COVID-19 protracted emergency strategic preparedness and response plan for the WHO African Region. From emergency response to long-term COVID-19 disease management: sustaining gains made during the COVID-19 pandemic, July 2023‒April 2025

COVID-19 protracted emergency strategic preparedness and response plan for the WHO African Region From emergency response to long-term COVID-19 disease management: sustaining gains made during the COVID-19 pandemic July 2023‒April 2025 COVID-19 protracted emergency strategic preparedness and response plan for the WHO African Region From emergency response to long-term COVID-19 disease management: sustaining gains made during the COVID-19 pandemic July 2023‒April 2025 COVID-19 protracted emergency strategic preparedness and response plan for the WHO African Region. From emergency response to long-term COVID-19 disease management: sustaining gains made during the COVID-19 pandemic, July 2023‒April 2025 ISBN: 978-929023503-3 © WHO African Region, 2023 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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COVID-19 protracted emergency strategic preparedness and response plan for the WHO African Region. From emergency response to long-term COVID-19 disease management: sustaining gains made during the COVID-19 pandemic, July 2023‒April 2025. Brazzaville: WHO African Region, 2023. Licence: CC BY- NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. 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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 WHO be liable for damages arising from its use. Designed in Brazzaville, Republic of Congo iii Contents Foreword ........................................................................................................................................ iv Abbreviations .................................................................................................................................. v 1. Situation overview ................................................................................................................. 1 2. Health systems recovery and resilience (2023‒2025): long-term management of COVID-19 ........................................................................................................................... 3 2.1 SPRP components: health preparedness, response and resilience ................................ 4 3. Strategic direction of the WHO-AFRO SPRP .......................................................................... 5 3.1 Goal and objectives of the AFRO SPRP ................................................................................... 5 3.2 Guiding principles ...................................................................................................................... 6 4. SPRP strategic priorities and interventions areas ................................................................. 7 4.1 Emergency coordination........................................................................................................... 7 4.2 Collaborative surveillance .................................................................................................... 9 4.3 Community protection ........................................................................................................ 11 4.4 Safe and scalable care ......................................................................................................... 13 4.5 Access to countermeasures................................................................................................ 14 5. Implementation framework: COVID-19 long-term disease control structure .................... 16 6. Monitoring and evaluation framework ............................................................................... 18 7. Moving forward: key considerations for building back better health systems ................. 19 8. Integration of humanitarian sector response ..................................................................... 21 8.1 Humanitarian sector integration approach ..................................................................... 21 Appendices .................................................................................................................................... 22 References .................................................................................................................................... 33 iv Foreword On 5 May 2023, the WHO Director-General concurred with the advice of the International Health Regulations (IHR (2005)) Emergency Committee on the COVID-19 pandemic that COVID-19 had become an established health issue which no longer constituted a public health emergency of international concern (PHEIC). The IHR (2005) Emergency Committee reached this conclusion in view of the decreasing trend in COVID-19 deaths, the decline in COVID-19 hospitalizations and the increasing levels of population immunity to SARS-CoV-2. While acknowledging the remaining risk of potential evolution of SARS-CoV-2, they advised that it was time to transition to long-term management of the COVID-19 pandemic. WHO has developed a global Strategic Preparedness and Response Plan (SPRP) built on the five core components of effective health emergency preparedness, response and resilience (HEPR), namely: emergency coordination, collaborative surveillance, community protection, safe and scalable care, and access to countermeasures. The WHO Regional Office for Africa (AFRO), in alignment with the global COVID-19 SPRP 2023‒ 2025, has prepared this customized regional SPRP to guide all stakeholders on the management of COVID-19 in this new era. This SPRP will serve as the ‘compass’ that Member States could adapt to country contexts. COVID-19 is still with us. It still has the potential to evolve into virulent strains. Let us stay vigilant and not relent in the protection of our vulnerable populations ‒ the elderly and individuals with comorbidities. It is important that the gains made during the emergency phase of the response be sustained and the lessons learnt contribute to building stronger, more resilient health systems that enhance health security in our Region. Dr Matshidiso Rebecca Moeti Regional Director v Abbreviations AAR after-action reviews AEFI adverse events following immunization Ag-RDT antigen rapid diagnostic test ARI acute respiratory illness CHWS community health workers COVAX COVID-19 Vaccine Global Access COVID-19 coronavirus disease 2019 CSO civil society organization DHMT district health management team EHS emergency health services EMT Emergency Management Team ERF Emergency Response Framework FBO faith-based organization HAI health care-associated infections HCW health care workers HEPR health emergency preparedness response and resilience ICU intensive care unit IHR International Health Regulations IDSR Integrated Disease Surveillance and Response IMST Incident Management Support Team ILI influenza-like illness IPC infection prevention and control KPIs key performance indicators NPHA national public health agency NPHI national public health institute OSL operations support and logistics vi PCR polymerase chain reaction PHEIC public health emergency of international concern PHSMs public health and social measures PoE point of entry PPE personal protective equipment RCCE risk communication and community engagement RI routine immunization SAGE Strategic Advisory Group of Experts on Immunization SARI severe acute respiratory illness SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 SimEx simulation exercises SOPs standard operating procedures SPRP Strategic Preparedness and Response Plan WCOs World Health Organization country offices WHO World Health Organization WHO-AFRO World Health Organization Regional Office for Africa 1 1. Situation overview The COVID-19 pandemic is in its fourth year following its declaration as a PHEIC in 2020. It has had great impact on the health and well-being of the people as well as national and global economies. The COVID- 19 pandemic has demonstrated that health is central to development and fundamental to economies, societies, national security and psychosocial and political stability. Predictions made early in the pandemic on the impact of COVID-19 on the African population and the health systems painted a bleak picture characterized by massive numbers of infections, hospitalizations, stress and deaths; coupled with the collapse of health systems. The reality was different. As of 21 June 2023, 12.5 million cases were recorded in Africa‒compared to 220 million that had been predicted in the first year alone1. Likewise, as of 21 June 2023, less than 300 000 deaths were recorded in Africa, compared to a prediction of 150 million in the first year alone. Other regions were hit worse than Africa. Nonetheless, the Region was found ill-prepared to effectively manage the pandemic given that our health systems were already weak and overstretched. Using the whole-of-government and whole-of-society approaches, nations have been able to contain the pandemic and minimize its impact. In addition to the COVID-19 pandemic, the African Region has grappled with several other emergencies like Ebola virus disease, cholera, monkeypox, Marburg virus disease, measles and humanitarian crises among other afflictions, which have further complicated the response. All these happenings took place amidst acute shortages of life-saving tools like vaccines, medical oxygen and personal protective equipment. Though access to vaccines has improved over time, the Region still has the lowest vaccination coverage with less than 40% of the population completing their primary vaccination series. 