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International Health Regulations (2005): summary of states parties 2011 report on IHR core capacity implementation : regional profiles

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WHO/HSE/GCR/2014.7

International Health Regulations (2005)

SUMMARY OF STATES PARTIES 2011 REPORT ON IHR CORE CAPACITY IMPLEMENTATION

Regional Profiles

© World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

African Region......................................................................................................................................................3 Region for the Americas .......................................................................................................................................7 Eastern Mediterranean Region ..........................................................................................................................11 European Region ...............................................................................................................................................15 South-East Asia Region .....................................................................................................................................19 Western Pacific Region ......................................................................................................................................23

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With the coming into force of the International Health Regulations (2005) (hereinafter “IHR” or “the Regulations”) on June 15, 2007, all IHR States Parties are required to assess the ability of their national structures and resources to meet minimum national core capacities for surveillance and response as specified in the IHR and to develop a plan of action to ensure that these capacities will be present and functioning throughout their territories by 2012. WHO is mandated to provide appropriate tools, guidance, and support to States Parties to achieve these goals. In accordance with Article 54 of the IHR and related resolution WHA61.2, States Parties and WHO are required to report annually to the World Health Assembly on the implementation of the Regulations. For this purpose, a monitoring framework was developed using technical expert views drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2011, 80% of countries (i.e.37/46) in the African region responded to the National Capacity Monitoring Questionnaire*, which is higher compared with 2009 (52%) and 2010 (50%). Throughout this Regional Summary sheet, percentage values relate to responding countries only. Information extracted from the inputs provided by National Focal Points is reflected here to provide an overview of the progress achieved in the region as reported by State Parties in 2011.

*For further reference and information on individual elements (core capacities, indicators, attributes) please consult: http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf

This summary provides information of responding countries on (i) eight core capacities, (ii) development of capacities at points of entry, and (iii) capacities for four IHR-relevant hazards: biological (including food safety and zoonoses),chemical and radio-nuclear. 

57% of countries report using the IHR Event Information Site (EIS) as an integral information resource. 73% of countries report that coordination between relevant ministries on events that may constitute a public health event or risk of national or international concern is in place. Standard Operating Procedures (SOPs) are available for coordination between IHR NFP and stakeholders of relevant sectors in 41% of countries. 62% of countries report having a multisectoral, multidisciplinary committee, body, or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 35% of countries through an actual event occurrence or through exercises and have been updated as needed. 68% of countries have identified national stakeholders involved in the implementation of IHR and 19% of countries conduct updates on the status of implementation of IHR annually. Roles and responsibilities of various stakeholders under the IHR have been defined in 41% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 30% of countries. An active IHR website or web page has been established in 14% of countries. Modest to good progress has been made in some areas of coordination and NFP communications. Further work is needed in sensitization of stakeholders on roles and responsibilities and testing coordination mechanisms.

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Legislation, regulations, administrative requirements, policies, or other government instruments, sufficient for implementation of the IHR.

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Legal requirements and instruments are assessed in 32% of countries and implemented in 22% of countries (with documentation available). National policies have been reviewed to facilitate the implementation of functions of the IHR National Focal point (IHR NFP) and of technical core capacities in 41% of countries. Key elements of national IHR legislation have been published in 8% of countries. Policies to facilitate IHR NFP core and expanded functions and to strengthen technical core capacities have been implemented in 35% of countries. Insufficient progress has been made in the area of national legislation, policy, and financing. Further work is needed across all attributes within this Core Capacity to meet IHR Implementation requirements.

Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)

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Lists of priority diseases or conditions for surveillance as well as case definitions for priority diseases are available in 95% of countries. Also, 92% of countries have designated specific units for surveillance of public health risks and 51% of countries indicate timely reporting from at least 80% of all reporting units. Surveillance data on epidemic prone and priority diseases is analysed at least weekly at national and sub-national levels in 81% of countries. 86% of countries have defined baseline estimates, trends, and thresholds for alert and action for the local public health response level for priority diseases/events. In 78% of countries, reports or other documentation showing that deviations or values exceeding thresholds are detected and used for action at the primary public health response level. At least quarterly feedback of surveillance results is disseminated to all levels and relevant stakeholders in 73% of countries. Evaluations of the early warning function of the indicator based surveillance have been carried out and country experiences, findings, and lessons learnt shared with the global community in 54% of countries.

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Coordination mechanism between relevant sectors implementing the IHR  The IHR NFP has been established in 86% of countries and information on the obligations of the NFP under the IHR has been distributed in 51% of countries. Additional roles and responsibilities for the IHR NFP functions have been implemented in 57% of countries. The NFP provides WHO with updated contact information and confirmation of the NFP on an annual basis in 81% of countries.

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Event-Based Surveillance

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SOPs and guidelines for event-based surveillance are available in 70% of countries. 81% of countries have designated unit(s) for event-based surveillance that may be part of an existing routine surveillance system. SOPs and guidelines for event capture, reporting, confirmation, verification, assessment, and notification have been developed and disseminated in 62% of countries. Information sources for public health events and risks have been identified in 68% of countries. A system at national and/or sub-national levels for capturing and registering public health events from a variety of sources including media (print, broadcast, community, electronic, internet etc.) is in place in 73% of countries. 62% of countries have actively engaged and sensitized community leaders, networks, health volunteers, and other community members to the detection and reporting of unusual health events. 70% of countries have arrangements with neighboring countries to share data on surveillance and the control of public health events that may be of international concern. In 51% of countries, implementation of local community reporting has been evaluated and updated as needed. Country experiences and findings on implementation of event-based surveillance, and the integration with indicator-based surveillance has been documented and shared with the global community in 38% of countries. The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 70% of countries and in 68% of countries, its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Country experiences and findings in notification and use of Annex 2 of the IHR have been documented and shared globally in 73% of countries. All events that meet the criteria for notification under Annex 2 of IHR have been notified by the IHR NFP to WHO within 24 hours of conducting risk assessments over the last 12 months in 38% of countries. 49% of countries report all events identified as urgent within the past 12 months were assessed within 48 hours of reporting. The IHR NFP can respond to all verification requests from WHO within 24 hours in 62% of countries reporting. Good to very good progress has been made in fulfilling the requirements for indicator and event based surveillance. Notification, evaluation, and assessment of notified events are areas for future improvement.

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been developed in 65% of countries. 35% of countries have implemented a national program for protecting health-care workers. Infection control measures and their effectiveness are regularly evaluated and published in 11% of countries. 46% report that tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions, according to national or international guidelines. 46% have qualified IPC professionals in place. In 32% of countries there is surveillance within high risk groups to promptly detect and investigate clusters of infectious disease patients, as well as unexplained illnesses in health workers. A monitoring system for antimicrobial resistance has been implemented, with available data on the magnitude and trends in 27% of countries. Good to very good progress has been made towards fulfilling response capacity in many areas, with significant need for improvement in establishing case management guidelines, evaluation of plans, and in the monitoring of antimicrobial resistance.

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Multi-hazard National Public Health Emergency Preparedness & Response Plan

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38% of countries have conducted an assessment of the capacity of existing national structures and resources to meet IHR core capacities for the implementation of IHR. A national plan to meet the IHR core capacity requirements has been developed (Annex 1A Article 2) in 38% of countries ,and a national public health emergency response plan for IHR related hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 57% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 35% of countries in an actual emergency or simulation and are updated as needed. In 57% of countries, a policy or strategy is in place to facilitate development of surge capacity and a national plan for surge capacity to respond to public health emergencies of national and international concern. Surge capacity is available in 41% of countries. Surge capacity has been tested either through response to a public health event or during an exercise and determined to be adequate in 27% of countries. 27% of countries have documented experiences and findings on emergency response and in mobilizing surge capacity and have shared with the global community.

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Public health risk and resource mapping Public Health Emergency Response mechanisms

    89% of countries have case management guidelines in place for priority conditions. Resources for rapid response during outbreaks of national or international concern are accessible in 62% of countries. In 68% of countries, management procedures have been established for command, communications, and control during public health emergency response operations. A functional, dedicated command and control operations centre at the national or other relevant level exists in 62% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 35% of countries. 32% of countries have offered assistance to other States Parties for developing their response capacities or implementing control measures. Rapid Response Teams (RRT) are available in 70% of countries, and of these. 57% have SOPs available for the deployment of RRT members. In 68% of countries, multidisciplinary RRT can be deployed within 48 hours from the time when the decision to respond is taken. Evaluations of response, including the timeliness and quality of response, are systematically carried out in 30% of countries.

National resources have been assessed by 14% of countries to address priority risks. A directory of experts in health and other sectors to support a response to IHRrelated hazards is available in 38% of countries. 32% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations. 19% of countries regularly assess the national risk profile and resources to accommodate emerging threats. A plan for management and distribution (if applicable) of national stockpiles is available in 38% of countries. 22% have stockpiles (critical stock levels) available and accessible for responding to the country's priority biological, chemical, and radiological events and other emergencies. 16% of countries contribute to international stockpiles. Insufficient progress has been made in the area of preparedness. Further effort is required across all attributes in order to fulfill the requirements for IHR implementation.

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Infection Prevention and Control (IPC) at national and hospital levels

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In 68% of countries, responsibilities are assigned for surveillance of health-careassociated infections and in 51% anti-microbial resistance. In 65% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available and have been implemented in 51%. SOPs, guidelines, and protocols for IPC is available to all hospitals in 62% of countries, and defined norms or guidelines for protecting health-care workers have

Mechanisms for effective risk communication during a public health emergency

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Risk communication partners and stakeholders have been identified in 68% of countries. A plan has been developed in 35% of countries and 16% have validated their plan through an actual emergency or simulation exercise in the past 12 months.

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Policies, SOPs, or guidelines on the clearance and release of information during a public health event have been developed in 41% of countries. 3% have evaluated public health communication after emergencies, including for timeliness, transparency, and appropriateness of communications, and have updated SOPs as needed following evaluation of the public health communication. In 70% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC (Information, Education and Communications) materials are tailored to the needs of the population in 73% of countries. 70% of countries have informed populations and partners have been informed of a real or potential risk within 24 hours in the past three national or international public health emergencies. Good progress has been made in making tailored IEC materials accessible. Evaluation of risk communications efforts and the sharing of these evaluations need improvement.

to guide and update biosafety regulations, procedures, and practice, including for decontamination and management of infectious waste. Modest progress has been made in the area of laboratory services. Inventory and accreditation of laboratories and biorisk assessment are areas for further work.

General obligation required at Points of Entry (PoE)

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Human resources available to implement IHR Core Capacity Requirements

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In 62% of countries a unit has been identified to assess human resource capacities to meet the country's IHR requirements. A needs assessment has been conducted to identify gaps in human resources and training (numbers and competencies) to meet IHR requirements in 32% of countries. A plan has been developed to meet training requirements in 30% of countries. Specific programs with allocated budgets to train workforces in IHR relevant hazards exist in 19% of countries; responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 19% of countries have achieved targets meeting workforce numbers and skills consistent with milestones set in training development plan. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally, or internationally in 51% of countries. Insufficient progress has been made in most human resource capacities. Attributes for improvement include identifying gaps in human resources and training and planning to meet training requirements.

A review meeting (or other appropriate method) to identify Points of Entry for designation has been conducted in 65% of countries and 59% have identified designated ports/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation have been sent to WHO (as specified in Article 20, no.3) by 35% of countries. Relevant legislation, regulations administrative acts, and other government instruments to facilitate IHR implementation at designated PoE has been updated as needed in 24% of countries. In 35% all designated ports have been assessed and updated IHR health documents implemented at designated PoE(s) in 49%. 16% of countries report a joint designation of PoE for core capacity development between countries.

Effective surveillance at PoE

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Priority conditions for surveillance at designated PoE have been identified in 57% of countries. 54% of countries have shared surveillance information at designated PoE with the surveillance department/unit. Mechanisms for the exchange of information between designated PoE and medical facilities are in place in 51% of countries. A review of surveillance health threats at designated PoE in the last 12 months and results published in 11% of countries.

Effective response at PoE

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SOPs for response at PoE are available in 24% of countries. A public health emergency contingency response plan at designated PoE has been tested and updated as needed in 5% of countries. Results of the effectiveness of response to public health events at PoE are published in 8% of countries. Modest to good progress has been made towards building capacities at Points of Entry. Further action is still required in building general, surveillance, and response capacities at designated Points of Entry and the development and testing of SOPs.

Laboratory services to test for priority health threats

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73% of countries have a policy to ensure the quality of laboratory diagnostic capacities. 57% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 68% of countries have national quality standards/guidelines available. A network of national and international laboratories is in place to meet diagnostic and confirmatory requirements and support outbreak investigations for event specified in Annex 2 of the IHR in 92% of countries. External Quality Assessment Schemes have been implemented for diagnostic laboratories for major public health disciplines in 73% of countries. More than 10 non-AFP (Acute Flaccid Paralysis) hazardous specimens per year were referred to national or international reference laboratories for examination in 78% of countries. All diagnostic laboratories are certified or accredited to international standards or to national standards adapted from international standards in 24% of countries.

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Mechanisms for detecting and responding to zoonoses and potential zoonoses

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In 76% of countries, there is a coordination mechanism within the responsible government authority(ies) for the detection of and response to zoonotic events. A national policy or strategy is in place for the surveillance and response to zoonotic events in 65% of countries. 68% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 54% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units, and laboratories have been established and documented. In 70% of countries there a list of priority zoonotic diseases with case definitions available. 59% collect and collate zoonotic disease data in a systematic and timely manner. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 38% of countries. 89% of countries have access to laboratory capacity, nationally or internationally, to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 46% of countries. A regularly updated roster (list) of experts that can respond to zoonotic events is available in 30% of countries. 59% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors. 51% of countries responded in a timely manner to more than 80% of zoonotic events of potential national and international concern.

