National Action Plan For Health Security

Objectives

Indonesia’s National Action Plan for Health Security (NAPHS) 2020–2024 is a multisectoral framework for strengthening national capacity to prevent, detect and respond to public health threats under the International Health Regulations (IHR) (2005).[1]Its vision is to contribute actively to global prevention, detection and response to potential pandemics arising from biological, chemical and radio-nuclear agents.[2]The plan links health security, health-system strengthening and national resilience, recognising their reciprocal relationship.[2]

• Strengthen capacity across the 19 Joint External Evaluation (JEE) technical areas, covering legislation and financing, coordination, antimicrobial resistance, zoonoses, food safety, biosafety and biosecurity, immunisation, laboratories, surveillance, reporting, workforce, preparedness, emergency operations, risk communication, points of entry, chemical events and radiation emergencies.[3][4]
• Develop a fully integrated, multisectoral national action plan for IHR implementation; establish coordination among ministries, agencies and institutions; and improve decision-making structures and delegated authority at national and subnational levels.[5]
• Prevent, detect and respond to outbreaks, pandemics and public health emergencies, including infectious, food-related, biological, chemical, radiological and nuclear hazards.[6][7]
• Strengthen One Health action across human, animal, agricultural, food and environmental sectors, particularly for zoonotic disease prevention, antimicrobial resistance and surveillance.[8][9][10]
• Maintain equitable vaccine delivery, adequate cold-chain and distribution capacity, quality control and readiness to address new disease threats.[11]
• Build surveillance, interoperable electronic reporting and laboratory systems that support timely national and international reporting, including to the World Health Organization, Food and Agriculture Organization and World Organisation for Animal Health.[12][13]
• Develop multi-hazard preparedness and response arrangements, including national, provincial, district and local plans, risk mapping, emergency operations, case management, medical countermeasures, personnel deployment and capacity at points of entry.[14][15][16][17]

Implementation

Implementation is designed as a coordinated, integrated and continually updated national effort led across government and extended to subnational authorities, international organisations, development partners and civil society.[18][2]Developed following Indonesia’s voluntary JEE in November 2017, the NAPHS uses a logic model to link priority activities, JEE indicators and short-, medium- and long-term capacity outcomes across all 19 technical areas.[1][19]It serves as guidance for ministries, agencies and institutions in planning, implementation, monitoring and evaluation, and as a reference for regional action plans.[3][7]

• Coordinate delivery through the Ministry of Health and relevant ministries, agencies and institutions, with governors, mayors and regents acting within their respective mandates and authority.[18]Promote Presidential Instruction Number 4 of 2019 as the reference for improving prevention, detection and response to outbreaks, pandemics and nuclear, biological and chemical emergencies.[2]
• Use the Global Health Resilience Working Group within the Ministry of Health to coordinate health-sector prevention, detection and response activities, alongside formal IHR focal points and technical-area coordinators.[5][20]Maintain the national IHR focal point as the communications mechanism with the World Health Organization, regional IHR contact points and relevant national sectors.[21]
• Retain JEE technical working groups and use World Health Organization planning and costing tools to translate assessment gaps into actionable plans, align activities with existing work plans and identify funding sources for unmet needs.[19][22]
• Strengthen delivery through intersectoral surveillance, data sharing and One Health coordination between health, agriculture, environment and forestry, fisheries and other relevant sectors.[8][12][13]Operational measures include training, risk mapping, laboratory accreditation and referral systems, specimen transport, external quality assurance, workforce deployment, contingency planning, tabletop exercises and field simulations.[23][24][15]
• Establish or reinforce emergency operations centres, multisectoral response teams, rapid-response laboratories and real-time biosurveillance, supported by common standards and cooperation arrangements between national and local authorities.[25]Strengthen public-health and security-sector links for deliberate biological events, including information systems, legal revision and biological-defence training.[16]
• Maintain risk communication through national guidance, communication plans, trained spokespeople, regular multisectoral meetings, media and social-media engagement, community outreach, hotlines and mechanisms to identify rumours, hoaxes and complaints.[17]
• Monitor implementation through annual self-assessments of the 19 technical areas using World Health Organization tools, ministry-level indicators and regular NAPHS monitoring and evaluation.[7][19]The Secretariat of the Cabinet is to evaluate implementation of Presidential Instruction Number 4 of 2019 using reports from the relevant coordinating ministries and report results directly to the President.[7]
• Assess financing by comparing supply-side health-security expenditure, measured through the Health Security Financing Assessments Tool, with NAPHS demand-side requirements to identify financing gaps.[1][19]Costing was undertaken by technical area using Ministry of Finance standard costs and World Health Organization costing tools, although the supplied material provides no consolidated 2020–2024 budget total.[22]An estimated implementation cost of USD 308,462,389 is reported for a five-year 2018–2022 implementation period.[26]

