Malawi Emergency Preparedness And Response Roadmap 2023-2025

Objectives

Malawi’s Emergency Preparedness and Response Roadmap 2023-2025 is a two-year health-security framework intended to strengthen the country’s ability to prepare for, detect, respond to and recover from outbreaks and other public health emergencies, in line with the International Health Regulations (2005). It addresses infectious diseases, zoonoses, neglected tropical diseases, climate-related hazards and other disasters through a multisectoral One Health approach.[1][2][3][4]

• Strengthen preparedness and resilience by improving risk assessment, contingency planning, emergency coordination, essential-service continuity and resource mobilisation.[5][6][7]
• Expand integrated disease surveillance and response, including indicator-based and event-based surveillance, cross-border surveillance, water-quality and environmental surveillance, digital data management, outbreak analytics and emergency information management.[8][9][10]
• Improve laboratory capacity for priority pathogens through strengthened sample collection, referral, testing, genomic sequencing, quality management, biosafety and biosecurity.[2][10][11]
• Build a trained, deployable multidisciplinary surge workforce of 200 multisectoral and transdisciplinary experts across Malawi’s five health zones to detect, investigate and contain outbreaks.[10][12][11]
• Strengthen public health emergency operations centres, emergency logistics, warehousing, transport, pre-positioned stocks and district-level readiness to support rapid emergency response.[2][11][13]
• Develop and implement a multi-hazard risk communication and community engagement strategy, supported by Technical Working Groups and resource-mobilisation planning.[2][13][14]
• Advance health-security governance by finalising the National Action Plan for Health Security, developing its annual operational plan, disseminating a One Health strategy, progressing relevant legislation and developing public-health and disaster-risk instruments.[2][7][15]
• Support disease-specific preparedness by developing a cholera-control strategy to 2030, alongside preventive measures including water, sanitation and hygiene interventions, immunisation and other public-health action.[2][4]

Implementation

Implementation is structured as a whole-of-government, multisectoral and partner-supported effort. The roadmap was developed through assessment of existing preparedness and response systems, resource mapping, gap analysis and prioritisation by Government of Malawi technical teams and partners, with World Health Organization support. It builds on existing national and sub-national emergency and surveillance structures, while translating regional Emergency Preparedness and Response flagship initiatives into nationally prioritised actions.[5][3][6]

• Coordinate across human, animal and environmental health sectors, alongside local government, water and sanitation, education, defence, justice, information and digitalisation, gender, mining, disaster management, finance and economic affairs institutions.[6]
• Engage district councils, civil society, communities, private-sector entities, academia, training institutions, donors, United Nations agencies, international organisations and non-governmental partners.[2][6][7]
• Use and strengthen existing systems, including the National Public Health Emergency Operations Center, Field Epidemiology Training Program, District Health Information Software 2, One Health Surveillance Platform and draft National Action Plan for Health Security.[3]
• Deliver surveillance scale-up through training of surveillance officers, trainers, health workers, facility focal points, community volunteers and leaders; distribution of technical guidance and reporting tools; integrated supportive supervision; mentorship; and quarterly One Health surveillance review meetings.[8][9]
• Strengthen laboratory and data capacity through procurement of collection devices, connectivity, laboratory equipment, reagents, sample-transport resources and digital systems; technical integration sessions; data-analytics training; laboratory quality-management activities; and risk assessments for biosafety and biosecurity.[9][10]
• Establish the surge workforce through a 15-member selection committee, equitable selection across health zones, emergency-response training, standard operating procedures, pocket guidelines, simulation exercises and periodic drills to maintain deployment readiness.[12][11]
• Improve district emergency operations centres through infrastructure and equipment assessments, renovation, workforce development, information-system strengthening, preparedness workshops and simulation exercises in national and district settings.[11][13]
• Improve logistics readiness by identifying and training 12 health logisticians, pre-positioning emergency stocks, acquiring multimodal vehicles with communication systems and expanding warehouse capacity in Blantyre, Lilongwe and Mzuzu.[13]
• Apply monitoring through risk assessments, International Health Regulations monitoring tools, Joint External Evaluations, After Action Reviews, simulation exercises, supportive supervision, quarterly reviews and composite indices that compare implemented activities with identified activities.[7][15][11][13][14]
• Track operational readiness through assessments of training quality, laboratory adherence to ISO 15189:2022, surge-team skills and deployment readiness, public health emergency operations centre performance, response time, stock availability and stakeholder feedback. The Emergency Response Logistics Readiness Index has a stated target of 70%.[11][13]
• Mobilise resources through mapping and assessment of available physical and financial resources, establishment of a nationally supported emergency contingency fund and identification of sustainable financing mechanisms. The World Health Organization is to support initial seed-funding mobilisation for priority interventions.[2][7][15]