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Laboratory biosafety and biosecurity practices

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68% of countries have biosafety guidelines accessible to individual laboratories. Regulations, policies, or strategies for laboratory biosafety exist in 57% of countries. In 57% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity, and biosafety guidelines, manuals, or SOPs have been disseminated to laboratories. Relevant staff have been trained on biosafety guidelines in 68% of countries. 62% of countries have identified an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. 35% of countries have conducted a biorisk assessment in laboratories

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51% of countries have shared country experiences and findings with the global community related to zoonotic risks and events of potential national and international concern. Good progress has been made in detecting and responding to zoonotic events. Further action is needed in maintaining rosters of experts and in timely exchange of surveillance information between animal and human health sectors.

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appropriate chemical units and surveillance units about urgent chemical events and potential chemical risks is available in 16% of countries. 11% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies. 35% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events. 8% of countries have tested chemical event response plans through occurrence of a real event or through a simulation exercise and updated them as needed. An adequately-resourced Poison Centre(s) is in place in 5% of the countries. Country experience and findings regarding chemical events and risk of national and international concern have been shared with the global community in 16% of countries. Insufficient progress has been made towards capacities to detect and respond to chemical events. Work across all attributes is needed to meet IHR requirements.

Detecting and responding to foodborne disease and food contamination

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National or international food safety standards are available in 76% of countries. 78% of countries have national food laws, regulations, or policy in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events is in place in 51% of countries. A functioning coordination mechanism has been established between the Food Safety Authorities, specifically the INFOSAN Emergency Contact Point (if member) and the IHR NFP in 38% of countries. 57% are active members of the INFOSAN network. 35% of countries have a list of priority food safety risks available. Guidelines or manuals on the surveillance, assessment, and management of priority food safety risks are available in 43% of countries. 16% of countries have systematically collected and analyzed epidemiological data related to food contamination. In 41% of countries, food safety authorities report systematically on food safety events of national or international concern to the surveillance unit. Risk-based food inspection services are in place in 65% of countries. 59% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques. In 27% of countries, a roster of food safety experts is available for the assessment, id and response to food safety events. 14% of countries have tested and updated operational plans for responding to food safety events as needed. 51% of countries have established mechanisms for tracing, recall, and disposal of contaminated products. 38% of countries have communication mechanisms and materials in place to inform, educate, and advise stakeholders across the farm-to-fork continuum. Food safety control management systems have been implemented in 59% of countries. In 46% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards, and regulations. An analysis of food safety events, foodborne illness trends, and outbreaks, which integrate data across the food chain, has been published in 16% of countries. Modest to good progress has been made in the capacity to detect and respond to foodborne disease and food contamination. Areas for further action include development and testing of operational plans and collection and analysis of data.

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Detecting and responding to radiological and nuclear emergencies

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Experts have been identified for public health assessment and response to radiological and nuclear events in 41% of countries. 35% of countries have a national policy or plan in place for the detection, assessment, and response to radiation emergencies. A national policy or plan for national and international transport of radioactive material and samples and waste management, including from hospitals and medical services, is in place in 22% of countries. 24% of countries have established a coordination and communication mechanism for risk assessments, risk communications, planning, exercising, and monitoring among relevant National Competent Authorities (NCAs) responsible for nuclear regulatory control/safety, national public health authorities, the Ministry of Health, the IHR NFP and other relevant sectors. 27% have designated focal points for radiological and nuclear events for coordination and communication with the Ministry of Health and/or the NFP. 32% of countries have monitoring in place for radiation emergencies. A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a PHEIC is in place in 14% of countries. In 16% of countries, scenarios, technical guidelines, and SOPs for risk assessment, reporting, event verification and notification, investigation, and management of radiation emergencies are available. A radiation emergency response plan is in place in 16% of countries. 8% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification. 19% of countries have a mechanism in place for access to health facilities (inside or outside of the country) with capacity to manage patients of radiation emergencies. 35% of countries have basic laboratory capacity and instruments to detect and confirm the presence of radiation and identify its type (alpha, beta, or gamma) for potential radiation hazards. Regularly updated collaborative mechanisms are in place in 30% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis, and ESR (electron-spin resonance technique). 8% have documented and shared country experiences with the detection and response to radiological risks and events with the global community Insufficient progress has been made towards fulfilling requirements for radiological events. Significant further action across all attributes is required to meet IHR requirements.

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Detection, alert and response to chemical emergencies

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30% of countries have identified experts for public health assessment and response to chemical incidents. In 30% national policies or plans are in place for chemical event surveillance, alert, and response. In 30% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR NFP and 24% have a functional coordination mechanism for surveillance and timely response across sectors. Surveillance is in place for chemical events, intoxication, or poisonings in 27% of countries. 16% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern. An inventory of major hazard sites and facilities that could be a source of chemical public health emergencies is available in 27% of countries. 11% have available and disseminated manuals and SOPs for rapid assessment, case management, and control of chemical events. A timely and systematic information exchange between

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With the coming into force of the International Health Regulations (2005) (hereinafter “IHR” or “the Regulations”) o n June 15, 2007, all IHR States Parties are required to assess the ability of their national structures and resources to meet minimum national core capacities for surveillance and response as specified in the IHR and to develop a plan of action to ensure that these capacities will be present and functioning throughout their territories by 2012. WHO is mandated to provide appropriate tools, guidance and support to States Parties to achieve these goals. In accordance with Article 54 of the IHR and related resolution WHA61.2, States Parties and WHO are required to report annually to the World Health Assembly on the implementation of the Regulations. For this purpose, a monitoring framework was developed using technical expert views drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2011, 80% of countries (i.e. 28/35) in the American region responded to the National Capacity Monitoring Questionnaire*, which is higher compared to 2009 (66%) and 2010 (57%). Throughout this Regional Summary sheet, percentage values relate to responding countries only. Information extracted from the inputs provided by National Focal Points is reflected here to provide an overview of the progress achieved in the region as reported by State Parties in 2011.

For further reference and information on individual elements (core capacities, indicators, attributes) please consult: http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf

82% of countries report using the IHR Event Information Site (EIS) as an integral information resource. 100% of countries report that coordination between relevant ministries on events that may constitute a public health event or risk of national or international concern is in place. Standard Operating Procedures (SOPs) are available for coordination between IHR NFP and stakeholders of relevant sectors in 61% of countries. 86% of countries report having a multisectoral, multidisciplinary committee, body, or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 68% of countries through an actual event occurrence or through exercises and have been updated as needed. 100% of countries have identified national stakeholders involved in the implementation of IHR and 46% of countries conduct updates on the status of implementation of IHR annually. Roles and responsibilities of various stakeholders under the IHR have been defined in 61% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 68% of countries. An active IHR website or web page has been established in 21% of countries. Very good progress has been made in the area of coordination and NFP communications with the region fulfilling some requirements. Further work is needed in updating the status of IHR implementation and defining roles and responsibilities of stakeholders.

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Legislation, regulations, administrative requirements, policies, or other government instruments, sufficient for implementation of the IHR.

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Legal requirements and instruments are assessed in 75% of countries and implemented in 46% of countries (documentation available). National policies have been reviewed to facilitate the implementation of functions of the IHR National Focal point (IHR NFP) and of technical core capacities in 82% of countries. Key elements of national IHR legislation have been published in 36% of countries. Policies to facilitate IHR NFP core and expanded functions and to strengthen technical core capacities have been implemented in 61% of countries (documentation available). Overall, good progress has been made towards fulfilling requirements for national policy and legislation. Further action is still required in implementation of legal requirements and policies.

Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)

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Lists of priority diseases or conditions for surveillance as well as case definitions for priority diseases are available in 100% of countries. Also, 96% of countries have designated specific units for surveillance of public health risks and 71% of countries indicate timely reporting from at least 80% of all reporting units. Surveillance data on epidemic prone and priority diseases is analysed at least weekly at national and sub-national levels in 93% of countries. 82% of countries have defined baseline estimates, trends, and thresholds for alert and action for the local public health response level for priority diseases/events. In 75% of countries reports or other documentation showing that deviations or values exceeding thresholds are detected and used for action at the primary public health response level. At least quarterly feedback of surveillance results is disseminated to all levels and relevant stakeholders in 82% of countries.

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Coordination mechanism between relevant sectors implementing the IHR  The IHR NFP has been established in 93% of countries and information on the obligations of the NFP under the IHR has been distributed in 75% of countries. Additional roles and responsibilities for the IHR NFP functions have been implemented in 46% of countries. The NFP provides WHO with updated contact information and confirmation of the NFP on an annual basis in 93% of countries.

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Evaluations of the early warning function of the indicator-based surveillance have been carried out and country experiences, findings, and lessons learnt shared with the global community in 57% of countries.

national infection prevention and control policies/guidelines, and an operational plan for infection control are available and have been implemented in 79%.

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Event-Based Surveillance

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SOPs and guidelines for event-based surveillance are available in 75% of countries. 96% of countries have designated unit(s) for event-based surveillance that may be part of an existing routine surveillance system. SOPs and guidelines for event capture, reporting, confirmation, verification, assessment, and notification have been developed and disseminated in 71% of countries. Information sources for public health events and risks have been identified in 96% of countries. A system at national and/or sub-national levels for capturing and registering public health events from a variety of sources, including media (print, broadcast, community, electronic, internet etc.), is in place in 89% of countries. 57% of countries have actively engaged and sensitized community leaders, networks, health volunteers, and other community members to the detection and reporting of unusual health events. 79% of countries have arrangements with neighboring countries to share data on surveillance and the control of public health events that may be of international concern. In 50% of countries, implementation of local community reporting has been evaluated and updated as needed. Country experiences and findings on implementation of event-based surveillance, and the integration with indicator-based surveillance has been documented and shared with the global community in 46% of countries. The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 93% of countries and in 96% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Country experiences and findings in notification and use of Annex 2 of the IHR have been documented and shared globally in 89% of countries. All events that meet the criteria for notification under Annex 2 of IHR have been notified by the IHR NFP to WHO within 24 hours of conducting risk assessments over the last 12 months in 75% of countries. 79% of countries report all events identified as urgent within the past 12 months were assessed within 48 hours of reporting. The IHR NFP can respond to all verification requests from WHO within 24 hours in 82% of countries reporting. Good to very good progress has been made in fulfilling implementation requirements for surveillance. The region has fulfilled requirements for establishing lists of priority diseases. Implementation of community level reporting is an area for improvement.

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SOPs, guidelines, and protocols for IPC are available to all hospitals in 86% of countries, and defined norms or guidelines for protecting health-care workers have been developed in 89% of countries. 46% of countries have implemented a national program for protecting health care workers. Infection control measures and their effectiveness are regularly evaluated and published in 29% of countries. 75% report that tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines. 79% have qualified IPC professionals in place. In 71% of countries there is surveillance within high risk groups to promptly detect and investigate clusters of infectious disease patients, as well as unexplained illnesses in health workers. A monitoring system for antimicrobial resistance been implemented, with available data on the magnitude and trends in 50% of countries. Overall, good, to very good progress has been made in the area of response. Evaluations of responses and infection control measures are areas for improvement.

Multi-hazard National Public Health Emergency Preparedness & Response Plan

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89% of countries have conducted an assessment of the capacity of existing national structures and resources to meet IHR core capacities for the implementation of IHR. A national plan to meet the IHR core capacity requirements has been developed (Annex 1A Article 2) in 75% of countries and a national public health emergency response plan for IHR-related hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 75% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 61% of countries in an actual emergency or simulation and are updated as needed. In 71% of countries, a policy or strategy is in place to facilitate development of surge capacity as well as a national plan for surge capacity to respond to public health emergencies of national and international concern. Surge capacity is available in 79% of countries. Surge capacity has been tested either through response to a public health event or during an exercise and determined to be adequate in 64% of countries. 50% of countries have documented and shared experiences and findings on emergency response and in mobilizing surge capacity with the global community.

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Public health risk and resource mapping

 Public Health Emergency Response mechanisms

National resources have been assessed by 36% of countries to address priority risks. A directory of experts in health and other sectors to support a response to IHRrelated hazards is available in 50% of countries. 57% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations. 46% of countries regularly assess the national risk profile and resources to accommodate emerging threats. A plan for management and distribution (if applicable) of national stockpiles is available in 54% of countries. 32% have stockpiles (critical stock levels) available and accessible for responding to the country's priority biological, chemical, and radiological events and other emergencies. 29% of countries contribute to international stockpiles. Progress on preparedness has been mixed in the region. Very good progress has been made in assessing the capacity of existing national structures and resources for IHR implementation. Good progress has been made in building surge capacity. Mapping of resources and access to stockpiles are areas for further improvement.

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79% of countries have case management guidelines in place for priority conditions. Resources for rapid response during outbreaks of national or international concern are accessible in 68% of countries. In 82% of countries, management procedures have been established for command, communications, and control during public health emergency response operations. A functional, dedicated command and control operations centre at the national or other relevant level exists in 82% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 71% of countries. 61% of countries have offered assistance to other States Parties for developing their response capacities or implementing control measures. Rapid Response Teams (RRT) are available in 89% of countries and 71% have SOPs available for the deployment of RRT members. In 89% of countries, multidisciplinary RRT can be deployed within 48 hours from the time when the decision to respond is taken. Evaluations of response, including the timeliness and quality of response, are systematically carried out in 43% of countries.

