National Action Plan for Health Security

Objectives

Sri Lanka’s National Action Plan for Health Security for 2019–2023 seeks to strengthen implementation of the International Health Regulations (IHR) (2005) and build a safer nation through stronger capacity to prevent, detect and respond efficiently and effectively to public health threats.[1][2]It adopts a whole-of-government, multisectoral and One Health framework spanning human, animal, agricultural, environmental and other relevant sectors.[3][2]

• Strengthen sustained multisectoral engagement, IHR core capacities, evidence-informed decision-making and results-based monitoring and evaluation.[2]
• Apply national and district risk profiling to prioritise hazards, with epidemics identified as the highest-scoring risk, followed by floods and droughts.[4][5]
• Align health-security activities with existing legislation, policies and plans on quarantine, notifiable diseases, food safety, animal and plant health, disaster management, environmental health, antimicrobial resistance, immunisation, laboratories and points of entry.[6]
• Strengthen legislation, policy and financing arrangements that enable IHR implementation and maintenance of core capacities, including revision of the Quarantine and Prevention of Disease Ordinance and documentation of cross-sectoral arrangements.[7][8]
• Develop antimicrobial resistance prevention, surveillance, infection prevention and control, stewardship and antibiotic-use oversight through a One Health approach across human, animal, food and environmental health.[9][10]
• Prevent zoonotic disease transmission through a national operational framework, surveillance and control plans for priority zoonoses, strengthened veterinary public health, laboratory capacity and animal quarantine.[11][12]
• Improve food safety through national policy, strategic planning, farm-to-plate collaboration, risk profiling, laboratory strengthening, surveillance, outbreak response, border controls and public communication.[13][14][15]
• Establish biosafety and biosecurity systems that secure and monitor dangerous pathogens and toxins, reduce dual-use and deliberate-use risks, and support sustainable programme funding.[16]
• Strengthen immunisation delivery, including national vaccine access, cold-chain capacity, quality control and legal support for the National Immunisation Policy through an Immunisation Act.[17]
• Build an equitable and sustainable public-health workforce, including field epidemiology capacity, with a target of one trained field epidemiologist per 200,000 population.[18]
• Enhance laboratory, surveillance and reporting capacities through real-time biosurveillance, interoperable electronic reporting, laboratory-data integration, syndromic surveillance and rapid notification of potential public health emergencies of international concern.[19][20][21]
• Improve preparedness and response for biological, chemical, radiological and nuclear hazards, emergency operations, medical countermeasures, personnel deployment, risk communication and public-health capacities at points of entry.[22][23][24][25][26][27]

Implementation

Implementation is designed as a dynamic, medium-term and results-based process, led by the Ministry of Health, Nutrition and Indigenous Medicine with participation from relevant ministries, departments, technical institutions, non-government partners and international organisations.[1][3][6]Activities are to be incorporated into the annual work plans of responsible ministries, departments and units, implemented in phases, and revised as needs change.[3][1]

• Coordinate national implementation through the Inter-ministerial IHR Committee, National IHR Steering Committee and National IHR Focal Points, with the Quarantine Unit and Epidemiology Unit serving as focal points and communication centres.[1][8][28]
• Require each principal stakeholder to prepare a five-year action plan using Joint External Evaluation recommendations, other priority areas and World Health Organization guidance.[6]
• Formalise sectoral coordination by appointing focal points, defining terms of reference, roles, responsibilities and meeting frequency, and using steering committee meetings to complete the annual IHR questionnaire.[28][29][30]
• Use One Health collaboration to link human, animal, agriculture, fisheries, food, wildlife, environmental and laboratory authorities, including integrated surveillance and information exchange at national, district and divisional levels.[2][11][31]
• Strengthen delivery systems through electronic registries and reporting tools, standard operating procedures, memoranda of understanding, national plans, laboratory referral networks, quality systems and shared laboratory facilities and data.[2][19][32]
• Develop workforce capacity through induction, refresher, in-service, continuous professional development, e-learning and field epidemiology training for public-health, laboratory, veterinary and other relevant personnel.[18][33]
• Operate emergency preparedness and response through multi-hazard risk assessments, national and district risk maps, a public health emergency operations centre handbook, trained rapid response teams, simulation exercises and post-response corrective-action planning.[34][35][36]
• Establish arrangements for international relief assistance, emergency procurement, storage and distribution of medical countermeasures, and deployment or receipt of public-health and medical personnel, including registration of a Sri Lankan National Emergency Medical Team with the World Health Organization.[24][37]
• Implement risk communication through the National Committee on Health Communication, the Health Promotion Bureau, training, media briefings, information materials, social media, a 24-hour hotline and engagement with affected communities.[25][38]
• Monitor progress using the IHR monitoring and evaluation framework, including annual IHR reporting, Joint External Evaluation, after-action reviews and simulation exercises.[39][40]Joint External Evaluation findings and routine evaluations provide the basis for the action plan, and the evaluation is intended to recur every five years.[41][2]
• Track implementation through technical-area output indicators, milestones and responsible authorities, including surveillance coverage, laboratory accreditation, trained personnel, plans and procedures completed, exercises conducted and facilities established.[42][43][44][45]

Financing is expected to rely mainly on government funds, with selected activities supported by donors; the plan also notes technical and financial assistance requested from the World Health Organization for the 2016 Joint External Evaluation.[3][40]The supplied material does not provide a consolidated quantified budget, funding gap, detailed allocations or economic assumptions, although it identifies budget-line holders and includes limited budget-related figures for two points-of-entry objectives without a stated currency.[46]

