National Action Plan for Health Security (2019-2023)

Objectives

Afghanistan’s National Action Plan for Health Security (NAPHS) for 2019–2023 seeks to achieve the core capacities required under the International Health Regulations (IHR) (2005), strengthen national and subnational health security, and contribute to the global health security agenda.[1][2]The plan uses the 19 Joint External Evaluation (JEE) technical areas, informed by the 2016 self-assessment and JEE recommendations, as its strategic framework for prioritising capacity gaps, actions and indicators.[1][2][3]

• Strengthen legal and policy arrangements, multisectoral coordination and implementation of IHR obligations across health-security technical areas.[4][3]
• Prevent and control antimicrobial resistance through multisectoral stewardship, pathogen detection and reporting, surveillance, healthcare-associated infection prevention and antimicrobial stewardship planning.[5]
• Improve prevention, detection and response for zoonotic diseases, foodborne threats, biosafety and biosecurity through One Health collaboration, active surveillance, laboratory strengthening, risk assessment and outbreak investigation.[5][6]
• Expand immunisation coverage, including in underserved communities, by engaging private providers, training vaccinators, upgrading health sub-centres, establishing vaccination centres and deploying mobile teams.[7][8]
• Strengthen laboratory systems, specimen referral and transport, diagnostic quality assurance, laboratory accreditation, real-time surveillance, electronic reporting and integrated data analysis.[7][9]
• Enhance preparedness for multi-hazard emergencies through updated plans, risk assessments, rapid response teams, emergency operations arrangements, a national health emergency stockpile and contingency planning.[10][11]
• Develop capacity for deliberate biological, chemical, radionuclear and radiation events, medical countermeasures, deployment of health personnel, risk communication and points-of-entry preparedness.[12][13][14]

The plan is costed over a five-year implementation period and estimates a total requirement of USD 17,495,323, although confirmed domestic allocations, external commitments and the quantified funding gap are not specified in the available text.[2][4]

Implementation

Implementation is designed as a nationally led, multisectoral process coordinated through the IHR multisectoral committee and supported by the IHR National Focal Point, relevant government bodies, technical experts, partners and donors.[2][4]The Ministry of Public Health leads delivery with technical support from the World Health Organization, while activities are intended to align with existing national strategies, programmes and the fiscal-year planning cycle.[14][15]

• Coordinate technical-area activities through the IHR multisectoral committee, which includes representation across the 19 technical areas and is expected to support resource allocation, fundraising, progress review and national consensus.[4][3][15]
• Define priority actions using JEE findings, including timelines, implementation frequency, costs, available resources, funding gaps and responsible implementers.[16]
• Review and update legislation, policies, regulations and standard operating procedures through a legislative advisers committee and relevant sectoral authorities to institutionalise IHR implementation.[3]
• Establish and support specialist coordination structures for antimicrobial resistance, zoonoses, food safety, biosafety, the human and animal health workforce, risk communication, and emergency preparedness.[5][17][18][19]
• Deliver interventions through public health, agriculture, environmental health, laboratory, surveillance, immunisation, primary-care and security institutions, as well as community health workers, private facilities, hospitals, laboratories, mobile teams and sentinel sites.[6][8][9]
• Build workforce and operational capacity through Field Epidemiology Training Programme opportunities, laboratory and biosafety training, vaccinators’ training, workshops, supervision, simulation exercises, table-top exercises, after-action reviews and external reference-laboratory engagement.[17][8][9]
• Strengthen emergency coordination by linking IHR functions with the Emergency Response Command and Control Centre, connecting national and provincial surveillance units, developing contingency plans and case-management guidance, and maintaining multidisciplinary rapid response teams.[10][11]
• Formalise joint procedures between public health and security authorities for deliberate biological events, and develop arrangements for the cross-border deployment of medical countermeasures and health personnel during emergencies.[12][20]
• Improve cross-border and points-of-entry readiness through surveillance, vector control, ill-passenger procedures, trained staff, contingency plans, simulation exercises and memoranda of understanding with neighbouring countries.[13][19]

Monitoring draws on the IHR Monitoring and Evaluation Framework, including annual reporting, JEE, after-action reviews and simulation exercises, alongside JEE scores and recommendations, surveillance data, technical-area indicators and semi-annual committee meetings.[21][3][14]Progress mechanisms include indicator-based and event-based surveillance, regular data sharing, electronic reporting tools, revised case definitions and reporting formats, laboratory monitoring, and review of emergency-plan functionality.[17][22][9]

