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We read with interest the recent analysis of Joint External Evaluations (JEE) to assess International Health Regulations (IHR) compliance in the WHO African region. It is fantastic to see the engagement in the African region with this voluntary process, with 40 of 47 countries having been evaluated to date and 41 published mission reports (including Zanzibar), the highest proportion of completed JEEs for any WHO region. We congratulate the WHO Regional Office for Africa (WHO AFRO) for its leadership of this critical process. We would like to add our perspective as a technical agency engaged with and supportive of the JEE process.
As part of Public Health England’s (PHE) IHR Strengthening Project we have been engaging with National Public Health Institutes (NPHIs) in four African countries namely: Ethiopia, Nigeria, Sierra Leone and Zambia. In addition, we work with regional public health institutions such as the Africa Centres for Disease Control and Prevention (Africa CDC), and WHO AFRO to extend our reach beyond the bilateral engagement countries listed. The JEE process, with the subsequent development of a National Action Plan for Health Security (NAPHS), has been instrumental in informing and shaping our areas of engagement. In each of our partner countries, we have worked closely with the leadership of the NPHI and the relevant government ministries to develop workplans that address the gaps and needs highlighted in the JEE and prioritised...
As part of Public Health England’s (PHE) IHR Strengthening Project we have been engaging with National Public Health Institutes (NPHIs) in four African countries namely: Ethiopia, Nigeria, Sierra Leone and Zambia. In addition, we work with regional public health institutions such as the Africa Centres for Disease Control and Prevention (Africa CDC), and WHO AFRO to extend our reach beyond the bilateral engagement countries listed. The JEE process, with the subsequent development of a National Action Plan for Health Security (NAPHS), has been instrumental in informing and shaping our areas of engagement. In each of our partner countries, we have worked closely with the leadership of the NPHI and the relevant government ministries to develop workplans that address the gaps and needs highlighted in the JEE and prioritised in the NAPHS. An example of this is the support provided to operationalise the Nigeria Centre for Disease Control (NCDC) Emergency Operations Centre (EOC) and strengthen its coordination at subnational level through development of Standard Operating Procedures (SOPs) and facilitating multi-sectoral simulation exercises. This followed the identification of public health emergency response coordination as a priority area for improvement in their NAPHS. We share the authors’ opinion that ‘JEEs… are galvanising multiple stakeholders to work together on health security’. We would add that focusing on the JEE and using the NAPHS development process as a coordination mechanism promotes efficiencies and leads to support driven by the host country’s identified and owned priorities rather than by donor interest.
Our approach aims to build sustainable systems beyond the traditional technical training activities. We deliver our support through four main workstreams:
1. Workforce development through needs assessment, planning and strategy
2. Context-specific technical training and strengthening of existing systems
3. Peer support and mentoring for system leadership
4. Strengthening NPHI coordination, planning and strategic functions
Each of the workstreams is co-developed with our host NPHIs, ensuring that they remain in the driving seat. We remain open to adapting our contribution to reflect changing priorities and strengthened local skills and competencies. This approach ensures long term sustainability with internal and external monitoring and evaluation to ensure accountability. As a public health agency, we have been able to use the JEE indicators as a proxy measure for impact. We have mapped our logframe indicators to the JEE indicators in order to demonstrate focus on priorities and progress. We are exploring similar mapping of our activities against self-assessment reports in order to monitor progress between JEEs. The authors of this paper are rightly concerned about this approach potentially introducing bias into the assessment to suit funding needs. However, if all partners engage in the NAPHS process and use it to demonstrate shared progress, this will result in less bias and increase collaborative and complimentary working. As the JEE process becomes more standardised and embedded within the global health architecture, we anticipate a greater scope for using JEE indicators to help evaluate donor health security programmes and encourage other partners to take this approach, thereby increasing transparency and accountability.
As this paper demonstrates, there are still clear gaps in IHR compliance across the African region, especially around emergency preparedness and response capabilities. The JEE process has been a step in the right direction to identifying and addressing these gaps in a constructive, coordinated, country-led way. Tackling these using a collaborative, sustainable approach will be key to protect the WHO African region from global health security threats. The reorientation of global health around the country-driven JEE process, rather than an agenda driven by outside priorities, is a welcome and much needed change.
Finally, we wish to highlight the potential value in engaging NPHIs as partners alongside WHO, donor institutions and governments in the ambition to strengthen global health security. NPHIs have the technical expertise and organisational infrastructure and culture to take a long term approach to partnership and collaboration, working alongside their less well-resourced partners to strengthen public health systems for health security and resilience. Peer learning between institutions represents a powerful, yet flexible approach to strengthening that can empower all participants. The International Association of National Public Health Institutes (IANPHI - www.ianphi.org), a member organisation of public health agencies has the capacity to facilitate such partnerships in support of strengthening public health systems and global health security. NCDC and PHE, as leading members of IANPHI, are actively working to promote such collaboration towards global health security. Such networks have strong potential for complementing and partnering with WHO in its ambition to achieve strengthened global public health.(1)
1. Verrecchia R, Dar O, Mohamed-Ahmed O, et al. Building operational public health capacity through collaborative networks of National Public Health Institutes. BMJ Global Health 2019;4:e001868.