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Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region
  1. Ambrose Talisuna1,
  2. Ali Ahmed Yahaya1,
  3. Soatiana Cathycia Rajatonirina1,
  4. Mary Stephen1,
  5. Antonio Oke1,
  6. Allan Mpairwe1,
  7. Amadou Bailo Diallo1,
  8. Emmanuel Onuche Musa1,
  9. Daniel Yota1,
  10. Freddy Mutoka Banza1,
  11. Roland Kimbi Wango1,
  12. Nathalie Amy Roberts2,
  13. Rajesh Sreedharan2,
  14. Nirmal Kandel2,
  15. Adrienne May Rashford2,
  16. Linda Lucy Boulanger2,
  17. Qudsia Huda2,
  18. Stella Chungong2,
  19. Zabulon Yoti1,
  20. Ibrahima Soce Fall1
  1. 1WHO Health Emergency Programme, World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
  2. 2WHO Health Emergency Programme, World Health Organisation, Geneva, Switzerland
  1. Correspondence to Ambrose Talisuna; talisunaa{at}


The International Health Regulations (IHR, 2005) are an essential vehicle for addressing global health security. Here, we report the IHR capacities in the WHO African from independent joint external evaluation (JEE). The JEE is a voluntary component of the IHR monitoring and evaluation framework. It evaluates IHR capacities in 19 technical areas in four broad themes: ‘Prevent’ (7 technical areas, 15 indicators); ‘Detect’ (4 technical areas, 13 indicators); ‘Respond’ (5 technical areas, 14 indicators), points of entry (PoE) and other IHR hazards (chemical and radiation) (3 technical areas, 6 indicators). The IHR capacity scores are graded from level 1 (no capacity) to level 5 (sustainable capacity). From February 2016 to March 2019, 40 of 47 WHO African region countries (81% coverage) evaluated their IHR capacities using the JEE tool. No country had the required IHR capacities. Under the theme ‘Prevent’, no country scored level 5 for 12 of 15 indicators. Over 80% of them scored level 1 or 2 for most indicators. For ‘Detect’, none scored level 5 for 12 of 13 indicators. However, many scored level 3 or 4 for several indicators. For ‘Respond’, none scored level 5 for 13 of 14 indicators, and less than 10% had a national multihazard public health emergency preparedness and response plan. For PoE and other IHR hazards, most countries scored level 1 or 2 and none scored level 5. Countries in the WHO African region are commended for embracing the JEE to assess their IHR capacities. However, major gaps have been identified. Urgent collective action is needed now to protect the WHO African region from health security threats.

  • Africa
  • acute public health event
  • health security
  • health emergencies
  • integrated disease surveillance and response
  • international health regulations
  • outbreaks
  • world health organisation

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  • Handling editor Seye Abimbola

  • Contributors AT, AAY, SCR, MS, AO, AM, ABD, EOM, DY, FMB, RKW, NAR, RS, NK, AMR, LLB, QH, SC, ZY, ISF planned, coordinated or participated in several JEEs. AT, RKW and NK analysed that data, AT wrote the first draft of the manuscript. All the authors reviewed and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available with WHO and reports are available online.

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