WHO/HSE/GCR/2014.6
International Health Regulations (2005)
SUMMARY OF STATES PARTIES 2010 REPORT ON IHR CORE CAPACITY IMPLEMENTATION
Regional Profiles
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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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IHR CAPACITY ANALYSIS REGIONAL SUMMARY - AFRICAN REGION NATIONAL CAPACITY MONITORING 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 representing inputs of technical expert drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO.
In 2010, 50% of countries (i.e. 23/46) in the African region responded to the National Capacity Monitoring Questionnaire*, which is lower compared to 2008 (78%) and 2009 (52%). 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 2010 To obtain a full overview of progress of all the indicators please consult the individual Country Profiles 2010. 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 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.
IHR NFP functions and operations as defined by IHR
In 87% of countries, the IHR NFP has been established. Information on
Regional Average Attribute Scores
In 91% of countries, the IHR NFP has provided WHO with updated contact Across the region, good progress has been made in establishing multisectoral collaboration. Further work needs to be done in its formalization and implementation. The IHR NFP has been established in most countries. Further efforts should aim at increased operational action of the IHR NFP.
obligations under the IHR has been disseminated to relevant national authorities and stakeholders in 61% of countries. Documentation of actions taken by the IHR NFP and relevant stakeholders following communications with WHO is available in 57% of countries. information and confirmed itself annually. In 2010, 70% of IHR NFP accessed the IHR Event Information Site (EIS) at least monthly and 83% initiated at least once (written) communication with WHO.
Core Capacity 1: National legislation, policy and financing Legislation, regulations, administrative requirements, policies or other government instruments, sufficient for implementation of the IHR
Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)
Core Capacity 3: Surveillance
Legal requirements and instruments are assessed in 39% of countries and Policies to facilitate IHR NFP core and expanded functions and to Across the region, modest progress has been made on assessing legislation and low progress has been made on implementing required legislation and policies. implemented in 22% 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 30% of countries. strengthen technical core capacities have been implemented in 26% of countries (documentation available).
Lists of priority diseases or conditions for surveillance as well as case
Surveillance data on epidemic prone and priority diseases is analysed at least
definitions for priority diseases are available in all countries. Also, all countries have designated specific units for surveillance of public health risks.
weekly at national and sub-national levels in 96% of countries. 96% 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 91% 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 78% of countries.
Core Capacity 2: Coordination and NFP Communications Coordination mechanism between relevant sectors implementing the IHR
82% of countries report that Coordination between relevant ministries on
In 70% of countries information sources for public health events and risks have been identified. 83% 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, and implemented in 52% of countries. public health events from a variety of sources including, media (print, broadcast, community, electronic, internet etc.) is in place in 61% of countries. 70% of countries have developed a local community (primary response) level reporting strategy. 70% 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. In 22% of countries, implementation of local community reporting has been evaluated and updated as needed. Reported events contain essential information specified in the IHR in 61% of countries. 3
Event-Based Surveillance
65% 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 57% of countries through an actual event occurrence or through exercises and have been updated as needed.
events that may constitute a public health event of national or international concern (PHEIC) is in place. Standard Operating Procedures are available for coordination between IHR NFP and stakeholders of relevant sectors in 9% of countries.
A system at national and/or sub-national levels for capturing and registering
61% of countries have a list of national stakeholders involved in the
implementation of IHR. Roles and responsibilities of various stakeholders under the IHR have been defined in 35% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 52% of countries and are implemented in 22% of countries.
The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 83% of countries and in 13 % its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Across the region, very good progress has been made in fulfilling requirements for Indicator-based and Event-based surveillance. Evaluation of reporting at community level is one of the areas requiring significant development efforts.
In 17% of countries, a policy or strategy 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 is available. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 39% of countries.
Core Capacity 4: Response
National resources have been assessed by 17% of countries to address priority A directory of experts in health and other sectors to support a response to risks. IHR-related hazards is available in 48% of countries. 26% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations. Major hazard sites or facilities that could be the source of chemical, radiological, nuclear or biological public health emergencies of international concern have been mapped by 13% of countries. 13% of countries have mobilized experts from multiple disciplines/sectors in response to an actual public health event or simulation exercise in the past twelve months. A plan for management and distribution (if applicable) of national stockpiles is available in 47% of countries. 26% have stockpiles (critical stock levels) for responding to the country's priority biological, chemical and radiological events and other emergencies available and accessible at all times and 26% have tested and updated a stockpile management system through a real or simulated exercise. Across the region, modest progress has been made in fulfilling preparedness requirements. Both in planning as well as risk and resource mapping significant gaps require further action.
Public health risk and resource mapping
Resources for rapid response during outbreaks of national or international In 83% of countries, management procedures have been established for concern are accessible in 78% of countries. 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 70% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 48% of countries. An evaluation of response including the timeliness and quality of response has been carried out and response procedures have been updated as needed following actual event occurrence or an assessment in 26% of countries. a roster of trained RRT members and SOPs available for the deployment of RRT members. In 65% of countries, multidisciplinary RRT can be deployed within 48 hrs from the time when the decision to respond is taken, and in 65% of countries RRT submit preliminary written reports on investigation and control measures to relevant authorities in less than one week of investigation. Finally in 43% of countries, RRT are mobilized for real events or through simulation exercise at least once a year at relevant levels.
Public Health Emergency Response mechanisms
Rapid Response Teams (RRT) are available in 74% of countries, and 30% have
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
Risk communication partners and stakeholders have been identified in 65% of
In 48% of countries responsibilities are assigned for surveillance of
SOPs, guidelines and protocols for IPC available to all hospitals in 35% of
health-care-associated infections and anti-microbial resistance. In 48% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available. The plan has been implemented nationwide and reviewed (documented) in 17% of countries. countries, and defined norms or guidelines for protecting health-care workers have been developed in 48% of countries. 43% have a national coordination for surveillance of relevant events such as health-care-associated infections, and infections of potential public health concern with defined strategies, objectives, and priorities in place. All tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines in 39% and have qualified IPC professionals in place in 43% of countries. The management of patients with highly infectious diseases meets established IPC standards in 49% of countries. In 39% 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 30% of countries. Across the region, good progress has been made in establishing Public Health Emergency Response mechanisms, with some areas requiring further attention. Infection Prevention and Control capacities need to be further developed both in planning and implementation.
A risk communication plan including social mobilization of communities has been
countries. A unit for coordinating public communications during a public health event is in place in 70% of countries, with defined roles and responsibilities of the stakeholders. developed in 43% of countries. Policies, SOPs or guidelines on the clearance and release of information during a public health event have been disseminated in 39% of countries. Policies, SOPs or guidelines are available in 35% of countries to support community-based risk communications interventions during public health emergencies. 13% 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 61% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC materials are tailored to the needs of the population in 83% of countries. Across the region, good progress has been made in establishing Risk Communication mechanisms. Areas such as evaluation of post-emergency communication and formalization of community based risk communication require further action.
Core Capacity 7: Human Resource Capacity
In 39% of countries a unit has been identified to assess human resource
Human resources available to implement IHR Core Capacity requirements
Core Capacity 5: Preparedness
In 52% of countries, an assessment of core capacities for the implementation of A national plan to meet the IHR core capacity requirements has been developed IHR been conducted (Annex 1A Article 2) and the report of the assessment shared with relevant national stakeholders. (Annex 1A Article 2) in 13% and a national public health emergency response plan for hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 9% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 13% of countries in an actual emergency or simulation and are updated as needed.
Multi-hazard National Public Health Emergency Preparedness & Response Plan
capacities to meet the country's IHR requirements. Critical gaps have been identified in existing human resources (numbers and competencies) to meet IHR requirements in 48% of countries. A training needs assessment has been conducted and a plan has been developed to meet training needs requirements in 9% of countries. In 13% of countries, responsible authorities have approved workforce development plans and funding for the implementation of the IHR. No country has 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 52% of countries. 26% of countries have provided evidence of a strengthened workforce when tested in an urgent public health event or simulation exercise. Progress on human resource capacity has been modest with weaknesses manifesting in implementation and planning and funding for workforce related attributes of the IHR.
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Core Capacity 8: Laboratory
65% of countries have a policy to ensure the quality of laboratory diagnostic
Laboratory services to test for priority health threats
In 48% of countries, designated PoE have trained personnel for the inspection of conveyances, and in 35% designated PoE have the capacity to safely dispose of potentially contaminated products. 43% of countries have a functioning programme for the surveillance and control of vectors and reservoirs in and near Points of Entry.
capacities. 39% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 70% of countries have designated National reference laboratories (NRL) and have disseminated a list of NRL to relevant stakeholders. 78% of countries have access to diagnostic services for priority diseases, for pathogens listed in Annex 2 (IHR 2005) and for public health threats including hazardous substances.
SOPs for response at PoE are available in 39% of countries. A public health
Effective response at PoE
External Quality Assessment Schemes have been implemented for diagnostic
laboratories for major public health disciplines in 65% of countries. A network of national and international laboratories has been established in 78% of countries to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 (IHR 2005). More than 10 non-AFP hazardous specimens per year referred to national or international reference laboratories for examination in 65% of countries. Laboratory test results in 87% of countries have been received from diagnostic laboratories in a timely manner to inform decision-making and actions.
emergency contingency response plan at designated PoE has been developed and disseminated to key stakeholders in 22% of countries. 4% of countries have integrated public health emergency contingency plans at designated PoE with other response plans, and have tested and updated them as needed.
Designated PoE have appropriate space, separate from other travelers, to
Laboratory biosafety and biosecurity practices
61% of countries have biosafety guidelines accessible to individual laboratories.
interview suspect or affected persons in 52% of countries. In 57%, the designated PoE can provide medical assessment or quarantine of suspect travelers, and care for affected travelers or animals. A referral and transport system for the safe transfer of ill travelers to appropriate medical facilities and access to relevant equipment, in place at a designated PoE is available in 48% of countries. Recommended public health measures can be applied at designated PoE in 61% of countries Across the region, good progress has been made in building capacity at Points of Entry. Further assessment of ports and formalization of response contingency and procedural planning are areas that still require significant attention.
Regulations, policies or strategies for laboratory biosafety exist in 57% of countries. In 35% 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 61% of countries. A national classification of microorganisms by risk group has been completed in 22% of countries. 30% of countries have an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. Biosafety procedures are implemented and regularly monitored in 26% of countries. 17% 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. Diagnostic laboratories are designated and authorized or certified BSL 2 or above for relevant levels of the health care system in 22% of countries. 4% of countries have evaluated country experience and findings related to biosafety and shared reports with the global community. Across the region, very good progress has been made in most of the attributes of laboratory services testing for priority health threats. In terms of laboratory biosafety and biosecurity practices progress is modest for most attributes, which reduces the overall progress within this capacity to good progress (51% Regional Average Attribute Score).
Hazard: Zoonotic Events
Mechanisms for detecting and responding to zoonoses and potential zoonoses
In 87% 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 74% of countries. 70% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 61% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories been established and documented.
In 74% of countries there a list of priority zoonotic diseases with case definitions
Points of Entry
available. 70% systematically and timely collect and collate zoonotic disease data. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 61% of countries. 87% 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 70% of countries.
A review meeting (or other appropriate method) to identify Points of Entry for
General obligations required at Points of Entry (PoE)
Timely and systematic information exchange between animal, human health
designation has been conducted in 78% of countries. 78% have designated a ‘Competent authority’ for each PoE and 83% have identified designated ports (as relevant)/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation been sent to WHO (as specified in Article 20, no.3) by 65% of countries. In 43% of countries, all designated airports have a competent authority and in 26% all designated airports have been assessed. In 26% of countries, all designated ports have competent authority and in 21% all designated ports has been assessed.
surveillance units and other relevant sectors regarding urgent zoonotic events and risks is available in 61% of countries. In 29% of countries, laboratories responsible for human diseases and animal diseases exchange regularly information zoonotic diseases.
A regularly updated roster (list) of experts that can respond to zoonotic events is In 57% of countries, animal health (domestic and wildlife) authorities/units
available in 48% of countries. 70% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.
Effective surveillance at PoE
Priority conditions for surveillance at designated PoE have been identified in
83% of countries. 78% 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 70% of countries. In 52% of countries, designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travelers, with adequate staff, equipment and premises. Surveillance of conveyances for presence of vectors and reservoirs at designated PoE have been established in 52% of countries.
participate in a national emergency response committee. In further 57% of countries operational, intersectoral public health plans for responding to zoonotic events have been tested through occurrence of events or simulation exercises and updated as needed. 48% of countries timely respond to more than 80% of zoonotic events of potential national and international concern. Across the region, very good progress has been made in establishing mechanisms for detecting and responding to zoonoses and potential zoonoses. A few attributes need increased effort, e.g. information exchange of laboratories.