Financing is intended to combine domestic budget allocation with mobilisation of partner and donor resources, using a common cost matrix to distinguish potential government financing from requirements for external resource mobilisation.[2][4][14]The available material does not specify financing shares, committed funding, a consolidated reporting timetable, numerical targets for all areas, or an evaluation budget.[4][14][11]

Monitoring & Evaluation

Monitoring is anchored in the International Health Regulations (IHR) Monitoring and Evaluation Framework and the 19 Joint External Evaluation (JEE) technical areas, using the 2016 self-assessment, JEE scores, indicators and recommendations to identify gaps, prioritise activities and assess progress towards IHR (2005) capacities.[1][21][2][14][15]

• Apply mandatory annual IHR reporting and voluntary JEE, after-action review and simulation-exercise processes.[21]
• Review implementation and updates through semi-annual meetings of the IHR multisectoral committee, supported by stakeholder consultation, technical-area review and national endorsement processes.[4][3]
• Maintain indicator-based and event-based surveillance at national and subnational levels; regularly share surveillance and outbreak data; and update disease lists, case definitions, investigation line lists, surveillance guidelines and monitoring checklists.[7][17]
• Strengthen timely cross-sector reporting of potential Public Health Emergencies of International Concern through the IHR National Focal Point, animal-health and ministerial focal points, defined terms of reference and information-sharing procedures.[17][22][18]
• Conduct national risk assessments every three years for emergency preparedness, while separately reviewing the national health emergency risk assessment annually with relevant stakeholders.[10][11]
• Test preparedness and response arrangements through table-top and simulation exercises, including emergency plans, points-of-entry contingency plans and coordination mechanisms, and undertake after-action reviews of emergency operations centre functionality and major outbreaks.[10][13][8][9]

Technical monitoring mechanisms include antimicrobial resistance pathogen detection and reporting plans; active zoonotic and foodborne disease surveillance; biosafety and biosecurity assessments; laboratory monitoring visits; and routine immunisation reporting through monthly and quarterly paper-based and electronic systems.[5][7]Immunisation, laboratory and surveillance progress can be measured through service-expansion, workforce, training, facility, reporting-tool, dashboard and sentinel-site indicators.[6][8][9]

• Assess laboratory biosafety and biosecurity at Ministry of Public Health and Ministry of Agriculture, Irrigation and Livestock laboratories, maintain inventories of facilities handling dangerous pathogens and toxins, and update biosafety protocols.[5][7]
• Track implementation through availability of policies, guidelines, standard operating procedures, assessment and monitoring reports, coordination forums, inventories and after-action reviews.[6][8][9]
• Measure workforce, risk communication, points-of-entry, chemical and radiation preparedness through training, assessment, exercise, reporting, designated-facility and emergency-plan outputs.[18][19][23]
• Support accountability through regular food-safety and laboratory-taskforce meetings, supervision of public and private laboratories, multisectoral coordination forums and reporting procedures.[15][6][9]

The plan identifies many activity-level measures but does not specify a consolidated quantitative indicator set, targets, baseline values, reporting timetable, evaluation budget or clearly assigned evaluation responsibilities for the overall plan.[4][14][15][22][11][20]

Costing & Financing

The National Action Plan for Health Security is a five-year, costed multisectoral plan, with an estimated total implementation cost of USD 17,495,323.[2][4]Costing is intended to support planning over 2019–2023 and to distinguish activities potentially financed through domestic government resources from unfunded requirements requiring external resource mobilisation.[1][4]

• Apply a common cost matrix, standard activity profiles and activity-frequency assumptions over the five-year plan period, with detailed technical-area costs in Annex B and annual technical-area summaries in Annex C.[4]
• Allocate a portion of the national budget and align domestic resources with national fiscal-year planning cycles.[2][14]
• Mobilise external technical and financial support through early coordination with partners, donors and domestic stakeholders, with the IHR multisectoral committee supporting resource allocation and fundraising after government endorsement.[14][15]
• Recognise that some activities may vary in cost or require unforeseen additional expenditure.[4]

Although the total estimated plan cost is provided, the available material does not specify confirmed domestic allocations, committed external financing, financing shares, a quantified funding gap or economic assumptions.[4][14][15][22]Additional budget and technical support are required for full implementation.[14]

Some programme areas identify quantified delivery requirements without associated budgets, including immunisation expansion, laboratory upgrades, surveillance strengthening and preparedness activities.[6][8][9]Vaccine distribution receives support from the United Nations Children’s Fund, but a sustainable lower-level vaccine supply independent of international partners remains necessary.[7]Radiation preparedness is constrained by limited human and financial resources, while chemical-event testing and response capacity also requires strengthening; no activity-level costs are specified.[13]