Monitoring & Evaluation

The National Action Plan for Health Security uses a results-based monitoring and evaluation approach aligned with the International Health Regulations (IHR) monitoring and evaluation framework. It combines annual IHR reporting, Joint External Evaluation (JEE), after-action reviews and simulation exercises to assess progress and identify capacity gaps.[39][3]JEE findings from 2017, routine evaluations and subsequent priority recommendations inform the five-year action plan, with the JEE intended to recur every five years.[41][2]

• Oversee plan implementation through the Inter-ministerial IHR Committee, national IHR steering arrangements and responsible ministries, departments and units, which are expected to monitor both the overall plan and sectoral activities.[1][39][3]
• Complete the annual IHR questionnaire through stakeholder participation and hold annual steering-committee meetings to receive implementation updates.[28][29][30]
• Review public-health risks periodically through district-level, multi-stakeholder risk profiling, consolidation into a national profile and updates as new information becomes available.[40][4]Risk assessment applies measures of impact, frequency, vulnerability, exposure and capacity, ranks hazards by calculated risk scores and identifies epidemics as the highest-scoring hazard in the cited assessment.[40][4][5]
• Track cross-sectoral coordination through steering-committee meetings, designation of sectoral focal points, documented focal-point roles and functional human-animal health information-exchange mechanisms.[29][47][31]
• Monitor antimicrobial resistance through surveillance and reporting of priority pathogens, veterinary laboratory activity, healthcare-associated infection prevention and control, antimicrobial stewardship, and the proportion of planned coordination meetings held.[9][42][10]
• Assess zoonotic-disease control through surveillance plans and reports, veterinary epidemiological bulletins, laboratory upgrades, workforce and facility capacity, joint investigations and annual evaluation of control plans for priority diseases.[11][12]
• Measure food-safety performance through policy and committee availability, risk-profiling capacity, laboratory reviews, accredited testing capacity, registered food businesses, surveillance and outbreak investigation, response reports and public-reporting systems.[48][14][15][49]
• Track biosafety and biosecurity through committee establishment, pathogen and toxin inventories, data tools and databases, standard operating procedures, legislation, laboratory upgrades and accreditation, and workforce training.[16][50][17]
• Monitor workforce and laboratory capacity through workforce norms and training needs, equitable staff distribution, immunisation-clinic readiness, core testing capability, specimen transport, referral networks, electronic laboratory reporting, quality assurance, accreditation and outsourced-testing approval arrangements.[51][19][43][32][52]
• Strengthen surveillance monitoring through indicator-based and event-based surveillance, interoperable electronic real-time reporting, integrated data analysis and syndromic surveillance.[20]Planned measures also include web-based disease notification, notification completeness and timeliness, influenza sentinel-site reporting, laboratory information exchange and periodic communicable-disease risk assessments.[47][31][53]
• Evaluate preparedness and emergency operations through risk assessments and maps, availability and use of emergency plans, training outputs, simulation exercises, emergency operations centre handbook development, activation procedures, after-action reviews and corrective-action follow-up.[33][22][34][35][44][36]
• Monitor medical countermeasures and personnel deployment through completion of procedures, guidelines, protocols and plans; assessed emergency stores; enhanced storage capacity; trained staff; simulation exercises; deployment equipment; and registration of a national emergency medical team.[24][37]
• Use risk-communication indicators covering national-plan and focal-point establishment, training, media engagement, information-material distribution, social-media networks, monthly regional risk reports, hotline development and feedback from affected communities.[25][38]
• Assess points-of-entry capacity through task completion, equipment and infrastructure provision, staff training, vector-surveillance activity, annual simulation exercises, contingency-plan publication and annual Quarantine Unit reporting.[26][54][55][46][56][57]
• Monitor chemical and radiation preparedness through coordinating bodies, guidelines, surveillance and risk-assessment outputs, accident and industry reports, laboratory and rapid-deployment capacity, information-sharing mechanisms, detection systems, trained responders, national plans and exercises.[58][59][60][61][62][63][64][65][27][45]

JEE scores provide a baseline across technical areas. Stronger cited capacities include measles vaccine coverage and national vaccine access and delivery, each scored 5, while important gaps include biosafety and biosecurity training and practices, multi-hazard preparedness planning, emergency-operations activation and radiological or nuclear emergency detection and response.[17][22][35][27][66]The source provides numerous output indicators and implementation milestones, but often does not specify standard reporting frequencies, consolidated evaluation methods or escalation procedures for accountability beyond the named committees, annual reporting, reviews and exercises.[32][20][53][24][67]

Costing & Financing

Financing for the National Action Plan for Health Security is intended to rely principally on government funds, with selected activities supported by donors.[3]The Ministry of Health also requested technical and financial assistance from the World Health Organization for the 2016 Joint External Evaluation.[40]Across the implementation tables, responsible institutions and budget-line holders are frequently identified, but most supplied sections do not provide monetary allocations, expenditure plans, funding sources, funding gaps, resource-mobilisation targets or economic assumptions.[29][51][25][67]

• Recognise that outbreaks impose social, health-system and short-term disease-control burdens, although no quantified cost estimates for these burdens are supplied.[1]
• Identify sustained funding for biosafety and biosecurity programmes as a priority, without specifying a funding mechanism or amount.[16]
• Provide resource requirements in-kind through planned investment in laboratory infrastructure, training institutions, surveillance and reporting systems, emergency stores, points-of-entry equipment, quarantine and isolation facilities, and chemical and radiation response capacity, without stated costs in most cases.[51][43][24][54][61][27]
• Record two budget-related figures for points-of-entry objectives, but leave their currency, detailed allocation, financing source and associated funding gap unspecified.[46]

A contents listing refers to total cost estimation by technical area, but the supplied extract does not include the underlying estimates.[68]Consequently, the document material does not enable a complete assessment of affordability, financing adequacy, budget phasing or unfunded implementation requirements.[68][67][69]