National Action Plan For Health Security

Objectives

Tanzania’s National Action Plan for Health Security 2017–2021 is a five-year, multisectoral framework to build and sustain capacities to prevent, detect, respond to and recover from public health threats through a One Health approach.[1][2][3]Its vision is a resilient nation able to protect human, animal and environmental health while mitigating economic impacts, and its mission is to attain and sustain the minimum core capacities of the International Health Regulations (2005).[2]

• Reduce morbidity, mortality, disability and socio-economic disruption from public health threats, contributing to Sustainable Development Goal 3 on healthy lives and well-being.[4][2]
• Strengthen national capacity to prevent outbreaks and other health emergencies, promptly detect and confirm them, and respond to and recover from their effects.[4][2]
• Coordinate preparedness and emergency capacities across sectors, administrative levels and existing national plans, using the International Health Regulations and One Health as organising frameworks.[1][2][3]
• Prioritise action across Prevent, Detect and Respond, alongside other International Health Regulations-related hazards, Points of Entry and cross-cutting activities.[5][6]
• Address critical gaps identified through the 2016 Joint External Evaluation and complementary assessments, while maintaining capacities in technical areas where performance was already stronger.[3][7]
• Strengthen legislation and financing, antimicrobial resistance, zoonotic disease control, food safety, biosafety and biosecurity, immunisation, laboratory systems, surveillance, workforce development, emergency preparedness, risk communication and Points of Entry.[8][9]
• Apply principles of country ownership, community participation, gender and human rights, equitable access, partnerships, evidence-led action, transparency, shared responsibility, resilience, cross-border cooperation and periodic adaptation.[10][2]
• Map and mobilise existing and potential domestic and external financing, and strengthen institutional arrangements for health security and One Health implementation.[4][2]

Implementation

Implementation is designed as a government-led, whole-of-society and multisectoral delivery model, coordinated under the Prime Minister’s Office and involving human, animal and environmental health sectors, local government, communities, civil society, the private sector, research institutions and development partners.[1][10][11]The plan acts as a coordination platform to align activities, responsibilities and resources across sectors, administrative levels and related strategies.[1][3][7]

• Guide implementation through the Prime Minister’s Office, with the Department of Disaster Management assigned a central coordination role and an interministerial steering committee proposed under the Disaster Management Act 2015.[11]
• Establish an inter-ministerial committee accountable to the Prime Minister’s Office, comprising relevant line ministries and co-opted development partners, to administer, monitor and evaluate implementation.[1][5]
• Lead implementation through the Ministry of Health, Community Development, Gender, Elderly and Children under the interministerial Steering Committee, while engaging regional and local government, disaster management, livestock and fisheries, finance, home affairs, education, infrastructure, laboratories, regulators, meteorological services and private health facilities.[12][13]
• Link delivery to the Tanzania Emergency Preparedness and Response Plan, Health Sector All-Hazards Plan, Health Sector Strategic Plan IV, National Disaster Management Policy, Integrated Disease Surveillance and Response Guidelines, One Health Strategic Plan, laboratory strategy and antimicrobial resistance action plan.[2]
• Sequence realistic, measurable and impact-oriented activities across years 1, 2 and 3 to 5, identify responsible ministries and offices, and align implementation with resource availability and mobilisation.[7]
• Strengthen service delivery through fixed, outreach and mobile services; personal protective equipment; human and animal health linkages; laboratory staffing and specimen referral; workforce and community-health-worker training; ambulances and communication vehicles; and temporary holding facilities at designated Points of Entry.[5]
• Operationalise emergency coordination through national and sub-national multisectoral rapid response teams, a public health Emergency Operations Centre, inter-ministerial agreements and the web Emergency Operations Centre information-sharing system.[5][8][9]
• Integrate supervision into routine quarterly schedules from national to local levels, incorporate relevant indicators into the Joint Annual Health Sector Review, and evaluate progress quarterly, annually, at mid-term and at end-term.[14]
• Collect evidence through human and animal health surveillance, annual reviews, after-action reviews, exercises and simulations, Joint External Evaluations, veterinary assessments, periodic supervision and facility-based assessments.[15][14][16]
• Mitigate delivery risks including weak stakeholder collaboration, delayed financing, staff turnover, limited public participation, unclear ownership and geographical barriers, while relying on timely funding, government ownership, coordination, advocacy and available human resources.[17][11]

