide the structure for the government and appropriate ministries to
implement activities crucial for the early detection, verification, notification, response,
and containment of public health events, thereby ensuring national and global health
security within the framework of the IHR.
Existing plans, such as pandemic preparedness plans, emergency preparedness plans,
and others should be taken into account when developing or updating the PoA. States
Parties may also consider including major elements of the IHR PoA into existing plans
and vice versa, as appropriate.
19
The aim of this phase is to ensure that a PoA is either updated or developed, taking into
account the priority areas and recommendations identified for action. Based on the
priorities and recommendations, each of the 13 thematic areas will identify appropriate
interventions. Below is a suggested template for outlining the plan and outputs (see also
Appendix 5 for an example of a template for a PoA):
a) Main findings and recommendations
b) Objectives
c) Activities
d) Timelines
e) Responsible entities
f) Milestones
g) Indicators
h) Budget and possible funding sources
Short-, mid-, and long-term activities should be clearly delineated within the plan.
Priority actions should take into consideration current IHR deadlines. The PoA should be
included in the draft report and may be used in the future to elaborate an even more
detailed plan, if one is deemed necessary, or as part of donor proposals.
Immediate next steps should be defined. These may include the finalization and
approval of the PoA, finalization of the meeting report (see proposed template in
Appendix 6), dissemination to solicitation of feedback from stakeholders, advocacy plan
development, proposal development, and mobilization of resources.
This plan should be presented to the stakeholders during a debriefing meeting (see
sample agenda in Appendix 7). The plan will then be finalized by the country within two
weeks, with support from partners and WHO.
5.4. Follow up to the desk review and planning
The IHR (2005) specifically requests that States Parties develop plans of action following
an initial assessment of the existing national structures and resources for implementing
the minimum core capacities for surveillance and response. Existing plans can therefore
be updated taking into account other plans such as pandemic preparedness plans,
emergency preparedness plans at the same time. States Parties could also consider
including major elements of the IHR plan of action into existing plans and vice versa, as
appropriate.
Table 3: Summary of activities to undertake during follow-up
Timeline Activities
Follow-up
phase
Implement the follow-up plan
Engage in stakeholder advocacy
20
Mobilize resources
Monitor implementation
5.5. Advocacy for IHR implementation
Advocacy is about making the case for change. It involves defining the issues and setting
goals and objectives, identifying the target audience, and delivering clear messages to
them as well as building support through successful partnerships. IHR advocacy in this
context is about encouraging target audiences to accelerate the implementation of IHR
(2005).
The aims are to:
• Sensitize national authorities at all levels on their roles and responsibilities in
the implementation of the IHR
• Increase awareness among national and international health partners, the
media, stakeholders in relevant sectors, and others as appropriate, in an effort
to obtain their effective involvement in the implementation of the IHR.
A number of activities should be carried out during this phase as summarized in Table 4.
Table 4: Summary of activities for advocacy
Timeline Activities
Advocacy 1. Define the issue
2. Set goals and objectives
3. Identify target audiences
4. Build support
5. Develop the message
6. Select channels of communication
7. Develop an implementation plan
8. Implement and monitor the plan
Define the issues that needs to be addressed and why they are important. IHR
implementation remains a challenge in many countries, with several hurdles and
impediments that may need to be addressed. These include, but are not limited to:
• Lack of political commitment
• Lack of awareness of the impact and consequence of compliance and non-
compliance
• Lack of resources (human resources and funding)
• Lack of countrywide ownership of the State Party commitment to implement
the IHR (often considered as an MoH responsibility)
• No funds committed to IHR implementation
• High turnover of decision makers and technical staff, requiring continuous
sensitization and advocacy
21
• Fear or reprisal following transparency
• Benefits to the State Party not sufficiently highlighted
Based on the specific issues and challenges identified by the country, goals and
objectives need to be set.
Once goals and objectives have been determined, target audiences need to be
identified. These should include: national authorities and appropriate decision makers
who have the authority to bring about the desired change. Additional audiences may
also be individuals and groups that influence decision makers. It is imperative to identify
and cluster them together in order to better adapt the strategies and messages to each
target audience for the desired impact. These additional groups could include the
political authority of the state, parliamentarians and elected local officials, the NFP,
professional health organizations, other appropriate government ministries, authorities
in charge of animal and plant production, partners, civil society, non-governmental
organizations (NGOs), media, and the private sector.