1 Cabore JW, Karamagi HC, Kipruto H, et al. The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model. BMJ Global Health 2020; 5: e002647. doi:10.1136/bmjgh-2020-002647 2 Figure 1: COVID-19 Epidemiological Situation in the Region Globally, 767 726 861 cases and 6 948 764 deaths had been reported as of 30 June 2023. The WHO African Region accounts for 1.2% of cases (9 002 990) and 2.5% of deaths (174 297) with a case fatality ratio of 1.9% (Figure 1).2 Currently, the weekly reported cases and deaths are at the lowest levels since the start of the pandemic, necessitating the need to move from an acute emergency response mode to longer-term disease control of COVID-19. On 5 May 2023, WHO Director-General Dr Tedros Adhanom Ghebreyesus declared that COVID-19 was no longer a public health emergency of international concern. COVID-19 is now an established and ongoing health issue which is stabilizing into an endemic state. Millions of people, however, continue to be infected or re-infected with SARS-CoV-2 and thousands of people die each week. Furthermore, inequities in access to life-saving tools and significant burdens from COVID-19 in many countries remain, together with the high risk of the emergence of new variants resulting in future surges. These factors call for continued effort in managing the pandemic, albeit with another approach. Given its long-term nature, the management of COVID-19 should be incorporated into routine health care services alongside other diseases to ensure the sustainability of prevention and response measures. This WHO AFRO SPRP (2023-2025) guides Member States on transiting from crisis response to sustainable, integrated, longer-term and strengthened COVID-19 disease management while continuing with disease prevention, management and control especially among vulnerable populations and controlling the incidence of more virulent variants by maintaining focused surveillance and response. 2 https://covid19.who.int/ June 26, 2023 3 2. Health systems recovery and resilience (2023‒2025): long-term management of COVID-19 COVID-19 pandemic exacerbated Africa's twin health crises of a high disease burden and fragile health systems. It unfolded deep challenges facing Africa’s health care systems and highlighted the need for serious health system reforms. Key challenges include chronic shortage of human and financial resources; poor organization and management; poor governance; limited capacity for data and information management; inadequate medicines, health commodities and supplies; and poor health infrastructure. All countries in the Region faced a delicate balance between effective response to the pandemic and ensuring uninterrupted delivery of essential health services with the latter facing greater hardship due to limited resources that were prioritized for the response at hand. Response to the pandemic led to a significant decline in health outcomes in other areas. Maintenance of the delivery of essential health services was critical to avoid increased morbidity and mortality in the population due to other infectious and noncommunicable diseases. Despite these efforts, the pandemic severely affected the health systems as reported in several publications and country situation reports. Lessons learnt from this response should be used to build long-term resilience in health systems for the future as we also address other determinants of health that render large populations in Africa vulnerable to poor health. On 3 May 2023, a COVID-19 global SPRP for the next 2 years (2023‒2025) was released to support countries transition from emergency response to long-term COVID-19 disease management. The focus is on integrating COVID-19 disease management into broader infectious disease prevention and control programmes during the protracted phase of the disease. This plan calls for countries to assimilate all COVID-19-associated activities into mainstream health systems. The regional COVID-19 SPRP (2023‒2025) aligns with the three strategic objectives outlined in the global COVID-19 SPRP as shown in Figure 2. Figure 2: Objectives of the 2023‒2025 COVID-19 SPRP 4 2.1 SPRP components: health preparedness, response and resilience WHO’s proposed global health architecture for HEPR is replacing the 10 COVID-19 response pillars in this protracted phase as countries transition from response mode to longer-term COVID-19 disease control. The components are emergency coordination, collaborative surveillance, community protection, safe and scalable care, and access to countermeasures (Figure 3). WHO-AFRO will support Member States as they adjust the implementation of COVID-19 activities from the 10-pillar architecture outlined in the 2020, 2021 and 2022 SPRPs to the five core components of COVID-19 preparedness, readiness and response for effective, equitable, inclusive, and coherent disease management and control (Figure 4). Figure 3: Five core components of COVID-19 preparedness, readiness, and response Figure 4. Alignment of COVID-19 operational plans with core HEPR components for effective management during the protracted phase 5 3. Strategic direction of the WHO-AFRO SPRP The AFRO COVID-19 SPRP (2023‒2025) serves as a guide for a holistic public health response to COVID-19 at regional, national, and subnational levels. The 2023 SPRP builds upon the lessons learnt from the implementation of 2020, 2021 and 2022 SPRPs and outlines a regional preparedness, response and recovery strategy for COVID-19. The SPRP has been adapted to reflect the regional context and challenges. It also considers epidemiological changes and recommendations from the annual and evaluation reports of the previous SPRPs. The updated 2023‒2025 COVID-19 strategy outlines practical, high-level actions that need to be sustained as response activities are adjusted to address the drivers of SARS-CoV-2 transmission and prioritizes activities that will continue to lessen the impact of the COVID-19 disease and strengthen health systems. 3.1 Goal and objectives of the AFRO SPRP The goal of the WHO-AFRO 2023‒2025 SPRP is to build resilient and sustainable health systems and engaged and resilient communities to prevent and respond to COVID-19 and other public health threats without disruption to the delivery of essential health services. The acute phase of the pandemic ended with the lifting of the PHEIC status on 5 May 2023 and moving into a period of ensuring sustainable comprehensive management of COVID-19 within broader disease prevention and control programmes. This will be achieved through five specific objectives aligned with the five HEPR core components (Figure 5). Figure 5: AFRO SPRP goals and objectives 6 The goal and objectives will be achieved by implementing the following activities outlined in Figure 6. 3.2 Guiding principles When implementing this SPRP, Member States should adhere to the following guiding principles (Figure 7). Integration: Ensure that the COVID-19 response activities are integrated into the mainstream health system and structures. Adopt a One Health approach to ensure a comprehensive and integrated approach, institutional coordination, collaboration and linkages during the implementation of the SPRP. Effective Leadership: Ensure that national and decentralized health systems leadership is strengthened for effective preparedness and response to public health emergencies including COVID-19. This is critical for building back better health systems. Equity: In the spirit of “leaving no one behind”, ensure that all individuals, including vulnerable populations, receive COVID-19-related services, including vaccination and other essential health services. Figure 6: Approaches to meeting the SPRP objectives Figure 7: AFRO SPRP guiding principles 7 The implementation of the SPRP should also recognize and respond to the gender differences in health and seek to address any underlying factors/barriers that contribute to gender inequalities in health. Decentralization: The implementation of the SPRP should ensure that decentralized health systems (regional, provincial, state, and districts, among others) are strengthened to ensure their fullest involvement and participation in the implementation of the SPRP strategic priorities. Community ownership: This SPRP is built on the principle of empowering communities, promoting collaboration and respecting local knowledge and expertise. Community engagement makes health security and emergency response efforts more effective, sustainable and responsive to the needs of communities, thus ultimately enhancing resilience and reducing the impact of emergencies on public health. Partnership and multisectoral collaboration: Coordinated efforts of a wide range of ministries, departments and agencies (MDAs), and development partners are important as well as building strategic partnerships with the private sector, nongovernmental organizations (NGOs), civil society organizations (CSOs), faith-based organizations (FBOs) and academia for an all-inclusive approach to the implementation of the SPRP and managing future public health emergencies. Evidence-based practice and learning: Available up-to-date evidence will guide informed decision-making during the transition and integration; it will further promote continuous learning and course correction during the implementation of the SPRP. 4. SPRP strategic priorities and interventions areas For each of the five components of the SPRP, Member States should consider the implementation of certain strategic priorities during the 24-month emergency transition period. A list of interventions is also outlined to support the strategic priorities and provides a summary of activities that will contribute to their achievement. 