National Action Plan for Health Security

Objectives

Sri Lanka’s National Action Plan for Health Security provides a five-year, multisectoral framework to strengthen International Health Regulations (2005) core capacities and national capability to prevent, detect and respond efficiently and effectively to public health threats.[1][2]Its vision is a safer nation through strengthened public health-security capacities, delivered through a One Health and whole-of-government approach.[3]

• Strengthen sustained multisectoral engagement, legal and institutional arrangements, risk assessment, core capacities and results-based monitoring for health security.[3]
• Integrate human, animal, agriculture and environmental health action through One Health surveillance, information exchange and coordinated preparedness.[2][3]
• Address prevention priorities including antimicrobial resistance, zoonotic diseases, food safety, biosafety and biosecurity, immunisation, laboratory systems, chemical hazards and radiation emergencies.[4][5][6][7][8][9]
• Improve detection through interoperable real-time reporting, laboratory quality systems, specimen referral, indicator- and event-based surveillance, syndromic surveillance and influenza surveillance.[10][11][12][13]
• Strengthen preparedness and response through multi-hazard risk mapping, joint emergency planning, public health emergency operations centre capacity, emergency medical teams, medical countermeasures, risk communication and Points of Entry readiness.[14][15][16][17][18][19]

The plan prioritises risk-informed action across natural, man-made, biological and complex hazards. Epidemics, floods, drought, lightning, land transport accidents, landslides, fire, chemical accidents, tsunami and cyclone are the ten highest-ranked public health hazards, with epidemics ranked first.[20][21]

Strategic action is intended to align with relevant national policies and sectoral plans while supporting national, regional and global health security.[22][2]The technical framework spans legislation and financing, coordination, prevention, detection and response functions, with Joint External Evaluation scores identifying particular weaknesses in biosafety and biosecurity practices, preparedness planning, risk and resource mapping, emergency operations activation and health-personnel deployment.[23][24][25]

Implementation

Implementation is designed as a dynamic, medium-term and results-based process for 2019 to 2023, with ministries, departments and units expected to incorporate relevant activities into annual work plans and deliver them in phases.[2]The Ministry of Health leads the plan, supported by relevant health, animal health, agriculture, environment, defence, foreign affairs, immigration, port, aviation, fisheries and other authorities.[1][22]

• Coordinate national implementation through the inter-ministerial International Health Regulations steering committee, chaired by the Director General of Health Services, with the International Health Regulations National Focal Points, Quarantine Unit and other designated agencies supporting implementation.[2][26][3]
• Formalise governance through legislative review, a multisectoral legal group, sectoral focal points, administrative instruments and annual completion of the International Health Regulations questionnaire.[27][28][29]
• Use consultation, consensus, scientific evidence, stakeholder meetings, technical working arrangements, standard operating procedures, memoranda of understanding and formal plans to support cross-sector coordination and continuity.[3]
• Deliver operational actions through workforce training, laboratory upgrades and accreditation, electronic systems, surveillance networks, risk assessments, simulations, emergency exercises, procurement, facility development and public communication.[30][13][31][32][19]

The delivery model assigns specialised responsibilities across sectors. The Epidemiology Unit, Medical Research Institute, Department of Animal Production and Health, Department of Agriculture, Ministry of Fisheries and Aquatic Resources, Disaster Preparedness and Response Division, Health Promotion Bureau, Directorate of Quarantine, Medical Supplies Division and Sri Lanka Atomic Energy Regulatory Commission hold roles across technical areas.[4][10][33][15][17][18][34]Provincial, district and local authorities are also involved in surveillance, risk assessment, service delivery, training and emergency response.[35][31]

Monitoring combines the International Health Regulations monitoring and evaluation framework, including Joint External Evaluation, annual reporting, after-action reviews and simulation exercises.[22][2]The 2017 Joint External Evaluation informed plan development and identified national priorities for action.[22][2]National steering-committee monitoring is scheduled every six months, while relevant ministries, departments and units monitor implementation quarterly through their heads and principal stakeholders.[27]

Activity-level monitoring uses milestones and output indicators, including amended laws, committee meetings, appointed focal points, surveillance coverage, laboratory accreditation, trained personnel, completed risk assessments, available plans and procedures, simulation exercises, functioning reporting systems, public communication mechanisms and published reports.[29][36][14][32][18][37]Financing is expected mainly from government funds, with selected activities supported by donors, but no total budget, activity costs, funding allocations or quantified funding gap is specified.[2]

Monitoring & Evaluation

The National Action Plan for Health Security uses a results-based monitoring and evaluation approach to strengthen International Health Regulations (IHR) 2005 capacities for prevention, detection and response. Oversight combines ministry and agency implementation responsibilities with national coordination through the inter-ministerial IHR steering committee, chaired by the Director General of Health Services.[22][2]