A large support base increases the chances of success. Successful partnerships within
the country that have made real progress on their issues need to be identified and good
practices, as well as lessons learnt, should be emulated. Examples could be a national
initiative with a national model/champion as an ambassador or spokesperson, or an
international one, such as the WHO-led Tobacco Free Initiative.
Message development should be based on the target audiences. The messaging should
focus on what has to be achieved and what recipients of the message are being asked to
do. Basic information packages should be developed and shared on the country’s
progress towards implementation of the IHR core capacities, the IHR hazards, and
capacities at PoE. Communication channels will depend on the nature of the target
audience and may be through face-to-face meetings, media (TV, national radio, local
radio, print media, social media, internet), traditional media (public gatherings,
community networks, town criers, village persuaders, etc.), and other appropriate
channels (pressure groups, religious groups, etc.)
An advocacy implementation plan should be developed and implemented that
identifies tasks, target audiences, roles and responsibilities, timeframes, expected
outcomes, and needed resources (see Appendix 8 for advocacy plan). As part of the
implementation of the plan, data should be continuously collected and analyzed, and
the advocacy effort should be monitored and evaluated to determine if the plan is
effective. The development of the advocacy plan could be an immediate follow up
activity of the desk review and planning workshop or a part of it, if time allows.
5.6. Resource mobilization
Resource mobilization in the context of the IHR is a continuous process of identifying
and using a wide range of available resources to sustain the implementation of the IHR.
It requires action-oriented resource gathering (which should also allow problems to be
22
addressed), a concrete strategy for achieving the desired outcomes, and should reflect a
coordinated, joint effort by government and non-governmental entities.
Resource mobilization efforts should be a country/ government-led process.
Development partners should align and harmonize their work so it fits with and within
the government’s plans (see the Paris Declaration and the Accra Agenda for Action).2,3
The aim of mobilizing resources for the IHR is to obtain adequate, timely, predictable
funding and support in order to effectively accelerate the implementation of the IHR.
These efforts should result in funding and other resource mobilization from various
sectors, as well as funding grant agreements and memoranda of understanding (MoUs)
with national stakeholders and international partners.
Table 5 summarizes a number of activities that should be carried out during this phase:
Table 5: Summary of activities for resource mobilization
Timeline Activities
Resource Mobilization 1. Identify country priorities and
needs under the IHR
2. Assess opportunities
3. Analyze the landscape for
resource mobilization
internationally
Following the review and plan development, there should be a reassessment of the
country’s priorities and goals. The roles and responsibilities of the different agencies and
governmental ministries in the implementation of the IHR should be well defined.
Actions in the plan requiring immediate implementation should be reviewed to ensure
that they are critical and have been included for priority resource allocation.
IHR implementation is a national obligation and, as such, resources may be mobilized
from various governmental agencies and ministries within the country. It is important,
therefore, to review what resources are immediately available within appropriate
sectors and what needs to be raised from the national government and national
partners. Resources for implementation and support may be sought from international
partners. Examples of national government and national partners include:
• Government and agency donors
• International financial institutions
2 Déclaration de Paris sur l’efficacité de l’aide au développement (Paris Declaration). Paris,
Organisation for Economic Co-operation and Development, 2005. Available at
http://www.oecd.org/document/18/0,3746,en_2649_3236398_35401554_1_1_1_1,00.html.
Accessed 17 September 2012. 3 Programme d’action d’Accra (Accra Agenda for Action). Accra, Organisation for Economic
Co-operation and Development, 2008. Available at
http://www.oecd.org/document/18/0,3746,en_ 2649_3236398_35401554_1_1_1_1,00.html.
Accessed 17 September 2012.
23
• Foundations
• Private sector
• Non-governmental and civil society organizations
• Academia
For effective resource mobilization, there should be a statement of resource
requirements, identification and availability of existing resources, and a strategy for
implementation. A variety of revenue sources, ranging from different funding sectors to
individual donations, exist within the country.
There should be active engagement and communication with donors, and more
information should be provided if requested by the donor. Proposals should be
prepared, taking into account the donors’ requirements (see Appendix 9.1 for an
example of a donor funding template and Appendix 9.2 for an example of IHR donor and
activity mapping). Donors usually want “value for money,” visibility, accurate and timely
reports, good coordination to ensure no overlap in activities or waste of resources, and
information sharing.
