Comparison of JEE and outbreak review in Madagascar
| JEE domain/indicator | JEE score | Major JEE recommendation | Outbreak response capacity | Degree of correspondance |
| IHR Coordination P.2.1 | 2 | Intersectoral committee exists but plan of work and response plan needed | A 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.4.3 | 2 | Need to elaborate and fund plan | Weak plan for seasonal vector control | N/A H H |
| Biosafety P.6.1 | 2 | Need intersectoral coordination and funding | Inadequate and insufficient IPC supplies | N/A H H |
| National Lab System D.1.1 | 4 | International accords existing; 13 national labs in place | Rapid Diagnostic kits not adequate and insufficient, delay for PCR confirmation. Laboratory testing was led in-country at Institut Pasteur. | H L H |
| Surveillance D.2.3 | 3 | Need for training and experience | Surveillance could have been improved to better reflect burden of disease; case definitions weak; weak detection capacity at the community level | M H M |
| Reporting D.3.2 | 2 | Not in place in all parts of the country | No clear reporting channels led to delay in response | H H H |
| Workforce D.4.1 | 2 | Inadequate outside of national level | Seemed to have adequate personnel for contact tracing but needed to train community health workers on plague surveillance and control | M H H |
| Preparedness R.1.2 | 1 | Need to analyse and map | Existence of national contingency plan which was not implemented and shared with all regions. No coordination of preparedness activities | H H H |
| Emergency Operations Activation R.2.1 | 2 | Able to establish RRTs | Insufficient trained and equipped multisectoral teams at the regional level | H M M |
| Emergency Operations Function R.2.3 | 2 | Experienced in plague response in prior years | Internal Incident Management System coordination was lacking | H M M |
| Emergency Operations Case Management R.2.4 | 2 | Existing guidelines | Revised treatment protocol developed, but not implemented; limited experience managing pulmonic plague cases | H M H |
| Medical Countermeasures R.4.1 | 1 | Need to establish procedures, stock control and logistics | Weak supply management; the logistics function not included in the national contingency plan | H H H |
| Risk Communication R.5.4 | 2 | Personnel exist but lack of feedback and local operationalisation | Mobilised 9000 to assist with risk communication and community engagement but there was still miscommunication regarding dignified safe burial and stigma of contacts | H M H |
| Points of entry PoE.2 | 1 | Lack of personnel and plans | Lack of Standard Operation Procedures and trained personnel at points of entry; implemented by international partners during outbreak | H H H |
JEE, joint external evaluation; RRT, Rapid Response Teams.