4.1 Emergency coordination Health emergency coordination for COVID-19 and other emergencies should be strengthened through standardized approaches to strategic planning, financing, operations and monitoring of HEPR. This requires the adoption of the One Health approach (a multistakeholder, multisectoral, multidisciplinary and multi-partner mechanism for planning, financing, monitoring and evaluation at the national and subnational levels). 8 Key functions under this objective are coordination, financing, monitoring and evaluation (M&E) and research. Coordination • Develop and/or ensure governance systems are in place to coordinate, mobilize and integrate community-based stakeholders to respond to imminent and actual events. • Establish (if not in place yet) and test health emergency response coordination mechanisms for different levels of public health and health service delivery (and include relevant sectors, organizations, stakeholders and partners at all levels). • Review pandemic preparedness, readiness and response actions and identify key recommendations for transitioning from the acute emergency response, including reviewing and updating: o the concept of operations at the strategic, operational and tactical levels as needed‒engage key sectors, decision-makers, partners and stakeholders; define response needs for projected and planned future response efforts (for example, resurgence); o multisectoral coordination mechanisms at the national and subnational levels to support COVID-19 emergency preparedness and response actions; o country-specific operational plans with estimated resource requirements for COVID-19 preparedness and response inclusive of vaccine readiness and research and innovation priorities as well as early recovery investments. • Define what technical areas are critical to be maintained in the formal response structure (see the six WHO COVID-19 policy briefs) when integrating the workforce and activities into existing public health programmes/sectors and what funding, staffing and resource requirements need to be identified when transitioning aspects of the response to specific public health programmes. • Reassess and characterize how information (surveillance, testing, sequencing, burden metrics and vaccination coverage among priority groups) will continue to be shared among responders. • Identify stakeholders as COVID-19-specific areas of work transition into the longer term and sustained public health programme/sectors. • Integrate and continue to promote whole-of-society and whole-of-government approaches to coordination, specifically to position the health sector response within the broader socioeconomic response and recovery. • Where possible, and to enhance continuity of knowledge, keep the experts and expertise developed during the COVID-19 response for effective and timely management of other public health emergencies at national and subnational levels. • Align the health sector response with humanitarian and development planning and strategic priorities, including supporting human rights, social cohesion and livelihoods; protect, assist and advocate for refugees, internally displaced persons (IDPs), migrants and vulnerable groups. Financing • Establish criteria for shifting from response-driven operations to longer-term sustained public health programmes (for example, technical, programme, workforce) and identify sustainable funding, staffing and resource requirements needed to transition aspects of the response to strengthened and established public health programmes. Objective 1. Maintain high-level commitment to the management of public health emergencies including COVID-19 at all levels of government, the private sector and academia 9 • Evaluate direct and indirect health and economic impacts of COVID-19 and adapt strategies to different contexts based on lessons learnt. Monitoring, evaluation and research • Conduct after-action reviews as a voluntary component under the IHR Monitoring and Evaluation Framework, following the recommendations of the 15th meeting of the IHR Emergency Committee–focusing on improving national coordination mechanisms for future public health emergencies. • Document country experiences to inform longer-term prevention, preparedness, readiness, response, and all- hazard risk management, and guide emergency risk management within the health system to promote resilience; use the data as input for the revision of National Action Plans for Health Security and their integration into national policies and plans. • Update country monitoring and evaluation indicators and systems to prioritize metrics for the burden and impact of COVID-19. • Share lessons learnt, success stories and dissemination of best practices in dealing with COVID-19 across countries and regions. • Conduct research studies on the transition and post-COVID-19 conditions working very closely with the ‘access to countermeasures’ and ‘safe and scalable care’ components for collaborative work on vaccines research, policy and strategy. 4.2 Collaborative surveillance The Emergency Preparedness and Response team at WHO AFRO has prioritized surveillance and testing of infectious diseases, using the Integrated Disease Surveillance and Response system (third edition) for effective response. Declining cases accompanied by the relaxation of public health and social measures and point-of-entry (PoE) requirements such as polymerase chain reaction (PCR) tests for travel, have led to decreasing numbers of specimens collected through routine surveillance and decreased diagnostic testing and sequencing. However, with continued intense circulation worldwide, new variants could emerge anywhere at any time so countries must remain vigilant. As the COVID-19 response transitions from emergency to routine health care services, it remains critical for WHO AFRO to continue to support countries in maintaining COVID-19 testing capacities as needed in alignment with national objectives for COVID-19 surveillance, testing and genomic/variant sequencing. Member States are encouraged to consider surveillance and testing strategies that integrate SARS-CoV-2 testing into the various established infectious diseases surveillance frameworks such as Integrated Disease Surveillance and Response (IDSR), sentinel surveillance for influenza, event-based surveillance, environmental surveillance, participatory surveillance, sero-epidemiologic surveillance and any other surveillance mechanisms for respiratory diseases. Surveillance at the human-animal-environment interface should also be implemented to address any spill over events. 10 Testing strategies may include molecular testing, antigen rapid tests or a combination of both at any level of the health system. However, implementation of testing should remain within the context of the national COVID-19 surveillance objectives summarized as follows: (a) to describe the current burden and epidemiology of disease (b) to monitor trends (c) to identify outbreaks and new pathogen. While each Member State may adopt a country-context strategy for continued surveillance and testing of SARS-CoV-2, it is important to note that any strategy adopted should: (a) be part of the national surveillance objectives. (b) be sustainable in the context of the country in terms of financial, human, and operational resources. (c) capitalize on existing or established systems where possible, including informal and formal community-based surveillance systems; (d) produce and report quality data; and (e) be flexible to adjust to the epidemiological situation in the country. To support countries in the WHO African Region in addressing COVID-19 surveillance and testing, the following approaches will be used, which utilize IDSR as the primary surveillance tool: (a) Testing of community members where signs and symptoms appear in clusters or unusual presentations, using the antigen detection rapid diagnostic test (Ag-RDT) or PCR commonly for those with a history of travel, church groups, traditional settings/ceremonies and also in closed settings such as boarding schools and prisons and linking these to genomic sequencing. (b) Integrate SARS-CoV-2 testing into influenza sentinel surveillance (if already established in-country). (c) If Member States have not established sentinel surveillance for influenza, the Influenza Team at WHO AFRO will be ready to support the implementation of sentinel surveillance. (d) There has been limited reporting of COVID-19 hospitalization data across WHO Member States which makes it difficult to draw firm real-time conclusions from hospitalization trends. Systematic reporting of severe presentations of COVID-19 by reporting hospitalizations and intensive care unit (ICU) admissions of patients with positive COVID-19 tests (with good incorporation of genomic Objective 2. Strengthen prevention, preparedness, and response to COVID-19 and other public health threats 11 sequencing) raises the need to ensure capturing of clinical data. Countries will be technically supported by AFRO to achieve the needful. 