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Hazard: Food Safety
National or international food safety standards are available in 65% of countries.
Detecting and responding to foodborne disease and food contamination
58% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events.
83% 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 in place in 52% of countries. Decisions of the food safety multisectoral body are implemented and outcomes documented in 35% 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 22% of countries. 35% are active members of the INFOSAN network.
None of the countries flag having a risk communication plan for chemical events An adequately-resourced Poison Centre(s) is in place in 16% of the countries. Across the region, chemical safety has made least progress. In quite a number of attributes, the total number of countries has not yet built the minimum capacities required.
that is coordinated with the national risk communications plan. None of the countries have tested chemical event response plans been through occurrence of real event or through a simulation exercise and updated them as needed.
30% 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 30% of countries. Further 30% of countries have collected and analyzed systematically epidemiological data related to food contamination. In 22% 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. 43% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques.
Hazard: Radiological Events
Detecting and responding to radiological and nuclear emergencies
Experts have been identified for public health assessment and response to
In 22% of countries, a roster of food safety experts is available for the
assessment and response to food safety events. 17% of countries have tested and updated operational plans for responding to food safety events as needed. Food safety events have been investigated by teams that include food safety experts in 52% of countries. 57% of countries have established mechanisms for tracing, recall and disposal of contaminated products.
radiological and nuclear events in 22% of countries. 22% 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 39% of countries. 9% 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.
13% of countries have communication mechanisms and materials in place to inform, educate and advise stakeholders across the farm-to-fork continuum.
An inventory of hazard sites and facilities using/handling radioactive sources
Food safety control management systems have been implemented in 61% of Across the region, good progress has been made in detecting and responding to foodborne disease and food contamination. Still, most of the Food Safety attributes are still work in progress and will need significant further efforts to accomplish the requirements under the IHR by 2012.
countries. In 35% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards and regulations.
which may be the source of a public health emergency of international concern is in place in 22% of countries. 17% of countries have a monitoring in place for radiation emergencies. Further 17% of countries have mapped the radiological risks that may be a source of a potential public health emergency of international concern (exposure, populations at risk, etc).
A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a public health emergency of international concern is in place in 4% of countries.
In 17% of countries, scenarios, technical guidelines and SOPs for risk
Hazard: Chemical Events
17% of countries have identified experts for public health assessment and
Detection, alert and response to chemical emergencies
response to chemical incidents. In 22% legislation, policy or protocol in place for chemical event surveillance, alert and response. In 13% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR National Focal Point and 4% have an alert system in place for rapid communication with the IHR NFP. Coordination mechanisms been tested and updated through exercises in 4% of countries.
assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. In 22% of countries, agencies responsible for radiation emergencies participate in a national emergency response committee and in coordinated responses to radiation emergencies. A radiation emergency response plan is in place in 13% of countries. 13% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification.
39% of countries have a mechanism in place for access to hospitals or radiological or nuclear event.
health-care facilities with capacity to manage patients from radiation emergencies (in or out of the country).
Surveillance is in place for chemical events, intoxication or poisonings in 22% of An inventory of major hazard sites and facilities that could be a source of
countries. 4% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern.
22% of countries have a strategy for public communication in case of a 30% 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.
chemical public health emergencies is available in 13%. No country flagged to 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 4% of countries.
Regularly updated collaborative mechanisms are in place in 13% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR. Across the region, modest progress has been made in mechanisms for detecting and responding to radiological and nuclear emergencies. Significant further action across this capacity is required.
8% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies.
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IHR CAPACITY ANALYSIS REGIONAL SUMMARY - REGION OF THE AMERICAS NATIONAL CAPACITY MONITORING 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 representing inputs of technical expert drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO.
In 2010, 57% of countries (i.e. 20/35) in the American region responded to the National Capacity Monitoring Questionnaire*, which is lower compared to 2008 (89%) and 2009 (66%). 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 2010. To obtain a full overview of progress of all the indicators please consult the individual Country Profiles 2010. 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 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.
IHR NFP functions and operations as defined by IHR
In all countries, the IHR NFP has been established. Information on obligations In all countries, the IHR NFP has provided WHO with updated contact Across the region, very good progress has been made in establishing multisectoral collaboration. The IHR NFP has been established in all countries, accesses the EIS and communicates with WHO. Room for action remains in the documentation following communications with WHO. under the IHR has been disseminated to relevant national authorities and stakeholders in 94% of countries. Documentation of actions taken by the IHR NFP and relevant stakeholders following communications with WHO is available in 88% of countries.
Regional Average Attribute Scores
information and confirmed itself annually. In 2010, IHR NFPs accessed the IHR Event Information Site (EIS) at least monthly and initiated at least once (written) communication with WHO in all countries.
Core Capacity 1: National legislation, policy and financing Legislation, regulations, administrative requirements, policies or other government instruments, sufficient for implementation of the IHR
Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)
Core Capacity 3: Surveillance
Legal requirements and instruments are assessed in 71% of countries and Policies to facilitate IHR NFP core and expanded functions and to Across the region, good progress has been made on assessing legislation. Progress implementing required legislation and policies is good and needs further action. implemented in 24% 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 53% of countries. strengthen technical core capacities have been implemented in 35% of countries (documentation available).
Lists of priority diseases or conditions for surveillance as well as case
Surveillance data on epidemic prone and priority diseases is analysed at least
definitions for priority diseases are available all countries. Also all countries have designated specific units to survey public health risks.
weekly at national and sub-national levels in 88% of countries. 71% 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 47% 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 71% of countries.
Core Capacity 2: Coordination and NFP Communications Coordination mechanism between relevant sectors implementing the IHR
94% of countries report that Coordination between relevant ministries on
In 65% of countries, information sources for public health events and risks have been identified. 94% 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, and implemented in 59% of countries. public health events from a variety of sources including, media (print, broadcast, community, electronic, internet etc.) is in place in 65% of countries. 59% of countries have developed a local community (primary response) level reporting strategy. 18% 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. In 24% of countries, implementation of local community reporting has been evaluated and updated as needed. Reported events contain essential information specified in the IHR in 59% of countries. 7
Event-Based Surveillance
65% of countries report having a multisectoral, multidisciplinary committee, 82% of countries have a list of national stakeholders involved in the body or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 71% of countries through an actual event occurrence or through exercises and have been updated as needed.
events that may constitute a public health event of national or international concern (PHEIC) is in place. Standard Operating Procedures are available for coordination between IHR NFP and stakeholders of relevant sectors in 53% of countries.
A system at national and/or sub-national levels for capturing and registering
implementation of IHR. 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 71% of countries and are implemented in 41% of countries.
The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 88% of countries and in 59% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Across the region, very good progress has been made in fulfilling requirements for Indicator-based and Event-based surveillance. Among areas requiring further development is reporting and stakeholder sensitization at community level.
In 47% of countries, a policy or strategy 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 is available. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 35% of countries.
Core Capacity 4: Response
National resources have been assessed by 35% of countries to address priority A directory of experts in health and other sectors to support a response to risks. IHR-related hazards is available in 59% of countries. 18% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations. Major hazard sites or facilities that could be the source of chemical, radiological, nuclear or biological public health emergencies of international concern have been mapped by 29% of countries. 88% of countries have mobilized experts from multiple disciplines/sectors in response to an actual public health event or simulation exercise in the past twelve months. A plan for management and distribution (if applicable) of national stockpiles is available in 53% of countries. 18% have stockpiles (critical stock levels) for responding to the country's priority biological, chemical and radiological events and other emergencies available and accessible at all times and 24% have tested and updated a stockpile management system through a real or simulated exercise. Across the region, good progress has been made in fulfilling preparedness capacity requirements. Areas requiring significant improvement include risk assessment, stockpiling, and testing surge capacity among others.
Public health risk and resource mapping
Resources for rapid response during outbreaks of national or international In 76% of countries, management procedures have been established for concern are accessible in 76% of countries. 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. An evaluation of response including the timeliness and quality of response has been carried out and response procedures have been updated as needed following actual event occurrence or an assessment in 18% of countries. a roster of trained RRT members and SOPs available for the deployment of RRT members. In 94% of countries, multidisciplinary RRT can be deployed within 48 hrs from the time when the decision to respond is taken, and in 65% of countries RRT submit preliminary written reports on investigation and control measures to relevant authorities in less than one week of investigation. Finally in 65% of countries, RRT are mobilized for real events or through simulation exercise at least once a year at relevant levels.
Public Health Emergency Response mechanisms
Rapid Response Teams (RRT) are available in 94% of countries, and 35% have
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
Risk communication partners and stakeholders have been identified in 88% of
In 71% of countries responsibilities are assigned for surveillance of
SOPs, guidelines and protocols for IPC available to all hospitals in 53% of
health-care-associated infections and anti-microbial resistance. In 59% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available. The plan has been implemented nationwide and reviewed (documented) in 18% of countries. countries, and defined norms or guidelines for protecting health-care workers have been developed in 94% of countries. 65% have a national coordination for surveillance of relevant events such as health-care-associated infections, and infections of potential public health concern with defined strategies, objectives, and priorities in place. All tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines in 71% and have qualified IPC professionals in place in 59% of countries. The management of patients with highly infectious diseases meets established IPC standards in 59% of countries. In 41% 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 47% of countries. Very good progress has been made in establishing Public Health Emergency Response mechanisms and building Infection Prevention and Control (IPC) capacities. Some areas require significant further attention, e.g. response evaluation, and the implementation of IPC plans, SOPs and protocols.
A risk communication plan including social mobilization of communities has been
countries. A unit for coordinating public communications during a public health event is in place in 82% of countries, with defined roles and responsibilities of the stakeholders. developed in 65% of countries. Policies, SOPs or guidelines on the clearance and release of information during a public health event have been disseminated in 59% of countries. Policies, SOPs or guidelines are available in 53% of countries to support community-based risk communications interventions during public health emergencies. 29% 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 materials are tailored to the needs of the population in 76% of countries. Across the region, very good progress has been made in building risk communication mechanisms for public health emergency. Post emergency evaluation of public health communication is among the attributes requiring further improvement to meet the IHR requirements for 2012.
Core Capacity 7: Human Resource Capacity
In 59% of countries a unit has been identified to assess human resource
Human resources available to implement IHR Core Capacity requirements
Core Capacity 5: Preparedness
In 88% of countries, an assessment of core capacities for the implementation of A national plan to meet the IHR core capacity requirements has been developed IHR been conducted (Annex 1A Article 2) and the report of the assessment shared with relevant national stakeholders. (Annex 1A Article 2) in 71% and a national public health emergency response plan for hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 47% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 41% of countries in an actual emergency or simulation and are updated as needed.
Multi-hazard National Public Health Emergency Preparedness & Response Plan
capacities to meet the country's IHR requirements. Critical gaps have been identified in existing human resources (numbers and competencies) to meet IHR requirements in 65% of countries. A training needs assessment has been conducted and a plan has been developed to meet training needs requirements in 35% of countries. In 35% 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 plan. A strategy has been developed for the country to access field epidemiology training (one year or more) in-country, regionally or internationally in 47% of countries. 53% of countries have provided evidence of a strengthened workforce when tested in an urgent public health event or simulation exercise. Progress on building human resource capacity has been good. Areas requiring further action include meeting training needs, workforce development planning and implementation.
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Core Capacity 8: Laboratory
59% of countries have a policy to ensure the quality of laboratory diagnostic
Laboratory services to test for priority health threats
In 71% of countries, designated PoE have trained personnel for the inspection of conveyances, and in 47% designated PoE have the capacity to safely dispose of potentially contaminated products. 65% of countries have a functioning programme for the surveillance and control of vectors and reservoirs in and near Points of Entry.
capacities. 47% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 76% of countries have designated National reference laboratories (NRL) and have disseminated a list of NRL to relevant stakeholders. 76% of countries have access to diagnostic services for priority diseases, for pathogens listed in Annex 2 (IHR 2005) and for public health threats including hazardous substances.