Once funds are received, accountability for the funds and implementation of the PoA is
crucial to build trust and ensure future fundraising opportunities. All aspects of the
process of fundraising and reporting should be documented. Multi-year core funding to
support IHR implementation should be explored.
VI. Monitoring the implementation of IHR plans
Monitoring implementation of the plan WHO has established an annual monitoring mechanism for IHR national core capacities
development through the Monitoring Questionnaire. The data are analysed and country
profiles that reflect the status of implementation are shared with countries. Twenty
indicators are used to report to the World Health Assembly (WHA) on an annual basis.
The implementation of country plans needs to be monitored. Monitoring entails a
continuous verification of progress made at all levels. Continuous verification would
judge whether implementation is going on as planned, would ensure accountability, and
could act as an advocacy tool. Monitoring also allows the early detection and resolution
of problems as they occur, resulting in improved performance and data quality.
24
VII. Appendices:
Appendix 1. Schedule and follow-up agenda
STEP TIME FRAME SUMMARY OF ACTIONS AND EXPECTED RESULTS
(See Section 5 for detailed activities)
PH
AS
E I
Planning 1-2 weeks Formal contact from SP requesting review
Pre-desk review checklist for SP (to be completed before the
mission arrives)
Finalize logistic arrangements for site visits (if required), security
clearances/briefings
WHO to get documentation on the organization, functioning, and
situation of the surveillance and response system with regard to
IHR requirements
PH
AS
E I
I
Sunday (or first
non-working day
of the week)
Day 0 Coordination meeting (NFP, MoH, WHO, and others as deemed
necessary by the country)
Review Programme of work, logistics, meeting arrangements,
agree on and invite participants to stakeholders debriefing, team
membership and roles
Monday Day 1 Courtesy meeting with WHO CO and MoH counterparts
(overview of mission, timelines, outputs, and final debriefing)
Briefing meeting with MoH counterparts and other stakeholders
from various sectors on Global Health Security, national and
WHO obligations under the IHR, and the core capacities,
including videos (IHRMT, PoE, Table Tops, etc.)
Overview of mission, timelines, outputs. Interviews and
document review with stakeholders and representatives from
various ministries using IHRMT and States Parties
Questionnaire/report as the basis and by thematic areas
Finalize site visits if required
Tuesday Day 2 Continue interviews and document review by core capacity
If site visits deemed necessary, selected sites at central level e.g.
Legal department, Laboratory, Health Facility, PoE
Agree on an outline for the PoA
Wednesday Day 3 SWOT analysis and interpretation of findings, using standard
template and presented by theme;
Agree on outline for the preliminary report
Thursday Day 4 Develop an outline of the implementation plan (PoA) which
includes an advocacy and resource mobilization component.
Prepare stakeholder meeting to validate key findings and
recommendations
25
Friday Day 5 Hold post-review debriefing meeting with key stakeholders and
partners to share preliminary findings
Discuss follow-up schedule and agree on a way forward
(finalization, dissemination, inclusion of feedback, etc.)
Finalize PoA and report
PH
AS
E I
II
Follow up after
desk review and
planning
Within 2 weeks Update and submit WHO monitoring questionnaire IHR
implementation if not yet done.
Develop advocacy plan
Develop resource mobilization strategy
Resource mobilization (present findings, proposals, and funding
requests to donors/development partners).
PH
AS
E
IV
Follow-up 5 weeks after review Follow-up and monitor the implementation of the plan of action.
26
Appendix 2.1. Summary of indicators and functions to be
reviewed during an enhanced desk review
Component
2.1
Question/
Attribute
number
Core Capacity: IHR
coordination,
communication and
advocacy
Status of
Achievement
Yes/No
Priority area
to address in
planning Y/N Comments
Indicator 2.1.2
*IHR NFP functions and
operations in place as
defined by IHR
2.1.2.1
IHR NFP has been
established
2.1.2.1
National stakeholders
responsible for the
implementation of IHR
been identified
Appendix 2.2. Details of attributes to be addressed within each core
capacity by desk review and planning exercise based on IHRMT
Legislation • Assessment of relevant legislation, regulations, administrative requirements,
and other government instruments for IHR (2005) implementation
• Policies to facilitate NFP core and expanded functions
Coordination • Coordination within relevant ministries on events that may constitute a public
health emergency or risk of national or international concern
• A multi-sectoral, multidisciplinary body, committee, or taskforce addressing IHR
requirements on surveillance and response
• Communications and collaboration with WHO
• Obligations of the IHR NFP under the IHR, are disseminated to relevant national
authorities and stakeholders
Surveillance • Clear structures for surveillance
• A designated unit with the capacity to monitor public health risks,4 verify alerts,
and respond to public health emergencies
• A functional event-based surveillance
• Capacity to assess all reports of urgent events within 48 hours of reporting, as
part of the risk assessment
4 Including zoonotic, food safety, radiological and nuclear, and chemical events that could
pose a health risk and/or be of international concern in addition to reporting of infectious
diseases.