4.3 Community protection Effective community response requires nations to build trust between administrative authorities, health authorities and communities through ongoing community mobilization and engagement. It is the basis for reliable and sustainable risk communication and community engagement (RCCE) and infodemic management. Helpful references ❖ Technical Guidelines for IDSR in the WHO African Region: Third edition for standard case definitions for influenza-like illness (ILI), acute respiratory infections (ARI), severe acute respiratory infections (SARI) and other priority diseases. ❖ Protocol for national influenza sentinel surveillance, for the establishment of influenza sentinel surveillance. ❖ The WHO Global Clinical Platform for COVID-19. Important guiding points ❖ The testing strategies described rely on passive surveillance mechanisms. In this regard, they will be influenced by health-seeking behaviour, and this may need to be taken into consideration depending on Member States’ surveillance objectives. ❖ The proposed approaches can be used in combination or singly. The systems are passive and can be applied at different levels of the health system as required. It may also be possible to swap between systems in response to the resurgence of cases. ❖ In instances where active surveillance strategies are required (for example, to investigate a cluster of respiratory illnesses), existing passive surveillance systems should not be disrupted. ❖ PCR is highly technical and resource intensive and may not be suitable or practical to implement at lower levels of the health system. Under these circumstances, Ag-RDT is recommended. ❖ The testing of SARI cases using PCR, particularly multiplex testing for multiple respiratory pathogens, has clinical value to determine the etiology of illness which may guide therapeutic interventions. Additionally, SARI cases can also be tested using Ag-RDT to expedite treatment if SARS-CoV-2 is identified as the etiologic agent. ❖ Ensure quality testing is maintained at community and subnational levels by periodically referring specimens to the national level for testing and storage/bio-banking. ❖ Data from surveillance and testing systems remain vital to monitor and track known and new SARS- CoV-2 variants. All levels of WHO (headquarters, AFRO and country offices) will continue to rely on these data for making important public health decisions. 12 To strengthen community protection and resilience, communities should be empowered to participate in efforts to identify and minimize risk and mitigate the consequences of public health events. This will require building the capacity of community members in health literacy and risk perception among other things. Nations should engage communities in addressing community concerns about the unintended consequences of responding to health emergencies so that daily life continues. Communities are protected through functional PoE health measures such as the provision of travel advice, self-monitoring of signs and symptoms, community surveillance, intensive case finding, international contact tracing and medical services among others. Vaccination remains a key intervention for protecting communities and controlling the COVID-19 pandemic in the Region. Currently, less than 40% of the population in the WHO African Region have completed their primary vaccination series. Under this component, Member States should prioritize the interventions outlined below. Figure 8: Key community protection interventions Protection of vulnerable individuals/populations from developing severe diseases through vaccination is a top priority for WHO. Member States are advised to use recommendations from the WHO Strategic Group of Experts (SAGE) to inform national policies on COVID-19 vaccination. Development of a COVID-19 vaccination integration plan using the guidance provided in the “Considerations for integrating COVID-19 vaccination into immunization programmes and primary health care for 2022 and beyond''. COVID-19 vaccination as an integral part of national immunization programmes (NIPs), primary health care (PHC) and other relevant health services with periodic intensified vaccination activities as needed. 13 Figure 9: The above are specific objectives for country-level engagements to enhance community protection. WHO-AFRO, in collaboration with other partners, will support Member States to enhance community protection against COVID-19 through the recommended activities in Appendix 1. 4.4 Safe and scalable care The COVID-19 pandemic caused global health service disruptions, affecting primary care, emergency care, critical care, rehabilitation care, palliative care and community care. These disruptions led to increased deaths from non-COVID-19 causes, threatening global health gains and the attainment of Sustainable Development Goals, particularly in Africa. Ensuring service restoration and safety is crucial during this protracted phase. The following are specific objectives: (a) Strengthen health systems to deliver essential health services that include COVID-19 by: • improving the functionality and adequacy of health infrastructure and logistics; • strengthening the multi-skilled workforce to deliver essential health services adequately and appropriately, including for COVID-19 and other respiratory conditions; • strengthening the skills of the workforce to include training in basic emergency and ICU care; Information and interventions •To ensure that credible, trusted, relevant, timely, accessible and actionable heath information and lifesaving interventions are provided, accepted and adopted by communities. Health care services •To ensure that travellers have access to basic preventive and health care services at PoEs within a strengthened and resilient health system. Readiness and response •To improve programme efficiency and sustainability, enhance demand for COVID-19 vaccination and improve user satisfaction while achieving and maintaining satisfactory coverage and addressing inequities. Objective 3. Enhance community resilience and protection mechanisms to mitigate the impacts of public health emergencies and crises Objective 4. Strengthen national and decentralized health systems to effectively deliver integrated health services that include COVID-19 14 • ensuring the availability of and access to essential medical commodities and supplies including COVID-19 therapeutics and medical oxygen; • strengthening health facility leadership and governance, including the interface with community health systems; • strengthening health information systems to monitor the continuity of essential health services. (b) Increase access and utilization of essential health services including COVID-19 by: • enhancing facility readiness for the provision of uninterrupted quality health services delivery; • restoring services suspended during the pandemic and addressing any new access barriers; • ensuring availability and access to COVID-19 therapeutics and medical oxygen; • reinforcing point-of-care testing and triage; • improving emergency and critical care workforce. (c) Enhance patient and health worker safety by: • building robust infection prevention and control (IPC) programmes at the national and facility levels (public and private facilities); • ensuring availability of updated IPC guidelines and standard operating procedures (SOPs); • ensuring regular IPC training for health care workers (HCWs); • establishing a surveillance system for health care-associated infections; • monitoring and improving IPC practices in health care facilities to maintain high standards; • optimizing workload, staffing and bed occupancy for effective IPC; • ensuring a clean and safe environment and availability of required supplies and equipment for IPC; • ensuring the availability of updated IPC guidelines and SoPs. Specific activities to support this component are listed in Appendix 2. 4.5 Access to countermeasures In comparison to other WHO regions, the WHO African Region's vaccination coverage remained low during the acute phase of COVID-19 pandemic, with only Liberia, Mauritius, Rwanda and Seychelles achieving the 70% target of the population completing the primary vaccination series. This low uptake in the African Region can be attributed to low-risk perception, low advocacy, misinformation and competing priorities in countries such as response to other public health crises including yellow fever, measles, polio, and monkeypox. As the response transitions to sustainable disease management, Member States are encouraged to increase COVID-19 vaccine coverage, especially among high-risk populations. 15 In this protracted emergency period, WHO-AFRO’s role in supporting the countries’ vaccination programmes will be maintained and COVAX will also provide funded doses and delivery support throughout 2023 in line with demand. Support to Member States after the end of 2023 will be done through follow-on activities as agreed upon and established. WHO African Region Member States are advised to maintain broader activities such as evolving SAGE policies, regulatory processes, and programme guidance. To support timely access to life-saving tools, Member States should ensure the availability of adequate technical capacity for operations support and logistics (OSL) at all levels. In addition, Member States should set up robust systems to enable speedy deployment of supplies in the event of an emergency. The specific objectives under this component are highlighted below. Objective 5: Improve COVID-19 access to life-saving tools WHO-AFRO encourages countries to plan for sustainable COVID-19 vaccination as an integral part of national immunization programmes (NIPs), primary health care (PHC), and other relevant health services, capitalizing on the COVID-19 vaccine investments, innovations, and tools to reach priority populations. Integrating Vaccination WHO-AFRO member states should work towards strengthening system capacities to provide whole population-focused vaccination to be able to reach the target priority groups since most immunization programs in the region have largely been children-focused. Priortizing vulnerable population 16 Figure 10: The above are specific objectives for country-level engagements to enhance access to countermeasures Specific activities are listed in Appendix 3. 