National Action Plan For Health Security

Objectives

Indonesia’s National Action Plan for Health Security (NAPHS) 2020–2024 provides an integrated, multisectoral framework for implementing the International Health Regulations (IHR) (2005) and strengthening national resilience against public health threats. It aims to improve the country’s capacity to prevent, detect and respond rapidly to naturally occurring, accidental and deliberate biological, chemical, radiological and nuclear events, outbreaks, pandemics and other public health emergencies of international concern.[1][2][3]The plan translates recommendations from Indonesia’s 2017 Joint External Evaluation (JEE) into priority actions across 19 technical areas, using logic models, indicators and capacity levels to guide progression.[4][5][6]

• Strengthen legislation, policy, financing, coordination and communication arrangements for IHR implementation and health security.[1][6][7]
• Advance a One Health approach linking human, animal, aquaculture, wildlife, food and environmental sectors, particularly for zoonotic diseases and antimicrobial resistance.[8][9][10]
• Improve prevention through immunisation, antimicrobial resistance control, food safety, biosafety, biosecurity and zoonoses prevention.[6][11][12][13]
• Enhance detection through accredited laboratories, real-time biosurveillance, interoperable electronic reporting, event-based surveillance and a trained epidemiological workforce.[14][15][16][17]
• Strengthen preparedness and response through multi-hazard contingency plans, emergency operations centres, trained rapid-response personnel, hospital readiness, medical countermeasures, risk communication and point-of-entry capacities.[18][19][20][21][22]
• Develop chemical, radiological and nuclear emergency capacities, including referral hospitals, laboratories, emergency protocols, protective-action criteria, stockpiles and community communication.[23][3][24][25]

The NAPHS also positions health security within wider national development, recognising that Indonesia’s dispersed geography, decentralised administration, double burden of communicable and non-communicable disease, and exposure to emerging infections require coordinated action across government and society.[26][27][28][29]

Implementation

Implementation is designed as a coordinated whole-of-government and multisectoral process, led principally by the Ministry of Health and supported by ministries, agencies, local governments, laboratories, health facilities, communities, academia, civil society, international organisations and development partners.[1][4][11][17]Presidential Instruction Number 4 of 2019 provides the principal legal mechanism for ministries, institutions, governors, mayors and regents to fulfil their respective mandates in preventing, detecting and responding to outbreaks, pandemics and nuclear, biological and chemical emergencies.[1][30][3]

• Coordinate national planning, implementation and monitoring across 22 participating ministries and institutions, with ministries and agencies selecting relevant NAPHS indicators within their mandates.[1][31][26]
• Use the Ministry of Health’s Global Health Resilience Working Group, technical working groups for the 19 JEE areas, focal points and regular multisectoral meetings to align prevention, detection and response activities.[30][5]
• Develop regional health-security action plans and strengthen provincial, district and city implementation through advocacy, technical assistance, training, dissemination and local-government engagement.[1][7][17]
• Apply logic models and the World Health Organization planning matrix to link JEE indicators, Global Health Security Agenda milestones, priority activities and short-, medium- and long-term capacity outcomes.[4][5]
• Integrate delivery through the national health-service network, including primary health centres, hospitals, laboratories, referral systems and community health facilities, while deploying personnel to remote areas through programmes such as Nusantara Sehat.[28][32][33]
• Conduct operational preparedness through hazard and resource mapping, updated contingency plans, tabletop exercises, field simulations, joint drills, workforce training, stockpile planning and review of hospital and laboratory readiness.[32][18][19][20]

Monitoring combines regular NAPHS review with annual IHR self-assessments, JEE-based indicators across 19 technical areas, peer assessment and voluntary external evaluation.[5][3]The Cabinet Secretariat is to monitor implementation of Presidential Instruction Number 4 of 2019 through reports from the Coordinating Ministry for Human Development and Cultural Affairs and the Coordinating Ministry for Political, Legal and Security Affairs, with results reported directly to the President.[3]Operational indicators include surveillance and reporting capacities, workforce and laboratory capability, emergency-operation activation, point-of-entry readiness, risk communication, food safety, antimicrobial resistance, chemical-event and radiation-emergency arrangements.[11][16][19][34][35][25]

Financing is intended to match NAPHS demand with available health-security funding. The Health Security Financing Assessments Tool assesses expenditure supplied by ministries, agencies, partners and donors during the preceding year, enabling comparison with NAPHS resource requirements and identification of financing gaps.[4][5][6]Priority activities were costed using Indonesian standard costs and World Health Organization costing tools.[6]The five-year implementation requirement was estimated at USD 308,462,389, while the stated allocation exercise assigned 95.2% of programme funding, equivalent to Indonesian rupiah 261,046,352 out of Indonesian rupiah 274,134,122.[36]No dedicated Budget Execution or Allotment Document accommodates health-security resources, requiring continued cross-stakeholder coordination for resource planning, implementation and monitoring.[32]