SOPs for response at PoE are available in 47% of countries. A public health
Effective response at PoE
External Quality Assessment Schemes have been implemented for diagnostic
laboratories for major public health disciplines in 76% of countries. A network of national and international laboratories has been established in 82% of countries to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 (IHR 2005). More than 10 non-AFP hazardous specimens per year referred to national or international reference laboratories for examination in 47% of countries. Laboratory test results in 65% of countries have been received from diagnostic laboratories in a timely manner to inform decision-making and actions.
emergency contingency response plan at designated PoE has been developed and disseminated to key stakeholders in 47% of countries. 18% of countries have integrated public health emergency contingency plans at designated PoE with other response plans, and have tested and updated them as needed.
Designated PoE have appropriate space, separate from other travelers, to
Laboratory biosafety and biosecurity practices
82% of countries have biosafety guidelines accessible to individual laboratories.
interview suspect or affected persons in 41% of countries. In 59%, the designated PoE can provide medical assessment or quarantine of suspect travelers, and care for affected travelers or animals. A referral and transport system for the safe transfer of ill travelers to appropriate medical facilities and access to relevant equipment, in place at a designated PoE is available in 59% of countries. Recommended public health measures can be applied at designated PoE in 59% of countries. Overall, good progress has been made on developing capacity at Points of Entry. Further efforts have to be made across this capacity to meet IHR requirements for effective surveillance and general obligations at Points of Entry.
Regulations, policies or strategies for laboratory biosafety exist in 65% of countries. In 65% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity. In 65% of countries, biosafety guidelines, manuals or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 65% of countries. A national classification of microorganisms by risk group has been completed in 41% of countries. 47% of countries have an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. Biosafety procedures are implemented and regularly monitored in 41% of countries. 24% 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. Diagnostic laboratories are designated and authorized or certified BSL 2 or above for relevant levels of the health care system in 65% of countries. 18% of countries have evaluated country experience and findings related to biosafety and shared reports with the global community. In the region, very good progress has been made in most of the attributes of laboratory services testing for priority health threats. Both in laboratory services to test for priority health threat and laboratory biosafety and biosecurity practices progress has to be made across all attributes, e.g. including evaluation of country experiences and biorisk assessments.
Hazard: Zoonotic Events
Mechanisms for detecting and responding to zoonoses and potential zoonoses
In 88% 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 71% of countries. 76% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 47% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories been established and documented.
In 82% of countries there a list of priority zoonotic diseases with case definitions
Points of Entry
available. 71% systematically and timely collect and collate zoonotic disease data. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 53% of countries. 82% 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 35% of countries.
A review meeting (or other appropriate method) to identify Points of Entry for
General obligations required at Points of Entry (PoE)
Timely and systematic information exchange between animal, human health
designation has been conducted in 82% of countries. 65% have designated a ‘Competent authority’ for each PoE and 76% have identified designated ports (as relevant)/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation been sent to WHO (as specified in Article 20, no.3) by 53% of countries. In 47% of countries, all designated airports have a competent authority and in 29% all designated airports have been assessed. In 41% of countries, all designated ports has competent authority and in 12% all designated ports has been assessed.
surveillance units and other relevant sectors regarding urgent zoonotic events and risks is available in 53% of countries. In 24% of countries, laboratories responsible for human diseases and animal diseases exchange regularly information zoonotic diseases.
A regularly updated roster (list) of experts that can respond to zoonotic events is In 65% of countries, animal health (domestic and wildlife) authorities/units
available in 41% of countries. 76% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.
Priority conditions for surveillance at designated PoE have been identified in
Effective surveillance at PoE
82% of countries. 82% 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 76% of countries. In 65% of countries, designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travelers, with adequate staff, equipment and premises. Surveillance of conveyances for presence of vectors and reservoirs at designated PoE have been established in 65% of countries.
participate in a national emergency response committee. In further 41% of countries operational, intersectoral public health plans for responding to zoonotic events have been tested through occurrence of events or simulation exercises and updated as needed. 76% of countries timely respond to more than 80% of zoonotic events of potential national and international concern. Across the region, good progress has been made in developing mechanisms for detecting and responding to zoonoses and potential zoonoses. A few attributes need increased effort, e.g. information exchange among laboratories.
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Hazard: Food Safety
National or international food safety standards are available in 94% of countries.
Detecting and responding to foodborne disease and food contamination
65% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events.
88% 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 in place in 76% of countries. Decisions of the food safety multisectoral body are implemented and outcomes documented in 65% 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 41% of countries. 59% are active members of the INFOSAN network.
18% of countries flag having a risk communication plan for chemical events that is coordinated with the national risk communications plan. 24% of countries have tested chemical event response plans been through occurrence of real event or through a simulation exercise and updated them as needed.
An adequately-resourced Poison Centre(s) is in place in 41% of the countries. Across the region, chemical safety has made less progress compared to other capacities. In quite a number of attributes related to planning and implementation progress is modest.
41% 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 59% of countries. Further 41% of countries have collected and analyzed systematically epidemiological data related to food contamination. In 35% 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. 65% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques.
Hazard: Radiological Events
Detecting and responding to radiological and nuclear emergencies
Experts have been identified for public health assessment and response to
In 53% of countries, a roster of food safety experts is available for the
assessment and response to food safety events. 35% of countries have tested and updated operational plans for responding to food safety events as needed. Food safety events have been investigated by teams that include food safety experts in 82% of countries. 71% of countries have established mechanisms for tracing, recall and disposal of contaminated products.
radiological and nuclear events in 47% of countries. 18% 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. 29% 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.
59% of countries have communication mechanisms and materials in place to inform, educate and advise stakeholders across the farm-to-fork continuum.
An inventory of hazard sites and facilities using/handling radioactive sources
Food safety control management systems have been implemented in 71% of Across the region, very good progress has been made in detecting and responding to foodborne disease and food contamination. Further implementation efforts are required, for example in the reporting of food safety events, testing and updating of operational plans, and collection and analysis of epidemiological data related to food contamination.
countries. In 59% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards and regulations.
which may be the source of a public health emergency of international concern is in place in 47% of countries. 29% of countries have a monitoring in place for radiation emergencies. Further 24% of countries have mapped the radiological risks that may be a source of a potential public health emergency of international concern (exposure, populations at risk, etc).
A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a public health emergency of international concern is in place in 12% of countries.
In 29% of countries, scenarios, technical guidelines and SOPs for risk
Hazard: Chemical Events
53% of countries have identified experts for public health assessment and
Detection, alert and response to chemical emergencies
response to chemical incidents. In 47% legislation, policy or protocol in place for chemical event surveillance, alert and response. In 47% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR National Focal Point and 53% have an alert system in place for rapid communication with the IHR NFP. Coordination mechanisms been tested and updated through exercises in 18% of countries.
assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. In 41% of countries, agencies responsible for radiation emergencies participate in a national emergency response committee and in coordinated responses to radiation emergencies. A radiation emergency response plan is in place in 24% of countries. 35% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification.
18% of countries have a mechanism in place for access to hospitals or radiological or nuclear event.
health-care facilities with capacity to manage patients from radiation emergencies (in or out of the country).
Surveillance is in place for chemical events, intoxication or poisonings in 35% of countries. 24% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern.
24% of countries have a strategy for public communication in case of a 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.
An inventory of major hazard sites and facilities that could be a source of
chemical public health emergencies is available in 29%. 35% of countries flagged to 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 29% of countries.
Regularly updated collaborative mechanisms are in place in 35% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR. This capacity shows the least progress compared to other capacities in the region. Detecting and responding to radiological and nuclear emergencies requires significant efforts among all of this capacities attributes.
29% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies.
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IHR CAPACITY ANALYSIS REGIONAL SUMMARY - EASTERN MEDITERRANEAN REGION NATIONAL CAPACITY MONITORING 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 representing inputs of technical expert drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2010, 82% of countries (i.e. 18/22) in the Eastern Mediterranean region responded to the National Capacity Monitoring Questionnaire*, which represents an increase compared to 2008 (50%) and 2009 (41%). Throughout this Regional Summary, 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 2010. To obtain a full overview of progress of all the indicators please consult the individual Country Profiles 2010. 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 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.
IHR NFP functions and operations as defined by IHR
In 94% of countries, the IHR NFP has been established. Information on
Regional Average Attribute Scores
In 94% of countries, the IHR NFP has provided WHO with updated contact Across the region, very good progress has been made in establishing multisectoral collaboration. Further efforts should aim at a completion of planning and implementation of the attributes. Especially the sensitization of stakeholders towards responsibilities is among less developed attributes.
obligations under the IHR has been disseminated to relevant national authorities and stakeholders in 76% of countries. Documentation of actions taken by the IHR NFP and relevant stakeholders following communications with WHO is available in 76% of countries. information and confirmed itself annually. In 2010, 82% of IHR NFP accessed the IHR Event Information Site (EIS) at least monthly and 76% initiated at least once (written) communication with WHO.
Core Capacity 1: National legislation, policy and financing Legislation, regulations, administrative requirements, policies or other government instruments, sufficient for implementation of the IHR
Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)
Core Capacity 3: Surveillance
Legal requirements and instruments are assessed in 88% of countries and Policies to facilitate IHR NFP core and expanded functions and to Across the region, very good progress has been made on assessing legislation. Less progress has been made on implementing required legislation and policies. implemented in 65% 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 88% of countries. strengthen technical core capacities have been implemented in 35% of countries (documentation available).
Lists of priority diseases or conditions for surveillance as well as case
Surveillance data on epidemic prone and priority diseases is analysed at least
definitions for priority diseases are available in all countries. Also, all countries have designated specific units for surveillance of public health risks.
weekly at national and sub-national levels in 71% 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 82% 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 71% of countries.
Core Capacity 2: Coordination and NFP Communications Coordination mechanism between relevant sectors implementing the IHR
94% of countries report that Coordination between relevant ministries on
In 82% of countries information sources for public health events and risks have been identified. 94% 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, and implemented in 69% of countries. public health events from a variety of sources including, media (print, broadcast, community, electronic, internet etc.) is in place in 71% of countries. 59% of countries have developed a local community (primary response) level reporting strategy. 47% 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. In 24% of countries, implementation of local community reporting has been evaluated and updated as needed. Reported events contain essential information specified in the IHR in 71% of countries. 11
Event-Based Surveillance
events that may constitute a public health event of national or international concern (PHEIC) is in place. Standard Operating Procedures are available for coordination between IHR NFP and stakeholders of relevant sectors in 47% of countries. body or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 82% of countries through an actual event occurrence or through exercises and have been updated as needed.
88% of countries report having a multisectoral, multidisciplinary committee, 71% of countries have a list of national stakeholders involved in the
A system at national and/or sub-national levels for capturing and registering
implementation of IHR. Roles and responsibilities of various stakeholders under the IHR have been defined in 59% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 47% of countries and are implemented in 35% of countries.
The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 94% of countries and in 71% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Across the region, very good progress has been made in fulfilling requirements for Indicator-based and Event-based surveillance. Evaluation of reporting at community level is one of the areas requiring significant development efforts.
In 59% of countries, a policy or strategy 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 is available. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 65% of countries.
Core Capacity 4: Response
National resources have been assessed by 88% of countries to address priority A directory of experts in health and other sectors to support a response to risks. IHR-related 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. Major hazard sites or facilities that could be the source of chemical, radiological, nuclear or biological public health emergencies of international concern have been mapped by 47% of countries. 76% of countries have mobilized experts from multiple disciplines/sectors in response to an actual public health event or simulation exercise in the past twelve months. A plan for management and distribution (if applicable) of national stockpiles is available in 88% of countries. 47% have stockpiles (critical stock levels) for responding to the country's priority biological, chemical and radiological events and other emergencies available and accessible at all times and 59% have tested and updated a stockpile management system through a real or simulated exercise. Progress on Preparedness is very good across the region. Conducting national risk assessments and stockpiling are among the attributes needing further significant attention to reach the IHR requirements in 2012.
Public health risk and resource mapping
Resources for rapid response during outbreaks of national or international In 94% of countries, management procedures have been established for concern are accessible in all countries. 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 94% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 94% of countries. An evaluation of response including the timeliness and quality of response has been carried out and response procedures have been updated as needed following actual event occurrence or an assessment in 76% of countries. roster of trained RRT members and SOPs available for the deployment of RRT members. In 82% of countries, multidisciplinary RRT can be deployed within 48 hrs from the time when the decision to respond is taken, and in 94% of countries RRT submit preliminary written reports on investigation and control measures to relevant authorities in less than one week of investigation. Finally in 94% of countries, RRT are mobilized for real events or through simulation exercise at least once a year at relevant levels.