27
Response
• Command, communication, and control mechanisms to coordinate and manage
outbreaks and other public health events.
• Multidisciplinary rapid response teams (RRT)
• Policies for case management
• Patient referral and transportation systems
• Infection Prevention and Control policy or operational plan
• Decontamination capabilities
Preparedness • Emergency preparedness/response plans
• Risk and resource mapping
• Surge Capacity
• Stockpiling
Risk Communication • Communications coordination
• Transparency and effectiveness of information dissemination
• Public and partner risk perception
• Social mobilization and communication
• Emergency communication plan
• Communication evaluation
Human Resources • Gaps in human resources and training
• A workforce development or training plan
• Training programmes and networks
Laboratory
• National capacity to deliver laboratory services
• Networking with national and international collaborating laboratories
• Specimen collection and transport
• Diagnostic capacity for priority events
• Laboratory Biosafety and laboratory biosecurity
• Quality assurance
Points of Entry (PoE) Implementation of IHR (2005) documents:
• Ship Sanitation Certificates (Annex 3)
• International Certificate of Vaccination or Prophylaxis (Annex 6)
• Maritime Declaration of Health (Annex 8)
• Health Part of the Aircraft General Declaration (Annex 9)
28
• Designation of airports and ports (and possibly ground crossings) for
development of capacities provided in IHR Annex 1
• Identification (send list to WHO) of ports authorized to issue Ship Sanitation
Certificates and provision of services as per IHR Annexes 1 and 3
• Coordination of relevant sectors in the prevention, detection, and response to
events that may constitute a public health emergency of international concern
at POE
• Core capacity requirements at designated airports, ports (and ground crossings)
as required in the IHR (2005)
Human health hazards (infectious, zoonotic, food safety, chemical,
and, radiological and nuclear): • National policy, strategy or plan for surveillance and response
• Functional mechanisms for intersectoral collaborations
• Guidelines or manuals on surveillance, assessment and management
• An operational plan for responding
29
Appendix 3. Desk review list of key documents 1. Examples of IHR-relevant documents as a source of information for the desk review
(not an exhaustive list)
a. Any relevant reports (around IHR capacities), various plans of action,
epidemiological, assessment reports available including risk assessment
b. Relevant legal documents (e.g. Public Health Acts, etc.)
c. Mapping of the facilities in the country including PoE, high risk areas etc.
d. List of development partners available in the country and mapping of their areas
of interest
e. Proposed desk review team members
2. IHR documents and tools (with links to PoE, legislation, chemical, laboratory,
IHRMT, regional strategies)
3. Related to the IHR (2005) obligations:
a. IHR articles on obligations and rights of States Parties
i. Review thoroughly the IHR (2005), including particularly the provisions
relating to rights and obligations of States Parties: Articles 1-13, 19-44, and
Annexes 1-9 Knowledge of what the IHR (2005) require is essential to
assessing and deciding what may need revision in national legislation and
regulations
ii. International travelers (persons): applying health measures and traveler
protections (including human rights) (Articles 3.1, 23, 30-32, 35-36, 40, 43,
45, and Annexes 6 and 7)
iii. National core capacity requirements (surveillance, response and designated
points of entry) (Articles 5.1, 13.1, 19(a), 20.1, 21, and Annex 1)
4. Other: Legislative guidance materials and assessment tasks
a. Review the WHO guidance materials on implementing the IHR in national
legislation and regulations. These materials will provide the framework for the
activities during the meeting. (See IHR (2005): Introduction to and toolkits for
implementation in national legislation. Available at: http://www.who.int/ihr/
legal_issues/legislation/en/index.html.)
