National Health Emergency Response Operations Plan (NHEROP)

Objectives

The National Health Emergency Response Operational Plan provides an all-hazards, multisectoral and multi-level framework for preparedness, response and recovery from infectious disease outbreaks, natural disasters, technological incidents and other public health emergencies. Its overarching purpose is to preserve life, reduce health impacts, protect public safety and meet the basic needs of affected populations through rapid, coordinated action extending to communities.[1][2]

• Apply risk-informed contingency planning based on a January 2023 assessment of 26 hazards using the World Health Organization Strategic Tool for Assessing Risks, with 15 hazards selected as planning priorities.[1][3]
• Prioritise very high-risk threats including Rift Valley fever, mining and quarry accidents, cholera or acute watery diarrhoea, COVID-19, novel influenza subtypes and antimicrobial-resistant microorganisms.[4][5]
• Strengthen prevention, preparedness, detection, response and recovery across surveillance, laboratories, case management, logistics, infection prevention and control, water, sanitation and hygiene, hazard containment, risk communication and community engagement.[6][7]
• Engage communities as equal partners in leadership, planning and implementation, using timely, evidence-based, inclusive and locally appropriate communication to enable informed protective decisions.[5][8]
• Align health emergency preparedness with international and national commitments, including the International Health Regulations (2005), Sustainable Development Goals, Global Health Security Agenda, Universal Health Coverage 2030, Sendai Framework and relevant Rwandan legislation and health-security plans.[9]
• Use the Incident Management System and After-Action Reviews to manage responses by objectives, identify good practice and gaps, and convert lessons into corrective actions for future health-security planning.[10]

Implementation

Implementation combines decentralised service delivery and multisectoral incident management at community, sector, district, provincial and national levels. The Ministry of Health provides policy direction and resource mobilisation; the Rwanda Biomedical Centre implements public health programmes, surveillance and emergency coordination; and Public Health Emergency Management Committees, Public Health Emergency Operations Centres, Incident Managers and Rapid Response Teams coordinate strategic, operational and tactical action.[11][3][12][13]

• Activate graded emergency arrangements following rapid risk assessment: sector-level structures for local events, district and provincial support for escalating emergencies, national operations for major events, and multisectoral or international support where required.[14][15]
• Assign activation authority to the Sector Executive Secretary at level 1, District Mayor at level 2, Minister of Health at level 3 and national disaster-management authority at level 4.[15]
• Organise incident management through management, operations, planning, logistics, and administration and finance functions, with the Public Health Emergency Operations Centre serving as the hub for information and resource coordination.[10][12]
• Deploy national and district Rapid Response Teams within 24 to 48 hours for risk assessment, investigation, case definition, epidemiological analysis, infection prevention and control, partner coordination and outbreak-control measures.[16][17]
• Maintain surge capacity through trained personnel, volunteers, Field Epidemiology and Training Programme graduates, Emergency Medical Teams and the 75-member African Volunteers Health Corps SURGE team, which can deploy within 24 to 48 hours, including beyond Rwanda where needed.[16][17]
• Deliver services through community health workers, health posts and centres, district and provincial hospitals, and referral hospitals, while requiring all facilities to contribute to emergency surveillance, investigation and response.[11][18]
• Operate a three-tier laboratory network linking peripheral laboratories, district hospitals and the National Reference Laboratory for sample transfer, quality assurance, supervision and referral testing; use private, university, referral and provincial laboratories to supplement capacity.[18][19]
• Coordinate medicines and commodity availability through Rwanda Medical Supply Ltd, which procures, warehouses and distributes health commodities, while the Expanded Programme of Immunisation manages vaccine procurement, storage and distribution.[18]
• Implement risk communication and community engagement through a national multisectoral task team, focal teams and implementing partners, using feedback lines, social listening, rumour tracking, media reviews, community and religious leaders, and accessible Kinyarwanda materials adapted to literacy levels and disabilities.[20][8]
• Monitor operations through incident action plans, situation reports, resource tracking, epidemiological analysis, laboratory quality assurance and regular coordination updates; conduct After-Action Reviews immediately after events or within three months.[10][12][17]
• Mobilise emergency resources through Ministry of Health engagement with the Ministry of Finance and Economic Planning and other stakeholders, supported by cash reserves for urgent disaster response; the available material does not provide quantified emergency budgets or allocations.[18][9]

Monitoring & Evaluation

The plan establishes a multi-level monitoring and response architecture centred on risk assessment, surveillance, incident management, reporting and post-event learning. Preparedness priorities draw on the January 2023 Strategic Tool for Assessing Risks assessment of 26 hazards, of which 15 were selected for contingency planning.[1][3]