Monitoring & Evaluation

The National Action Plan for Health Security (NAPHS) uses a multisectoral monitoring and evaluation approach built around International Health Regulations (IHR) (2005) core capacities, the 2017 Joint External Evaluation (JEE), annual self-assessments and indicators across 19 technical areas.[4][5][3]Ministries, agencies and institutions are responsible for selecting relevant NAPHS indicators and monitoring implementation within their mandates.[26][3]

• Use the JEE as a voluntary external assessment mechanism, with standardised target statements, indicators and capacity-level scoring to assess preparedness, prevention, detection and response.[1][2][5]
• Conduct annual self-assessments of IHR core capacities across 19 technical areas using World Health Organization tools, alongside peer assessment and voluntary external evaluation involving domestic and independent experts.[5][3]
• Monitor and evaluate NAPHS implementation in accordance with Annual Plan practice and through regular ministry, agency and institutional review.[26][5][3]
• Report implementation through mechanisms including an annual IHR coordination report, routine synchronisation of surveillance data, and reporting to the World Health Organization, Food and Agriculture Organization and World Organisation for Animal Health.[37][16][17]
• Require the Cabinet Secretariat to monitor implementation of Presidential Instruction Number 4 of 2019 using reports from the Coordinating Ministry for Human Development and Cultural Affairs and the Coordinating Ministry for Political, Legal and Security Affairs, with results reported directly to the President.[3]

Indicators cover the full health-security system, including legislation and coordination, antimicrobial resistance, zoonoses, food safety, biosafety, immunisation, laboratories, surveillance, workforce, preparedness, emergency operations, risk communication, points of entry, chemical events and radiological or nuclear emergencies.[6][23]Selected baselines include a JEE final result of 63%, although the supplied extract does not define the underlying status categories.[30]The plan also records 2017 capacity references for several technical indicators, including surveillance, reporting, food safety, laboratory systems, immunisation, points of entry and chemical-event capacities.[11][12][14][16][35][24]

• Strengthen surveillance through indicator- and event-based systems, interoperable electronic reporting, laboratory data feeds, risk assessment, syndromic surveillance and cross-sectoral data sharing.[15][16][17]
• Track antimicrobial resistance through laboratory surveillance, antimicrobial-use monitoring, infection prevention and control, and stewardship indicators.[11][10]
• Assess food safety, biosafety and biosecurity through monitoring samples, inspection and supervision activities, national inventories, laboratory standards, certification and training.[12][38][13]
• Review preparedness through hazard and resource mapping, contingency-plan reviews, training, simulations, tabletop exercises, infrastructure assessments and emergency-operation-centre procedures.[19][20]
• Evaluate point-of-entry responses and publish results, while monitoring routine capacity and effective response at designated points of entry.[22][35]

A specific operational target is for trained public health emergency operations centre staff to activate a coordinated response within 120 minutes of identifying an emergency.[20]The source does not provide a complete consolidated reporting calendar, uniform indicator definitions, verification procedures, independent evaluation arrangements or quantified performance results for all 19 technical areas.[6][23][12][19]

Costing & Financing

Financing is intended to link NAPHS resource requirements, representing demand for health-security investment, with the supply of expenditure identified across ministries, partners, donors, agencies and institutions.[4][5][6]The Health Security Financing Assessments Tool is intended to assess expenditure in the previous year and compare it with NAPHS needs to identify financing gaps and potential funding sources.[4][5]

• Use standard costs based on Ministry of Finance regulations to cost priority activities across technical areas, with selected activities entered through World Health Organization costing tools.[6]
• Complete activity drafting and costing for 12 of 19 technical areas during the July 2018 workshop, and map planned and budgeted activities across all 19 areas at the October 2018 multisectoral meeting.[6]
• Use the 2018–2022 allocation exercise to estimate a five-year NAPHS implementation requirement of USD 308,462,389.[36]
• Allocate Indonesian rupiah 261,046,352 from a stated programme allocation of Indonesian rupiah 274,134,122, equivalent to 95.2% of that allocation.[36]
• Direct a considerable share of funding towards immunisation as a preventive health-security measure.[36]

Government health expenditure increased from Indonesian rupiah 2.7 trillion in 2009 to Indonesian rupiah 104 trillion in 2017, rising from 2.7% to 5% of government expenditure.[32]However, health spending as a share of gross domestic product remained below the average for middle-to-low-income countries.[32]No dedicated Budget Execution or Allotment Document accommodates health-security resources, requiring coordination among stakeholders for planning, implementation and monitoring.[32]

The plan calls for sustainable surveillance financing, increased local-government allocations for disaster preparedness, and increased budgetary and human-resource support for One Health response teams and sub-national zoonotic-disease prevention and detection.[10][39][16][19]The Health Security Financing Assessments Tool assessment was delayed because required survey-based assessments had not been completed.[6]The supplied material does not specify a comprehensive breakdown of programme budgets, confirmed funding sources, quantified financing gaps, economic assumptions or allocations for most technical areas.[6][36]