b. Key legislative assessment tasks
i. Identify all legislative subjects and operational functions at all government
levels relevant for the State Party to implement the IHR (2005).
ii. Identify all existing domestic legislation, regulations, and other instruments
relevant to each of the subject areas and functions covered under the IHR
(2005).This includes any legislation adopted to implement the prior IHR
(1969), as amended, keeping in mind the broader scope and other
differences in this 2005 version.
iii. Specify any legislation, regulations, and other instruments which may
potentially interfere or conflict with full or efficient IHR (2005)
implementation. Specify any necessary enabling or authorizing legislation
which may be required to exercise rights or fulfill obligations.
iv. With regard to these tasks, pay particular attention to: the priority subject
areas for implementation; the specifically mandatory IHR (2005)
requirements; and the rights and functions in the IHR (2005) particularly
relevant to your State's individual context, including its public health
infrastructure and priorities, its trade and travel flows, points of entry, and
its economic and geographical characteristics.
30
Appendix 4.1. Examples of SWOT analysis templates
Appendix 4.2. Enhanced SWOT Analysis
Translate into tasks
for the Plan of
Action
Strengths Weaknesses
Opportunities
How to use existing
strengths to take
advantages of opportunities
How to overcome
weaknesses that prevent
taking advantage of
opportunities
Threats
How to use strengths to
reduce likelihood and
impact of threats
How to overcome
weaknesses that will make
these threats a reality
31
Appendix 4.3. Example of output of SWOT analysis by core capacity
Core Capacity 1: National Legislation Policy and Financing
Strengths • Legislation exists
• Some guidelines and regulations are available for all IHR-related
sectors
• IHR NFP established
• Access to international guidelines
Weaknesses • Poor sensitization of high level policy / decision makers
• No dissemination or publication of existing information on IHR
• Partners are not sensitized to IHR and have no orientation on the
implementation of policies related to IHR
• No policy to facilitate IHR NFP functions
• Documents are outdated (i.e. regulations, guidelines, bylaws, statutory
requirements, etc.)
• No assessment or review of legislation in line with IHR (2005)
• Key partners do not include IHR in their plans
Opportunities • Review of Public Health Act started
• Various resolutions at the regional committees and the World Health
Assembly to support IHR implementation and core capacity
development
Threats • Donor dependency leading to implementation of donor priorities
• Cabinet approval for development of IHR policy not secured
• Traditionally poor collaboration between various ministries on
legislative issues
Recommendations
• Develop IHR advocacy strategy for the decision makers
• Develop IHR policy to facilitate and strengthen IHR NFP
• Develop SoPs for NFP coordination, sharing of information, and
verification of information
• Assess existing legislation in line with IHR
• Update legislation, guidelines, and policies and disseminate them to
stakeholders and implementing partners
• Provide training on IHR related legislation
• Develop a web site / web page for IHR and information dissemination
32
Appendix 5. Example of a Plan of Action template
Hazard: Radiation Emergencies Goals Objectives Expected
results Activities Milestones
(targets) Timeframe Implementers Resources Risk/
assumptions/ obstacle
Cost/ US$
Indicator of performance
Start End
Year 1
Year 2
Year 3
Year 4
Year 5
Establish
national
policy for
radiation
detection
and response
Develop
national
radiation
emergency
policy
National
radiation
emergency
policy
Literature
review
(referring to
related
organization
policies)
Available
documentatio
n
Jun
2012 Jul
2012
National
Radiation
Protection
Agency
RPA, IAEA,
WHO
Literature Cooperati
on with
other
agencies
80,
000
National
Radiation
Emergenc
y policy
document
available
Development of
a working draft
Working draft Aug
2012 Sept
2012
RPA,
AG
Human
resources
Availabilit
y of
drafting
staff
Stakeholder
consultations
Call for
consultative
meetings
Sept
2012 Nov
2012
RPA Meeting
facilitation Conflicts
of
interests
Availabilit
y of funds
Expert review
and finalization
of draft
Input by
experts
Nov
2012 Feb
2013
Consultants
and (RPA)
Experts Availabilit
y of
experts
Presentation of
document to
stakeholders
Document
forwarded to
Attorney
General’s
office
Mar
2013 Mar
2013
RPAZ Logistical
support
Cabinet
approval
of
document
33
Appendix 6. Proposed Report template
Assessment team members
Abbreviations and acronyms
Executive summary