Public Health Emergency Response mechanisms
Rapid Response Teams (RRT) are available in all countries, and 59 have a
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
Risk communication partners and stakeholders have been identified in 88% of
In 71% of countries responsibilities are assigned for surveillance of
SOPs, guidelines and protocols for IPC available to all hospitals in 65% of
health-care-associated infections and anti-microbial resistance. In 82% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available. The plan has been implemented nationwide and reviewed (documented) in 53% of countries. countries, and defined norms or guidelines for protecting health-care workers have been developed in 88% of countries. 59% have a national coordination for surveillance of relevant events such as health-care-associated infections, and infections of potential public health concern with defined strategies, objectives, and priorities in place. All tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines in 65% and have qualified IPC professionals in place in 65% of countries. The management of patients with highly infectious diseases meets established IPC standards in 71% of countries. 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 29% of countries. Across the region, very good progress has been made in establishing Public Health Emergency Response mechanisms, with some areas requiring further attention. Infection Prevention and Control capacities need to be further developed both in planning and implementation.
A risk communication plan including social mobilization of communities has been
countries. A unit for coordinating public communications during a public health event is in place in 88% of countries, with defined roles and responsibilities of the stakeholders. developed in 76% of countries. Policies, SOPs or guidelines on the clearance and release of information during a public health event have been disseminated in 59% of countries. Policies, SOPs or guidelines are available in 71% of countries to support community-based risk communications interventions during public health emergencies. 41% 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 materials are tailored to the needs of the population in all countries. Across the region, very good progress has been made in establishing Risk Communication mechanisms, with updated information sources being available to media and public in all countries. Areas requiring improvement include policy formulation, dissemination and post-emergency evaluation.
Core Capacity 7: Human Resource Capacity
In 65% of countries a unit has been identified to assess human resource
Human resources available to implement IHR Core Capacity requirements
Core Capacity 5: Preparedness
In 53% of countries, an assessment of core capacities for the implementation of A national plan to meet the IHR core capacity requirements has been developed IHR been conducted (Annex 1A Article 2) and the report of the assessment shared with relevant national stakeholders. (Annex 1A Article 2) in 76% and a national public health emergency response plan for hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 65% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 41% of countries in an actual emergency or simulation and are updated as needed.
Multi-hazard National Public Health Emergency Preparedness & Response Plan
capacities to meet the country's IHR requirements. Critical gaps have been identified in existing human resources (numbers and competencies) to meet IHR requirements in 53% of countries. A training needs assessment has been conducted and a plan has been developed to meet training needs requirements in 53% of countries. In 29% of countries, responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 35% 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 47% of countries. 53% of countries have provided evidence of a strengthened workforce when tested in an urgent public health event or simulation exercise. Progress on human resource capacity has been good, but among others requires approving workforce development plans and funding for the implementation of the IHR.
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Core Capacity 8: Laboratory
82% of countries have a policy to ensure the quality of laboratory diagnostic
Laboratory services to test for priority health threats
In 53% of countries, designated PoE have trained personnel for the inspection of conveyances, and in 59% designated PoE have the capacity to safely dispose of potentially contaminated products. 41% of countries have a functioning programme for the surveillance and control of vectors and reservoirs in and near Points of Entry.
capacities. 82% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 76% of countries have designated National reference laboratories (NRL) and have disseminated a list of NRL to relevant stakeholders. 76% of countries have access to diagnostic services for priority diseases, for pathogens listed in Annex 2 (IHR 2005) and for public health threats including hazardous substances.
SOPs for response at PoE are available in 53% of countries. A public health
Effective response at PoE
External Quality Assessment Schemes have been implemented for diagnostic
laboratories for major public health disciplines in 76% of countries. A network of national and international laboratories has been established in 65% of countries to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 (IHR 2005). More than 10 non-AFP hazardous specimens per year referred to national or international reference laboratories for examination in 88% of countries. Laboratory test results in 94% of countries have been received from diagnostic laboratories in a timely manner to inform decision-making and actions.
emergency contingency response plan at designated PoE has been developed and disseminated to key stakeholders in 41% of countries. 41% of countries have integrated public health emergency contingency plans at designated PoE with other response plans, and have tested and updated them as needed.
Designated PoE have appropriate space, separate from other travelers, to
Laboratory biosafety and biosecurity practices
71% of countries have biosafety guidelines accessible to individual laboratories.
interview suspect or affected persons in 53% of countries. In 59%, the designated PoE can provide medical assessment or quarantine of suspect travelers, and care for affected travelers or animals. A referral and transport system for the safe transfer of ill travelers to appropriate medical facilities and access to relevant equipment, in place at a designated PoE is available in 82% of countries. Recommended public health measures can be applied at designated PoE in 65% of countries. Overall, good progress has been made on Points of Entry capacity. Further efforts have to be made across this capacity to meet the IHR requirements for effective surveillance and general obligations at Points of Entry.
Regulations, policies or strategies for laboratory biosafety exist in 88% of countries. In 65% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity. In 65% of countries, biosafety guidelines, manuals or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 71% of countries. A national classification of microorganisms by risk group has been completed in 47% of countries. 41% of countries have an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. Biosafety procedures are implemented and regularly monitored in 59% of countries. 41% 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. Diagnostic laboratories are designated and authorized or certified BSL 2 or above for relevant levels of the health care system in 76% of countries. 35% of countries have evaluated country experience and findings related to biosafety and shared reports with the global community. Across the region, very good progress has been made in most of the attributes of laboratory services testing for priority health threats. In laboratory biosafety and biosecurity practices less progress has been made, requiring further action in areas such as biorisk assessment in laboratories and evaluating and sharing country experiences.
Hazard: Zoonotic Events
Mechanisms for detecting and responding to zoonoses and potential zoonoses
In 94% 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 88% of countries. 82% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 65% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories been established and documented.
All countries have a list of priority zoonotic diseases with case definitions
Points of Entry
available. 82% systematically and timely collect and collate zoonotic disease data. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 82% 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 53% of countries.
A review meeting (or other appropriate method) to identify Points of Entry for
General obligations required at Points of Entry (PoE)
Timely and systematic information exchange between animal, human health
designation has been conducted in 82% of countries. 59% have designated a ‘Competent authority’ for each PoE and 65% have identified designated ports (as relevant)/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation been sent to WHO (as specified in Article 20, no.3) by 53% of countries. In 47% of countries, all designated airports have a competent authority and in 35% all designated airports have been assessed. In 35% of countries, all designated ports have competent authority and in 24% all designated ports has been assessed.
surveillance units and other relevant sectors regarding urgent zoonotic events and risks is available in 65% of countries. In 35% of countries, laboratories responsible for human diseases and animal diseases exchange regularly information zoonotic diseases.
A regularly updated roster (list) of experts that can respond to zoonotic events is In 82% of countries, animal health (domestic and wildlife) authorities/units
available in 71% of countries. 76% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.
Priority conditions for surveillance at designated PoE have been identified in
Effective surveillance at PoE
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 76% of countries. In 65% of countries, designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travelers, with adequate staff, equipment and premises. Surveillance of conveyances for presence of vectors and reservoirs at designated PoE have been established in 35% of countries.
participate in a national emergency response committee. In further 59% of countries operational, intersectoral public health plans for responding to zoonotic events have been tested through occurrence of events or simulation exercises and updated as needed. 59% of countries timely respond to more than 80% of zoonotic events of potential national and international concern. Across the region, very good progress has been made in developing mechanisms for detecting and responding to zoonoses and potential zoonoses. Areas requiring improvement include among others the exchange of regular information of laboratories responsible for human diseases and animal diseases zoonotic diseases.
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Hazard: Food Safety
National or international food safety standards are available in all countries.
Detecting and responding to foodborne disease and food contamination
53% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events.
94% 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 in place in 76% of countries. Decisions of the food safety multisectoral body are implemented and outcomes documented in 35% 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 41% of countries. 29% are active members of the INFOSAN network.
41% of the countries flag having a risk communication plan for chemical events An adequately-resourced Poison Centre(s) is in place in 41% of the countries. In the region, chemical safety is the least developed capacity required by the IHR. Most attributes in this capacity require significant improvement.
that is coordinated with the national risk communications plan. 29% of the countries have tested chemical event response plans been through occurrence of real event or through a simulation exercise and updated them as needed.
47% 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 53% of countries. Further 59% of countries have collected and analyzed systematically epidemiological data related to food contamination. In 53% 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. 53% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques.
Hazard: Radiological Events
Detecting and responding to radiological and nuclear emergencies
Experts have been identified for public health assessment and response to
In 59% of countries, a roster of food safety experts is available for the
assessment and response to food safety events. 24% of countries have tested and updated operational plans for responding to food safety events as needed. Food safety events have been investigated by teams that include food safety experts in 53% of countries. 71% of countries have established mechanisms for tracing, recall and disposal of contaminated products.
radiological and nuclear events in 53% of countries. 65% 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 71% of countries. 59% 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.
47% of countries have communication mechanisms and materials in place to inform, educate and advise stakeholders across the farm-to-fork continuum.
An inventory of hazard sites and facilities using/handling radioactive sources
Food safety control management systems have been implemented in 65% of Across the region, good progress has been made in detecting and responding to foodborne disease and food contamination. Further implementation efforts are required, for example the testing and updating of operational plans.
countries. In 47% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards and regulations.
which may be the source of a public health emergency of international concern is in place in 59% of countries. 65% of countries have a monitoring in place for radiation emergencies. Further 24% of countries have mapped the radiological risks that may be a source of a potential public health emergency of international concern (exposure, populations at risk, etc).
A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a public health emergency of international concern is in place in 47% of countries.
Hazard: Chemical Events
In 29% of countries, scenarios, technical guidelines and SOPs for risk
47% of countries have identified experts for public health assessment and
Detection, alert and response to chemical emergencies
response to chemical incidents. In 41% legislation, policy or protocol in place for chemical event surveillance, alert and response. In 41% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR National Focal Point and 35% have an alert system in place for rapid communication with the IHR NFP. Coordination mechanisms been tested and updated through exercises in 29% of countries.
assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. In 53% of countries, agencies responsible for radiation emergencies participate in a national emergency response committee and in coordinated responses to radiation emergencies. A radiation emergency response plan is in place in 41% of countries. 24% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification.
35% of countries have a mechanism in place for access to hospitals or radiological or nuclear event.
Surveillance is in place for chemical events, intoxication or poisonings in 35% of countries. 35% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern.
health-care facilities with capacity to manage patients from radiation emergencies (in or out of the country).
41% of countries have a strategy for public communication in case of a 59% 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.
An inventory of major hazard sites and facilities that could be a source of
chemical public health emergencies is available in 35%. 18% of countries flagged to 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 41% of countries.
Regularly updated collaborative mechanisms are in place in 12% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR. Across the region, good progress has been made in Mechanisms for Detecting and responding to radiological and nuclear emergencies. Further areas of necessary action include among others the planning, mapping and response simulation training. 14
41% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies.
IHR CAPACITY ANALYSIS REGIONAL SUMMARY - EUROPEAN REGION NATIONAL CAPACITY MONITORING 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 representing inputs of technical expert drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO. In 2010, 62% of countries (i.e. 33/53) in the European region responded to the National Capacity Monitoring Questionnaire*, which is lower compared to 2008 (75%), but represents an increase compared to 2009 (58%). 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 in2010. To obtain a full overview of progress of all the indicators please consult the individual Country Profiles 2010. 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 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.
IHR NFP functions and operations as defined by IHR
In all countries, the IHR NFP has been established. Information on obligations In all countries, the IHR NFP has provided WHO with updated contact Across the region, very good progress has been made in establishing multisectoral collaboration. Further efforts should aim at a completion of planning and implementation of the attributes. Especially the sensitization of stakeholders towards responsibilities is among less developed attributes. under the IHR has been disseminated to relevant national authorities and stakeholders in 86% of countries. Documentation of actions taken by the IHR NFP and relevant stakeholders following communications with WHO is available in 79% of countries.
Regional Average Attribute Scores
information and confirmed itself annually. In 2010, 93% of IHR NFP accessed the IHR Event Information Site (EIS) at least monthly and 90% initiated at least once (written) communication with WHO.
Core Capacity 1: National legislation, policy and financing Legislation, regulations, administrative requirements, policies or other government instruments, sufficient for implementation of the IHR
Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)
Core Capacity 3: Surveillance
Legal requirements and instruments are assessed in 79% of countries and Policies to facilitate IHR NFP core and expanded functions and to Across the region, very good progress has been made on assessing legislation. Less progress has been made on implementing required legislation and policies. 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 76% of countries. strengthen technical core capacities have been implemented in 52% of countries (documentation available).