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Infection Prevention and Control (IPC) at national and hospital levels

Mechanisms for effective risk communication during a public health emergency

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In 89% of countries responsibilities are assigned for surveillance of health-careassociated infections and in 82% for anti-microbial resistance. In 71% of countries

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Risk communication partners and stakeholders have been identified in 93% of countries. A plan has been developed in 64% of countries and 54% have validated

their plan through an actual emergency or simulation exercise in the past 12 months.

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Policies, SOPs, or guidelines on the clearance and release of information during a public health event have been developed in 61% of countries. 43% have evaluated public health communication after emergencies, including for timeliness, transparency, and appropriateness of communications, and have updated SOPs as needed following evaluation of the public health communication. In 96% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC (Information, Education and Communications) materials are tailored to the needs of the population in 89% of countries. 89% of countries have informed populations and partners have been informed of a real or potential risk within 24 hours in the past three national or international public health emergencies. Progress on risk communication in the region has been mixed, with very good progress in making IEC materials available, but only good progress in the development of SOPs and modest progress in evaluation. Further work is needed in the evaluation of public health communications and development and validation of plans.

in 86% of countries. 64% of countries have identified an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. 46% of countries have conducted a biorisk assessment in laboratories to guide and update biosafety regulations, procedures, and practices, including for decontamination and management of infectious waste. Good to very good progress have been made in making laboratory services available to test for priority health threats. Biorisk assessment and accreditation of laboratories are areas for further work.

General obligation required at Points of Entry (PoE)

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Human resources available to implement IHR Core Capacity Requirements

A review meeting (or other appropriate method) to identify Points of Entry for designation has been conducted in 71% of countries and 75% have identified designated ports/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation has been sent to WHO (as specified in Article 20, no.3) by 50% of countries. Relevant legislation, regulations administrative acts, and other government instruments to facilitate IHR implementation at designated PoE has been updated as needed in 29% of countries. In 54% all designated ports have been assessed and updated IHR health documents implemented at designated PoE(s) in 57% of countries. 7% of countries report a joint designation of PoE for core capacity development between countries.

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In 68% of countries a unit has been identified to assess human resource capacities to meet the country's IHR requirements. A needs assessment has been conducted to identify gaps in human resources and training (numbers and competencies) to meet IHR requirements in 64% of countries. A plan has been developed to meet training requirements in 46% of countries. Specific programs with allocated budgets to train workforces in IHR relevant hazards exist in 43% of countries; responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 39% of countries have achieved targets meeting workforce numbers and skills consistent with milestones set in training development plans. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally, or internationally in 68% of countries. Modest to good progress has been made in the area of human resources. Further work is needed in planning, budgeting, and implementation.

Effective surveillance at PoE

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Priority conditions for surveillance at designated PoE have been identified in 57% of countries. 68% of countries have shared surveillance information at designated PoE with the surveillance department/unit. Mechanisms for the exchange of information between designated PoE and medical facilities are in place in 61% of countries. A review of surveillance health threats at designated PoE in the last 12 months and results have been published in 14% of countries.

Effective response at PoE

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SOPs for response at PoE are available in 54% of countries. A public health emergency contingency response plan at designated PoE has been tested and updated as needed in 21% of countries. Results of the effectiveness of response to public health events at PoE are published in 11% of countries. Modest progress has been made towards general obligations, surveillance, and response at Points of Entry. Further work is needed across most attributes to achieve full implementation.

Laboratory services to test for priority health threats

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71% of countries have a policy to ensure the quality of laboratory diagnostic capacities. 68% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 93% of countries have national quality standards/guidelines available. A network of national and international laboratories is in place to meet diagnostic and confirmatory requirements and support outbreak investigations for event specified in Annex 2 of the IHR in 89% of countries. External Quality Assessment Schemes have been implemented for diagnostic laboratories for major public health disciplines in 79% of countries. More than 10 non-AFP (Acute Flaccid Paralysis) hazardous specimens per year are referred to national or international reference laboratories for examination in 57% of countries. All diagnostic laboratories are certified or accredited to international standards or to national standards adapted from international standards in 39% of countries.

Mechanisms for detecting and responding to zoonoses and potential zoonoses

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In 89% of countries, there is a coordination mechanism within the responsible government authority/ies for the detection of and response to zoonotic events. A national policy or strategy is in place for the surveillance and response to zoonotic events in 82% of countries. 86% of countries have designated focal points responsible for animal health for coordination with the Ministry of Health and/or IHR NFP. 79% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories have been established and documented. In 89% of countries there a list of priority zoonotic diseases with case definitions available. 71% collect and collate zoonotic disease data in a systematic and timely manner. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 64% of countries. 93% of countries have access to laboratory capacity, nationally or internationally, to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 71% of countries. A regularly updated roster (list) of experts that can respond to zoonotic events is available in 46% of countries. 75% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors. 79% of countries respond in a timely manner to more than 80% of zoonotic events of potential national and international concern.

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Laboratory biosafety and biosecurity practices

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100% of countries have biosafety guidelines accessible to individual laboratories. Regulations, policies, or strategies for laboratory biosafety exist in 86% of countries. In 71% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity, and biosafety guidelines, manuals, or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines

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50% of countries have shared country experiences and findings related to zoonotic risks and events of potential national and international concern with the global community. Good to very good progress has been made towards detecting and responding to zoonotic events. Attributes for further improvement include surveillance and the maintenance of a roster of available experts.

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43% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies. 61% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events. 25% of countries have tested chemical event response plans through occurrence of a real event or through a simulation exercise and have updated them as needed. An adequately-resourced Poison Centre(s) is in place in 39% of the countries. Country experience and findings regarding chemical events and risks of national and international concern have been shared with the global community in 32% of countries. Modest to good progress has been made for capacities to detect and respond to chemical events. Further work is needed in testing response plans and listing of priority chemical events.

Detecting and responding to foodborne disease and food contamination

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National or international food safety standards are available in 89% of countries. 96% of countries have national food laws, regulations, or policies in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events is in place in 82% of countries. A functioning coordination mechanism has been established between the Food Safety Authorities, specifically the INFOSAN Emergency Contact Point (if member) and the IHR NFP in 79% of countries. 75% are active members of the INFOSAN network. 46% of countries have a list of priority food safety risks available. Guidelines or manuals on the surveillance, assessment, and management of priority food safety risks are available in 61% of countries. 54% of countries have systematically collected and analyzed epidemiological data related to food contamination. In 50% of countries, food safety authorities systematically report on food safety events of national or international concern to the surveillance unit. Risk-based food inspection services are in place in 71% of countries. 82% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques. In 54% of countries, a roster of food safety experts is available for the assessment and response to food safety events. 25% of countries have tested and updated operational plans for responding to food safety events as needed. 89% of countries have established mechanisms for tracing, recall, and disposal of contaminated products. 68% of countries have communication mechanisms and materials in place to inform, educate, and advise stakeholders across the farm-to-fork continuum. Food safety control management systems have been implemented in 75% of countries. In 61% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards, and regulations. An analysis of food safety events, foodborne illness trends, and outbreaks which integrate data across the food chain has been published in 29% of countries. Progress towards fulfilling requirements for the detection and response to food safety events has been mixed. Further work is needed on analysis of food safety events, identification of experts, communication materials, and the testing of operational plans.

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Detecting and responding to radiological and nuclear emergencies

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Experts have been identified for public health assessment and response to radiological and nuclear events in 54% of countries. 54% of countries have a national policy or plan for the detection, assessment, and response to radiation emergencies in place. A national policy or plan for national and international transport of radioactive material and samples and waste management, including from hospitals and medical services is in place in 46% of countries. 50% of countries have established a coordination and communication mechanism for risk assessments, risk communications, planning, exercising, and monitoring among relevant National Competent Authorities (NCAs) responsible for nuclear regulatory control/safety, national public health authorities, the Ministry of Health, the IHR NFP, and other relevant sectors. 43% have designated focal points for radiological and nuclear events for coordination and communication with the Ministry of Health and/or the NFP. 43% of countries have monitoring in place for radiation emergencies. A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a PHEIC is in place in 36% of countries. In 36% of countries, scenarios, technical guidelines, and SOPs for risk assessment, reporting, event verification and notification, investigation, and management of radiation emergencies are available. A radiation emergency response plan is in place in 46% of countries. 29% of countries have carried out radiation emergency response drills regularly at national level, including requesting international assistance (as needed) and international notification. 32% of countries have a mechanism in place for access to health facilities (inside or outside of the country) with capacity to manage patients of radiation emergencies. 50% of countries have basic laboratory capacity and instruments to detect and confirm presence of radiation and identify its type (alpha, beta, or gamma) for potential radiation hazards. Regularly updated collaborative mechanisms are in place in 36% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR (electron-spin resonance technique). 21% have documented and shared country experiences with the global community about the detection and response to radiological risks and events. Insufficient to moderate progress has been made in the areas of detection and response to radiological and radio-nuclear emergencies. Further work is required across most attributes.

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Detection, alert, and response to chemical emergencies

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64% of countries have identified experts for public health assessment and response to chemical incidents. In 46% of countries national policies or plans are in place for chemical event surveillance, alert, and response. In 61% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR NFP and 54% have a functional coordination mechanism for surveillance and timely response across sectors. Surveillance is in place for chemical events, intoxication, or poisonings in 61% of countries. 32% of countries have a list of priority chemical events/syndromes that may constitute a potential PHEIC. An inventory of major hazard sites and facilities that could be a source of chemical public health emergencies is available in 46% of countries. 32% have available and disseminated manuals and SOPs for rapid assessment, case management, and control of chemical events. A timely and systematic information exchange between appropriate chemical units and surveillance units about urgent chemical events and potential chemical risks is available in 50% of countries.

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With the coming into force of t he International Health Regulations (2005) (hereinafter “IHR” or “the Regulations”) on June 15, 2007, all IHR States Parties are required to assess the ability of their national structures and resources to meet minimum national core capacities for surveillance and response as specified in the IHR and to develop a plan of action to ensure that these capacities will be present and functioning throughout their territories by 2012. WHO is mandated to provide appropriate tools, guidance and support to States Parties to achieve these goals. In accordance with Article 54 of the IHR and related resolution WHA61.2, States Parties and WHO are required to report annually to the World Health Assembly on the implementation of the Regulations. For this purpose, a monitoring framework was developed using technical expert views drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2011, 77% of countries (i.e. 17/22) in the Eastern Mediterranean region responded to the National Capacity Monitoring Questionnaire*, which is higher compared to 2009 (41%), but lower than 2010 (82%). Throughout this Regional Summary sheet, percentage values relate to responding countries only. Information extracted from the inputs provided by National Focal Points is reflected here to provide an overview of the progress achieved in the region as reported by State Parties in 2011. For further reference and information on individual elements (core capacities, indicators, attributes) please consult: http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf

94% of countries report using the IHR Event Information Site as an integral information resource. 94% of countries report that coordination between relevant ministries on events that may constitute a public health event or risk of national or international concern is in place. Standard Operating Procedures (SOPs) are available for coordination between IHR NFP and stakeholders of relevant sectors in 76% of countries. 88% of countries report having a multisectoral, multidisciplinary committee, body, or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 59% of countries through an actual event occurrence or through exercises and have been updated as needed. 100% of countries have identified national stakeholders involved in the implementation of IHR and 65% of countries conduct updates on the status of implementation of IHR annually. Roles and responsibilities of various stakeholders under the IHR have been defined in 76% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 65% of countries. An active IHR website or web page has been established in 29% of countries. Overall very good progress has been made in the area of coordination and NFP communications. The region has fulfilled requirements for establishment of the NFP and identification of stakeholders. Testing of coordination mechanisms is an area for further work.

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Legislation, regulations, administrative requirements, policies, or other government instruments, sufficient for implementation of the IHR.

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Legal requirements and instruments are assessed in 82% of countries and implemented in 71% of countries (documentation available). National policies have been reviewed to facilitate the implementation of functions of the IHR National Focal point (IHR NFP) and of technical core capacities in 82% of countries. Key elements of national IHR legislation have been published in 35% of countries. Policies to facilitate IHR NFP core and expanded functions and to strengthen technical core capacities have been implemented in 76% of countries (documentation available). Good to very good progress has been made in the area of legislation, policy and financing. Further work is needed in the area of implementation.

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Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)

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Lists of priority diseases or conditions for surveillance as well as case definitions for priority diseases are available in 100% of countries. Also, 100% of countries have designated specific units for surveillance of public health risks and 76% of countries indicate timely reporting from at least 80% of all reporting units. Surveillance data on epidemic prone and priority diseases is analysed at least weekly at national and sub-national levels in 94% of countries. 82% of countries have defined baseline estimates, trends, and thresholds for alert and action for the local public health response level for priority diseases/events. In 76% of countries reports or other documentation showing that deviations or values exceeding thresholds are detected and used for action at the primary public health response level. At least quarterly feedback of surveillance results is disseminated to all levels and relevant stakeholders in 82% of countries.

 Coordination mechanism between relevant sectors implementing the IHR  The IHR NFP has been established in 100% of countries and information on the obligations of the NFP under the IHR has been distributed in 88% of countries. Additional roles and responsibilities for the IHR NFP functions have been implemented in 41% of countries. The NFP provides WHO with updated contact information and confirmation of the NFP on an annual basis in 94% of countries.

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national infection prevention and control policies/guidelines and an operational plan for infection control are available and have been implemented in 71%.