• Apply the World Health Organization IHR monitoring and evaluation framework through Joint External Evaluation, annual IHR reporting, after-action reviews and simulation exercises.[22][2][35]
• Review IHR implementation periodically, recognising that national health security capacity requires continual assessment and progress. Sri Lanka completed the Joint External Evaluation in June 2017, with the final report published in August 2017.[35][2]
• Monitor implementation nationally every six months through the IHR steering committee and quarterly at ministry, department and unit level through responsible heads and stakeholders.[27]
• Incorporate plan activities into annual work plans and implement them in phases, principally across 2019 to 2023.[2][27]
• Track legal and coordination outputs, including legislative amendments, legal mapping, multisectoral groups, administrative instruments, circulars, focal-point appointments, steering committee meetings and completion of annual IHR questionnaires.[27][28][29]
• Measure antimicrobial resistance progress through planned coordination meetings, detection and reporting of priority pathogens, surveillance-site coverage, healthcare-associated infection reporting, staff training, isolation capacity and farm surveillance.[4][38][39]
• Monitor zoonotic disease control, food safety and laboratory systems through approved strategies and plans, surveillance reports, laboratory upgrades and accreditation, testing coverage, referral-system capacity, outbreak investigations, national review meetings and food-safety alert systems.[5][40][41][42][43][44][10][45]
• Assess biosafety and biosecurity through committee establishment, pathogen inventories, databases, standard operating procedures, legislation, containment systems, accreditation, workforce norms and training capacity.[6][30][46]
• Strengthen surveillance and reporting by monitoring interoperable human-animal information exchange, electronic notification, reporting completeness and timeliness, communicable-disease risk assessments, international reporting instruments, influenza sentinel reporting and joint sector meetings.[12][47][13][48]
• Track workforce development through completed training modules, e-learning participation, stakeholder meetings, field epidemiology training, strategic workforce plans and district and national multi-hazard risk-assessment reports and maps.[31][49][14]
• Use consultations, simulations, corrective actions, lessons learnt, emergency operations centre guidance, preparedness-plan usability and stakeholder participation to evaluate emergency preparedness and response.[15][16][32][50]
• Monitor risk communication through national plans, focal points, district monthly reporting, communication materials, social media, hotlines, media engagement, community feedback and calls to the Suwaseriya hotline.[18][51][52]
• Assess Points of Entry preparedness through equipment and facility completion, staff training, vector surveillance, information-system development, annual reports and simulation exercises.[19][53][37]
• Track chemical and radiological preparedness through surveillance guidance, simulations, incident reports, risk-assessor training, stakeholder action plans, laboratory infrastructure progress, detection systems, emergency procedures, health-facility readiness, national exercises and responder training.[8][54][9][34]

Joint External Evaluation scores identify strengths in measles immunisation coverage, national vaccine access and delivery, and internal and partner communication and coordination, each scored 5. Lower-scoring areas include biosafety and biosecurity training and practices, national preparedness planning, risk and resource mapping, emergency operations activation and health-personnel deployment, each scored 1.[24][25]Quantitative baselines, consolidated reporting schedules, evaluation targets and a unified accountability framework are not consistently specified beyond the listed indicators, milestones and responsible authorities.[55][6][30][46]

Costing & Financing

Financing for the National Action Plan for Health Security is expected to come mainly from government funds, with donors supporting selected activities.[2]The Minister of Health committed policy and financial support, alongside necessary legislative action.[1]However, the available material does not provide a total plan budget, activity-level costing, funding allocations, donor contributions, resource-mobilisation targets, financing gaps or economic assumptions.[2]

• Recognise that disease outbreaks impose immediate costs for control measures, patient care and hospital admissions, alongside wider social disruption.[1]
• Assign responsible institutions and budget-line holders across legal reform, surveillance, laboratories, antimicrobial resistance, food safety, emergency preparedness, risk communication, Points of Entry, chemical events and radiation preparedness, without specifying monetary allocations.[27][4][40][11][15][18][19][8][34]
• Mobilise technical and financial assistance from the World Health Organization for the 2016 Joint External Evaluation process; the amount of assistance is not specified.[35]
• Secure funding for chemical laboratory development as an implementation indicator, alongside monitoring physical and financial infrastructure progress; no funding amount or source is specified.[54]
• Resource emergency preparedness through procurement of medical countermeasures, emergency storage and distribution capacity, staff training, simulations, and equipment and supplies for the national emergency medical team, without cost estimates.[17][56][57]

The broader economic context reports per capita gross domestic product of 4,065 US dollars in 2017 and gross national income per capita at current prices of 546,408 Sri Lankan rupees in 2016.[58]These figures are contextual indicators rather than a costed financing framework for the plan.[58]