5. Implementation framework: COVID-19 long-term disease control structure For a well-coordinated transition, the control structure below is proposed for COVID-19 long-term disease management. Previous response structures will be integrated into existing health system structures. The coordination of the whole system shall be the responsibility of the WHO-AFRO COVID-19 Incident Management Support Team (IMST) in close collaboration with the clusters and WHO country offices to ensure that implementation is in line with the set goals and objectives. In this phase of the pandemic, the COVID-19 IMST should transform into the COVID-19 Emergency Management Support Team (EMST) and work very closely with all health clusters at AFRO; the COVID-19 Incident Management Teams (IMT) in countries should transform into COVID-19 Emergency Management Teams (EMT) within the national health system. Integration and scale-up •Integration of COVID-19 vaccination into immunization programmes and primary health services based on country-specific contexts. •Scale-up of COVID-19 vaccination among high-risk priority populations. Sustainability & supplies •Capitalize on COVID-19 investments and innovations to build more sustainable programmes and strengthen the health systems. •Reinforcement of contingency plan supplies, prepositioning and replenishment at country and regional levels. OSL-HR & oxygen supplies •Scaling up OSL human resource capacity to support operations and health logistics for transition. •Reinforcement of medical oxygen supplies and system maintainance. 17 COVID-19 long-term disease control structures Figure 11: Proposed coordination framework for protracted COVID-19 disease management Description Response structures during the response. During the COVID-19 response WHO AFRO established an Incident Management Support Team (IMST) -comprising eight critical functions with two additional support units and two oversight units- to deliver effective operational response to the COVID-19 pandemic in line with the Emergency Response Framework (ERF). The IMST functions were contextualized).and adapted to country national systems and subnational structures, while the sub-functions were added (and some removed) as the response progressed to address the expanding (or shrinking) needs for services and support. Reporting (downward-upward) is from subnational to national structures and from national structures to the IMST, while feedback (upward-downward) is provided from the IMST to national and national to subnational structures. Transition structures. In the transition phase of a protracted emergency, the COVID-19 Emergency Management Support Team (EMST) will collaborate with the clusters within WHO/AFRO for well- coordinated integration until full integration into the existing health system is achieved. The national IMT will do same with ministries of health national structures (such as public health emergency operations centres (PHEOC), national public health agencies (NPHA), national public health institutes (NPHI) or directorates) to manage COVID-19 like any other disease. Similarly, the subnational task teams will pass roles to decentralized structures (district health management teams (DHMT), regions, provinces or states). While full ownership of the management of COVID-19 will gradually become the responsibility of the Member States, AFRO clusters will provide advice and feedback to the different elements of the response and integration to national and subnational decentralized health system structures. Transition coordination. In the protracted emergency period, a lean team will be maintained at AFRO COVID-19 EMST and the hubs, while focal persons will be appointed at WCOs. These small teams will provide technical updates and evidence-informed options to AFRO clusters and Member States in guiding the transition. 18 6. Monitoring and evaluation framework Based on key performance indicators (KPIs) and lessons learnt over the past 3 years of the pandemic and considering the 2023‒2025 global SPRP and the recommendations from the IHR-EC, the Regional Office has defined a set of 16 KPIs that fit the current transition phase to support Member States and partners in managing COVID-19 as a long-term disease. The KPIs covering the five core components of HEPR, will be assessed quarterly and an outcome evaluation of the SPRP conducted at the end of the period. This SPRP provides a pathway for enhancing evidence-based policy design, linking data gathering and monitoring with people-centred outcomes for better health. The KPIs will measure the level of effectiveness and efficiency of operations during the transition period and provide an evidence base for planning, decision-making and corrective action. Table 1: Key performance indicators for monitoring and evaluation of the plan for COVID-19 in 2023 KPI Indicator Target (%) 1 Percentage of countries that have established all HEPR key functions of emergency coordination, collaborative oversight, community protection, safety and scalability of care, and access to countermeasures that are covered by the country to support the transition to long-term management of COVID-19. 70 2 Percentage of countries that have a transition plan. 100 3 Percentage of countries that have integrated COVID-19 surveillance into routine infectious disease surveillance systems under the regional IDSR strategy. 70 4 Percentage of countries with districts (or regions) sharing timely and complete Epi surveillance data on COVID-19 (cases and deaths) through weekly IDSR reporting channels or existing surveillance platforms in the country. 70 5 Percentage of countries that share SARS-CoV-2 genomic sequencing data regularly. 50 6 Percentage of countries with 70% of stocks of SARS-CoV-2 diagnostics‒either Ag- RDT or PCR reagents for testing available. 70 7 Percentage of countries developing and rolling out appropriate messages for the current COVID-19 phase to the population. 70 8 Percentage of countries that have lifted international travel-related health measures such as proof of vaccination against COVID-19. 100 9 Percentage of countries that have administered at least 70% of received doses. 70 10 Percentage of countries with 70% of the general population fully vaccinated with the primary series. 70 11 Percentage of countries that have integrated COVID-19 vaccination into routine immunization services. 70 19 KPI Indicator Target (%) 12 Percentage of countries that have an active IPC operational action plan that complies with WHO recommendations for the implementation of IPC minimum requirements at the national level. 70 13 Percentage of countries that have integrated COVID-19 clinical care pathways into primary health care systems to ensure that individuals who test positive for SARS-CoV-2 are efficiently linked to care. 70 14 Percentage of countries that can produce medical oxygen locally. 70 15 Percentage of countries with a comparable number of outpatient consultations as in the pre-COVID-19 period (2019). 70 16 Percentage of countries with a comparable number of facility-based deliveries as in the pre-COVID-19 period (2019). 70 7. Moving forward: key considerations for building back better health systems During the current transition from a responsive crisis to longer-term disease control, continued collaborative work is required more than ever in order not to lose the hard-fought gains. Leveraging the lessons learnt and best practices during the response, WHO-AFRO will continue to work with Member States to ensure that COVID-19 is managed more sustainably and ensure that health systems are strengthened to enhance their absorptive, adaptive and transformative capacities to manage future public health threats without disruption in the provision of essential health services. Member States are encouraged to consider the following strategic approaches towards building back better resilient and responsive health systems. • Advance a One Health approach to zoonotic pathogens: the existence of linkages among the ‘epidemiological triad’ of people-animals-environment should be well factored into the routine management of COVID-19 by all WHO African Region member countries, taking cues from previous experiences with zoonotically-inclined emergencies. • Investing in health workers: reviewing and strengthening the training and support measures for health workers could help maintain and expand a healthy, motivated, well-compensated, professionally trained and well-equipped workforce to continue to deliver emergency health services (EHS) during and beyond health emergencies. • Balancing pandemic containment and health service access: avoiding blanket lockdowns and coordinating pandemic containment measures with strategies to enable continued access to EHS could help prevent deterrents to health care usage and support the sustainability of coping mechanisms to ensure EHS continuity such as telemedicine/digital health, task sharing/shifting and changing of health service delivery modalities (by time, place and process). 