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Event-Based Surveillance

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SOPs and guidelines for event-based surveillance are available in 71% of countries. 100% of countries have designated unit(s) for event-based surveillance that may be part of an existing routine surveillance system. SOPs and guidelines for event capture, reporting, confirmation, verification, assessment and notification have been developed and disseminated in 53% of countries. Information sources for public health events and risks have been identified in 100% of countries. A system at national and/or sub-national levels for capturing and registering public health events from a variety of sources, including media (print, broadcast, community, electronic, internet etc.), is in place in 100% of countries. 59% of countries have actively engaged and sensitized community leaders, networks, health volunteers, and other community members to the detection and reporting of unusual health events. 65% of countries have arrangements with neighboring countries to share data on surveillance and the control of public health events that may be of international concern. In 59% of countries, implementation of local community reporting has been evaluated and updated as needed. Country experiences and findings on implementation of event-based surveillance, and the integration with indicator-based surveillance has been documented and shared with the global community in 41% of countries. The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 94% of countries and in 100% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Country experiences and findings in notification and use of Annex 2 of the IHR have been documented and shared globally in 100% of countries. All events that meet the criteria for notification under Annex 2 of IHR have been notified by the IHR NFP to WHO within 24 hours of conducting risk assessments over the last 12 months in 82% of countries. 94% of countries report all events identified as urgent within the past 12 months were assessed within 48 hours of reporting. The IHR NFP can respond to all verification requests from WHO within 24 hours in 88% of countries reporting. The region has fulfilled or has made very good progress towards fulfilling requirements for the establishment of indicator and event-based surveillance. Further work is needed on review of early warning functioning and on implementation, review and updating of SOPs.

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SOPs, guidelines and protocols for IPC are available to all hospitals in 76% of countries, and defined norms or guidelines for protecting health-care workers have been developed in 71% of countries. 47% of countries have implemented a national program for protecting health care workers. Infection control measures and their effectiveness are regularly evaluated and published in 59% of countries. 76% report that tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines. 71% have qualified IPC professionals in place. In 59% of countries there is surveillance within high risk groups to promptly detect and investigate clusters of infectious disease patients, as well as unexplained illnesses in health workers. A monitoring system for antimicrobial resistance been implemented, with available data on the magnitude and trends in 41% of countries.

Good to very good progress has been made in the area of response, with requirements fulfilled for the establishment of Rapid Response Teams. Further work is required in the establishment of programmes for protecting health care workers and monitoring systems for antimicrobial resistance.

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Multi-hazard National Public Health Emergency Preparedness & Response Plan

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71% of countries have conducted an assessment of the capacity of existing national structures and resources to meet IHR core capacities for the implementation of IHR. A national plan to meet the IHR core capacity requirements has been developed (Annex 1A Article 2) in 65% of countries and a national public health emergency response plan for IHR-related hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 76% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 59% of countries in an actual emergency or simulation and are updated as needed. In 76% of countries, a policy or strategy is in place to facilitate development of surge capacity as well as a national plan for surge capacity to respond to public health emergencies of national and international concern. Surge capacity if available in 71% of countries. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 53% of countries. 47% of countries have documented and shared experiences and findings on emergency response and in mobilizing surge capacity with the global community.

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Public health risk and resource mapping Public Health Emergency Response mechanisms

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National resources have been assessed by 71% of countries to address priority risks. A directory of experts in health and other sectors to support a response to IHRrelated hazards is available in 71% of countries. 41% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations 35% of countries regularly assess the national risk profile and resources to accommodate emerging threats. A plan for management and distribution (if applicable) of national stockpiles is available in 59% of countries. 41% have stockpiles (critical stock levels) available and accessible for responding to the country's priority biological, chemical and radiological events and other emergencies. 24% of countries contribute to international stockpiles. Overall good progress has been made towards preparedness capacities. More work is needed on the testing of surge capacities, documentation of experiences, stockpiling, risk assessment and testing of plans.

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71% of countries have case management guidelines in place for priority conditions. Resources for rapid response during outbreaks of national or international concern are accessible in 94% of countries. In 71% of countries, management procedures have been established for command, communications, and control during public health emergency response operations. A functional, dedicated command and control operations centre at the national or other relevant level exists in 82% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 71% of countries. 29% of countries have offered assistance to other States Parties for developing their response capacities or implementing control measures. Rapid Response Teams (RRT) are available in 100% of countries, and 65% have SOPs available for the deployment of RRT members. In 100% of countries, multidisciplinary RRT can be deployed within 48 hours from the time when the decision to respond is taken. Evaluations of response including the timeliness and quality of response are systematically carried out in 65% of countries.

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Infection Prevention and Control (IPC) at national and hospital levels

Mechanisms for effective risk communication during a public health emergency  Risk communication partners and stakeholders have been identified in 94% of countries. A plan has been developed in 71% of countries and 53% have validated their plan through an actual emergency or simulation exercise in the past 12 months.

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In 76% of countries responsibilities are assigned for surveillance of health-careassociated infections and in 53% for anti-microbial resistance. In 71% of countries

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Policies, SOPs or guidelines on the clearance and release of information during a public health event have been developed in 29% of countries. 53% have evaluated public health communication after emergencies, including for timeliness, transparency, and appropriateness of communications, and have updated SOPs as needed following evaluation of the public health communication. In 94% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC (Information, Education and Communications) materials are tailored to the needs of the population in 88% of countries. 82% of countries have informed populations and partners have been informed of a real or potential risk within 24 hours in the past three national or international public health emergencies. Modest to good progress has been made in risk communication, with very good progress identifying partners and making tailored IEC information available. Further work is needed on the development of SOPs on the clearance and release of information and the evaluation of public health communication.

responsible for inspection of laboratories for compliance with biosafety requirements. 47% of countries have conducted a biorisk assessment in laboratories to guide and update biosafety regulations, procedures and practices, including for decontamination and management of infectious waste. Good to very good progress has been made in the area of laboratory services. Biorisk assessment and the accreditation of laboratories require further improvement.

General obligation required at Points of Entry (PoE)

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Human resources available to implement IHR Core Capacity Requirements

A review meeting (or other appropriate method) to identify Points of Entry for designation has been conducted in 82% of countries and 94% have identified designated ports /airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation has been sent to WHO (as specified in Article 20, no.3) by 65% of countries. Relevant legislation, regulations administrative acts, and other government instruments to facilitate IHR implementation at designated PoE has been updated as needed in 53% of countries. In 71% all designated ports have been assessed and updated IHR health documents implemented at designated PoE(s) in 71%. 29% of countries report a joint designation of PoE for core capacity development between countries.

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In 82% of countries a unit has been identified to assess human resource capacities to meet the country's IHR requirements. A needs assessment has been conducted to identify gaps in human resources and training (numbers and competencies) to meet IHR requirements in 59% of countries. A plan has been developed to meet training requirements in 65% of countries. Specific programs with allocated budgets to train workforces in IHR relevant hazards exist in 47% of countries; responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 29% of countries have achieved targets meeting workforce numbers and skills consistent with milestones set in training development plans. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally or internationally in 71% of countries. Modest to good progress has been made towards many attributes of human resource capacity. Further work is needed to identify gaps in human resources and training, and in the planning, budgeting and implementing of health workforce measures.

Effective surveillance at PoE

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Priority conditions for surveillance at designated PoE have been identified in 76% of countries. 71% of countries have shared surveillance information at designated PoE with the surveillance department/unit. Mechanisms for the exchange of information between designated PoE and medical facilities are in place in 65% of countries. A review of surveillance health threats at designated PoE in the last 12 months and results have been published in 24% of countries.

Effective response at PoE

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SOPs for response at PoE are available in 47% of countries. A public health emergency contingency response plan at designated PoE has been tested and updated as needed in 47% of countries. Results of the effectiveness of response to public health events at PoE are published in 12% of countries. Good to very good progress has been made across many attributes in general obligations and effective surveillance at PoE. Further work is required in joint designation at PoE, surveillance and response requirements especially in the development and testing of plans and procedures.

Laboratory services to test for priority health threats

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94% of countries have a policy to ensure the quality of laboratory diagnostic capacities. 71% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 76% of countries have national quality standards/guidelines available. A network of national and international laboratories is in place to meet diagnostic and confirmatory requirements and support outbreak investigations for event specified in Annex 2 of the IHR in 82% of countries. External Quality Assessment Schemes have been implemented for diagnostic laboratories for major public health disciplines in 94% of countries. More than 10 non-AFP (Acute Flaccid Paralysis) hazardous specimens per year are referred to national or international reference laboratories for examination in 76% of countries. All diagnostic laboratories are certified or accredited to international standards or to national standards adapted from international standards in 47% of countries.

Laboratory services to test for priority health threats

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In 100% of countries, there is a coordination mechanism within the responsible government authority(ies) for the detection of and response to zoonotic events. A national policy or strategy is in place for the surveillance and response to zoonotic events in 82% of countries. 88% of countries have designated focal points responsible for animal health for coordination with the Ministry of Health and/or IHR NFP. 88% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories have been established and documented. In 76% of countries there a list of priority zoonotic diseases with case definitions available. 65% collect and collate zoonotic disease data in a systematic and timely manner. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 65% of countries. 88% of countries have access to laboratory capacity, nationally or internationally to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 41% of countries. A regularly updated roster (list) of experts that can respond to zoonotic events is available in 53% of countries. 82% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors. 71% of countries respond in a timely manner to more than 80% of zoonotic events of potential national and international concern.

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Laboratory biosafety and biosecurity practices

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82% of countries have biosafety guidelines accessible to individual laboratories. Regulations, policies or strategies for laboratory biosafety exist in 71% of countries. In 71% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity, and biosafety guidelines, manuals, or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 82% of countries. 47% of countries have identified an institution or person

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35% of countries have shared country experiences and findings related to zoonotic risks and events of potential national and international concern with the global community. The region has made good to very good progress towards fulfilling many requirements for detecting and responding to zoonoses and potential zoonoses. Further work is needed in community level surveillance and the exchange of surveillance information.

appropriate chemical units and surveillance units about urgent chemical events and potential chemical risks is available in 35% of countries.

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53% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies. 65% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events. 41% of countries have tested chemical event response plans through occurrence of a real event or through a simulation exercise and have updated them as needed. An adequately-resourced Poison Centre(s) is in place in 47% of the countries. Country experience and findings regarding chemical events and risks of national and international concern have been shared with the global community in 24% of countries. Modest to good progress has been made in fulfilling requirements for detection, alert and response to chemical emergencies. Development and dissemination of SOPs remains an area for improvement.

Detecting and responding to foodborne disease and food contamination

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National or international food safety standards are available in 100% of countries. 88% of countries have national food laws, regulations, or policies in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events is in place in 71% of countries. A functioning coordination mechanism has been established between the Food Safety Authorities, specifically the INFOSAN Emergency Contact Point (if member) and the IHR NFP in 53% of countries. 47% are active members of the INFOSAN network. 71% of countries have a list of priority food safety risks available. Guidelines or manuals on the surveillance, assessment and management of priority food safety risks are available in 71% of countries. 65% of countries have systematically collected and analyzed epidemiological data related to food contamination. In 71% of countries, food safety authorities systematically report on food safety events of national or international concern to the surveillance unit. Risk-based food inspection services are in place in 76% of countries. 82% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques. In 47% of countries, a roster of food safety experts is available for the assessment and response to food safety events. 41% of countries have tested and updated operational plans for responding to food safety events as needed. 82% of countries have established mechanisms for tracing, recall and disposal of contaminated products. 59% of countries have communication mechanisms and materials in place to inform, educate, and advise stakeholders across the farm-to-fork continuum. Food safety control management systems have been implemented in 88% of countries. In 53% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards, and regulations. An analysis of food safety events, foodborne illness trends, and outbreaks which integrate data across the food chain has been published in 6% of countries. Good to very good progress has been made towards fulfilling many requirements for detecting and responding to foodborne disease and food contamination. Testing of response plans is an area for further improvement.

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Hazard: Radiological Events Detecting and responding to radiological and nuclear emergencies

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Experts have been identified for public health assessment and response to radiological and nuclear events in 76% of countries. 71% of countries have a national policy or plan for the detection, assessment, and response to radiation emergencies in place. A national policy or plan for national and international transport of radioactive material and samples and waste management, including from hospitals and medical services is in place in 59% of countries. 71% of countries have established a coordination and communication mechanism for risk assessments, risk communications, planning, exercising and monitoring among relevant National Competent Authorities (NCAs) responsible for nuclear regulatory control/safety, national public health authorities, the Ministry of Health, the IHR NFP and other relevant sectors. 71% have designated focal points for radiological and nuclear events for coordination and communication with the Ministry of Health and/or the NFP. 65% of countries have monitoring in place for radiation emergencies. A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a PHEIC is in place in 59% of countries. In 41% of countries, scenarios, technical guidelines, and SOPs for risk assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. A radiation emergency response plan is in place in 65% of countries. 41% of countries have carried out radiation emergency response drills regularly at national level, including requesting international assistance (as needed) and international notification. 53% of countries have a mechanism in place for access to health facilities (inside or outside of the country) with capacity to manage patients of radiation emergencies. 71% of countries have basic laboratory capacity and instruments to detect and confirm presence of radiation and identify its type (alpha, beta, or gamma) for potential radiation hazards. Regularly updated collaborative mechanisms are in place in 24% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR (electron-spin resonance technique). 18% have documented and shared country experiences with the global community about the detection and response to radiological risks and events. Modest to good progress has been made towards detecting and responding to radiological emergencies. Further action is required across all attributes.