• Assess hazards, exposure, vulnerability and coping capacity through national emergency risk assessment, with templates recording risk and confidence at district, national and global levels, response timeframes, reassessment needs and escalation decisions.[3][21]
• Strengthen facility and community surveillance, including routine rapid-antigen testing and genomic surveillance for COVID-19 variants; influenza surveillance operates through six sentinel sites, while antimicrobial-resistance surveillance uses 12 human-health and five animal-health sentinel sites.[4][22]
• Coordinate disease surveillance, investigation and response through the Rwanda Biomedical Centre Public Health Surveillance, Emergency Preparedness and Response Division, with operations decentralised to provincial and district levels.[3]
• Require health facilities to participate in surveillance, investigation and emergency response, supported by a three-tier public laboratory network linking the National Reference Laboratory, district hospitals and peripheral health centres.[18]
• Maintain laboratory quality assurance through National Reference Laboratory standards, licensing, certification and accreditation oversight, and external quality-control partnerships with the National Institute of Public Health in South Africa and the United States Centers for Disease Control and Prevention.[19][23]
• Use community-based surveillance coordinated by health centres, while community animal health workers and sector veterinary officers support animal-health surveillance and response.[19]
• Convene Public Health Emergency Management Committees quarterly when no event is occurring; district Rapid Response Teams meet daily during outbreaks and quarterly otherwise.[9][19][17]
• Monitor emergency operations through the Incident Management System planning function, which tracks resources, analyses incident information, develops Incident Action Plans, maintains a common operating picture and prepares situation reports.[12][6]
• Report outbreak status, cases, deaths, case-fatality rates, incidence or attack rates, affected populations, trends, laboratory findings, contact tracing, response actions, gaps and recommendations through structured situation reports.[24][25]
• Monitor Risk Communication and Community Engagement through information management, feedback collection, rumour tracking, social listening and daily reviews of traditional and social media; the Rwanda Health Communications Centre and Office of the Government Spokesperson produce daily reports on health emergencies and disasters.[5][8]
• Evaluate response effectiveness during recovery, document lessons and challenges, review communication materials, and conduct an After-Action Review immediately after an event or within three months to identify good practice, gaps and corrective actions.[26][10]
• Maintain accountability through defined activation and deactivation authorities, incident-management roles, regular leadership briefings and formal approval of immediate actions in grading processes.[15][12][7]

The supplied material does not provide a single consolidated indicator framework, numerical performance targets, universal reporting timetable, independent evaluation mechanism or detailed accountability framework.[5][10][6][27]

Costing & Financing

Financing arrangements focus on rapid emergency resource mobilisation, budget preparation and financial administration, but the supplied material does not state quantified emergency-response budgets, funding gaps, financing totals or economic assumptions.[18][9][10][28]

• Maintain emergency funds as cash reserves for rapid release to disaster-response sectors and immediate action, with the Ministry of Finance and Economic Planning reserving resources for unplanned expenditure or financial emergencies.[18][9]
• Mobilise health-emergency resources through the Ministry of Finance and Economic Planning and other stakeholders; the Prime Minister’s Office convenes relevant ministries, while the responsible ministry presents the response budget.[18]
• Assign national Public Health Emergency Management Committee leadership responsibility for policy direction and resource mobilisation, with planning, logistics and administration and finance functions supporting budgeting, procurement, accounting, cost management and records.[12]
• Prepare and monitor budgets, expenditure, cash flows, procurement contracts, compensation claims and cost-sharing arrangements through the finance and administration function; operational teams submit resource and funding requests through logistics and finance structures.[28][27]
• Include a cost plan and detailed budget in Risk Communication and Community Engagement preparedness planning, although no amounts or financing sources are provided.[8]
• Record costs against individual activities or tasks in the Incident Action Plan template, without providing a programme budget total.[29]
• Manage medicines, supplies and consumables at optimum cost through Rwanda Medical Supply Ltd, which procures, stores and distributes commodities for public facilities.[3]
• Recognise East, Central and Southern Africa Health Community technical and financial support for development of the plan, without an associated monetary value.[1]
• Identify an Economic Recovery Fund intended to support businesses severely affected by COVID-19 to resume operations and safeguard jobs; its value and operating arrangements are not specified in the supplied extract.[30]

Resource needs are also reflected in a June 2020 request for infection-prevention and control materials for the Rubavu District cholera outbreak, but the request specifies quantities rather than prices or funding.[24]