Table 4

Comparison of JEE and outbreak review in Madagascar

JEE domain/indicatorJEE scoreMajor JEE recommendationOutbreak response capacityDegree of correspondance
IHR Coordination P.2.12Intersectoral committee exists but plan of work and response plan neededA high-level inter-Ministerial coordination forum had to be established by the Prime Minister’s office to lead the response as the Inter-sectoral Support Group for Plague Control (GIALP) was not operational.H M H
Zoonotic Diseases P.4.32Need to elaborate and fund planWeak plan for seasonal vector controlN/A H H
Biosafety P.6.12Need intersectoral coordination and fundingInadequate and insufficient IPC supplies N/A H H
National Lab System D.1.14International accords existing; 13 national labs in placeRapid Diagnostic kits not adequate and insufficient, delay for PCR confirmation. Laboratory testing was led in-country at Institut Pasteur.H L H
Surveillance D.2.33Need for training and experienceSurveillance could have been improved to better reflect burden of disease; case definitions weak; weak detection capacity at the community levelM H M
Reporting D.3.22Not in place in all parts of the countryNo clear reporting channels led to delay in responseH H H
Workforce D.4.12Inadequate outside of national levelSeemed to have adequate personnel for contact tracing but needed to train community health workers on plague surveillance and controlM H H
Preparedness R.1.21Need to analyse and mapExistence of national contingency plan which was not implemented and shared with all regions. No coordination of preparedness activitiesH H H
Emergency Operations Activation R.2.12Able to establish RRTsInsufficient trained and equipped multisectoral teams at the regional levelH M M
Emergency Operations Function R.2.32Experienced in plague response in prior yearsInternal Incident Management System coordination was lackingH M M
Emergency Operations Case Management R.2.42Existing guidelinesRevised treatment protocol developed, but not implemented; limited experience managing pulmonic plague casesH M H
Medical Countermeasures R.4.11Need to establish procedures, stock control and logisticsWeak supply management; the logistics function not included in the national contingency planH H H
Risk Communication R.5.42Personnel exist but lack of feedback and local operationalisationMobilised 9000 to assist with risk communication and community engagement but there was still miscommunication regarding dignified safe burial and stigma of contactsH M H
Points of entry PoE.21Lack of personnel and plansLack of Standard Operation Procedures and trained personnel at points of entry; implemented by international partners during outbreakH H H
  • JEE, joint external evaluation; RRT, Rapid Response Teams.