National Health Emergency Response Operations Plan (NHEROP)

Objectives

Provide Rwanda with an all-hazards, multi-level and multisectoral framework for preparedness, rapid response and recovery across 15 priority hazards identified through the January 2023 national risk assessment.[1][2]The plan aims to preserve lives, reduce health impacts, safeguard the public and meet the basic needs of affected populations during infectious disease outbreaks, natural disasters, technological incidents and other emergencies.[2]

• Guide coordinated action against biological, natural and technological hazards, including unsafe food and water, chemical and radiation incidents, structural collapse, conflict and climate-related risks.[1]
• Prioritise very high-risk hazards, including Rift Valley fever, mining and quarry accidents, cholera or acute watery diarrhoea, COVID-19, influenza caused by new subtypes and antimicrobial-resistant microorganisms.[3][4]
• Strengthen prevention, preparedness, detection, response and recovery through health security, disaster risk reduction, One Health, animal health, food and nutrition, and chemical, biological, radiological, nuclear and explosive preparedness.[5]
• Enhance risk communication and community engagement to prevent, control and reduce common health hazards, using evidence-based, human-rights-based, people-centred and systems-oriented approaches.[4][6]
• Use the Incident Management System as a standardised, scalable framework to align agencies, manage resources against objectives and improve emergency communication.[7]
• Support recovery and continuity of essential health services through established health-system strengthening instruments, COVID-19 vaccination, community outreach, medical missions, respiratory care and medical oxygen strategies.[8]

Implementation

Implement the plan through decentralised, multisectoral emergency management spanning communities, health facilities, sectors, districts, provinces and national institutions.[9][10]The Ministry of Health leads national policy, regulation, coordination, monitoring and resource mobilisation, while the Rwanda Biomedical Centre implements preventive, curative and rehabilitative interventions and coordinates public health surveillance, preparedness and response.[11][9]

• Coordinate strategic, operational and tactical response functions through national and district Public Health Emergency Management Committees, Public Health Emergency Operations Centres and Rapid Response Teams.[12]National committees are chaired by the Minister of Health and district committees by District Mayors.[12]
• Activate emergency structures progressively at sector, district, national or beyond-national level following rapid risk assessment.[13]The Sector Executive Secretary, District Mayor, Minister of Health and National Disaster Management Authority respectively hold activation or declaration authority at the relevant response levels.[14]
• Operate the Incident Management System through management, operations, planning, logistics, and administration and finance functions under an Incident Manager.[7]These functions cover surveillance, laboratory services, case management, environmental health, risk communication and community engagement, vaccination, procurement, transport, supplies, finance, human resources and records.[7][12]
• Deploy national and district Rapid Response Teams within 24 to 48 hours for risk assessment, investigation, diagnosis verification, case finding, infection prevention and control, data analysis, control recommendations and partner coordination.[10][15]Mobilise surge personnel through the Incident Management System, including African Volunteers of Health corps-SURGE members, Field Epidemiology Training Programme trainees, trained ministry staff, partners and volunteers.[16]
• Maintain service delivery from community health workers through primary and intermediate care to referral hospitals, supported by health facilities, transport, utilities, supplies and emergency equipment.[11][17]
• Maintain a three-tier public laboratory network linking the National Reference Laboratory, hospital laboratories and health-centre laboratories, complemented by private, university, satellite and external reference laboratories.[17][18]The National Reference Laboratory provides national referral, standards, quality and regulatory functions, including specialised testing and genomic sequencing.[18]
• Strengthen surveillance through health facilities, communities and points of entry, with active case finding, contact tracing, epidemiological data management, geographic information systems, laboratory confirmation and hazard-specific sentinel surveillance.[19]COVID-19 arrangements include rapid antigen testing and genomic surveillance, while antimicrobial resistance surveillance uses twelve human-health and five animal-health sentinel sites.[20]
• Coordinate One Health and disaster-management action across human health, animal health, environmental services, disaster management and other relevant sectors.[21]Animal-health emergencies are coordinated through the Veterinary Services Programme, district veterinary officers and sector veterinary officers.[21]
• Implement risk communication and community engagement through national and district task teams involving government, public and private institutions, United Nations agencies, local authorities, security services, academia, civil society, disability organisations and media houses.[6]Use radio, television, print, social media, toll-free feedback lines, social listening, media reviews and participatory research, with accessible materials primarily in Kinyarwanda and adapted to audiences’ literacy, gender and disability needs.[22][23]
• Prepare Incident Action Plans for each operational period, defining the situation, objectives, strategies, activities, responsible persons, costs and completion dates.[24]Use situation reports, incident updates, partner mapping, grading reports and leadership briefings to maintain a common operating picture and escalate decisions.[25][26]
• Monitor response effectiveness through dynamic risk assessment, epidemiological analysis, surveillance reporting, resource tracking, rumour monitoring and regular Situation Reports.[27][7]Conduct After-Action Reviews immediately after an event where possible and no later than three months afterwards to identify good practice, gaps, lessons and corrective actions.[14]
• Mobilise emergency resources through responsible line ministries, the Ministry of Finance and Economic Planning, other stakeholders and institutional emergency budgets.[17][5]Emergency funds are held as cash reserves for rapid release to disaster-response sectors, while Level 4 events may require cross-sectoral or international support when national resources are constrained.[5][27]