Monitoring & Evaluation

The plan establishes a comprehensive monitoring, evaluation and accountability framework for health security, combining routine surveillance, periodic review, independent assessment and multisectoral oversight. Progress is to be assessed quarterly, annually, at mid-term and at end-term, under coordination structures accountable to the Prime Minister’s Office.[5][15][13][14]

• Use the inter-ministerial committee or high-level multisectoral technical group to administer, monitor and evaluate implementation, with accountability to the Prime Minister’s Office.[1][5][3]
• Collect data through human and animal health surveillance, annual reviews and reporting, after-action reviews, simulation exercises, Joint External Evaluations, veterinary assessments, periodic supervision and facility-based surveys.[15][14][18][16]
• Integrate supervision into routine quarterly schedules from national ministries through regional and local government levels, and incorporate relevant indicators into the Joint Annual Health Sector Review.[14][18]
• Monitor surveillance quality through reporting timeliness and completeness, quarterly feedback to subnational levels, outbreak investigation and response, morbidity, mortality, case-fatality rates, and data accuracy, representativeness and validity.[18]
• Apply International Health Regulations assessment processes, including annual self-evaluation and reporting to the World Health Organization, Joint External Evaluation, after-action reviews and simulation exercises.[4][18][16]
• Use Joint External Evaluation indicators across 19 technical areas, scored from 1 for no capacity to 5 for sustainable capacity; Tanzania completed a baseline evaluation in 2016, planned a follow-up in 2019, and planned mixed internal and external mid-term and end-term reviews in 2019 and 2021 respectively.[16]
• Track time-bound implementation targets covering legal reform, antimicrobial-resistance sentinel sites, electronic surveillance, notification of potential Public Health Emergencies of International Concern within 24 hours, hazard-specific plans, rapid response teams and simulation exercises.[8][9]

Baseline assessments identified substantial capacity gaps: the 2016 Joint External Evaluation found no technical area at sustainable capacity, while most capacities were rated limited to developed.[4]Core-component average scores were 2.4 for Prevent, 2.8 for Detect, 2.0 for Respond and 2.5 for other International Health Regulations-related hazards and points of entry.[6]The framework aims to generate information for decision-making, programme development, resource allocation, management, transparency and accountability across all levels and stakeholders.[14]

Costing & Financing

The five-year National Action Plan for Health Security is costed at 190,489,946,211.64 Tanzanian shillings, equivalent to USD 86,586,339, excluding immunisation costs.[6]Detect is the largest costed component, followed by Prevent; the plan also identifies costs for Respond, other International Health Regulations-related hazards and points of entry, and cross-cutting activities.[5][6]

• Allocate USD 50,329,373 to Detect, USD 22,054,730 to Prevent, USD 9,281,500 to other International Health Regulations-related hazards and points of entry, USD 4,850,782 to Respond, and USD 69,955 to cross-cutting activities.[5]
• Recognise livestock vaccine procurement as a principal cost driver, alongside laboratory staffing, workforce training, community health worker incentives, transport, temporary holding facilities at points of entry, supportive-supervision vehicles and information-sharing arrangements.[5][6]
• Map and mobilise domestic and external financing, classify activities by funding source, sequence implementation according to resource availability, and review whether high-cost activities are included in government budgets or may attract development-partner support.[4][2][3][7]
• Maintain budget lines for International Health Regulations implementation in relevant settings and for medical countermeasures, although the available extract does not provide their allocations.[16][8][9]
• Manage financing risks including delayed applications or disbursements, unavailable domestic or external resources, changes in government, inflation and inaccurate forecasting.[17]

Including animal vaccines raises the stated implementation cost to USD 603,158,558.[5]The source presents different estimates of the resulting scale of increase, describing it as seven-fold in one section and 38-fold where the immunisation technical area is included; the extracts do not reconcile this difference.[5][6]Confirmed external commitments include USD 30,000,000 from the World Bank for 2010–2020, USD 2,219,005 from the Food and Agriculture Organization for 2017–2020, and USD 11,000,000 from the United States Centers for Disease Control and Prevention and partners for 2014–2019.[19]