1. Introduction
2. Country background
2.1. Geography
2.2. Demography
2.3. Socioeconomic and health status indicators
2.4. Communicable diseases and chemical and radiological hazard burden
2.5. Health system
2.5.1. MoH organization/organizational chart
2.5.2. Distribution of health services
2.5.3. Human resources
2.5.4. Health-care financing
2.6. Overview of existing surveillance and response system including community surveillance
2.6.1. Priority risks and diseases (all hazards)
2.6.2. Procedure for notification
2.6.3. Confirmation of events
2.6.4. Response
2.6.5. Private sector surveillance
3. Objectives of the assessment
4. Methodology
4.1. Field assessment
4.2. Data analysis
4.3. Debriefing and feedback
5. Findings of the assessment
5.1. IHR legislation and policy
5.2. IHR coordination
5.3. Surveillance
5.4. Response
5.5. IHR preparedness
5.6. Risk communication
5.7. Human resources
5.8. Laboratory services
5.9. Potential hazards
5.10. PoE
6. Recommendations
7. Next steps
8. Work plan
9. Appendices
34
Appendix 7. Sample agenda and list of participants for stakeholder
meeting
Sample agenda 10.00- 10.20: Overview of IHR
10.20- 10.40: Overview of IHR core capacity in the Region
10.40-11.00: General discussion
11.00-11.30: IHR review findings and recommendations
11.30-12.00: Discussion
12.00-12.15: Roles and responsibilities of partners and each level for IHR core capacity
implementation
12.15 - 12.30: Next steps
Sample list of participants Minister of Health (Chair) and WHO/WHO country representative (Co-chair)
Assessment team
Representatives from various departments within the Ministry of Health
Representatives from relevant government ministries and agencies
Representatives from UN partner agencies
Representatives from national non-governmental organizations (NGOs)
Representatives from international NGOs
Representatives from the national and international donor community
Other relevant stakeholders in the country
35
Appendix 8. Sample summary advocacy plan
Summary Advocacy Plan
Goal Objectiv
es
Tasks Activities Target/
audience
Indicators Channels
of
communic
ation
Timeline Responsibil
ity
Outco
mes
Needed
Resources
36
Appendix 9.1. Samples of donor proposal template
[Proposal Title] Contribution Proposal Title
The title is the selling point and should be concise and informative,
reflecting the central theme of the project
Geographical focus
Indicate if this refers to:
-Country-wide
-Major sectors, or regions/provinces/communities
Beneficiaries
Proposal period
Total budget
Amount requested
Contact details
Sample contents in a donor proposal Introduction: Present the historical background to the problem, including what and how various actors have
responded to the problem to date and the limitations of such activities. Use statistical
evidence, graphs, tables, and pictures if available.
Sources for statistics include World Health Reports, United Nations Development Program
(UNDP) Human Development Report, Organisation for Economic Co-operation and Development
(OECD), United Nations Population Fund (UNFPA) State of the World Population, Economist
Intelligence Unit, Global Burden of Disease and Risk Factors (Disease-control Priorities Project),
WHO data and statistics, and WHO health statistics and health information systems.
http://www.who.int/research/en/
Rationale Objective(s) and specific result of the proposal of the proposal Partners: Present the partners, at local, regional, national and international level. Describe
who the key project partners (implementers) are, who will provide technical expertise and
advice, etc.
Implementation and organizational capacity: Present implementation arrangements and
contribution proposal management structure; Inputs are the means that must be provided in
order to attain the expected result, e.g. personnel, technical expertise, IT, equipment and
supplies, etc., and the existing capacity in the area of work, including the professional
capacities and experience of relevant project staff and those of its key partners.
Impact and sustainability: Present the expected outcomes or long-term impact of the
Draft
Agreement
Initiate, draft, negotiate & submit proposals
Clear
Agreement
Sign
Agreement
Record
Agreement
37
contribution, what will happen as a result, such as changes in policy, behaviour, or condition of
target population. (Direct and indirect beneficiaries/target population, impact on the
achievement of Millennium Development Goals (MDGs) and other relevant policies).
Monitoring, evaluation, and dissemination: Present monitoring and evaluation plans, such
as who will monitor project progress at different levels. Include information/a plan for mid-
term and final external evaluations.