20 • Cultivating community engagement: investing resources in community engagement and deploying community health workers (CHWs) to support public health communication efforts and EHS delivery have proved demonstrably effective. • Building public trust: is an ongoing process and is the foundation for effective health interventions and collaboration. There needs to be transparent communication, active listening, meaningful participation in decision-making, collaborative design and problem-solving, consistent and reliable information sharing, responsiveness to community need, demonstrated accountability and long-term commitment, among others. • Responsive service delivery: sustaining and embedding innovations in responsive, flexible service delivery through mobile clinics, integrated community vaccination and testing programmes, and telemedicine could help sustain EHS and build system resilience. • Addressing health supply constraints: supply chain disruption and limited access to health commodities had a significant impact on the sustainability of EHS provision. Providing support to cover transportation, electrical power, equipment and communication costs where they impact health service delivery may mitigate disruptions to accessibility. Formalizing innovations in drug provision, such as multi-month drug dispensing or home delivery approaches, could contribute to building supply chain resilience. • Prioritizing health funding: increased government investment in health during the COVID-19 pandemic was essential to EHS continuity. • Fostering multisectoral approaches and partnerships: multisectoral approaches, working across government silos and uniting diverse actors across sectors proved crucial in the COVID-19 pandemic response. Leveraging engagement with non-state actors and private sector stakeholders in service provision and the design of innovative funding mechanisms offers the potential to reduce out-of- pocket expenditure and increase service sustainability in the short and long term. • Advance research and development for SARS-CoV-2 and other respiratory pathogens: focus on research to deepen understanding of and current behaviour of the virus regarding transmission patterns, mutation and how it interacts with the human immune system. • Sustaining COVID-19 innovations: many innovations were created to respond to the pandemic, including hygiene and sanitation facilities in homes and public places and digitized systems for detecting fake medical certificates. It is worthwhile refining and finding the means to sustain these innovations to serve wider purposes and share lessons learnt. • Investing in strengthening preparedness for future public health emergencies The COVID-19 pandemic showed that national governments are ill-equipped to deal effectively with the scale and complexity of health emergencies. The fragmented nature of the current modes of health emergency governance, functional systems and financial mechanisms undermines the ability of member states to respond rapidly, predictably, equitably, and inclusively to health emergencies. Member States should ensure adequate, predictable, and timely financing for health emergency preparedness and response as this is essential for the management of ongoing and future public health emergencies. 21 Effective financing depends not only on more funds but also on more effective mechanisms to ensure that funds are allocated rapidly and targeted to fill critical gaps. 8. Integration of humanitarian sector response Humanitarian responses are the actions and measures implemented by humanitarian organizations and governments to address the needs of vulnerable populations affected by crises, disasters, conflicts or emergencies, while health emergency response refers to the actions and strategies implemented to address and mitigate the health consequences of a public health emergency or crisis. Humanitarian and health emergency responses are interrelated and share cross-cutting themes as highlighted in Appendix 4. 8.1 Humanitarian sector integration approach To integrate humanitarian response and health emergency response in the context of the AFRO SPRP 2023‒2025, it is important to adopt a comprehensive and coordinated approach from the 10 pillars to the five components of the HEPR as demonstrated below. Figure 12: The detailed integration of humanitarian and health emergency response approaches into the HEPR components is highlighted in Appendix 5. Country contextualized humanitarian approaches HEPR component-based objectives, interventions and activities 22 Appendices Appendix 1: Suggested areas of intervention and activities for community protection Capacity building Build capacity in the design, integration and implementation of equity and gender responsive health programmes and interventions. Build capacity in RCCE and infodemic management at national and subnational levels to design effective RCCE strategies for specific contexts. Consider integrated training packages that include health promotion and prevention actions, as well as strengthening countries’ capacities for early warning, risk reduction and management of national and global health risks Effective communication Establish effective communication systems between formal health structures and community structures and map and leverage existing ones. Health management committee Establish community health management committees in health facilities with community representation. Establish a mechanism to sustain, manage and supervise the community health workforce as part of wider efforts to revitalize primary health care structures. Coordination mechanism Strengthen RCCE coordination mechanisms at all levels of government, civil society, and partners to provide integrated RCCE interventions that address multiple public health events. After-action review Conduct COVID-19 after-action reviews (AARs) that incorporate community engagement indicators to inform the transition. Mapping partners Map RCCE and infodemic management partners to ensure the sustainability of RCCE activities. RCCE for multiple public health events Establish an RCCE and infodemic management platform that supports multiple public health events. Operational studies Undertake socio-anthropological operational studies to identify motivators, enablers, and barriers of health-promoting behaviour like vaccination. Implementation research Conduct social, environmental and behavioural research to understand drivers and determinants of health, well-being and inequities that exacerbate the impact of emergencies. CSOs Use CSOs to enhance community engagement in positive health behaviour. Trust in interventions Encourage risk-sensitive behaviours by normalizing and sustaining public health and social measures (PHSMs) that help reduce the spread of COVID-19 and other diseases (for example, hand hygiene, use of masks and respiratory etiquette among other things.) Infodemic management Develop national strategies for infodemic management and develop message banks that address various questions about the pandemic. M&E of RCCE and PoE Monitor the effectiveness of the RCCE strategy and document lessons learnt to inform future preparedness and response activities. Maintenance of PoE infrastructure such as isolation units, health checkpoints and travellers’ pathways to ensure adherence with PHSMs. POE strengthening Strengthen PoE capacity through training and simulation exercises to enhance readiness. Cross-border collaboration Strengthen cross-border collaborations such as mapping population movements, risk assessments, implementing mitigation measures and AARs. Implementation of PoE plans Develop and implement PoE Public HEPR Plans and conduct SimEx for preparedness and readiness Integration of COVID-19 vaccination into routine immunization programmes, • Identify other health services that can be co-delivered with COVID-19 vaccination (including co-administration when relevant with other vaccines, like influenza, by targeting similar high-risk groups) and other health 23 PHC, and other relevant health services interventions (such as noncommunicable disease screening, HIV services and pregnancy follow-up, among others). • Develop a plan for COVID-19 vaccination integration that utilizes a combination of service delivery strategies (existing or new) across the life course to ensure sustainability of COVID-19 vaccination. • Ensure that COVID-19 vaccination supports recovery of other essential health services, including routine immunization, without excessively diverting resources and, where possible, explore synergies between recovery activities and COVID-19 vaccination. Accelerate vaccination of high- priority groups • Map and measure progress in vaccinating high-priority populations and develop targeted approaches/determine how integration will reach them. • Conduct periodic intensified COVID-19 vaccination activities to reach high- priority groups (as needed). Health systems strengthening and routine immunization (RI) recovery • Capitalize on COVID-19 investments to strengthen RI systems (for example, adverse events following immunization (AEFI) surveillance and data management). Demand and community engagement • Generate and sustain demand for COVID-19 vaccines and routine immunization. • Drive vaccine uptake by identifying and addressing barriers, facilitating enablers, communicating risk, managing infodemics and generating demand for vaccination and immunization through effectively engaging communities to become empowered and resilient. 