Monitoring & Evaluation

The plan establishes a multi-level monitoring, surveillance and review architecture for public health emergencies, combining all-hazards risk assessment, routine and event-based surveillance, operational reporting, incident management, community feedback and post-event learning. The January 2023 national assessment used the World Health Organization Strategic Tool for Assessing Risks to rank 26 hazards and select 15 priorities for preparedness and response.[1][3]

• Use the Ministry of Health to monitor and evaluate implementation of health-sector and related-sector policies, strategies and programmes, while the Rwanda Biomedical Centre Public Health Surveillance, Emergency Preparedness and Response Division coordinates surveillance and response with government institutions and partners.[11][9]
• Strengthen hazard detection through health-facility and community surveillance, laboratory confirmation, rapid antigen testing and genomic surveillance for COVID-19, six influenza sentinel sites, and coordinated human and animal antimicrobial resistance surveillance.[20]
• Maintain antimicrobial resistance surveillance through twelve human-health and five animal-health sentinel sites, alongside implementation of the One Health Policy, One Health Strategic Plan and National Action Plan on antimicrobial Resistance.[20]
• Require all health facilities to contribute to public health emergency surveillance, investigation and response, supported by a three-tier laboratory network for sample transfer, quality control, supervision and mentorship.[17]
• Use National Reference Laboratory referral, standards, licensing, certification and accreditation functions to oversee laboratory quality, including referral of specimens requiring special handling, genomic sequencing or polymerase chain reaction testing.[18]
• Apply external quality assurance through international laboratory collaboration, including quality-control testing for multidrug-resistant tuberculosis and quarterly panels for epidemic bacteria, malaria, tuberculosis microscopy, CD4 counts, HIV testing and polymerase chain reaction capacity.[22]
• Implement structured Risk Communication and Community Engagement monitoring through information management, feedback collection, rumour tracking, social listening and daily traditional and social-media reviews that generate daily reports on health emergencies and disasters.[4][23]
• Activate dynamic risk assessment throughout responses, maintain situational awareness and brief relevant command posts and emergency operations centres regularly.[27]
• Use the Incident Management System planning function to collect and analyse information, track resources, prepare Incident Action Plans, produce Situation Reports and monitor and evaluate response activities.[7]
• Require national and district strategic coordination committees to meet at least weekly during a response, while national and district rapid response teams meet daily during outbreaks and quarterly when no outbreak is occurring.[12][15][16]
• Report cumulative and progress implementation results to the Incident Manager or designated information-management structure at the frequency set for each operational period.[28][19]
• Use Situation Reports and surveillance reporting to track suspected, probable and confirmed cases; deaths; case fatality; incidence or attack rates; trends; geographical distribution; notification delays; laboratory results; exposure investigations; and contact-tracing outcomes.[25][29]
• Conduct an After Action Review immediately after an event where possible and no later than three months afterwards, using a structured qualitative process to identify good practice, gaps, lessons and corrective actions.[14][7]

A comprehensive indicator framework, quantified performance targets, independent accountability mechanism and standard reporting timetable are not specified across the supplied extracts, beyond the operational reports, committee oversight, laboratory regulation and review mechanisms described.[30][7][29]

Costing & Financing

The plan describes institutional mechanisms for financing emergency operations and resource mobilisation, but does not provide a costed implementation plan, total budget, monetary allocation, quantified funding gap or economic assumptions for overall preparedness and response.[17][5][31][28]

• Provide technical and financial support for development of the National Health Emergency Response Operations Plan through the East, Central and Southern Africa Health Community.[1]
• Use an emergency financing system under which the Prime Minister’s Office convenes concerned ministries, the responsible line ministry prepares a response budget, and the Ministry of Finance mobilises and manages available and required resources.[17][5]
• Allocate institutional budgets for emergency action plans and emergency needs among entities with emergency-management responsibilities.[17][5]
• Hold emergency cash reserves through the Ministry of Finance and Economic Planning for rapid release to disaster-response sectors, unplanned expenditure and financial emergencies; mobilise public-health emergency funds through that ministry and other stakeholders.[5]
• Use Incident Management System planning, logistics and administration and finance functions to support action planning and budgeting, resource acquisition, tracking, distribution, expenditure control, cash-flow monitoring, procurement, payments, compensation claims and financial-status reporting.[7][31][28]
• Mobilise resources through national and district strategic coordination structures, including sources within and outside government at national level.[12]
• Prepare a Risk Communication and Community Engagement preparedness cost plan and detailed budget, although no amounts or financing sources are supplied.[23]
• Include a cost field for each activity or task in Incident Action Plans, while leaving activity-level costs and budget totals unspecified.[24]
• Keep immediate response support within the limit of the Contingency Funds for Emergencies where no emergency grading is recommended.[32]
• Recognise that Level 4 emergencies may require support from other sectors or international partners when national resources are limited.[27]
• Consider the Economic Recovery Fund as a mechanism established to help businesses severely affected by COVID-19 resume operations and safeguard jobs, without specifying a health-sector allocation.[8]

The supplied material identifies financial resources, approved budgets, resource requests and cost-sharing as operational considerations, but does not specify funding shares, expenditure ceilings, donor commitments, currency amounts, costing methodology or affordability assumptions.[33][19][28]