List indicators and source of indicators for monitoring and evaluation (if not mentioned
earlier) .The criteria (quantity and quality) of outputs should be provided. Present the channels
that will be used for disseminating and sharing project results. Include a list of risk factors.
Budget: e.g. Summary budget in USD………………………………… $_________ Total Budget…………….…………………………………… $_________ Funds Secured…………….……………………………….… $_________ Funds Sought…………….…………………………………… $_________
38
Appendix 9.2. Example of IHR donor and activity mapping
Activities Activity still a priority? Yes/No
Funded Yes/No/ Partially
Donor Amount Expenditure
Status*
Funding continued? Yes/No (If
no, why?) Title of activity 1
Sub activity 1
Sub activity 2
Sub activity 3
Title of activity 2
Sub activity 1
Sub activity 2
Sub activity 3
Title of activity 3
Sub activity 1
Sub activity 2
* Status of implementation of activity,
i.e. on track, on hold for xx reason, etc.
39
Appendix 10. Specific attributes that need strengthening based on 2010
Data from States Parties questionnaire
Points of Entry (PoE) Integration of public health emergency contingency plans at designated PoE with other
response plans.
� Assessment of designated airports and ports.
� Identification of competent authorities at designated ports.
� Development of public health emergency contingency response plan at designated
PoE and dissemination to key stakeholders.
� Establishment of a functioning programme for the surveillance and control of
vectors and reservoirs in and near Points of Entry.
Chemical Events
� Identification of a list of priority chemical events/syndromes that may constitute a
potential public health event of national and international concern.
� Timely and systematic information exchange between appropriate chemical units
and surveillance units about urgent chemical events and potential chemical risks.
� Establishment of an alert system regarding chemical events for rapid
communication with the IHR NFP.
� Testing and updating coordination mechanisms regarding chemical events through
exercises.
� Development of a risk communication plan for chemical events that is coordinated
with the national risk communications plan.
� Development and dissemination of manuals and SOPs for rapid assessment, case
management, and control of chemical events.
Radiological and Nuclear Events
� Systematic information exchange between relevant National Competent Authorities
and human health surveillance units about urgent radiological events and potential
risks that may constitute a public health emergency of international concern.
� Development of a national policy or plan for the detection, assessment, and
response to radiation emergencies.
� Establishment of a mechanism for access to hospitals or health-care facilities with
capacity to manage patients from radiation emergencies.
� Mapping of the radiological risks that may be a source of a potential public health
emergency of international concern.
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� Regular radiation emergency response drills at national level, including requesting
international assistance (as needed) and international notification.
� Establishment of a coordination and communication mechanism for risk
assessments, risk communications, planning, exercising and monitoring among
relevant National Competent Authorities responsible for nuclear regulatory
control/safety, national public health authorities, the MoH, the IHR NFP and other
relevant sectors.
Food Safety
� Testing and updating of operational plans for responding to food safety events.
� Establishment of a functioning coordination mechanism between national food
safety authorities and the IHR NFP.
� Development of a list of priority food safety risks.
� Establishment of a roster of food safety experts for the assessment and response to
food safety events.
Zoonosis
� Regular information exchange on zoonotic diseases among the laboratories
responsible for human diseases and animal diseases.
� Testing and updating of operational, intersectoral public health plans for responding
to zoonotic events through occurrence of events or simulation exercises.
� Establishment of a regularly updated roster (list) of experts who can respond to
zoonotic events.
Coordination
� Implementation of plan(s) to sensitize stakeholders to their roles and
responsibilities.
Surveillance
� Dissemination of regular (at least quarterly) feedback of surveillance results to all
levels and other relevant stakeholders.
� IHR NFP response to verification requests from WHO within 24 hours (Art 10).
Preparedness
� Mapping of major hazard sites or facilities that could be the source of chemical,
radiological, nuclear, or biological public health emergencies of international
concern.
Laboratory
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� Establishment and regular update of collaborative mechanisms for access to
specialized laboratories that are able to perform bioassays, biological dosimetry by
cytogenetic analysis, and ESR.
Human Resources
� Approval by responsible authorities, of workforce development plan(s) and funding
for IHR implementation.
� Achievement of targets for meeting workforce numbers and skills consistent with
milestones set in training development plan.