National Action Plan for Health Security (2019-2023)

Objectives

Afghanistan’s National Action Plan for Health Security (NAPHS) for 2019–2023 seeks to strengthen national capacity to prevent, detect, assess, report and respond to public-health threats in line with the International Health Regulations (IHR) (2005). It translates recommendations from the Joint External Evaluation (JEE) across 19 technical areas into a costed, multisectoral programme of action, aligned with the IHR Monitoring and Evaluation Framework.[1][2][3]

• Strengthen the legal basis for IHR implementation, update relevant legislation and regulations, clarify National Focal Point functions, and improve coordination, communication and information exchange across sectors.[3][4]
• Address antimicrobial resistance through surveillance, healthcare-associated infection prevention and control, antimicrobial stewardship, multisectoral governance and implementation of the national antimicrobial-resistance action plan.[3][5]
• Improve prevention and control of zoonotic diseases through active surveillance, routine data sharing between animal and public health sectors, veterinary epidemiology capacity, cross-border collaboration and implementation of the national zoonotic disease strategy.[6]
• Strengthen food safety by clarifying sectoral roles, improving food-borne disease detection and outbreak response, expanding laboratory capacity, conducting risk assessments and establishing functional multisectoral coordination.[6][7]
• Establish comprehensive biosafety and biosecurity arrangements, including updated guidelines and protocols, laboratory assessments, workforce training, coordination mechanisms and inventories of dangerous pathogens and toxins.[6][8]
• Increase routine immunisation coverage by reaching underserved communities and children, engaging private facilities, improving coverage denominators, training vaccinators, upgrading health sub-centres, establishing urban vaccination centres and deploying mobile teams.[8][9]
• Improve national laboratory capacity through policies, operational plans, quality assurance, specimen collection and transport systems, diagnostic guidance, point-of-care services, referral arrangements, accreditation and research capacity.[8][9][10]
• Maintain and improve real-time indicator- and event-based surveillance, including electronic reporting and analysis, laboratory surveillance, interoperable data systems and notification of potential public health emergencies of international concern.[11][12]
• Build a capable public-health workforce through Field Epidemiology Training Programme opportunities, workforce-gap assessment, retention measures, and inclusion of epidemiologists, microbiologists and other public-health specialists in human-resources planning.[11][13][4]
• Enhance emergency preparedness and response through multi-hazard plans, annual risk assessment, risk and resource mapping, emergency stockpiles, multidisciplinary rapid response teams, strengthened emergency operations and hazard-specific contingency plans.[13][14]
• Strengthen preparedness for deliberate biological events, medical countermeasure deployment, risk communication, points of entry, chemical incidents and radiation emergencies.[15][16][17]

Implementation

Implementation is intended to be Afghanistan-led, supported technically by the World Health Organization (WHO), and organised through multisectoral planning, coordination, implementation and resource mobilisation. The Ministry of Public Health, the IHR National Focal Point and multisectoral committee provide central coordination, working with the Ministry of Agriculture, Irrigation and Livestock, security authorities, other government bodies, technical experts, development partners, donors, private providers, laboratories and relevant international organisations.[2][18][17][7]

• Coordinate implementation through the IHR multisectoral committee, representing the 19 technical areas, with the National Focal Point consolidating sectoral inputs and following up with national institutions on endorsement, resource allocation and fundraising.[19][17][20]
• Secure senior government endorsement to legitimise implementation and support cross-sector participation; the plan identifies endorsement by the Minister of Public Health and other senior sectoral officials as necessary for strong implementation.[19][17]
• Use thematic working groups to define activities, timelines, implementation frequency, resource availability and gaps, and responsible implementers for each technical area.[18]
• Align activities with existing national strategies and the fiscal-year planning cycle to reinforce domestic commitment and enable allocation of government resources.[17]
• Mobilise additional domestic and external financial and technical support from partners and donors, allowing contributions to individual technical areas or the wider health-security programme.[2][17]
• Apply standard operating procedures, guidelines, protocols, case definitions, reporting tools and contingency plans across surveillance, laboratory systems, outbreak investigation, emergency response, risk communication and points-of-entry operations.[7][10][4][21]
• Deliver services and capacity strengthening through training, workshops, mentoring, laboratory and facility assessments, monitoring visits, reference-laboratory support, simulation exercises, table-top exercises, after-action reviews and community-level delivery mechanisms.[8][13][7][9]
• Establish technical coordination mechanisms for priority areas, including zoonotic-disease committees at central and provincial levels, food-safety control arrangements, a biosafety and biosecurity coordination forum, a human and animal health workforce committee, and risk-communication advisory and provincial teams.[6][7][9][4][21]
• Integrate IHR functions into the Emergency Command and Control Centre, connect national and provincial coordination structures with surveillance units, and link public-health emergency operations with related structures such as the polio emergency operations centre.[13][14]
• Engage neighbouring countries through memoranda of understanding and other cross-border arrangements for points-of-entry preparedness, disease control and, where needed, access to chemical-testing capacity.[16][22]
• Monitor progress using JEE-informed indicators, annual IHR reporting, surveillance data, risk assessments, exercise reports, after-action reviews and semi-annual multisectoral committee meetings.[23][3][13][4]