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 Detection, alert and response to chemical emergencies

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 71% of countries have identified experts for public health assessment and response to chemical incidents. In 47% of countries national policies or plans are in place for chemical event surveillance, alert and response. In 65% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR NFP and 41% have a functional coordination mechanism for surveillance and timely response across sectors. Surveillance is in place for chemical events, intoxication or poisonings in 47% of countries. 29% of countries have a list of priority chemical events/syndromes that may constitute a potential PHEIC. An inventory of major hazard sites and facilities that could be a source of chemical public health emergencies is available in 53% of countries. 12% have available and disseminated manuals and SOPs for rapid assessment, case management and control of chemical events. A timely and systematic information exchange between

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With the coming into force of the International Health Regulations (2005) (hereinafter “IHR” or “the Regulations”) on June 15 , 2007, all IHR States Parties are required to assess the ability of their national structures and resources to meet minimum national core capacities for surveillance and response as specified in the IHR and to develop a plan of action to ensure that these capacities will be present and functioning throughout their territories by 2012. WHO is mandated to provide appropriate tools, guidance and support to States Parties to achieve these goals. In accordance with Article 54 of the IHR and related resolution WHA61.2, States Parties and WHO are required to report annually to the World Health Assembly on the implementation of the Regulations. For this purpose, a monitoring framework was developed using technical expert views drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2011, 83% of countries (i.e. 44/53) in the European region responded to the National Capacity Monitoring Questionnaire*, which is higher compared to 2009 (58%) and 2010 (62%). Throughout this Regional Summary sheet, percentage values relate to responding countries only. Information extracted from the inputs provided by National Focal Points is reflected here to provide an overview of the progress achieved in the region as reported by State Parties in 2011. For further reference and information on individual elements (core capacities, indicators, attributes) please consult: http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf

information and confirmation of the NFP on an annual basis in 98% of countries. 82% of countries report using the IHR Event Information Site (EIS) as an integral information resource. 95% of countries report that coordination between relevant ministries on events that may constitute a public health event or risk of national or international concern is in place. Standard Operating Procedures (SOPs) are available for coordination between IHR NFP and stakeholders of relevant sectors in 55% of countries. 73% of countries report having a multisectoral, multidisciplinary committee, body, or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 68% of countries through an actual event occurrence or through exercises and have been updated as needed. 93% of countries have identified national stakeholders involved in the implementation of IHR and 43% of countries conduct updates on the status of implementation of IHR annually. Roles and responsibilities of various stakeholders under the IHR have been defined in 66% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 57% of countries. An active IHR website or web page has been established in 32% of countries. Good to very good progress has been made in the area of coordination and NFP communications. Further work is needed on the development of SOPs and updating of IHR implementation.

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Legislation, regulations, administrative requirements, policies, or other government instruments, sufficient for implementation of the IHR.

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Legal requirements and instruments are assessed in 89% of countries and implemented in 66% of countries (documentation available). National policies have been reviewed to facilitate the implementation of functions of the IHR National Focal point (IHR NFP) and of technical core capacities in 77% of countries. Key elements of national IHR legislation have been published in 68% of countries. Policies to facilitate IHR NFP core and expanded functions and to strengthen technical core capacities have been implemented in 57% of countries (documentation available). Good to very good progress has been made on ensuring adequate government instruments in place are sufficient for implementation of IHR. Further work is needed on implementing required legislation and policies.

Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)

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Lists of priority diseases or conditions for surveillance as well as case definitions for priority diseases are available in 98% of countries. Also, 98% of countries have designated specific units for surveillance of public health risks and 93% of countries indicate timely reporting from at least 80% of all reporting units. Surveillance data on epidemic prone and priority diseases is analysed at least weekly at national and sub-national levels in 95% of countries. 89% of countries have defined baseline estimates, trends, and thresholds for alert and action for the local public health response level for priority diseases/events. In 80% of countries reports or other documentation showing that deviations or values exceeding thresholds are detected and used for action at the primary public health response level. At least quarterly feedback of surveillance results is disseminated to all levels and relevant stakeholders in 95% of countries.

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Coordination mechanism between relevant sectors implementing the IHR  The IHR NFP has been established in 98% of countries and information on the obligations of the NFP under the IHR has been distributed in 80% of countries. Additional roles and responsibilities for the IHR NFP functions have been implemented in 45% of countries. The NFP provides WHO with updated contact

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Evaluations of the early warning function of the indicator-ased surveillance have been carried out and country experiences, findings, and lessons learnt shared with the global community in 43% of countries.

national infection prevention and control policies/guidelines and an operational plan for infection control are available and have been implemented in 84%.

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Event-Based Surveillance

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SOPs and guidelines for event-based surveillance are available in 70% of countries. 98% of countries have designated unit(s) for event-based surveillance that may be part of an existing routine surveillance system. SOPs and guidelines for event capture, reporting, confirmation, verification, assessment and notification have been developed and disseminated in 70% of countries. Information sources for public health events and risks have been identified in 95% of countries. A system at national and/or sub-national levels for capturing and registering public health events from a variety of sources, including media (print, broadcast, community, electronic, internet etc.), is in place in 89% of countries. 57% of countries have actively engaged and sensitized community leaders, networks, health volunteers, and other community members to the detection and reporting of unusual health events. 77% of countries have arrangements with neighboring countries to share data on surveillance and the control of public health events that may be of international concern. In 52% of countries, implementation of local community reporting has been evaluated and updated as needed. Country experiences and findings on implementation of event-based surveillance, and the integration with indicator-based surveillance has been documented and shared with the global community in 50% of countries. The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 95% of countries and in 95% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Country experiences and findings in notification and use of Annex 2 of the IHR have been documented and shared globally in 89% of countries. All events that meet the criteria for notification under Annex 2 of IHR have been notified by the IHR NFP to WHO within 24 hours of conducting risk assessments over the last 12 months in 82% of countries. 84% of countries report all events identified as urgent within the past 12 months were assessed within 48 hours of reporting. The IHR NFP can respond to all verification requests from WHO within 24 hours in 80% of countries reporting. Good to very good progress has been made towards fulfilling the requirements for both indicator and event-based surveillance. Further work is needed on community level evaluation, use of the decision making instrument and sharing of experiences.

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SOPs, guidelines and protocols for IPC are available to all hospitals in 91% of countries, and defined norms or guidelines for protecting health-care workers have been developed in 100% of countries. 77% of countries have implemented a national program for protecting health care workers. Infection control measures and their effectiveness are regularly evaluated and published in 68% of countries. 86% report that tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines. 89% have qualified IPC professionals in place. In 80% of countries there is surveillance within high risk groups to promptly detect and investigate clusters of infectious disease patients, as well as unexplained illnesses in health workers. A monitoring system for antimicrobial resistance been implemented, with available data on the magnitude and trends in 73% of countries. Good to very good progress has been made in the area of response. Evaluations of response and SOPs for the deployment of RRTs are areas for further focus.

Multi-hazard National Public Health Emergency Preparedness & Response Plan

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73% of countries have conducted an assessment of the capacity of existing national structures and resources to meet IHR core capacities for the implementation of IHR. A national plan to meet the IHR core capacity requirements has been developed (Annex 1A Article 2) in 61% of countries and a national public health emergency response plan for IHR-related hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 66% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 66% of countries in an actual emergency or simulation and are updated as needed. In 68% of countries, a policy or strategy is in place to facilitate development of surge capacity as well as a national plan for surge capacity to respond to public health emergencies of national and international concern. Surge capacity if available in 80% of countries. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 57% of countries. 27% of countries have documented and shared experiences and findings on emergency response and in mobilizing surge capacity with the global community.

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Public health risk and resource mapping

 Public Health Emergency Response mechanisms

National resources have been assessed by 48% of countries to address priority risks. A directory of experts in health and other sectors to support a response to IHRrelated hazards is available in 66% of countries. 73% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations 64% of countries regularly assess the national risk profile and resources to accommodate emerging threats. A plan for management and distribution (if applicable) of national stockpiles is available in 84% of countries. 80% have stockpiles (critical stock levels) available and accessible for responding to the country's priority biological, chemical and radiological events and other emergencies. 25% of countries contribute to international stockpiles. Overall, modest to good progress has been made in the area of preparedness. Areas for further work include risk and resource mapping and testing of plans.

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68% of countries have case management guidelines in place for priority conditions. Resources for rapid response during outbreaks of national or international concern are accessible in 93% of countries. In 93% of countries, management procedures have been established for command, communications, and control during public health emergency response operations. A functional, dedicated command and control operations centre at the national or other relevant level exists in 84% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 66% of countries. 30% of countries have offered assistance to other States Parties for developing their response capacities or implementing control measures. Rapid Response Teams (RRT) are available in 73% of countries, and 59% have SOPs available for the deployment of RRT members. In 80% of countries, multidisciplinary RRT can be deployed within 48 hours from the time when the decision to respond is taken. Evaluations of response including the timeliness and quality of response are systematically carried out in 43% of countries.

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Mechanisms for effective risk communication during a public health emergency

Infection Prevention and Control (IPC) at national and hospital levels

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In 100% of countries responsibilities are assigned for surveillance of health-careassociated infections and in 84% for anti-microbial resistance. In 91% of countries

Risk communication partners and stakeholders have been identified in 93% of countries. A plan has been developed in 52% of countries and 48% have validated their plan through an actual emergency or simulation exercise in the past 12 months. 16

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Policies, SOPs or guidelines on the clearance and release of information during a public health event have been developed in 55% of countries. 57% have evaluated public health communication after emergencies, including for timeliness, transparency, and appropriateness of communications, and have updated SOPs as needed following evaluation of the public health communication. In 91% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC (Information, Education and Communications) materials are tailored to the needs of the population in 84% of countries. 89% of countries have informed populations and partners have been informed of a real or potential risk within 24 hours in the past three national or international public health emergencies. Progress on risk communication has been mixed with very good progress on the establishment of risk communication mechanisms with updated information sources being available to the media and public in most countries. Areas requiring improvement include communication planning, validation of plans, and post-emergency evaluation.

61% of countries have conducted a biorisk assessment in laboratories to guide and update biosafety regulations, procedures and practices, including for decontamination and management of infectious waste. Good to very good progress has been made towards fulfilling laboratory capacity requirements. Further work is required in biorisk assessment and evaluating and sharing country experiences.

General obligation required at Points of Entry (PoE)

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Human resources available to implement IHR Core Capacity Requirements

A review meeting (or other appropriate method) to identify Points of Entry for designation has been conducted in 89% of countries and 80% have identified designated ports /airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation has been sent to WHO (as specified in Article 20, no.3) by 61% of countries. Relevant legislation, regulations administrative acts, and other government instruments to facilitate IHR implementation at designated PoE has been updated as needed in 61% of countries. In 45% all designated ports have been assessed and updated IHR health documents implemented at designated PoE(s) in 66%. 11% of countries report a joint designation of PoE for core capacity development between countries.

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In 55% of countries a unit has been identified to assess human resource capacities to meet the country's IHR requirements. A needs assessment has been conducted to identify gaps in human resources and training (numbers and competencies) to meet IHR requirements in 48% of countries. A plan has been developed to meet training requirements in 32% of countries. Specific programs with allocated budgets to train workforces in IHR relevant hazards exist in 25% of countries; responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 23% of countries have achieved targets meeting workforce numbers and skills consistent with milestones set in training development plans. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally or internationally in 43% of countries. Insufficient progress has been made in most areas of human resource capacity. Further work is needed in workforce development and training plans, and overall budgeting and implementation.

Effective surveillance at PoE

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Priority conditions for surveillance at designated PoE have been identified in 64% of countries. 68% of countries have shared surveillance information at designated PoE with the surveillance department/unit. Mechanisms for the exchange of information between designated PoE and medical facilities are in place in 84% of countries. A review of surveillance health threats at designated PoE in the last 12 months and results have been published in 9% of countries.

Effective response at PoE

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SOPs for response at PoE are available in 66% of countries. A public health emergency contingency response plan at designated PoE has been tested and updated as needed in 34% of countries. Results of the effectiveness of response to PH events at PoE are published in 7% of countries. Good to very good progress has been made towards fulfilling requirements at PoE. Further efforts should include sharing and review of surveillance information and validation of SOPs through exercises.

Laboratory services to test for priority health threats

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91% of countries have a policy to ensure the quality of laboratory diagnostic capacities. 66% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 84% of countries have national quality standards/guidelines available. A network of national and international laboratories is in place to meet diagnostic and confirmatory requirements and support outbreak investigations for event specified in Annex 2 of the IHR in 86% of countries. External Quality Assessment Schemes have been implemented for diagnostic laboratories for major public health disciplines in 75% of countries. More than 10 non-AFP (Acute Flaccid Paralysis) hazardous specimens per year are referred to national or international reference laboratories for examination in 61% of countries. All diagnostic laboratories are certified or accredited to international standards or to national standards adapted from international standards in 59% of countries.

Laboratory services to test for priority health threats

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In 95% of countries, there is a coordination mechanism within the responsible government authority(ies) for the detection of and response to zoonotic events. A national policy or strategy is in place for the surveillance and response to zoonotic events in 86% of countries. 84% of countries have designated focal points responsible for animal health for coordination with the Ministry of Health and/or IHR NFP. 89% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories have been established and documented. In 89% of countries there a list of priority zoonotic diseases with case definitions available. 95% collect and collate zoonotic disease data in a systematic and timely manner. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 84% of countries. 93% of countries have access to laboratory capacity, nationally or internationally to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 82% of countries. A regularly updated roster (list) of experts that can respond to zoonotic events is available in 66% of countries. 93% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors. 86% of countries respond in a timely manner to more than 80% of zoonotic events of potential national and international concern.