Monitoring & Evaluation

Monitoring combines International Health Regulations (2005) assessment processes, integrated surveillance, operational readiness reviews and activity-based performance measurement. The roadmap identifies substantial surveillance, laboratory, emergency operations, logistics and risk-communication gaps, but does not set out one consolidated results framework, baseline or overarching accountability structure.[7][8][11]

• Use the International Health Regulations Monitoring and Evaluation Framework, including the State Party Self-Assessment Annual Reporting Tool, Joint External Evaluation, After Action Reviews and Simulation Exercises, to identify preparedness and response weaknesses.[7]
• Conduct risk assessments that gather, assess and document information, assign risk levels, and inform prioritisation and mitigation; assess risks at points of entry and develop location-specific contingency plans.[7][15]
• Review implementation quarterly through assessments of actions agreed at high-level ministerial meetings and quarterly One Health Surveillance review meetings.[15][9]
• Monitor Integrated Disease Surveillance and Response through indicator-based surveillance for 41 medical conditions and weekly, monthly and quarterly reporting requirements. The assessment found that weekly and monthly reporting were in use, while quarterly reporting was not.[8]
• Expand event-based surveillance and third-edition Integrated Disease Surveillance and Response training, which at the time of assessment had reached five districts for event-based surveillance training and eight of 29 districts for the updated training.[8]
• Use national and district surveillance coordinators, facility focal points, data clerks, Health Surveillance Assistants, community volunteers and community structures to support reporting and early warning.[8]
• Strengthen surveillance and decision-making through interoperable data systems, outbreak analytics, emergency information management, supportive supervision, mentorship and consultations on system integration.[10]
• Assess implementation using composite indices based on the proportion of successfully implemented activities among all identified activities for surveillance, laboratory capacity, Public Health Emergency Operations Centres, emergency logistics and multi-hazard risk communication and community engagement.[11][13][14]
• Evaluate training quality, supervision, mentorship and review meetings for surveillance personnel, laboratory staff, community actors and surge responders; assess laboratory compliance with ISO 15189:2022 and the effectiveness of biosafety, biosecurity and quality-management activities.[11]
• Track selection, training, drills, knowledge retention, skills and deployment readiness for 200 multisectoral surge experts across five health zones, and assess the effectiveness of the 15-member selection committee.[11]
• Assess Public Health Emergency Operations Centre activities through operational-readiness feedback from national and district preparedness officers; measure logistics through response time, stock availability and stakeholder feedback. The Emergency Response Logistics Readiness Index target is 70%.[13]
• Address identified constraints in information flow, district capacity development, contingency planning, sample transport and referral, pathogen testing and sequencing, network coverage, digital equipment, interoperability and laboratory quality management.[3][8][9]

No detailed roadmap-wide indicator matrix, reporting timetable beyond the quarterly mechanisms, evaluation baseline or formal accountability mechanism is specified in the supplied material.[7][15][10][12]

Costing & Financing

Financing is framed around resource mapping, mobilisation and the development of costed preparedness interventions. Explicit costs are provided for the PROSE component and for surveillance, data and laboratory activities, while several other priority actions require resources without published costings in the supplied sections.[6][8][10][11]

• Mobilise resources to operationalise the two-year roadmap, with the Government of Malawi committing support and the World Health Organization committing to help the Ministry of Health and partners mobilise initial seed funding for priority interventions.[5][2]
• Establish a national emergency contingency fund using local contributions and map sustainable funding mechanisms for emergencies.[7][15]
• Develop a national costed roadmap following identification of existing resources, gaps and priorities for the Emergency Preparedness and Response flagship initiative.[6]
• Allocate a stated two-year PROSE budget total of 1,932,501.02 United States dollars across listed priorities and an unlabelled budget line.[8]
• Provide a separate listed programme-cost total of 7,751,927 United States dollars for integrated disease surveillance and response, cross-border and environmental surveillance, digitised data management, outbreak analytics, emergency information management and laboratory capacity.[10]
• Resource procurement, training, emergency stocks, vehicles, warehouse expansion, infrastructure renovation and risk-communication planning, although no budgets are supplied for these activities in the relevant sections.[11][13][14]

Preparedness resource needs are reported to have been underestimated. No overall roadmap budget, quantified funding gap, comprehensive funding-source breakdown, financing allocation plan or economic assumptions are specified.[3][7][15][10]