Monitoring & Evaluation

Monitoring is anchored in the International Health Regulations (IHR) Monitoring and Evaluation Framework and the 19 technical areas assessed through the Joint External Evaluation (JEE). These provide the basis for assessing national capacities, defining activities and tracking progress towards IHR standards.[1][23][20][12]The plan combines mandatory annual reporting with voluntary JEE, after-action reviews and simulation exercises.[23]

• Use indicator- and event-based surveillance at national and subnational levels, with regular data sharing, updated disease lists and case definitions, outbreak line lists, checklists, laboratory surveillance and electronic reporting tools.[8][11][12][10]
• Strengthen zoonotic, foodborne-disease, antimicrobial-resistance, chemical-event, radiological and points-of-entry surveillance, including cross-sector information exchange between human and animal health authorities.[6][16][24][5]
• Improve immunisation monitoring through monthly and quarterly paper-based and electronic reporting, while addressing weaknesses in collection, analysis, reporting and coverage denominators.[8]
• Track delivery through activity indicators, including policies and protocols available, coordination mechanisms established, assessment and monitoring reports completed, personnel trained, facilities supported, mobile teams deployed and exercises conducted.[7][9][10][4][21][22]
• Assess preparedness by testing emergency and points-of-entry contingency plans through simulation exercises, reviewing emergency operations through after-action reviews, and conducting national risk assessments every three years.[13][16]
• Review national risk assessments annually with relevant stakeholders and use health emergency risk assessments and JEE findings to update preparedness plans.[14]
• Discuss progress through semi-annual IHR multisectoral committee meetings and maintain committee follow-up through coordination, reporting and fundraising activities.[3][17][20]

Reporting and accountability include notification of potential public health emergencies of international concern to the World Health Organization, designated sectoral focal points, national and provincial communication, and reporting against specified availability and activity indicators.[12][4][21][22]However, the plan extract does not set out a single consolidated indicator framework, indicator baselines or targets, a comprehensive reporting timetable, or a distinct formal accountability mechanism.[1][8][11][14][24]

Costing & Financing

The National Action Plan for Health Security was designed as a detailed, costed multisectoral plan for a five-year implementation period, with an overall estimated cost of USD 17,495,323.[2][18][19]Annex B presents annual activity costs for 2019 to 2023, including totals in United States dollars and Afghanis where available.[5]

• Apply a common-cost matrix, agreed with stakeholders and supported by technical input, using standardised profiles for activities such as training and consultancy.[19]
• Estimate costs according to the frequency of activities over the five-year plan period, while recognising that some activities may vary in cost or require unforeseen expenditure.[19]
• Allocate part of the national budget and align technical activities with the fiscal-year planning cycle to support domestic resource allocation.[2][17]
• Mobilise additional technical and financial support from domestic stakeholders, partners and donors, with the IHR multisectoral committee expected to support resource allocation and fundraising.[17][20]
• Fund resource-intensive requirements such as workforce development, laboratory and electronic surveillance, rapid response teams, emergency stockpiles, simulation exercises and emergency operations.[11][13]

The extract distinguishes resources potentially available from domestic government sources from additional external resources requiring mobilisation.[19]It does not specify confirmed domestic allocations, secured external commitments, a quantified monetary funding gap, an overall financing strategy, or broader economic assumptions.[19][17][5]