Lists of priority diseases or conditions for surveillance as well as case
Surveillance data on epidemic prone and priority diseases is analysed at least
definitions for priority diseases are available in 90% of countries. Also, 90% of countries have designated specific units for surveillance of public health risks.
weekly at national and sub-national levels in 86% of countries. 79% 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 79% 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 86% of countries.
Core Capacity 2: Coordination and NFP Communications Coordination mechanism between relevant sectors implementing the IHR
86% of countries report that Coordination between relevant ministries on
In 93% of countries information sources for public health events and risks have been identified. 86% 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 72% of countries, and implemented in 55% of countries. public health events from a variety of sources including, media (print, broadcast, community, electronic, internet etc.) is in place in 72% of countries. 76% of countries have developed a local community (primary response) level reporting strategy. 45% 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. In 52% of countries, implementation of local community reporting has been evaluated and updated as needed. Reported events contain essential information specified in the IHR in 83% of countries. 15
Event-Based Surveillance
69% of countries report having a multisectoral, multidisciplinary committee, 66% of countries have a list of national stakeholders involved in the 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.
events that may constitute a public health event of national or international concern (PHEIC) is in place. Standard Operating Procedures are available for coordination between IHR NFP and stakeholders of relevant sectors in 34% of countries.
A system at national and/or sub-national levels for capturing and registering
implementation of IHR. Roles and responsibilities of various stakeholders under the IHR have been defined in 55% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 45% of countries and are implemented in 28% of countries.
The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 97% of countries and in 41 % its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Across the region, very good progress has been made in fulfilling requirements for Indicator-based and Event-based surveillance. Sensitization of key stakeholders is one of the areas still requiring significant development efforts.
In 55% of countries, a policy or strategy 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 is available. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 59% of countries.
Core Capacity 4: Response
National resources have been assessed by 55% of countries to address priority A directory of experts in health and other sectors to support a response to risks. IHR-related hazards is available in 72% of countries. 48% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations. Major hazard sites or facilities that could be the source of chemical, radiological, nuclear or biological public health emergencies of international concern have been mapped by 69% of countries. 83% of countries have mobilized experts from multiple disciplines/sectors in response to an actual public health event or simulation exercise in the past twelve months. A plan for management and distribution (if applicable) of national stockpiles is available in 79% of countries. 76% have stockpiles (critical stock levels) for responding to the country's priority biological, chemical and radiological events and other emergencies available and accessible at all times and 76% have tested and updated a stockpile management system through a real or simulated exercise. Progress on Preparedness is very good across the region. Conducting national risk and resource assessments are among the attributes needing further significant attention to reach the IHR requirements in 2012.
Public health risk and resource mapping
Resources for rapid response during outbreaks of national or international In 90% of countries, management procedures have been established for concern are accessible in 97% of countries. 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 93% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 83% of countries. An evaluation of response including the timeliness and quality of response has been carried out and response procedures have been updated as needed following actual event occurrence or an assessment in 52% of countries. a roster of trained RRT members and SOPs available for the deployment of RRT members. In 86% of countries, multidisciplinary RRT can be deployed within 48 hrs from the time when the decision to respond is taken, and in 76% of countries RRT submit preliminary written reports on investigation and control measures to relevant authorities in less than one week of investigation. Finally in 72% of countries, RRT are mobilized for real events or through simulation exercise at least once a year at relevant levels.
Public Health Emergency Response mechanisms
Rapid Response Teams (RRT) are available in 76% of countries, and 52% have
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
Risk communication partners and stakeholders have been identified in 93% of
In all countries responsibilities are assigned for surveillance of
SOPs, guidelines and protocols for IPC available to all hospitals in 83% of
health-care-associated infections and anti-microbial resistance. In 90% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available. The plan has been implemented nationwide and reviewed (documented) in 59% of countries. countries, and defined norms or guidelines for protecting health-care workers have been developed in 93% of countries. 86% have a national coordination for surveillance of relevant events such as health-care-associated infections, and infections of potential public health concern with defined strategies, objectives, and priorities in place. All tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines in 83% and have qualified IPC professionals in place in 79% of countries. The management of patients with highly infectious diseases meets established IPC standards in 90% of countries. In 79% 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 66% of countries. Across the region, very good progress has been made in establishing Public Health Emergency Response mechanisms and developing Infection Prevention and Control capacities. Some areas still require further focused attention, e.g. the nationwide implementation of plans.
A risk communication plan including social mobilization of communities has been
countries. A unit for coordinating public communications during a public health event is in place in 86% of countries, with defined roles and responsibilities of the stakeholders. developed in 45% of countries. Policies, SOPs or guidelines on the clearance and release of information during a public health event have been disseminated in 62% of countries. Policies, SOPs or guidelines are available in 69% of countries to support community-based risk communications interventions during public health emergencies. 41% 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 all countries, regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC materials are tailored to the needs of the population in 86% of countries. Across the region, very good progress has been made in establishing Risk Communication mechanisms, with updated information sources being available to media and public in all countries. Among areas requiring improvement are communication planning and post-emergency evaluation.
Core Capacity 7: Human Resource Capacity
In 55% of countries a unit has been identified to assess human resource
Human resources available to implement IHR Core Capacity requirements
Core Capacity 5: Preparedness
In 59% of countries, an assessment of core capacities for the implementation of A national plan to meet the IHR core capacity requirements has been developed IHR been conducted (Annex 1A Article 2) and the report of the assessment shared with relevant national stakeholders. (Annex 1A Article 2) in 62% and a national public health emergency response plan for hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 55% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 45% of countries in an actual emergency or simulation and are updated as needed.
Multi-hazard National Public Health Emergency Preparedness & Response Plan
capacities to meet the country's IHR requirements. Critical gaps have been identified in existing human resources (numbers and competencies) to meet IHR requirements in 31% of countries. A training needs assessment has been conducted and a plan has been developed to meet training needs requirements in 38% of countries. In 17% of countries, responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 28% 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 55% of countries. 52% of countries have provided evidence of a strengthened workforce when tested in an urgent public health event or simulation exercise. Human resource capacity is the weakest capacity in the region. It requires improvements across all attributes in terms of planning and implementation.
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Core Capacity 8: Laboratory
93% of countries have a policy to ensure the quality of laboratory diagnostic
Laboratory services to test for priority health threats
In 72% of countries, designated PoE have trained personnel for the inspection of conveyances, and in 59% designated PoE have the capacity to safely dispose of potentially contaminated products. 52% of countries have a functioning programme for the surveillance and control of vectors and reservoirs in and near Points of Entry.
capacities. 62% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 79% of countries have designated National reference laboratories (NRL) and have disseminated a list of NRL to relevant stakeholders. 86% of countries have access to diagnostic services for priority diseases, for pathogens listed in Annex 2 (IHR 2005) and for public health threats including hazardous substances.
SOPs for response at PoE are available in 62% of countries. A public health
Effective response at PoE
External Quality Assessment Schemes have been implemented for diagnostic
laboratories for major public health disciplines in 86% of countries. A network of national and international laboratories has been established in 76% of countries to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 (IHR 2005). More than 10 non-AFP hazardous specimens per year referred to national or international reference laboratories for examination in 66% of countries. Laboratory test results in 97% of countries have been received from diagnostic laboratories in a timely manner to inform decision-making and actions.
emergency contingency response plan at designated PoE has been developed and disseminated to key stakeholders in 45% of countries. 28% of countries have integrated public health emergency contingency plans at designated PoE with other response plans, and have tested and updated them as needed.
Designated PoE have appropriate space, separate from other travelers, to
Laboratory biosafety and biosecurity practices
90% of countries have biosafety guidelines accessible to individual laboratories.
interview suspect or affected persons in 62% of countries. In 66%, the designated PoE can provide medical assessment or quarantine of suspect travelers, and care for affected travelers or animals. A referral and transport system for the safe transfer of ill travelers to appropriate medical facilities and access to relevant equipment, in place at a designated PoE is available in 79% of countries. Recommended public health measures can be applied at designated PoE in 66% of countries. Overall, good progress has been made on Points of Entry capacity. Further efforts have to be made across this capacity to meet the IHR requirements for effective surveillance and general obligations at Points of Entry.
Regulations, policies or strategies for laboratory biosafety exist in 90% of countries. In 69% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity. In 76% of countries, biosafety guidelines, manuals or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 86% of countries. A national classification of microorganisms by risk group has been completed in 72% of countries. 72% of countries have an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. Biosafety procedures are implemented and regularly monitored in 79% of countries. 66% 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. Diagnostic laboratories are designated and authorized or certified BSL 2 or above for relevant levels of the health care system in 76% of countries. 48% of countries have evaluated country experience and findings related to biosafety and shared reports with the global community. Across the region, very good progress has been made in most of the attributes of laboratory services testing for priority health threats. Further action in several areas such as among others updating laboratory inventories, biorisk assessment in laboratories and evaluating and sharing country experiences.
Hazard: Zoonotic Events
Mechanisms for detecting and responding to zoonoses and potential zoonoses
In 86% 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. 69% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 69% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories been established and documented.
In 86% of countries there a list of priority zoonotic diseases with case definitions
Points of Entry
available. 93% systematically and timely collect and collate zoonotic disease data. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 86% of countries. 97% 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 93% of countries.
A review meeting (or other appropriate method) to identify Points of Entry for
General obligations required at Points of Entry (PoE)
Timely and systematic information exchange between animal, human health
designation has been conducted in 79% of countries. 66% have designated a ‘Competent authority’ for each PoE and 62% have identified designated ports (as relevant)/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation been sent to WHO (as specified in Article 20, no.3) by 59% of countries. In 41% of countries, all designated airports have a competent authority and in 14% all designated airports have been assessed. In 34% of countries, all designated ports have competent authority and in 17% all designated ports has been assessed.
surveillance units, and other relevant sectors regarding urgent zoonotic events and risks is available in 86% of countries. In 52% of countries, laboratories responsible for human diseases and animal diseases exchange regularly information zoonotic diseases.
A regularly updated roster (list) of experts that can respond to zoonotic events is In 48% of countries, animal health (domestic and wildlife) authorities/units
available in 72% of countries. 83% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.
Effective surveillance at PoE
Priority conditions for surveillance at designated PoE have been identified in
72% of countries. 76% 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 76% of countries. In 66% of countries, designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travelers, with adequate staff, equipment and premises. Surveillance of conveyances for presence of vectors and reservoirs at designated PoE have been established in 62% of countries.
participate in a national emergency response committee. In further 59% of countries operational, intersectoral public health plans for responding to zoonotic events have been tested through occurrence of events or simulation exercises and updated as needed. 83% of countries timely respond to more than 80% of zoonotic events of potential national and international concern. Across the region, very good progress has been made in Mechanisms for detecting and responding to zoonoses and potential zoonoses. A few attributes need increased effort, e.g. participation of animal health (domestic and wildlife) authorities/units in a national emergency response committee.
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Hazard: Food Safety
National or international food safety standards are available in 90% of countries.
Detecting and responding to foodborne disease and food contamination
83% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events.
93% 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 in place in 83% of countries. Decisions of the food safety multisectoral body are implemented and outcomes documented in 76% 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 72% of countries. 83% are active members of the INFOSAN network.
48% of countries flag having a risk communication plan for chemical events that is coordinated with the national risk communications plan. 52% of countries have tested chemical event response plans been through occurrence of real event or through a simulation exercise and updated them as needed.
An adequately-resourced Poison Centre(s) is in place in 72% of the countries. Chemical safety across the region is a well developed capacity required by the IHR. In terms of planning and implementation action is required in several areas, e.g. in communication planning or maintaining of priority event lists.
72% 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 76% of countries. Further 90% of countries have collected and analyzed systematically epidemiological data related to food contamination. In 86% 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 97% of countries. 86% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques.
Hazard: Radiological Events
Detecting and responding to radiological and nuclear emergencies
Experts have been identified for public health assessment and response to
In 76% of countries, a roster of food safety experts is available for the
assessment and response to food safety events. 69% of countries have tested and updated operational plans for responding to food safety events as needed. Food safety events have been investigated by teams that include food safety experts in 93% of countries. 97% of countries have established mechanisms for tracing, recall and disposal of contaminated products.
radiological and nuclear events in 86% of countries. 83% 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 83% of countries. 86% 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.