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Laboratory biosafety and biosecurity practices

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89% of countries have biosafety guidelines accessible to individual laboratories. Regulations, policies or strategies for laboratory biosafety exist in 84% of countries. In 66% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity, and biosafety guidelines, manuals, or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 80% of countries. 66% of countries have identified an institution or person responsible for inspection of laboratories for compliance with biosafety requirements.

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50% of countries have shared country experiences and findings related to zoonotic risks and events of potential national and international concern with the global community. Very good progress has been made towards nearly all requirements for zoonotic events. Further work is still needed on development and maintenance of rosters of experts and sharing experiences.

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77% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies. 70% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events. 64% of countries have tested chemical event response plans through occurrence of a real event or through a simulation exercise and have updated them as needed. An adequately-resourced Poison Centre(s) is in place in 68% of the countries. Country experience and findings regarding chemical events and risks of national and international concern have been shared with the global community in 34% of countries. Good to very good progress has been made towards most requirements for detection, alert and response to chemical emergencies. More action is needed in the development and dissemination of SOPs, surveillance and information exchange.

Detecting and responding to foodborne disease and food contamination

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National or international food safety standards are available in 95% of countries. 98% of countries have national food laws, regulations, or policies in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events is in place in 95% of countries. A functioning coordination mechanism has been established between the Food Safety Authorities, specifically the INFOSAN Emergency Contact Point (if member) and the IHR NFP in 84% of countries. 77% are active members of the INFOSAN network. 77% of countries have a list of priority food safety risks available. Guidelines or manuals on the surveillance, assessment and management of priority food safety risks are available in 84% of countries. 91% of countries have systematically collected and analyzed epidemiological data related to food contamination. In 93% of countries, food safety authorities systematically report on food safety events of national or international concern to the surveillance unit. Risk-based food inspection services are in place in 98% of countries. 95% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques. In 91% of countries, a roster of food safety experts is available for the assessment and response to food safety events. 59% of countries have tested and updated operational plans for responding to food safety events as needed. 95% of countries have established mechanisms for tracing, recall and disposal of contaminated products. 95% of countries have communication mechanisms and materials in place to inform, educate, and advise stakeholders across the farm-to-fork continuum. Food safety control management systems have been implemented in 100% of countries. In 95% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards, and regulations. An analysis of food safety events, foodborne illness trends, and outbreaks which integrate data across the food chain has been published in 64% of countries. Good to very good progress has been made on requirements for detecting and responding to foodborne disease and food contamination. Further efforts should include the testing and updating of operational plans.

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Detecting and responding to radiological and nuclear emergencies

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Experts have been identified for public health assessment and response to radiological and nuclear events in 82% of countries. 86% of countries have a national policy or plan for the detection, assessment, and response to radiation emergencies in place. A national policy or plan for national and international transport of radioactive material and samples and waste management, including from hospitals and medical services is in place in 80% of countries. 82% of countries have established a coordination and communication mechanism for risk assessments, risk communications, planning, exercising and monitoring among relevant National Competent Authorities (NCAs) responsible for nuclear regulatory control/safety, national public health authorities, the Ministry of Health, the IHR NFP and other relevant sectors. 73% have designated focal points for radiological and nuclear events for coordination and communication with the Ministry of Health and/or the NFP. 91% of countries have monitoring in place for radiation emergencies. A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a PHEIC is in place in 68% of countries. In 75% of countries, scenarios, technical guidelines, and SOPs for risk assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. A radiation emergency response plan is in place in 82% of countries. 80% of countries have carried out radiation emergency response drills regularly at national level, including requesting international assistance (as needed) and international notification. 70% of countries have a mechanism in place for access to health facilities (inside or outside of the country) with capacity to manage patients of radiation emergencies. 84% of countries have basic laboratory capacity and instruments to detect and confirm presence of radiation and identify its type (alpha, beta, or gamma) for potential radiation hazards. Regularly updated collaborative mechanisms are in place in 59% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR (electron-spin resonance technique). 50% have documented and shared country experiences with the global community about the detection and response to radiological risks and events with the global community. Good to very good progress has been made towards detecting and responding to radiological events. Further areas for action include updating of collaborative mechanisms for access to specialized laboratories and health facilities.

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 Detection, alert and response to chemical emergencies

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77% of countries have identified experts for public health assessment and response to chemical incidents. In 80% of countries national policies or plans are in place for chemical event surveillance, alert and response. In 82% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR NFP and 75% have a functional coordination mechanism for surveillance and timely response across sectors. Surveillance is in place for chemical events, intoxication or poisonings in 70% of countries. 55% of countries have a list of priority chemical events/syndromes that may constitute a potential PHEIC. An inventory of major hazard sites and facilities that could be a source of chemical public health emergencies is available in 77% of countries. 59% have available and disseminated manuals and SOPs for rapid assessment, case management and control of chemical events. A timely and systematic information exchange between appropriate chemical units and surveillance units about urgent chemical events and potential chemical risks is available in 57% of countries.

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With the coming into force of the International Health Regulations (2005) (hereinafter “IHR” or “the Regulations”) on June 15, 2007, all IHR States Parties are required to assess the ability of their national structures and resources to meet minimum national core capacities for surveillance and response as specified in the IHR and to develop a plan of action to ensure that these capacities will be present and functioning throughout their territories by 2012. WHO is mandated to provide appropriate tools, guidance and support to States Parties to achieve these goals. In accordance with Article 54 of the IHR and related resolution WHA61.2, States Parties and WHO are required to report annually to the World Health Assembly on the implementation of the Regulations. For this purpose, a monitoring framework was developed using technical expert views drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2011, 100% of countries (i.e. 11/11) in the South East Asian region responded to the National Capacity Monitoring Questionnaire*, which is equal to 2010 (100%) and higher than 2009 (64%). Throughout this Regional Summary sheet, percentage values relate to responding countries only. Information extracted from the inputs provided by National Focal Points is reflected here to provide an overview of the progress achieved in the region as reported by State Parties in 2011. For further reference and information on individual elements (core capacities, indicators, attributes) please consult: http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf

information and confirmation of the NFP on an annual basis in 91% of countries. 73% of countries report using the IHR Event Information Site (EIS) as an integral information resource. 91% of countries report that coordination between relevant ministries on events that may constitute a public health event or risk of national or international concern is in place. Standard Operating Procedures (SOPs) are available for coordination between IHR NFP and stakeholders of relevant sectors in 45% of countries. 73% of countries report having a multisectoral, multidisciplinary committee, body, or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 45% of countries through an actual event occurrence or through exercises and have been updated as needed. 100% of countries have identified national stakeholders involved in the implementation of IHR and 73% of countries conduct updates on the status of implementation of IHR annually. Roles and responsibilities of various stakeholders under the IHR have been defined in 82% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 73% of countries. An active IHR website or web page has been established in 27% of countries. Good to very good progress has been made towards fulfilling many IHR NFP functions and operations. An NFP has been established in all countries. Further progress is needed in development of SOPs and testing of plans.

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Legislation, regulations, administrative requirements, policies, or other government instruments, sufficient for implementation of the IHR.

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Legal requirements and instruments are assessed in 82% of countries and implemented in 55% of countries (documentation available). National policies have been reviewed to facilitate the implementation of functions of the IHR National Focal point (IHR NFP) and of technical core capacities in 73% of countries. Key elements of national IHR legislation have been published in 27% of countries. Policies to facilitate IHR NFP core and expanded functions and to strengthen technical core capacities have been implemented in 45% of countries (documentation available). Modest to good progress has been made on assessing legislation. More progress is needed on implementing required legislation and policies.

Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)

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Lists of priority diseases or conditions for surveillance as well as case definitions for priority diseases are available in 100% of countries. Also, 100% of countries have designated specific units for surveillance of public health risks and 64% of countries indicate timely reporting from at least 80% of all reporting units. Surveillance data on epidemic prone and priority diseases is analysed at least weekly at national and sub-national levels in 91% of countries. 55% of countries have defined baseline estimates, trends, and thresholds for alert and action for the local public health response level for priority diseases/events. In 64% of countries reports or other documentation showing that deviations or values exceeding thresholds are detected and used for action at the primary public health response level. At least quarterly feedback of surveillance results is disseminated to all levels and relevant stakeholders in 73% of countries.

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Coordination mechanism between relevant sectors implementing the IHR  The IHR NFP has been established in 100% of countries and information on the obligations of the NFP under the IHR has been distributed in 91% of countries. Additional roles and responsibilities for the IHR NFP functions have been implemented in 45% of countries. The NFP provides WHO with updated contact

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Infection Prevention and Control (IPC) at national and hospital levels

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Event-Based Surveillance

In 82% of countries responsibilities are assigned for surveillance of health-careassociated infections and in 64% for anti-microbial resistance. In 91% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available and have been implemented in 73%. SOPs, guidelines and protocols for IPC are available to all hospitals in 82% of countries, and defined norms or guidelines for protecting health-care workers have been developed in 91% of countries. 45% of countries have implemented a national program for protecting health care workers. Infection control measures and their effectiveness are regularly evaluated and published in 27% of countries. 73% report that tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines. 82% have qualified IPC professionals in place. In 36% of countries there is surveillance within high risk groups to promptly detect and investigate clusters of infectious disease patients, as well as unexplained illnesses in health workers. A monitoring system for antimicrobial resistance been implemented, with available data on the magnitude and trends in 36% of countries. Good to very good progress has been made in the area of response. Further implementation is required in areas such as evaluation of infection control and response measures and monitoring of antimicrobial resistance.

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SOPs and guidelines for event-based surveillance are available in 91% of countries. 100% of countries have designated unit(s) for event-based surveillance that may be part of an existing routine surveillance system. SOPs and guidelines for event capture, reporting, confirmation, verification, assessment and notification have been developed and disseminated in 64% of countries. Information sources for public health events and risks have been identified in 82% of countries. A system at national and/or sub-national levels for capturing and registering public health events from a variety of sources, including media (print, broadcast, community, electronic, internet etc.), is in place in 82% of countries. 55% of countries have actively engaged and sensitized community leaders, networks, health volunteers, and other community members to the detection and reporting of unusual health events. 55% of countries have arrangements with neighboring countries to share data on surveillance and the control of public health events that may be of international concern. In 45% of countries, implementation of local community reporting has been evaluated and updated as needed. Country experiences and findings on implementation of event based surveillance, and the integration with indicator based surveillance has been documented and shared with the global community in 55% of countries. The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 91% of countries and in 82% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Country experiences and findings in notification and use of Annex 2 of the IHR have been documented and shared globally in 82% of countries. All events that meet the criteria for notification under Annex 2 of IHR have been notified by the IHR NFP to WHO within 24 hours of conducting risk assessments over the last 12 months in 73% of countries. 73% of countries report all events identified as urgent within the past 12 months were assessed within 48 hours of reporting. The IHR NFP can respond to all verification requests from WHO within 24 hours in 91% of countries reporting. Mixed progress has been made in fulfilling requirements for indicator and event-based surveillance with some requirements fulfilled and others only seeing modest progress. Work is needed in defining thresholds for and evaluating community reporting and the use of the decision instrument.

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Multi-hazard National Public Health Emergency Preparedness & Response Plan

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73% of countries have conducted an assessment of the capacity of existing national structures and resources to meet IHR core capacities for the implementation of IHR. A national plan to meet the IHR core capacity requirements has been developed (Annex 1A Article 2) in 73% of countries and a national public health emergency response plan for IHR-related hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 64% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 82% of countries in an actual emergency or simulation and are updated as needed. In 82% of countries, a policy or strategy is in place to facilitate development of surge capacity as well as a national plan for surge capacity to respond to public health emergencies of national and international concern. Surge capacity if available in 36% of countries. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 55% of countries. 36% of countries have documented and shared experiences and findings on emergency response and in mobilizing surge capacity with the global community.

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 Public Health Emergency Response mechanisms

Public health risk and resource mapping

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82% of countries have case management guidelines in place for priority conditions. Resources for rapid response during outbreaks of national or international concern are accessible in 100% of countries. In 82% of countries, management procedures have been established for command, communications, and control during public health emergency response operations. A functional, dedicated command and control operations centre at the national or other relevant level exists in 82% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 55% of countries. 45% of countries have offered assistance to other States Parties for developing their response capacities or implementing control measures. Rapid Response Teams (RRT) are available in 100% of countries, and 73% have SOPs available for the deployment of RRT members. In 82% of countries, multidisciplinary RRT can be deployed within 48 hours from the time when the decision to respond is taken. Evaluations of response including the timeliness and quality of response are systematically carried out in 45% of countries.

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National resources have been assessed by 27% of countries to address priority risks. A directory of experts in health and other sectors to support a response to IHRrelated hazards is available in 55% of countries. 27% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations 36% of countries regularly assess the national risk profile and resources to accommodate emerging threats. A plan for management and distribution (if applicable) of national stockpiles is available in 91% of countries. 55% have stockpiles (critical stock levels) available and accessible for responding to the country's priority biological, chemical and radiological events and other emergencies. 18% of countries contribute to international stockpiles. Mixed progress has been made in the area of preparedness. Further work needed towards implementation includes validation of mechanisms for surge capacity, risk and resource mapping, and sharing of country experiences.

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Mechanisms for effective risk communication during a public health emergency

biosafety and biosecurity, and biosafety guidelines, manuals, or SOPs have been disseminated to laboratories.

