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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3

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

4

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.

5

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.

7

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

8

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

13

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,

14

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

15

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

17

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.