83% of countries have communication mechanisms and materials in place to inform, educate and advise stakeholders across the farm-to-fork continuum.
An inventory of hazard sites and facilities using/handling radioactive sources
Food safety control management systems have been implemented in 97% of Across the region, good progress has been made in detecting and responding to foodborne disease and food contamination. Further implementation efforts are required, for example the testing and updating of operational plans and the putting in place of communication mechanisms.
countries. In 86% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards and regulations.
which may be the source of a public health emergency of international concern is in place in 83% of countries. 86% of countries have a monitoring in place for radiation emergencies. Further 72% of countries have mapped the radiological risks that may be a source of a potential public health emergency of international concern (exposure, populations at risk, etc).
A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a public health emergency of international concern is in place in 76% of countries.
Hazard: Chemical Events
In 76% of countries, scenarios, technical guidelines and SOPs for risk
79% of countries have identified experts for public health assessment and
Detection, alert and response to chemical emergencies
response to chemical incidents. In 76% legislation, policy or protocol in place for chemical event surveillance, alert and response. In 62% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR National Focal Point and 62% have an alert system in place for rapid communication with the IHR NFP. Coordination mechanisms been tested and updated through exercises in 55% of countries.
assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. In 90% of countries, agencies responsible for radiation emergencies participate in a national emergency response committee and in coordinated responses to radiation emergencies. A radiation emergency response plan is in place in 79% of countries. 72% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification.
79% of countries have a mechanism in place for access to hospitals or radiological or nuclear event.
Surveillance is in place for chemical events, intoxication or poisonings in 79% of countries. 34% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern.
health-care facilities with capacity to manage patients from radiation emergencies (in or out of the country).
72% of countries have a strategy for public communication in case of a 86% 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.
An inventory of major hazard sites and facilities that could be a source of
chemical public health emergencies is available in 69%. 59% of countries flagged to 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 69% of countries.
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. Across the region, very good progress has been made in Mechanisms for Detecting and responding to radiological and nuclear emergencies. Further areas of necessary action include among others the updating of collaborative mechanisms for access to specialized laboratories. 18
76% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies.
IHR CAPACITY ANALYSIS REGIONAL SUMMARY - SOUTH EAST ASIAN REGION NATIONAL CAPACITY MONITORING 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 representing inputs of technical expert drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO.
In 2010, 100% of countries (11 countries) in the South East Asian region responded to the National Capacity Monitoring Questionnaire*, which means an increase compared to 2008 (91%) and 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 2010. To obtain a full overview of progress of all the indicators please consult the individual Country Profiles 2010. 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 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.
IHR NFP functions and operations as defined by IHR
In all countries, the IHR NFP has been established. Information on obligations In all countries, the IHR NFP has provided WHO with updated contact Across the region, very good progress has been made in establishing multisectoral collaboration. Further work needs to be done in its formalization and implementation. The IHR NFP is established in all countries, and is fully functional in nearly all countries. under the IHR has been disseminated to relevant national authorities and stakeholders in 80% of countries. Documentation of actions taken by the IHR NFP and relevant stakeholders following communications with WHO is available in 90% of countries.
Regional Average Attribute Scores
information and confirmed itself annually. In 2010, 70% of IHR NFP accessed the IHR Event Information Site (EIS) at least monthly and 90% initiated at least once (written) communication with WHO.
Core Capacity 1: National legislation, policy and financing Legislation, regulations, administrative requirements, policies or other government instruments, sufficient for implementation of the IHR
Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)
Core Capacity 3: Surveillance
Legal requirements and instruments are assessed in 70% of countries and Policies to facilitate IHR NFP core and expanded functions and to Across the region, very good progress has been made on assessing legislation. Less progress has been made on implementing required legislation and policies. implemented in 70% 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 90% of countries. strengthen technical core capacities have been implemented in 50% of countries (documentation available).
Lists of priority diseases or conditions for surveillance as well as case
Surveillance data on epidemic prone and priority diseases is analysed at least
definitions for priority diseases are available in all countries. Also, all countries have designated specific units for surveillance of public health risks.
weekly at national and sub-national levels in 80% of countries. 90% 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 all 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 80% of countries.
Core Capacity 2: Coordination and NFP Communications Coordination mechanism between relevant sectors implementing the IHR
All countries report that Coordination between relevant ministries on events 90% of countries report having a multisectoral, multidisciplinary committee, 90% of countries have a list of national stakeholders involved in the body or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 90% of countries through an actual event occurrence or through exercises and have been updated as needed.
In 90% of countries information sources for public health events and risks have been identified. 80% 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 80% of countries, and implemented in 60% of countries. public health events from a variety of sources including, media (print, broadcast, community, electronic, internet etc.) is in place in 80% of countries. 70% of countries have developed a local community (primary response) level reporting strategy. 90% 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. In 50% of countries, implementation of local community reporting has been evaluated and updated as needed. Reported events contain essential information specified in the IHR in 80% of countries. 19
Event-Based Surveillance
that may constitute a public health event of national or international concern (PHEIC) is in place. Standard Operating Procedures are available for coordination between IHR NFP and stakeholders of relevant sectors in 60% of countries.
A system at national and/or sub-national levels for capturing and registering
implementation of IHR. Roles and responsibilities of various stakeholders under the IHR have been defined in 50% of countries. Plans to sensitize all relevant stakeholders to their roles and responsibilities under the IHR are available in 70% of countries and are implemented in 60% of countries.
The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 90% of countries and in 40% its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Across the region, very good progress has been made in fulfilling requirements for Indicator-based and Event-based surveillance. Evaluation of reporting at community level is one of the areas requiring more development efforts.
In 50% of countries, a policy or strategy 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 is available. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 40% of countries.
Core Capacity 4: Response
National resources have been assessed by 30% of countries to address priority A directory of experts in health and other sectors to support a response to risks. IHR-related hazards is available in 50% of countries. 50% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations.
Public health risk and resource mapping
Resources for rapid response during outbreaks of national or international In 90% of countries, management procedures have been established for concern are accessible in all countries. 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 80% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 90% of countries. An evaluation of response including the timeliness and quality of response has been carried out and response procedures have been updated as needed following actual event occurrence or an assessment in 50% of countries. roster of trained RRT members and SOPs available for the deployment of RRT members. In 80% of countries, multidisciplinary RRT can be deployed within 48 hrs from the time when the decision to respond is taken, and in 90% of countries RRT submit preliminary written reports on investigation and control measures to relevant authorities in less than one week of investigation. Finally in 90% of countries, RRT are mobilized for real events or through simulation exercise at least once a year at relevant levels.
Public Health Emergency Response mechanisms
40% of countries have mobilized experts from multiple disciplines/sectors in
Rapid Response Teams (RRT) is available in all countries, and 60% have a
response to an actual public health event or simulation exercise in the past twelve months. A plan for management and distribution (if applicable) of national stockpiles is available in 90% of countries. 20% have stockpiles (critical stock levels) for responding to the country's priority biological, chemical and radiological events and other emergencies available and accessible at all times and 40% have tested and updated a stockpile management system through a real or simulated exercise. Preparedness is the weakest core capacity in the region. For example, surge capacity planning has to be further developed, and public health risk and resource mapping efforts need to be expanded.
Core Capacity 6: Risk Communication
Mechanisms for effective risk communication during a public health emergency
Risk communication partners and stakeholders have been identified in all
Infection Prevention and Control (IPC) at national and hospital levels
In 80% of countries responsibilities are assigned for surveillance of
SOPs, guidelines and protocols for IPC available to all hospitals in 80% of
health-care-associated infections and anti-microbial resistance. In 90% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available. The plan has been implemented nationwide and reviewed (documented) in 60% of countries. countries, and defined norms or guidelines for protecting health-care workers have been developed in 90% of countries. 70% have a national coordination for surveillance of relevant events such as health-care-associated infections, and infections of potential public health concern with defined strategies, objectives, and priorities in place. All tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines in 80% and have qualified IPC professionals in place in 60% of countries. The management of patients with highly infectious diseases meets established IPC standards in 80% of countries. In 70% 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 60% of countries. Across the region, very good progress has been made in establishing Public Health Emergency Response mechanisms. Response resources are accessible in all countries. Further implementation is required in areas such as response evaluation and review of planning instruments.
A risk communication plan including social mobilization of communities has been
countries. A unit for coordinating public communications during a public health event is in place in 90% of countries, with defined roles and responsibilities of the stakeholders. developed in 90% of countries. Policies, SOPs or guidelines on the clearance and release of information during a public health event have been disseminated in 80% of countries. Policies, SOPs or guidelines are available in 50% of countries to support community-based risk communications interventions during public health emergencies. 20% 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 all countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC materials are tailored to the needs of the population in all countries. Across the region, very good progress has been made in establishing Risk Communication mechanisms. Areas requiring further attention include policy formulation and dissemination and post-emergency evaluation.
Core Capacity 7: Human Resource Capacity
Human resources available to implement IHR Core Capacity requirements capacities to meet the country's IHR requirements. Critical gaps have been identified in existing human resources (numbers and competencies) to meet IHR requirements in 60% of countries. A training needs assessment has been conducted and a plan has been developed to meet training needs requirements in 50% of countries. In 50% of countries, responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 10% 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 80% of countries. 80% of countries have provided evidence of a strengthened workforce when tested in an urgent public health event or simulation exercise. Progress on human resource capacity has been good, but among others requires efforts in assessing capacity, training needs and meeting workforce capacity planning targets. 20
In 60% of countries a unit has been identified to assess human resource
Core Capacity 5: Preparedness
In all countries, an assessment of core capacities for the implementation of IHR A national plan to meet the IHR core capacity requirements has been developed been conducted (Annex 1A Article 2) and the report of the assessment shared with relevant national stakeholders. (Annex 1A Article 2) in 70% and a national public health emergency response plan for hazards and Points of Entry (PoE) has been developed (Annex 1A, Article 6g) in 50% of countries. National public health emergency response plan(s) for multiple hazards and PoE have been tested in 60% of countries in an actual emergency or simulation and are updated as needed.
Multi-hazard National Public Health Emergency Preparedness & Response Plan
Core Capacity 8: Laboratory
90% of countries have a policy to ensure the quality of laboratory diagnostic
Laboratory services to test for priority health threats
In 50% of countries, designated PoE have trained personnel for the inspection of conveyances, and in 40% designated PoE have the capacity to safely dispose of potentially contaminated products. 40% of countries have a functioning programme for the surveillance and control of vectors and reservoirs in and near Points of Entry.
capacities. All countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 80% of countries have designated National reference laboratories (NRL) and have disseminated a list of NRL to relevant stakeholders. 80% of countries have access to diagnostic services for priority diseases, for pathogens listed in Annex 2 (IHR 2005) and for public health threats including hazardous substances.
SOPs for response at PoE are available in 70% of countries. A public health
Effective response at PoE
External Quality Assessment Schemes have been implemented for diagnostic
laboratories for major public health disciplines in 90% of countries. A network of national and international laboratories has been established in all countries to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 (IHR 2005). More than 10 non-AFP hazardous specimens per year referred to national or international reference laboratories for examination in 60% of countries. Laboratory test results in 90% of countries have been received from diagnostic laboratories in a timely manner to inform decision-making and actions.
emergency contingency response plan at designated PoE has been developed and disseminated to key stakeholders in 50% of countries. 30% of countries have integrated public health emergency contingency plans at designated PoE with other response plans, and have tested and updated them as needed.
Designated PoE have appropriate space, separate from other travelers, to
Laboratory biosafety and biosecurity practices
90% of countries have biosafety guidelines accessible to individual laboratories.
interview suspect or affected persons in 50% of countries. In 60%, the designated PoE can provide medical assessment or quarantine of suspect travelers, and care for affected travelers or animals. A referral and transport system for the safe transfer of ill travelers to appropriate medical facilities and access to relevant equipment, in place at a designated PoE is available in 80% of countries. Recommended public health measures can be applied at designated PoE in 50% of countries. Overall, good progress has been made on Points of Entry capacity. Further efforts have to be made across this capacity to meet the IHR requirements for effective surveillance and general obligations at Points of Entry.