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Risk communication partners and stakeholders have been identified in 100% of countries. A plan has been developed in 91% of countries and 45% have validated their plan through an actual emergency or simulation exercise in the past 12 months. Policies, SOPs, or guidelines on the clearance and release of information during a public health event have been developed in 64% of countries. 27% have evaluated public health communication after emergencies, including for timeliness, transparency, and appropriateness of communications, and have updated SOPs as needed following evaluation of the public health communication. In 82% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC (Information, Education and Communications) materials are tailored to the needs of the population in 82% of countries. 91% of countries have informed populations and partners have been informed of a real or potential risk within 24 hours in the past three national or international public health emergencies. Mixed progress has been made in risk communication. Areas that require further attention include post-emergency evaluation and testing of public health communication plans.

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Relevant staff has been trained on biosafety guidelines in 82% of countries. 73% of countries have identified an institution or person responsible for inspection of laboratories for compliance with biosafety requirement. 27% of countries have conducted a biorisk assessment in laboratories to guide and update biosafety regulations, procedures, and practice, including for decontamination and management of infectious waste. Good to very good progress has been made across most laboratory capacity requirements. Further action is needed in areas such as national inventories, biorisk assessment, the implementation of biosafety procedures, and accreditation of laboratories.

General obligation required at Points of Entry (PoE)

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Human resources available to implement IHR Core Capacity Requirements

A review meeting (or other appropriate method) to identify Points of Entry for designation has been conducted in 100% of countries and 82% have identified designated ports /airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation has been sent to WHO (as specified in Article 20, no.3) by 55% of countries. Relevant legislation, regulations administrative acts, and other government instruments to facilitate IHR implementation at designated PoE has been updated as needed in 45% of countries. In 64% all designated ports have been assessed and updated IHR health documents implemented at designated PoE(s) in 64%. 18% of countries report a joint designation of PoE for core capacity development between countries.

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In 82% of countries a unit has been identified to assess human resource capacities to meet the country's IHR requirements. A needs assessment has been conducted to identify gaps in human resources and training (numbers and competencies) to meet IHR requirements in 55% of countries. A plan has been developed to meet training requirements in 64% of countries. Specific programs with allocated budgets to train workforces in IHR relevant hazards exist in 64% of countries; responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 27% of countries have achieved targets meeting workforce numbers and skills consistent with milestones set in training development plans. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally or internationally in 82% of countries. Mixed good progress on human resource capacity has been made across the region. Further efforts are required in assessing capacity and training needs.

Effective surveillance at PoE

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Priority conditions for surveillance at designated PoE have been identified in 73% of countries. 73% of countries have shared surveillance information at designated PoE with the surveillance department/unit. Mechanisms for the exchange of information between designated PoE and medical facilities are in place in 64% of countries. A review of surveillance health threats at designated PoE in the last 12 months and results have been published in 18% of countries.

Effective response at PoE

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SOPs for response at PoE are available in 55% of countries. A public health emergency contingency response plan at designated PoE has been tested and updated as needed in 18% of countries. Results of the effectiveness of response to public health events at PoE are published in 9% of countries. Good to very good progress has been made on capacity development at Points of Entry. Further efforts should include assessment of airports and designation of competent authorities, and the development of SOPs.

Laboratory services to test for priority health threats

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82% of countries have a policy to ensure the quality of laboratory diagnostic capacities. 64% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 82% of countries have national quality standards/guidelines available. A network of national and international laboratories is in place to meet diagnostic and confirmatory requirements and support outbreak investigations for event specified in Annex 2 of the IHR in 91% of countries. External Quality Assessment Schemes have been implemented for diagnostic laboratories for major public health disciplines in 73% of countries. More than 10 non-AFP (Acute Flaccid Paralysis) hazardous specimens per year are referred to national or international reference laboratories for examination in 82% of countries. All diagnostic laboratories are certified or accredited to international standards or to national standards adapted from international standards in 45% of countries.

Laboratory services to test for priority health threats

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In 100% of countries, there is a coordination mechanism within the responsible government authority(ies) for the detection of and response to zoonotic events. A national policy or strategy is in place for the surveillance and response to zoonotic events in 91% of countries. 100% of countries have designated focal points responsible for animal health for coordination with the Ministry of Health and/or IHR NFP. 82% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories have been established and documented. In 91% of countries there a list of priority zoonotic diseases with case definitions available. 82% collect and collate zoonotic disease data in a systematic and timely manner. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 64% of countries. 91% of countries have access to laboratory capacity, nationally or internationally to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 82% of countries. A regularly updated roster (list) of experts that can respond to zoonotic events is available in 45% of countries. 91% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.

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Laboratory biosafety and biosecurity practices

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64% of countries have biosafety guidelines accessible to individual laboratories. Regulations, policies, or strategies for laboratory biosafety exist in 55% of countries. In 45% of countries, a responsible entity has been designated for laboratory

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82% of countries respond in a timely manner to more than 80% of zoonotic events of potential national and international concern. 64% of countries have shared country experiences and findings related to zoonotic risks and events of potential national and international concern with the global community. Very good progress has been made towards most requirements in the area of zoonotic events. Further work is needed in sharing of surveillance data and maintaining rosters of experts.

appropriate chemical units and surveillance units about urgent chemical events and potential chemical risks is available in 18% of countries.

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27% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies. 45% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events. No of countries have tested chemical event response plans through occurrence of a real event or through a simulation exercise and have updated them as needed. An adequately-resourced Poison Centre(s) is in place in 55% of the countries. Country experience and findings regarding chemical events and risks of national and international concern have been shared with the global community in 9% of countries. Insufficient to modest progress has been made in establishing mechanisms for detection, alert and response to chemical emergencies. All attributes in this capacity still require improvement.

Detecting and responding to foodborne disease and food contamination

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National or international food safety standards are available in 100% of countries. 100% of countries have national food laws, regulations, or policies in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events is in place in 73% of countries. A functioning coordination mechanism has been established between the Food Safety Authorities, specifically the INFOSAN Emergency Contact Point (if member) and the IHR NFP in 73% of countries. 91% are active members of the INFOSAN network. 64% of countries have a list of priority food safety risks available. Guidelines or manuals on the surveillance, assessment and management of priority food safety risks are available in 73% of countries. 55% of countries have systematically collected and analyzed epidemiological data related to food contamination. In 36% of countries, food safety authorities systematically report on food safety events of national or international concern to the surveillance unit. Risk-based food inspection services are in place in 82% of countries. 55% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques. In 36% of countries, a roster of food safety experts is available for the assessment and response to food safety events. 27% of countries have tested and updated operational plans for responding to food safety events as needed. 73% of countries have established mechanisms for tracing, recall and disposal of contaminated products. 55% of countries have communication mechanisms and materials in place to inform, educate, and advise stakeholders across the farm-to-fork continuum. Food safety control management systems have been implemented in 91% of countries. In 91% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards, and regulations. An analysis of food safety events, foodborne illness trends, and outbreaks which integrate data across the food chain has been published in 18% of countries. Mixed progress has been made towards requirements for detecting and responding to food safety events. Further efforts should include maintaining food safety expert rosters and testing of plans.

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Detecting and responding to radiological and nuclear emergencies

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Experts have been identified for public health assessment and response to radiological and nuclear events in 64% of countries. 55% of countries have a national policy or plan for the detection, assessment, and response to radiation emergencies in place. A national policy or plan for national and international transport of radioactive material and samples and waste management, including from hospitals and medical services is in place in 45% of countries. 27% of countries have established a coordination and communication mechanism for risk assessments, risk communications, planning, exercising and monitoring among relevant National Competent Authorities (NCAs) responsible for nuclear regulatory control/safety, national public health authorities, the Ministry of Health, the IHR NFP and other relevant sectors. 27% have designated focal points for radiological and nuclear events for coordination and communication with the Ministry of Health and/or the NFP. 45% of countries have monitoring in place for radiation emergencies. A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a PHEIC is in place in 27% of countries. In 36% of countries, scenarios, technical guidelines, and SOPs for risk assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. A radiation emergency response plan is in place in 27% of countries. 9% of countries have carried out radiation emergency response drills regularly at national level, including requesting international assistance (as needed) and international notification. 27% of countries have a mechanism in place for access to health facilities (inside or outside of the country) with capacity to manage patients of radiation emergencies. 55% of countries have basic laboratory capacity and instruments to detect and confirm presence of radiation and identify its type (alpha, beta, or gamma) for potential radiation hazards. Regularly updated collaborative mechanisms are in place in 45% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR (electron-spin resonance technique). 27% have documented and shared country experiences with the global community about the detection and response to radiological risks and events. Insufficient to modest progress has been made in developing mechanisms for detecting and responding to radiological and nuclear events. Further efforts are required across all attributes of this capacity.

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Detection, alert and response to chemical emergencies

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55% of countries have identified experts for public health assessment and response to chemical incidents. In 45% of countries national policies or plans are in place for chemical event surveillance, alert and response. In 45% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR NFP and 27% have a functional coordination mechanism for surveillance and timely response across sectors. Surveillance is in place for chemical events, intoxication or poisonings in 45% of countries. 27% of countries have a list of priority chemical events/syndromes that may constitute a PHEIC. An inventory of major hazard sites and facilities that could be a source of chemical public health emergencies is available in 36% of countries. 27% have available and disseminated manuals and SOPs for rapid assessment, case management and control of chemical events. A timely and systematic information exchange between

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With the coming into force of the Int ernational Health Regulations (2005) (hereinafter “IHR” or “the Regulations”) on June 15, 2007, all IHR States Parties are required to assess the ability of their national structures and resources to meet minimum national core capacities for surveillance and response as specified in the IHR and to develop a plan of action to ensure that these capacities will be present and functioning throughout their territories by 2012. WHO is mandated to provide appropriate tools, guidance and support to States Parties to achieve these goals. In accordance with Article 54 of the IHR and related resolution WHA61.2, States Parties and WHO are required to report annually to the World Health Assembly on the implementation of the Regulations. For this purpose, a monitoring framework was developed using technical expert views drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2011, 70% of countries (i.e. 19/27) in the Western Pacific region responded to the National Capacity Monitoring Questionnaire*, which is lower compared with 2009 (93%) and 2010 (78%). Throughout this Regional Summary sheet, percentage values relate to responding countries only. Information extracted from the inputs provided by National Focal Points is reflected here to provide an overview of the progress achieved in the region as reported by State Parties in 2011. For further reference and information on individual elements (core capacities, indicators, attributes) please consult: http://www.who.int/ihr/IHR_Monitoring_Framework_Checklist_and_Indicators.pdf

100% of countries report using the IHR Event Information Site (EIS) as an integral information resource. 100% of countries report that coordination between relevant ministries on events that may constitute a public health event or risk of national or international concern is in place. Standard Operating Procedures (SOPs) are available for coordination between IHR NFP and stakeholders of relevant sectors in 79% of countries. 89% of countries report having a multisectoral, multidisciplinary committee, body, or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 89% of countries through an actual event occurrence or through exercises and have been updated as needed. 95% of countries have identified national stakeholders involved in the implementation of IHR and 37% of countries conduct updates on the status of implementation of IHR annually. Roles and responsibilities of various stakeholders under the IHR have been defined in 74% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 74% of countries. An active IHR website or web page has been established in 26% of countries. Good to very good progress has been made towards fulfilling most requirements for multisectoral collaboration and NFP functions. An NFP has been established in all countries. Improvement is needed in updating stakeholders about IHR implementation.

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Legislation, regulations, administrative requirements, policies, or other government instruments, sufficient for implementation of the IHR.

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Legal requirements and instruments are assessed in 68% of countries and implemented in 63% of countries (documentation available). National policies have been reviewed to facilitate the implementation of functions of the IHR National Focal point (IHR NFP) and of technical core capacities in 68% of countries. Key elements of national IHR legislation have been published in 58% of countries. Policies to facilitate IHR NFP core and expanded functions and to strengthen technical core capacities have been implemented in 68% of countries (documentation available). Good progress has been made towards assessing if legislation in place is sufficient for implementation of IHR. Further work is needed in the implementation of legislation and policies.

Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)

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Lists of priority diseases or conditions for surveillance as well as case definitions for priority diseases are available in 100% of countries. Also, 100% of countries have designated specific units for surveillance of public health risks and 89% of countries indicate timely reporting from at least 80% of all reporting units. Surveillance data on epidemic prone and priority diseases is analysed at least weekly at national and sub-national levels in 84% of countries. 95% of countries have defined baseline estimates, trends, and thresholds for alert and action for the local public health response level for priority diseases/events. In 84% of countries reports or other documentation showing that deviations or values exceeding thresholds are detected and used for action at the primary public health response level. At least quarterly feedback of surveillance results is disseminated to all levels and relevant stakeholders in 79% of countries. Evaluations of the early warning function of the indicator-based surveillance have been carried out and country experiences, findings, and lessons learnt shared with the global community in 79% of countries.

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Coordination mechanism between relevant sectors implementing the IHR  The IHR NFP has been established in 100% of countries and information on the obligations of the NFP under the IHR has been distributed in 89% of countries. Additional roles and responsibilities for the IHR NFP functions have been implemented in 63% of countries. The NFP provides WHO with updated contact information and confirmation of the NFP on an annual basis in 100% of countries.