24 Appendix 2: Safe and scalable care strategic priorities, interventions and proposed activities Strategic priority 1: strengthen health system for the delivery of essential health services including COVID-19 cases Intervention areas Key recommended activities Improve functionality and adequacy of health infrastructure and logistics • Strengthen the health supply chain management at all levels for public health emergencies. • Improve existing health infrastructure by providing isolation wards and ICUs for the management of respiratory conditions including COVID-19 disease. • Establish a national standard for minimum medical oxygen capacity and plans for scalability. • Access the Access to COVID-19 Tools (ACT) Accelerator platform to procure COVID-19 therapeutics. • Maintain a minimum stockpile of COVID-19 drugs and essential supplies. • Ensure maintenance of medical equipment and infrastructure in facilities. • Ensure that health facilities have plans and protocols in place for communication on risks, early warning, and evolving situations for all staff, patients, visitors, community and other stakeholders, accompanied by communication materials, technical guidance, training and exercises. • Reinforce national/facility ambulance services and clearly define referral pathways. • Decentralize ambulance and blood services and increase bed spaces for hospital admissions. • Strengthen cold chain infrastructure at all levels. • Ensure dedicated budgets and monitoring and evaluation for national planning and activities for maintaining essential health services. • Create a dedicated platform for monitoring inventory and stockouts of essential medications, equipment and supplies and for the coordination of re-distribution of supplies. Strengthen the multi- skilled workforce to deliver essential health services including COVID-19 and other respiratory conditions adequately and appropriately • Organize relevant stakeholders to periodically review national training or mentoring curricula for HCWs on prioritizing emergency and critical care. • Establish a framework for reviewing national case management guidelines for SARI/ILI to include SARS-CoV-2 case management and therapeutics. • Conduct regular capacity-building programmes. • Maintain on-site training, mentorship and supportive supervision for HCWs. • Develop a database for all trained HCWs for easy access and retrieval when needed. • Establish national and facility-based emergency medical teams (EMTs) to respond to public health and clinical emergencies. 25 • Support the retention of health care workers by providing lasting solutions such as transparent, performance-based promotions and capacity-building programmes. • Conduct regular reviews of critical care capacities and scalability by establishing a dashboard to document and monitor progress. • Develop facility-level multi-hazard response plans. Strengthen health facility leadership and governance, including the interface with community health systems • Put in place national and sub-national structures to manage integrated health services and avoid disruption during COVID-19 resurgence and other public health threats. • Train health workers on leadership skills and resource management. • Ensure the availability and utilization of health care guidelines and SoPs. • Improve health facility relationships with CHWs in delivering integrated health services, including emergency preparedness and response. • Use social accountability tools (for example, community scorecard) to monitor health services continuity and community perceptions. Strategic priority 2: increased utilization of essential health services including COVID-19 Intervention areas Key recommended activities Enhance facility readiness for provision of uninterrupted quality health service delivery • Strengthen reporting and monitoring of health service delivery, tracking performance and evaluating results with the use of standardized indicators. Restore and maintain services suspended during the pandemic and address any new barriers to access • Implement catch-up vaccination activities, restore coverage back to at least pre-pandemic times and strengthen systems within primary health care. • Integrate COVID-19 vaccination into the routine immunization services. • Scale up innovative service delivery models that remain relevant post-acute phase of the pandemic and potentially post-pandemic. • Integrate the care of people with post-COVID-19 conditions (PCC) into existing programmes for chronic illnesses/primary health care and psychosocial care. • Strengthen communication strategies to restore public confidence and drive demand for essential health services using multiple communication approaches (for example, social media channels). • Continue to strengthen outreach mechanisms and community-based health care. Ensure availability and access to COVID-19 therapeutics and medical oxygen • Establish a national standard for minimum medical oxygen capacity and plans for scalability. • Maintain a minimum stockpile of all COVID-19-related drugs and essential supplies. • Conduct regular reviews of critical care capacities and scalability by establishing a dashboard to document and monitor progress. 26 Reinforce point-of-care testing and triage • Provide a designated triage area and point of contact testing space in PHC facilities. • Conduct regular training, mentorship and supportive supervision on triage using the WHO Integrated Interagency Triage Tool (IITT) as the standard. Strategic priority 3: enhance patient and health workers’ safety Intervention areas Key recommended activities Build robust IPC programmes at national and facility levels • Develop a national action plan for IPC. • Prepare a legal framework for IPC. • Develop preparedness plans for high-threat pathogens. • Strengthen the system of protection of health personnel against occupational risk. • Set up IPC committees at national and facility levels. • Develop, update and adapt the national IPC guide. • Disseminate national IPC guidelines at the facility level. • Implement updated IPC guidelines across health facilities. Ensure regular IPC training for HCWs • Develop IPC pre-service course curricula for medical science students. • Develop in-service curricula for IPC. • Train health workers on using the developed in-service IPC curricula. Establish a surveillance system for health care- associated infections (HAI) • Set up HAI surveillance working groups at national and subnational levels. • Conduct an HAI point prevalence survey. • Develop a national plan for HAI surveillance. • Implement a national HAI plan in pilot facilities. Monitoring and improving IPC practices in health care facilities continuously to maintain high standards for IPC • Set up working groups for monitoring and evaluation of IPC practices. • Prepare a national plan for monitoring and evaluation of IPC practices. • Develop a digital system for collecting, analysing and reporting data from health care facility (HCF) assessments. Optimize workload, staffing and bed occupancy for effective IPC • Develop protocols and policies for workload, staffing and bed occupancy. • Assess staffing levels and workload. • Advocate for optimal staffing and reasonable workloads. • Conduct regular monitoring and adjustment of bed occupancy rates. Ensuring adequate environment and equipment for IPC • Prepare standards and norms for the built environment, materials and equipment for IPC. • Conduct regular audits of the built environment, materials and equipment for IPC. • Train staff on the proper use and maintenance of equipment. 27 Appendix 3: Access to countermeasure key intervention and recommended activities Intervention areas Recommended activities Regulatory • Prepare for vaccines, diagnostics, and therapeutics to be authorized within national regulatory frameworks to ensure long-term availability and supply. Strengthen vaccine storage and cold chain, distribution planning, and waste management • Establish storage, cold chain and distribution capacity needed for delivery of additional vaccines and decreased wastage. • Reinforce the supply chain control and management system (quality assurance, stockpiling, storage, security, transportation and distribution arrangements) for medical and other essential supplies. Integration of immunization supply chain components • Ensure preventive and corrective maintenance of cold chain equipment. • Continue to gather key monitoring and performance information, including KPI monitoring of lead times, supply gaps and optimization (efficiency, consumption rates, loss rates and access to local markets). • Integrate delivery and distribution of key COVID-19 product supplies (for example, vaccines, diagnostics, personal protective equipment (PPE), biomedical equipment and therapeutics) where appropriate into routine systems. Financing (for example, human resources, capacity-building, updating country guidance and tools, cold chain and oxygen sources equipment maintenance). • Map costs of COVID-19 vaccine delivery and integration as well as the need for catalytic funding to streamline processes and share costs and resources with other interventions. • Adjust financing mechanisms as necessary. • Estimate technical assistance needs for the process of integration. • Map oxygen sources equipment and installation for preventive and curative maintenance. COVID-19 stockpiling and management • Stockpile and pre-position COVID-19 essential supplies for immediate response when needed. Research • Invest in research to address critical unknowns associated with COVID-19 interventions such as vaccination. 