Regulations, policies or strategies for laboratory biosafety exist in 90% of countries. In 60% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity. In 80% of countries, biosafety guidelines, manuals or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 80% of countries. A national classification of microorganisms by risk group has been completed in 30% of countries. 50% of countries have an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. Biosafety procedures are implemented and regularly monitored in 50% of countries. 20% 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. Diagnostic laboratories are designated and authorized or certified BSL 2 or above for relevant levels of the health care system in 80% of countries. 30% of countries have evaluated country experience and findings related to biosafety and shared reports with the global community. Across the region, very good progress has been made in most of the attributes of laboratory services testing for priority health threats. In laboratory biosafety and biosecurity practices less progress has been made, requiring further action in areas such as biorisk assessment in laboratories and implementation of biosafety procedures among others.
Hazard: Zoonotic Events
Mechanisms for detecting and responding to zoonoses and potential zoonoses
In 80% 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 90% of countries. 90% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 90% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories been established and documented.
In 80% of countries there a list of priority zoonotic diseases with case definitions
Points of Entry
available. 50% systematically and timely collect and collate zoonotic disease data. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 70% of countries. All countries have access to laboratory capacity, nationally or internationally to confirm priority zoonotic events. Zoonotic disease surveillance is implemented with a community component in 80% of countries.
A review meeting (or other appropriate method) to identify Points of Entry for
General obligations required at Points of Entry (PoE)
Timely and systematic information exchange between animal, human health
designation has been conducted in 90% of countries. 80% have designated a ‘Competent authority’ for each PoE and 80% have identified designated ports (as relevant)/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation been sent to WHO (as specified in Article 20, no.3) by 60% of countries. In 40% of countries, all designated airports have a competent authority and in 20% all designated airports have been assessed. In 40% of countries, all designated ports have competent authority and in 10% all designated ports has been assessed.
surveillance units and other relevant sectors regarding urgent zoonotic events and risks is available in 60% of countries. In 40% of countries, laboratories responsible for human diseases and animal diseases exchange regularly information zoonotic diseases.
A regularly updated roster (list) of experts that can respond to zoonotic events is In 60% of countries, animal health (domestic and wildlife) authorities/units
available in 30% of countries. 90% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.
Priority conditions for surveillance at designated PoE have been identified in
Effective surveillance at PoE
50% of countries. 60% 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 80% of countries. In 70% of countries, designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travelers, with adequate staff, equipment and premises. Surveillance of conveyances for presence of vectors and reservoirs at designated PoE have been established in 70% of countries.
participate in a national emergency response committee. In further 50% of countries operational, intersectoral public health plans for responding to zoonotic events have been tested through occurrence of events or simulation exercises and updated as needed. 40% of countries timely respond to more than 80% of zoonotic events of potential national and international concern. Across the region, very good progress has been made in developing mechanisms for detecting and responding to zoonoses and potential zoonoses. Areas of improvement mostly relate to implementation issues, such as maintenance of the expert roster, timely response to zoonotic events, etc.
21
Hazard: Food Safety
National or international food safety standards are available in 90% of countries.
Detecting and responding to foodborne disease and food contamination
40% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events.
All countries have national food laws, regulations or policy in place to facilitate food safety control. An operational national multisectoral mechanism for food safety events in place in 80% of countries. Decisions of the food safety multisectoral body are implemented and outcomes documented in 70% 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 50% of countries. 60% are active members of the INFOSAN network.
30% of the countries flag having a risk communication plan for chemical events An adequately-resourced Poison Centre(s) is in place in 30% of the countries. Compared to other capacities, chemical safety has made comparatively low progress. Most attributes in this capacity require significant improvement.
that is coordinated with the national risk communications plan. 30% of the countries have tested chemical event response plans been through occurrence of real event or through a simulation exercise and updated them as needed.
60% 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 70% of countries. Further 60% of countries have collected and analyzed systematically epidemiological data related to food contamination. In 40% 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 90% of countries. 60% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques.
Hazard: Radiological Events
Detecting and responding to radiological and nuclear emergencies
Experts have been identified for public health assessment and response to
In 40% of countries, a roster of food safety experts is available for the
assessment and response to food safety events. 40% of countries have tested and updated operational plans for responding to food safety events as needed. Food safety events have been investigated by teams that include food safety experts in 70% of countries. 70% of countries have established mechanisms for tracing, recall and disposal of contaminated products.
radiological and nuclear events in 50% of countries. 40% 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 40% of countries. 10% 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.
40% of countries have communication mechanisms and materials in place to inform, educate and advise stakeholders across the farm-to-fork continuum.
An inventory of hazard sites and facilities using/handling radioactive sources
Food safety control management systems have been implemented in 90% of Across the region, very good progress has been made in detecting and responding to foodborne disease and food contamination. Further implementation efforts are required, e.g. ensuring NFP and INFOSAN collaboration, maintaining food safety expert rosters and developing communication mechanisms.
countries. In 60% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards and regulations.
which may be the source of a public health emergency of international concern is in place in 40% of countries. 40% of countries have a monitoring in place for radiation emergencies. Further 20% of countries have mapped the radiological risks that may be a source of a potential public health emergency of international concern (exposure, populations at risk, etc).
A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a public health emergency of international concern is in place in 10% of countries.
In 30% of countries, scenarios, technical guidelines and SOPs for risk
Hazard: Chemical Events
30% of countries have identified experts for public health assessment and
Detection, alert and response to chemical emergencies
response to chemical incidents. In 40% legislation, policy or protocol in place for chemical event surveillance, alert and response. In 40% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR National Focal Point and 20% have an alert system in place for rapid communication with the IHR NFP. Coordination mechanisms been tested and updated through exercises in 20% of countries.
assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. In 20% of countries, agencies responsible for radiation emergencies participate in a national emergency response committee and in coordinated responses to radiation emergencies. A radiation emergency response plan is in place in 30% of countries. 10% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification.
30% of countries have a mechanism in place for access to hospitals or radiological or nuclear event.
health-care facilities with capacity to manage patients from radiation emergencies (in or out of the country).
Surveillance is in place for chemical events, intoxication or poisonings in 50% of countries. 10% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern.
20% of countries have a strategy for public communication in case of a 40% 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.
An inventory of major hazard sites and facilities that could be a source of
chemical public health emergencies is available in 20%. 30% of countries flagged to 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 20% of countries.
Regularly updated collaborative mechanisms are in place in 10% of countries for access to specialized laboratories that are able to perform bioassays, biological dosimetry by cytogenetic analysis and ESR. Across the region, least progress has been made in developing mechanisms for detecting and responding to radiological and nuclear emergencies. Both, in terms of planning and implementation, further significant efforts are required. 22
30% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies.
IHR CAPACITY ANALYSIS REGIONAL SUMMARY - WESTERN PACIFIC REGION NATIONAL CAPACITY MONITORING 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 representing inputs of technical expert drawn globally from WHO Member States, technical institutions, WHO partners, and from within WHO.
In 2010, 78% of countries (i.e. 21/27) in the Western Pacific region responded to the National Capacity Monitoring Questionnaire*, therefore response compliance increased compared to 2008 (59%), but is lower compared to 2009 (93%). 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 2010. To obtain a full overview of progress of all the indicators please consult the individual Country Profiles 2010. 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 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.
IHR NFP functions and operations as defined by IHR
In 90% of countries, the IHR NFP has been established. Information on In all countries, the IHR NFP has provided WHO with updated contact Across the region, very good progress has been made in establishing multisectoral collaboration. Further work needs to be done in its formalization and implementation. The IHR NFP is established in all countries, and is fully functional in nearly all countries.
Regional Average Attribute Scores
obligations under the IHR has been disseminated to relevant national authorities and stakeholders in 81% of countries. Documentation of actions taken by the IHR NFP and relevant stakeholders following communications with WHO is available in 86% of countries. information and confirmed itself annually. In 2010, 90% of IHR NFP accessed the IHR Event Information Site (EIS) at least monthly and 90% initiated at least once (written) communication with WHO.
Core Capacity 1: National legislation, policy and financing Legislation, regulations, administrative requirements, policies or other government instruments, sufficient for implementation of the IHR
Early warning function for detection of public health events in indicator-based (Routine) surveillance (IBS)
Core Capacity 3: Surveillance
Legal requirements and instruments are assessed in 81% of countries and Policies to facilitate IHR NFP core and expanded functions and to Across the region, very good progress has been made on assessing legislation. Less progress has been made on implementing required legislation and policies. implemented in 67% 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 76% of countries. strengthen technical core capacities have been implemented in 62% of countries (documentation available).
Lists of priority diseases or conditions for surveillance as well as case
Surveillance data on epidemic prone and priority diseases is analysed at least
definitions for priority diseases are available in 95% of countries. Also, 90% of countries have designated specific units for surveillance of public health risks.
weekly at national and sub-national levels in 86% of countries. 81% 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 86% of countries.
Core Capacity 2: Coordination and NFP Communications Coordination mechanism between relevant sectors implementing the IHR
95% of countries report that Coordination between relevant ministries on
In 90% of countries information sources for public health events and risks have been identified. 86% 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 76% of countries, and implemented in 62% of countries. public health events from a variety of sources including, media (print, broadcast, community, electronic, internet etc.) is in place in 76% of countries. 62% of countries have developed a local community (primary response) level reporting strategy. 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. In 52% of countries, implementation of local community reporting has been evaluated and updated as needed. Reported events contain essential information specified in the IHR in 71% of countries. 23
Event-Based Surveillance
71% of countries report having a multisectoral, multidisciplinary committee, 81% of countries, have a list of national stakeholders involved in the body or task force to address IHR requirements on surveillance and response for a PHEIC is in place. Coordination mechanisms have been tested in 95% of countries through an actual event occurrence or through exercises and have been updated as needed.
events that may constitute a public health event of national or international concern (PHEIC) is in place. Standard Operating Procedures are available for coordination between IHR NFP and stakeholders of relevant sectors in 48% of countries.
A system at national and/or sub-national levels for capturing and registering
implementation of IHR. 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 52% of countries and are implemented in 48% of countries.
The decision instrument in Annex 2 of the IHR (2005) is used to notify WHO in 86% of countries and in 57 % its use has been reviewed, with procedures for decision making updated on the basis of lessons learnt. Across the region, very good progress has been made in fulfilling requirements for Indicator-based and Event-based surveillance. Evaluation of reporting at community level is one of the areas requiring further development efforts.
In 67% of countries, a policy or strategy 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 is available. Surge capacity has been tested either through response to a public health event or during an exercise, and determined to be adequate in 76% of countries.
Core Capacity 4: Response
National resources have been assessed by 67% of countries to address priority A directory of experts in health and other sectors to support a response to risks. IHR-related hazards is available in 67% of countries. 67% of countries have conducted a national risk assessment to identify the most likely sources of ‘urgent public health event’ and vulnerable populations. Major hazard sites or facilities that could be the source of chemical, radiological, nuclear or biological public health emergencies of international concern have been mapped by 29% of countries. 71% of countries have mobilized experts from multiple disciplines/sectors in response to an actual public health event or simulation exercise in the past twelve months. A plan for management and distribution (if applicable) of national stockpiles is available in 71% of countries. 62% have stockpiles (critical stock levels) for responding to the country's priority biological, chemical and radiological events and other emergencies available and accessible at all times and 76% have tested and updated a stockpile management system through a real or simulated exercise. Across the region, very good progress has been made in establishing Risk Communication mechanisms. Areas requiring further attention remain, e.g. lacking hazard site mapping or shortfalls in stockpiling.
Public health risk and resource mapping
Resources for rapid response during outbreaks of national or international In 95% of countries, management procedures have been established for concern are accessible in 95% of countries. 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 86% of countries. Emergency response management procedures have been evaluated after a real or simulated public health response in 71% of countries. An evaluation of response including the timeliness and quality of response has been carried out and response procedures have been updated as needed following actual event occurrence or an assessment in 67% of countries. a roster of trained RRT members and SOPs available for the deployment of RRT members. In 90% of countries, multidisciplinary RRT can be deployed within 48 hrs from the time when the decision to respond is taken, and in 86% of countries RRT submit preliminary written reports on investigation and control measures to relevant authorities in less than one week of investigation. Finally in 86% of countries, RRT are mobilized for real events or through simulation exercise at least once a year at relevant levels.