Monitoring & Evaluation

Monitoring and evaluation are built around the International Health Regulations (IHR) (2005), the 19 Joint External Evaluation (JEE) technical areas, Indonesia’s Logic Model and regular self-assessment. The framework combines surveillance, operational readiness testing, intersectoral reporting and high-level oversight, although several extracts do not specify consolidated reporting cycles, targets or evaluation methods.[19][7][12]

• Use annual self-assessments of all 19 technical areas with World Health Organization tools, supplemented by self-evaluation, peer assessment and voluntary external evaluation. Indonesia’s JEE took place in November 2017.[19][7]
• Link priority actions, baseline capacity and intended capacity improvements to standard JEE indicators and capacity levels through the Logic Model.[1][19]
• Monitor implementation by ministries, agencies and institutions across prevention, detection and response areas, with GO! applying the approach used for the Annual Plan.[2][7]
• Require ministries and institutions to select relevant NAPHS indicators under Presidential Instruction Number 4 of 2019.[2]
• Maintain surveillance through indicator-based and event-based systems, interoperable electronic reporting, laboratory data feeds, animal-health reporting, weekly emerging infectious disease reports and routine data synchronisation.[12][13]
• Track IHR coordination through indicator P.2.1, which had a 2017 capacity level of 3, and produce an action plan, defined reporting responsibilities, internal communication arrangements, stakeholder reports and an annual report.[21]
• Assess antimicrobial resistance detection through indicator P.3.1, which had a 2017 capacity level of 2, including laboratory designation, antimicrobial-use and resistance monitoring, and integrated surveillance guidance.[27]
• Assess zoonotic disease surveillance, veterinary workforce capacity and zoonotic-response mechanisms through indicators P.4.1, P.4.2 and P.4.3.[28]
• Monitor food safety through indicator P.5.1, with a 2017 capacity level of 3, including targets for 19,000 animal-product safety monitoring samples and supervision of 50 units or facilities.[29]
• Assess biosafety and biosecurity through indicators P.6.1 and P.6.2; the latter had a 2017 capacity level of 3.[30][11]
• Monitor surveillance and reporting through indicators D.2.1, D.2.2 and D.3.1, including EWARS, ISIKHNAS, SIZE, electronic reporting, syndromic surveillance and reporting to the World Health Organization, Food and Agriculture Organization and World Organisation for Animal Health.[12][13]
• Monitor human resources through indicators D.4.1, D.4.2 and D.4.3, covering workforce availability, applied epidemiology training, workforce databases and a national human-resources strategy.[24][14]
• Test preparedness through contingency-plan reviews, risk mapping, tabletop exercises, simulations and emergency operations centre procedures.[15][25]
• Use Cabinet Secretariat oversight of Presidential Instruction Number 4 of 2019, drawing on 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.[7]

The JEE final score was reported as 63%, while the extract also presents figures of 34 and 14 without defining them. JEE findings and reports were publicly available and intended to inform the National Action Plan for Health Security.[5][20]

Costing & Financing

Costing combines a five-year National Action Plan for Health Security estimate, activity-level costing and a Health Security Financing Assessments Tool (HSFAT) exercise intended to compare available expenditure with planned financing requirements. The material identifies important resource needs but generally does not provide detailed funding sources, monetary gaps or programme-level budgets.[26][19][22]

• Estimate total NAPHS implementation costs for 2018 to 2022 at USD 308,462,389.[26]
• Allocate 95.2% of the stated programme allocation to implementation of all programmes, represented by Indonesian Rupiah 261,046,352 out of Indonesian Rupiah 274,134,122.[26]
• Prioritise immunisation as a preventive health-security investment.[26]
• Use HSFAT to assess health-security expenditure by ministries, agencies, institutions, partners and donors during the preceding fiscal year, and compare this supply-side evidence with NAPHS financing demand to identify positive or negative gaps.[1][19][22]
• Apply Indonesia’s standard costs under a Ministry of Finance regulation and enter planned activities into World Health Organization costing tools for each technical area.[22]
• Map planned and budgeted activities, fund allocations and priority actions across all 19 technical areas through the October 2018 finalisation process.[22]
• Address the absence of a dedicated Budget Execution Document allocation for health-security activities through coordinated planning, implementation and monitoring among stakeholders.[6]
• Increase allocations for One Health response teams, zoonotic disease prevention and detection, local disaster planning and emergency response, although no monetary amounts are supplied.[10][28][14]

Government health expenditure reportedly rose from Indonesian Rupiah 2.7 trillion in 2009 to Indonesian Rupiah 104 trillion in 2017, while spending as a share of gross domestic product remained below the average for middle-to-low-income countries.[6]Broader economic assumptions include annual gross domestic product growth of 5.7% to 2036, gross domestic product of USD 23,199 in 2045, a 2045 poverty-rate target of zero or 0.02%, and elimination of extreme poverty by 2040.[31]

Most technical-area extracts identify non-monetised resource requirements, including laboratories, surveillance systems, stockpiles, medicines, medical countermeasures, infrastructure, equipment, training, personnel and emergency-response capacity. They do not specify detailed financing commitments, funding sources, quantified gaps or implementation cost assumptions.[14][32][33][34]