28 Appendix 4: Key cross-cutting themes between health emergency response and humanitarian response Themes Interconnectedness Protection Both health emergency response and humanitarian response prioritize the protection of the general population and vulnerable populations, especially children, women, the elderly and displaced individuals. This protection entails their physical and psychological well-being, prevention and response to violence and abuse and upholding their human rights and dignity. Community engagement Both health emergency response and humanitarian response recognize the importance of engaging with affected communities, involving them in decision-making processes, getting their buy-in and co-designing and implementing interventions with them (as appropriate), thereby facilitating a more participatory and accountable response, enhancing trust and acceptance, and ensuring that interventions are contextually appropriate and responsive to meet the needs and preferences of the communities. Coordination and collaboration Effective coordination and collaboration among actors and relevant stakeholders are essential in both health emergency and humanitarian responses, leading to a more coherent and efficient response, minimizing duplication of activities and maximizing the use of available and scarce resources in delivering interventions. The collaboration between the two sectors promotes a comprehensive approach that addresses both immediate health concerns and needs, and the broader humanitarian needs. Data and information sharing Effective health emergency response and humanitarian response rely on accurate and timely data. Both sectors emphasize the importance of data collection, analysis and sharing of information to guide decision- making, identify needs and gaps and monitor the impact of interventions. Furthermore, sharing data and information between the two sectors fosters a more coordinated and evidence-based response. Risk communication and community awareness The need for crystal-clear and timely communication is crucial in both health emergency response and humanitarian response and cannot be overemphasized. Effective risk communication is important in the dissemination of accurate and timely information through appropriate channels, addressing misconceptions and promoting preventive measures and positive health-seeking behaviours. In addition, community awareness campaigns play a vital role in empowering individuals and communities to protect themselves and their loved ones and in providing accurate and reliable information to make informed decisions through behaviour change. 29 Themes Interconnectedness Capacity-building Both sectors prioritize capacity-building to strengthen response and preparedness. This includes training and empowering national and subnational health and humanitarian responders, local health care workers, community volunteers, community-based institutions and organizations to effectively address health and unfolding humanitarian emergencies in providing appropriate support and care. Capacity- building efforts aim to enhance preparedness, response capabilities and long-term resilience in both health and humanitarian challenges. Cross-cutting collaboration Both responses often require collaboration within sectors and with other sectors through multi- and transdisciplinary, interministerial and multisectoral approaches in human and animal health, water, sanitation, food security, shelter, education and other sectors. It is without doubt that these sectors are interconnected, and their integration ensures and enhances a holistic (inclusive of a whole-of-society and whole-of- government approach) and comprehensive response to the needs of affected populations. Preparedness and resilience The importance of preparedness and building resilience to better respond to future emergencies is essential and vital to both sectors. This involves developing and deploying or implementing early warning systems and contingency plans, securing supplies, re-stocking essential commodities and enabling preparedness measures, as well as strengthening health systems and community capacities to withstand shocks and recover from emergencies quickly. 30 Appendix 5. Integration of humanitarian and health emergency response approaches into the components and WHO/AFRO SPRP 2023‒2025 Components Approaches Emergency coordination Ensure coordinated planning, preparedness and response through the establishment of a multisectoral coordination mechanism that brings together key actors and stakeholders from the humanitarian and health sectors. Co-develop joint planning and preparedness frameworks that address both humanitarian and health emergency needs in alignment with the SPRP. Conduct joint needs assessments to identify and prioritize the most pressing needs in the affected areas and assessments of both humanitarian and health- related needs. Encourage sharing of data, information and resources between sectors to support identification of gaps and overlaps to enable more efficient and effective responses. Integrate response operations to enhance collaboration between humanitarian and health response actors on the ground or in the field. Jointly set monitoring indicators, monitor activities and co-develop reporting tools for joint evaluation. Advocate for and mobilize resources for integrated humanitarian and health responses for impact and engage with donors, policymakers and other stakeholders to secure the necessary resources for integrated response operations. Collaborative surveillance Enhance coordination and cooperation between various stakeholders and sectors to collect, analyse and share data and information related to public health threats and humanitarian needs. Share and integrate data and information from various triangulated sources including health data, humanitarian assessments, population data, epidemiological data and other relevant information. Establish and/or strengthen data-sharing agreements and mechanisms to ensure data privacy, confidentiality and proper use of information. Standardize data collection and reporting protocols for effective surveillance by co-defining common indicators, case definitions and data elements to ensure consistency in data collection and reporting across the sectors for comparability and integration of data emanating from various sources. Establish and/or strengthen early warning systems to detect and respond to public health threats and humanitarian needs using monitoring indicators such as disease outbreaks, population displacement, malnutrition rates and other relevant parameters for timely and targeted interventions. Engage affected communities and local stakeholders in collaborative surveillance and involve community members in data collection, reporting and analysis informed by local knowledge in enhancing community ownership and ensuring the relevance and accuracy of the collected data and information. Develop a joint monitoring and evaluation framework to assess the impact and effectiveness of integrated interventions. Community protection Ensure community engagement and participation in decision-making processes and response activities to understand their needs and perspectives 31 Components Approaches and incorporate their feedback into the planning and implementation of integrated interventions. Conduct comprehensive risk assessments and analyses to identify and understand specific protection risks confronted by communities such as risks related to violence, exploitation, abuse, discrimination and other threats to safety and well-being to design and implement targeted protection interventions. Build and/or strengthen community-based protection networks, leaders and structures to encourage resilience and safety of affected communities by training and empowerment through risk protection, raising or creating awareness, information sharing, encouraging vaccine uptake and demand generation for vaccines and adherence to adjustments of PHSMs. Improve border health across communities in and around border towns, settlements and entry ports maintaining vigilance and spot checks. Provide avenues for training programmes, workshops and knowledge sharing to enhance understanding of population movement and protection principles, and improvement of skills. Advocate for the integration of protection in response plans, promoting adherence to international human rights standards and advocating for policy changes that support community protection. Safe and scalable care Strengthen the capacity of humanitarian and health responders to integrate their efforts into providing training on cross-cutting issues such as IPC, case management, clinical management operations, community engagement, mental health and psychosocial support. Strengthen essential local health care systems by improving infrastructure, enhancing capacity-building for health care workers, ensuring the availability of essential medical supplies and equipment and strengthening health information systems. Promote integration and coordination among different sectors of health, water and sanitation, food security, protection and others through integrated services. Strengthen diagnostic capabilities through access to reliable and accurate diagnostic tools, testing kits and laboratory services to ensure early detection, rapid diagnosis and effective management of health emergencies. Establish and strengthen laboratory networks and capacities at national, subnational and local levels Provide access to appropriate treatment and clinical care for affected individuals through the establishment of treatment protocols, HCW training on best practices and providing necessary medical interventions and therapeutics. Foster intersectoral collaboration with health-care providers and organizations to ensure the availability and accessibility of quality treatment services in both humanitarian and health emergency responses. Support the implementation of IPC protocols in health care facilities, makeshift clinics, community settings and temporary shelters. 32 Components Approaches Access to countermeasures Facilitate access to vaccines and immunization services to prevent the spread of diseases and protect vulnerable populations through availability, affordability and the equitable distribution of vaccines with humanitarian and health emergency responses. Establish integrated vaccination campaigns in affected areas and promote community acceptance and uptake of immunization. Ensure availability of essential medicines, medical supplies and equipment through supply chains, procurement systems and collaboration with pharmaceutical companies, international organizations and local suppliers to ensure availability and affordability of essential health care products. 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