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Event-Based Surveillance

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SOPs and guidelines for event-based surveillance are available in 84% of countries. 100% of countries have designated unit(s) for event-based surveillance that may be part of an existing routine surveillance system. SOPs and guidelines for event capture, reporting, confirmation, verification, assessment and notification have been developed and disseminated in 74% of countries. Information sources for public health events and risks have been identified in 95% of countries. A system at national and/or sub-national levels for capturing and registering public health events from a variety of sources, including media (print, broadcast, community, electronic, internet etc.), is in place in 100% of countries. 58% of countries have actively engaged and sensitized community leaders, networks, health volunteers, and other community members to the detection and reporting of unusual health events. 89% of countries have arrangements with neighboring countries to share data on surveillance and the control of public health events that may be of international concern. In 53% of countries, implementation of local community reporting has been evaluated and updated as needed. Country experiences and findings on implementation of event-based surveillance, and the integration with indicator-based surveillance has been documented and shared with the global community in 63% of countries. The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 95% of countries and in 95% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Country experiences and findings in notification and use of Annex 2 of the IHR have been documented and shared globally in 100% of countries. All events that meet the criteria for notification under Annex 2 of IHR have been notified by the IHR NFP to WHO within 24 hours of conducting risk assessments over the last 12 months in 89% of countries. 84% of countries report all events identified as urgent within the past 12 months were assessed within 48 hours of reporting. The IHR NFP can respond to all verification requests from WHO within 24 hours in 89% of countries reporting. Good to very good progress has been made towards fulfilling requirements for indicator and event-based surveillance. Implementation, review and updating of SOPs and guidelines, active engagement with stakeholders and evaluation of community level reporting are areas for further improvement.

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SOPs, guidelines, and protocols for IPC are available to all hospitals in 100% of countries, and defined norms or guidelines for protecting health-care workers have been developed in 100% of countries. 63% of countries have implemented a national program for protecting health care workers. Infection control measures and their effectiveness are regularly evaluated and published in 47% of countries. 89% report that tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines. 79% have qualified IPC professionals in place. In 74% of countries there is surveillance within high risk groups to promptly detect and investigate clusters of infectious disease patients, as well as unexplained illnesses in health workers. A monitoring system for antimicrobial resistance been implemented, with available data on the magnitude and trends in 58% of countries. Good to very good progress has been made towards fulfilling most requirements for response capacities. Further work is required in evaluation of IPC procedures, surveillance within high-risk groups, and monitoring for antimicrobial resistance.

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Multi-hazard National Public Health Emergency Preparedness & Response Plan

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74% of countries have conducted an assessment of the capacity of existing national structures and resources to meet IHR core capacities for the implementation of IHR. A national plan to meet the IHR core capacity requirements has been developed (Annex 1A Article 2) in 89% of countries and a national public health emergency response plan for IHR-related hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 79% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 84% of countries in an actual emergency or simulation and are updated as needed. In 95% of countries, a policy or strategy is in place to facilitate development of surge capacity as well as a national plan for surge capacity to respond to public health emergencies of national and international concern. Surge capacity if available in 74% of countries. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 74% of countries. 47% of countries have documented and shared experiences and findings on emergency response and in mobilizing surge capacity with the global community.

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Public health risk and resource mapping Public Health Emergency Response mechanisms

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National resources have been assessed by 42% of countries to address priority risks. A directory of experts in health and other sectors to support a response to IHRrelated hazards is available in 68% of countries. 47% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations 53% of countries regularly assess the national risk profile and resources to accommodate emerging threats. A plan for management and distribution (if applicable) of national stockpiles is available in 79% of countries. 68% have stockpiles (critical stock levels) available and accessible for responding to the country's priority biological, chemical, and radiological events and other emergencies. 21% of countries contribute to international stockpiles. Modest to good progress has been made towards fulfilling most requirements for preparedness. Areas for further attention include resource and risk assessment.

89% of countries have case management guidelines in place for priority conditions. Resources for rapid response during outbreaks of national or international concern are accessible in 100% of countries. In 100% of countries, management procedures have been established for command, communications, and control during public health emergency response operations. A functional, dedicated command and control operations centre at the national or other relevant level exists in 95% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 89% of countries. 63% of countries have offered assistance to other States Parties for developing their response capacities or implementing control measures. Rapid Response Teams (RRT) are available in 95% of countries, and 74% have SOPs available for the deployment of RRT members. In 95% of countries, multidisciplinary RRT can be deployed within 48 hours from the time when the decision to respond is taken. Evaluations of response including the timeliness and quality of response are systematically carried out in 74% of countries.

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Core Capacity 6: Risk Communication Mechanisms for effective risk communication during a public health emergency

Infection Prevention and Control (IPC) at national and hospital levels

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In 95% of countries responsibilities are assigned for surveillance of health-careassociated infections and in 95% for anti-microbial resistance. In 100% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available and have been implemented in 79%.

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Risk communication partners and stakeholders have been identified in 100% of countries. A plan has been developed in 89% of countries and 79% have validated their plan through an actual emergency or simulation exercise in the past 12 months. Policies, SOPs, or guidelines on the clearance and release of information during a public health event have been developed in 89% of countries. 58% have evaluated

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public health communication after emergencies, including for timeliness, transparency, and appropriateness of communications, and have updated SOPs as needed following evaluation of the public health communication. In 89% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC (Information, Education and Communications) materials are tailored to the needs of the population in 95% of countries. 95% of countries have informed populations and partners have been informed of a real or potential risk within 24 hours in the past three national or international public health emergencies. Good to very good progress has been made towards fulfilling risk communication requirements. Areas requiring further attention include post-emergency evaluation.

update biosafety regulations, procedures and practices, including for decontamination and management of infectious waste. Good to very good progress has been made in laboratory capacity. Further work is needed in inspection, inventory and accreditation of laboratories and the conduct of biorisk assessments.

Points of Entry General obligation required at Points of Entry (PoE)

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Human resources available to implement IHR Core Capacity Requirements

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In 68% of countries a unit has been identified to assess human resource capacities to meet the country's IHR requirements. A needs assessment has been conducted to identify gaps in human resources and training (numbers and competencies) to meet IHR requirements in 53% of countries. A plan has been developed to meet training requirements in 58% of countries. Specific programs with allocated budgets to train workforces in IHR relevant hazards exist in 58% of countries; responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 37% of countries have achieved targets meeting workforce numbers and skills consistent with milestones set in training development plans. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally or internationally in 79% of countries.

A review meeting (or other appropriate method) to identify Points of Entry for designation has been conducted in 89% of countries and 95% have identified designated ports /airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation has been sent to WHO (as specified in Article 20, no.3) by 53% of countries. Relevant legislation, regulations administrative acts, and other government instruments to facilitate IHR implementation at designated PoE has been updated as needed in 63% of countries. In 42% all designated ports have been assessed and updated IHR health documents implemented at designated PoE(s) in 68%. 26% of countries report a joint designation of PoE for core capacity development between countries.

Effective surveillance at PoE

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Priority conditions for surveillance at designated PoE have been identified in 74% of countries. 58% of countries have shared surveillance information at designated PoE with the surveillance department/unit. Mechanisms for the exchange of information between designated PoE and medical facilities are in place in 74% of countries. A review of surveillance health threats at designated PoE in the last 12 months and results have been published in 32% of countries.

Modest to good progress has been made on human resource capacity. Further implementation is required in identification of gaps, planning, budgeting, and implementation.

Effective response at PoE

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Core Capacity 8: Laboratory Laboratory services to test for priority health threats

SOPs for response at PoE are available in 58% of countries. A public health emergency contingency response plan at designated PoE has been tested and updated as needed in 42% of countries. Results of the effectiveness of response to public health events at PoE are published in 32% of countries. Modest to good progress has been made on Points of Entry capacity. Further efforts are needed in assessment of designated PoE, testing and updating of plans, and evaluation of response.

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89% of countries have a policy to ensure the quality of laboratory diagnostic capacities. 53% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 89% of countries have national quality standards/guidelines available. A network of national and international laboratories is in place to meet diagnostic and confirmatory requirements and support outbreak investigations for event specified in Annex 2 of the IHR in 100% of countries. External Quality Assessment Schemes have been implemented for diagnostic laboratories for major public health disciplines in 95% of countries. More than 10 non-AFP (Acute Flaccid Paralysis) hazardous specimens per year are referred to national or international reference laboratories for examination in 58% of countries. All diagnostic laboratories are certified or accredited to international standards or to national standards adapted from international standards in 58% of countries.

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Laboratory services to test for priority health threats

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In 95% of countries, there is a coordination mechanism within the responsible government authority(ies) for the detection of and response to zoonotic events. A national policy or strategy is in place for the surveillance and response to zoonotic events in 84% of countries. 95% of countries have designated focal points responsible for animal health for coordination with the Ministry of Health and/or IHR NFP. 79% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories have been established and documented. In 79% of countries there a list of priority zoonotic diseases with case definitions available. 74% collect and collate zoonotic disease data in a systematic and timely manner. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 79% of countries. 84% of countries have access to laboratory capacity, nationally or internationally to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 68% of countries. A regularly updated roster (list) of experts that can respond to zoonotic events is available in 58% of countries. 89% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors. 84% of countries respond in a timely manner to more than 80% of zoonotic events of potential national and international concern.

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Laboratory biosafety and biosecurity practices

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84% of countries have biosafety guidelines accessible to individual laboratories. Regulations, policies, or strategies for laboratory biosafety exist in 68% of countries. In 79% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity, and biosafety guidelines, manuals, or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 79% of countries. 63% of countries have identified an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. 47% of countries have conducted a biorisk assessment in laboratories to guide and

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58% of countries have shared country experiences and findings related to zoonotic risks and events of potential national and international concern with the global community. Good to very good progress has been made in most areas for detecting and responding to zoonoses and potential zoonoses. Further work is needed in establishing intersectoral collaboration, defining priority zoonotic diseases, and zoonotic surveillance.

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appropriate chemical units and surveillance units about urgent chemical events and potential chemical risks is available in 47% of countries. 47% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies. 53% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events. 47% of countries have tested chemical event response plans through occurrence of a real event or through a simulation exercise and have updated them as needed. An adequately-resourced Poison Centre(s) is in place in 37% of the countries. Country experience and findings regarding chemical events and risks of national and international concern have been shared with the global community in 42% of countries. Insufficient to modest progress has been made towards requirements for detection, alert and response to chemical emergencies. Further work is needed across all attributes to meet requirements.

Detecting and responding to foodborne disease and food contamination

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National or international food safety standards are available in 95% of countries. 100% of countries have national food laws, regulations, or policies in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events is in place in 84% of countries. A functioning coordination mechanism has been established between the Food Safety Authorities, specifically the INFOSAN Emergency Contact Point (if member) and the IHR NFP in 89% of countries. 89% are active members of the INFOSAN network. 58% of countries have a list of priority food safety risks available. Guidelines or manuals on the surveillance, assessment and management of priority food safety risks are available in 68% of countries. 63% of countries have systematically collected and analyzed epidemiological data related to food contamination. In 79% of countries, food safety authorities systematically report on food safety events of national or international concern to the surveillance unit. Risk-based food inspection services are in place in 79% of countries. 68% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques. In 53% of countries, a roster of food safety experts is available for the assessment and response to food safety events. 53% of countries have tested and updated operational plans for responding to food safety events as needed. 68% of countries have established mechanisms for tracing, recall and disposal of contaminated products. 84% of countries have communication mechanisms and materials in place to inform, educate, and advise stakeholders across the farm-to-fork continuum. Food safety control management systems have been implemented in 79% of countries. In 74% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards, and regulations. An analysis of food safety events, foodborne illness trends, and outbreaks which integrate data across the food chain has been published in 58% of countries. Progress on food safety capacity requirements in the region ranges from modest to having fulfilled requirements for putting legislation in place to facilitate food safety control. Further efforts are required in the testing of operational plans and collection and analysis of epidemiological data related to food contamination.

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Detecting and responding to radiological and nuclear emergencies

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Experts have been identified for public health assessment and response to radiological and nuclear events in 53% of countries. 42% of countries have a national policy or plan for the detection, assessment, and response to radiation emergencies in place. A national policy or plan for national and international transport of radioactive material and samples and waste management, including from hospitals and medical services is in place in 47% of countries. 58% of countries have established a coordination and communication mechanism for risk assessments, risk communications, planning, exercising and monitoring among relevant National Competent Authorities (NCAs) responsible for nuclear regulatory control/safety, national public health authorities, the Ministry of Health, the IHR NFP and other relevant sectors. 58% have designated focal points for radiological and nuclear events for coordination and communication with the Ministry of Health and/or the NFP. 42% of countries have monitoring in place for radiation emergencies. A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a PHEIC is in place in 42% of countries. In 37% of countries, scenarios, technical guidelines, and SOPs for risk assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. A radiation emergency response plan is in place in 47% of countries. 37% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification. 47% of countries have a mechanism in place for access to health facilities (inside or outside of the country) with capacity to manage patients of radiation emergencies. 53% of countries have basic laboratory capacity and instruments to detect and confirm presence of radiation and identify its type (alpha, beta, or gamma) for potential radiation hazards. Regularly updated collaborative mechanisms are in place in 37% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR (electron-spin resonance technique). 42% have documents and shared country experiences with the global community about the detection and response to radiological risks and events with the global community. Modest progress has been made across most requirements for detecting and responding to radiation emergencies. Further efforts are required in terms of planning and implementation.

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Detection, alert and response to chemical emergencies

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47% of countries have identified experts for public health assessment and response to chemical incidents. In 47% of countries national policies or plans are in place for chemical event surveillance, alert and response. In 68% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR NFP and 58% have a functional coordination mechanism for surveillance and timely response across sectors. Surveillance is in place for chemical events, intoxication or poisonings in 58% of countries. 26% of countries have a list of priority chemical events/syndromes that may constitute a potential PHEIC. An inventory of major hazard sites and facilities that could be a source of chemical public health emergencies is available in 32% of countries. 37% have available and disseminated manuals and SOPs for rapid assessment, case management and control of chemical events. A timely and systematic information exchange between

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Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 23 mai 2014

Source Organisation mondiale de la santé