Public Health Emergency Response mechanisms
Rapid Response Teams (RRT) are available in 90% of countries, and 71% have
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
Risk communication partners and stakeholders have been identified in 90% of
In 86% of countries responsibilities are assigned for surveillance of
SOPs, guidelines and protocols for IPC available to all hospitals in 76% of
health-care-associated infections and anti-microbial resistance. In 81% of countries national infection prevention and control policies/guidelines and an operational plan for infection control are available. The plan has been implemented nationwide and reviewed (documented) in 57% of countries. countries, and defined norms or guidelines for protecting health-care workers have been developed in 86% of countries. 81% have a national coordination for surveillance of relevant events such as health-care-associated infections, and infections of potential public health concern with defined strategies, objectives, and priorities in place. All tertiary hospitals have designated area(s) and defined procedures for the care of patients requiring specific isolation precautions according to national or international guidelines in 81% and have qualified IPC professionals in place in 76% of countries. The management of patients with highly infectious diseases meets established IPC standards in 71% of countries. In 52% 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 81% of countries. Across the region, very good progress has been made in establishing Public Health Emergency Response mechanisms. Response resources are accessible in nearly all countries. Further implementation is required in areas such as surveillance with high risk groups and review of plans.
A risk communication plan including social mobilization of communities has been
countries. A unit for coordinating public communications during a public health event is in place in 81% of countries, with defined roles and responsibilities of the stakeholders. developed in 62% of countries. Policies, SOPs or guidelines on the clearance and release of information during a public health event have been disseminated in 71% of countries. Policies, SOPs or guidelines are available in 62% of countries to support community-based risk communications interventions during public health emergencies. 38% 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 86% of the countries regularly updated information sources are accessible to media and the public for information dissemination. Accessible and relevant IEC materials are tailored to the needs of the population in 86% of countries. Across the region, very good progress has been made in establishing Risk Communication mechanisms. Areas requiring further attention include policy formulation and dissemination and post-emergency evaluation.
Core Capacity 7: Human Resource Capacity
In 52% of countries a unit has been identified to assess human resource
Human resources available to implement IHR Core Capacity requirements
Core Capacity 5: Preparedness
In 81% of countries, an assessment of core capacities for the implementation of A national plan to meet the IHR core capacity requirements has been developed IHR been conducted (Annex 1A Article 2) and the report of the assessment shared with relevant national stakeholders. (Annex 1A Article 2) in 71% and a national public health emergency response plan for 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 71% of countries in an actual emergency or simulation and are updated as needed.
Multi-hazard National Public Health Emergency Preparedness & Response Plan
capacities to meet the country's IHR requirements. Critical gaps have been identified in existing human resources (numbers and competencies) to meet IHR requirements in 62% of countries. A training needs assessment has been conducted and a plan has been developed to meet training needs requirements in 62% of countries. In 43% of countries, responsible authorities have approved workforce development plans and funding for the implementation of the IHR. 33% 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 62% of countries. 71% of countries have provided evidence of a strengthened workforce when tested in an urgent public health event or simulation exercise. Progress on human resource capacity has been good, but among others requires efforts in achieving targets meeting workforce numbers and skills consistent with milestones set in countries' training development plans.
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Core Capacity 8: Laboratory
62% of countries have a policy to ensure the quality of laboratory diagnostic
Laboratory services to test for priority health threats
In 67% of counries, designated PoE have trained personnel for the inspection of
capacities. 71% of countries have an updated and accessible inventory of public and private laboratories with relevant diagnostic capacity available. 81% of countries have designated National reference laboratories (NRL) and have disseminated a list of NRL to relevant stakeholders. 76% of countries have access to diagnostic services for priority diseases, for pathogens listed in Annex 2 (IHR 2005) and for public health threats including hazardous substances.
conveyances, and in 57% designated PoE have the capacity to safely dispose of potentially contaminated products. 57% of countries have a functioning programme for the surveillance and control of vectors and reservoirs in and near Points of Entry.
SOPs for response at PoE are available in 71% of countries. A public health
Effective response at PoE
External Quality Assessment Schemes have been implemented for diagnostic
laboratories for major public health disciplines in 81% of countries. A network of national and international laboratories has been established in 67% of countries to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 (IHR 2005). More than 10 non-AFP hazardous specimens per year referred to national or international reference laboratories for examination in 48% of countries. Laboratory test results in 71% of countries have been received from diagnostic laboratories in a timely manner to inform decision-making and actions.
emergency contingency response plan at designated PoE has been developed and disseminated to key stakeholders in 67% of countries. 52% of countries have integrated public health emergency contingency plans at designated PoE with other response plans, and have tested and updated them as needed.
Designated PoE have appropriate space, separate from other travelers, to
Laboratory biosafety and biosecurity practices
67% of countries have biosafety guidelines accessible to individual laboratories.
interview suspect or affected persons in 62% of countries. In 67%, the designated PoE can provide medical assessment or quarantine of suspect travelers, and care for affected travelers or animals. A referral and transport system for the safe transfer of ill travelers to appropriate medical facilities and access to relevant equipment, in place at a designated PoE is available in 86% of countries. Recommended public health measures can be applied at designated PoE in 62% of countries. Overall, good progress has been made on Points of Entry capacity. Further efforts have to be made across this capacity to meet the IHR requirements for effective surveillance and general obligations at Points of Entry.
Regulations, policies or strategies for laboratory biosafety exist in 57% of countries. In 48% of countries, a responsible entity has been designated for laboratory biosafety and biosecurity. In 67% of countries, biosafety guidelines, manuals or SOPs have been disseminated to laboratories. Relevant staff has been trained on biosafety guidelines in 81% of countries. A national classification of microorganisms by risk group has been completed in 43% of countries. 43% of countries have an institution or person responsible for inspection of laboratories for compliance with biosafety requirements. Biosafety procedures are implemented and regularly monitored in 52% of countries. 43% 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. Diagnostic laboratories are designated and authorized or certified BSL 2 or above for relevant levels of the health care system in 71% of countries. 24% of countries have evaluated country experience and findings related to biosafety and shared reports with the global community. Across the region, very good progress has been made in most of the attributes of laboratory services testing for priority health threats. Still, across the attributes increased effort is required to meet the requirements of the IHR by 2012.
Hazard: Zoonotic Events
Mechanisms for detecting and responding to zoonoses and potential zoonoses
In 81% 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 71% of countries. 81% of countries have designated focal points responsible for animal health for coordination with the MoH and/or IHR NFP. 76% have functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories been established and documented.
In 62% of countries there a list of priority zoonotic diseases with case definitions
Points of Entry
A review meeting (or other appropriate method) to identify Points of Entry for
General obligations required at Points of Entry (PoE)
available. 57% systematically and timely collect and collate zoonotic disease data. A systematic information exchange between animal and human health surveillance units about urgent zoonotic events and potential zoonotic risks exists in 67% of countries. 81% 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 62% of countries.
designation has been conducted in 76% of countries. 76% have designated a ‘Competent authority’ for each PoE and 76% have identified designated ports (as relevant)/airports for development of capacities specified in Annex 1. A list of authorized ports offering certificates relating to ship sanitation been sent to WHO (as specified in Article 20, no.3) by 48% of countries. In 29% of countries, all designated airports have a competent authority and in 14% all designated airports have been assessed. In 29% of countries, all designated ports has competent authority and in 14% all designated ports has been assessed.
Timely and systematic information exchange between animal, human health
surveillance units, and other relevant sectors regarding urgent zoonotic events and risks is available in 67% of countries. In 48% of countries, laboratories responsible for human diseases and animal diseases exchange regularly information zoonotic diseases.
A regularly updated roster (list) of experts that can respond to zoonotic events is In 48% of countries, animal health (domestic and wildlife) authorities/units
available in 62% of countries. 76% of countries have established a mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors.
Priority conditions for surveillance at designated PoE have been identified in
Effective surveillance at PoE
86% of countries. 76% 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 76% of countries. In 62% of countries, designated PoE have access to appropriate medical services including diagnostic facilities for the prompt assessment and care of ill travelers, with adequate staff, equipment and premises. Surveillance of conveyances for presence of vectors and reservoirs at designated PoE have been established in 52% of countries.
participate in a national emergency response committee. In further 62% of countries operational, intersectoral public health plans for responding to zoonotic events have been tested through occurrence of events or simulation exercises and updated as needed. 67% of countries timely respond to more than 80% of zoonotic events of potential national and international concern. Across the region, very good progress has been made in developing mechanisms for detecting and responding to zoonoses and potential zoonoses. Areas of improvement mostly relate to implementation issues, for example ensuring the participation of animal health authorities in a national emergency response committee.
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Hazard: Food Safety
National or international food safety standards are available in 76% of countries.
Detecting and responding to foodborne disease and food contamination
52% of countries have laboratory capacity or access to laboratory capacity to confirm priority chemical events.
95% 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 in place in 71% of countries. Decisions of the food safety multisectoral body are implemented and outcomes documented in 62% 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 57% of countries. 57% are active members of the INFOSAN network.
38% of the countries flag having a risk communication plan for chemical events An adequately-resourced Poison Centre(s) is in place in 43% of the countries. Compared to other capacities, chemical safety has made comparatively low progress. Most attributes in this capacity require significant improvement to meet the IHR requirements in 2012.
that is coordinated with the national risk communications plan. 62% of the countries have tested chemical event response plans been through occurrence of real event or through a simulation exercise and updated them as needed.
48% 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 57% of countries. Further 48% of countries have collected and analyzed systematically epidemiological data related to food contamination. In 57% 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 62% of countries. 67% of countries have access to laboratory capacity to confirm priority food safety events of national or international concern including molecular techniques.
Hazard: Radiological Events
Detecting and responding to radiological and nuclear emergencies
Experts have been identified for public health assessment and response to
In 52% of countries, a roster of food safety experts is available for the
assessment and response to food safety events. 48% of countries have tested and updated operational plans for responding to food safety events as needed. Food safety events have been investigated by teams that include food safety experts in 67% of countries. 81% of countries have established mechanisms for tracing, recall and disposal of contaminated products.
radiological and nuclear events in 43% of countries. 43% 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 48% of countries. 29% 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.
62% of countries have communication mechanisms and materials in place to inform, educate and advise stakeholders across the farm-to-fork continuum.
An inventory of hazard sites and facilities using/handling radioactive sources
Food safety control management systems have been implemented in 76% of Across the region, very good progress has been made in detecting and responding to foodborne disease and food contamination. Further implementation efforts are required, for example the testing and updating of operational plans for responding to food safety events, or collection and analysis of epidemiological data related to food contamination
countries. In 76% of countries, information from foodborne outbreaks and food contamination has been used to strengthen food management systems, safety standards and regulations.
which may be the source of a public health emergency of international concern is in place in 48% of countries. 43% of countries have a monitoring in place for radiation emergencies. Further 38% of countries have mapped the radiological risks that may be a source of a potential public health emergency of international concern (exposure, populations at risk, etc).
A systematic information exchange between radiological competent authorities and human health surveillance units about urgent radiological events and potential risks that may constitute a public health emergency of international concern is in place in 43% of countries.
In 38% of countries, scenarios, technical guidelines and SOPs for risk
Hazard: Chemical Events
62% of countries have identified experts for public health assessment and
Detection, alert and response to chemical emergencies
response to chemical incidents. In 52% legislation, policy or protocol in place for chemical event surveillance, alert and response. In 48% of countries national authorities responsible for chemical events have designated a focal point for coordination with the Ministry of Health and/or the IHR National Focal Point and 48% have an alert system in place for rapid communication with the IHR NFP. Coordination mechanisms been tested and updated through exercises in 48% of countries.
assessment, reporting, event verification and notification, investigation and management of radiation emergencies are available. In 57% of countries, agencies responsible for radiation emergencies participate in a national emergency response committee and in coordinated responses to radiation emergencies. A radiation emergency response plan is in place in 43% of countries. 38% of countries have carried out radiation emergency response drills out regularly at national level, including requesting international assistance (as needed) and international notification.
43% of countries have a mechanism in place for access to hospitals or radiological or nuclear event.
health-care facilities with capacity to manage patients from radiation emergencies (in or out of the country).
Surveillance is in place for chemical events, intoxication or poisonings in 52% of countries. 38% of countries have a list of priority chemical events/syndromes that may constitute a potential public health event of national and international concern.
43% of countries have a strategy for public communication in case of a 48% 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.
An inventory of major hazard sites and facilities that could be a source of
chemical public health emergencies is available in 38%. 48% of countries flagged to 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 38% of countries.
Regularly updated collaborative mechanisms are in place in 29% of countries for Across the region, least progress has been made in developing mechanisms for detecting and responding to radiological and nuclear emergencies. Both, in terms of planning and implementation, further significant efforts are required. 26
access to specialized laboratories that are able to perform bioassays , biological dosimetry by cytogenetic analysis and ESR.
52% of countries have an emergency response plan that defines the roles and responsibilities of relevant agencies for chemical emergencies.