National Guidelines on Epidemic Preparedness and Response

Objectives

Strengthen epidemic preparedness and response to prevent, detect, investigate, manage and control infectious-disease outbreaks rapidly, reducing morbidity, mortality and disability through coordinated surveillance, timely treatment, prevention and community action.[1][2]The framework prioritises early recognition of epidemic-prone diseases, conditions targeted for elimination or eradication, and other threats of public-health importance.[3][4]

• Establish clear outbreak-response roles, functional preparedness and response plans, priority disease lists, locally appropriate alert and epidemic thresholds, and strengthened capacity at national, provincial, district, sub-district, facility and community levels.[1][2][3]
• Detect suspected outbreaks through sensitive clinical, laboratory and community surveillance; verify rumours; confirm diagnoses; define affected areas and populations; and initiate investigation and control without delay.[5][6]
• Reduce transmission through case management, infection prevention and control, immunisation, safe water and sanitation, food safety, vector control, environmental measures, health education and technically appropriate disease-specific interventions.[7][8]
• Protect high-risk populations and contacts through referral, isolation where appropriate, active case finding, contact monitoring, prophylaxis or vaccination when indicated, and tailored prevention measures for priority diseases.[9][8][10][11]
• Maintain readiness through contingency plans, emergency stocks, trained personnel, laboratory support, transport, communications, emergency services and financial resources that can be deployed during outbreaks.[12][13]

The strategy also supports disease-specific control, including elimination and eradication activities, such as high routine and supplementary oral polio vaccine coverage, and prevention and management of cholera, measles, malaria, tuberculosis, foodborne disease, rabies, haemorrhagic fever and other communicable threats.[14][15][16][17][11]

Implementation

Deliver preparedness and response through multidisciplinary, multisectoral outbreak response committees and teams, with senior officials empowered to make immediate decisions and with participation adapted to the outbreak context and locally available resources.[2][18]National and provincial structures provide coordination, technical guidance, resource mobilisation and support, while district and sub-district teams lead local detection, investigation, response and feedback.[2][19]

• Convene national and provincial outbreak response committees and district and sub-district teams that include surveillance, epidemiology, health information, laboratory, environmental and port health, clinical care, infection control, pharmacy, finance, communications, emergency medical services, disaster management and primary health care functions.[2]
• Engage health facilities, relevant government departments, laboratories, emergency and disaster services, communities, leaders, non-governmental organisations, international agencies, civic structures and media in prevention, response and risk communication.[2][20][13]
• Operate routine meetings outside outbreaks and frequent, including daily, coordination meetings during outbreaks; maintain agreed terms of reference, secretarial support, minutes, clear responsibilities and reporting lines.[18]
• Use an Early Warning System and weekly reporting on priority conditions, with locally adapted priority disease lists and thresholds that distinguish alerts requiring investigation from epidemics requiring a definite response.[3][13]
• Report suspected immediately reportable diseases within 48 hours, communicate investigation updates between teams and higher levels, and use outbreak logs, line lists and standard forms to record cases, rumours, actions and outcomes.[6][21][7]
• Prepare field investigations by assessing the credibility, severity and transmission risk of notifications; arranging staff, travel, authorisations, community engagement, specimen handling, laboratory testing, rapid-response kits and information flows.[6]
• Support health facilities with recommended medicines, supplies, treatment guidance, standard precautions and infection-control measures; identify additional cases through records review, facility searches, contact tracing and community investigation.[9]
• Maintain contingency stocks capable of managing at least 100 people per week in outbreak-risk districts, subject to disease burden, stock type, resource availability and infrastructure; monitor stock levels, shortages and expiry.[12]
• Provide concise, culturally appropriate public communication through community leaders, schools, groups and media, promoting prevention, early recognition, referral, treatment seeking and behaviours that reduce transmission without stigma or panic.[20][11]

Monitoring and evaluation combine surveillance analysis, operational supervision and post-outbreak learning. Teams analyse cases and deaths by time, place and person using epidemic curves, maps, line lists and demographic, clinical, laboratory and outcome data to identify sources, transmission patterns, populations at risk and appropriate control measures.[22][23]Timeliness assessment tracks intervals from first case onset through facility presentation, investigation, response and notification.[22]

• Monitor reporting completeness, timeliness and accuracy; weekly trends in cases and deaths; threshold crossings; laboratory confirmation; response actions; supply use; staff performance; and community engagement.[21][20][24]
• Conduct monthly support visits and on-the-job training to assess readiness, standard case-definition use, data quality, outbreak investigation, response implementation, supervision and resource availability.[20][24]
• Define indicators with numerators and denominators, compare performance against recommended standards or targets, identify gaps and agree corrective actions.[24]
• Document each outbreak, including investigation findings, response, impact, lessons learnt, conclusions, recommendations and feedback to facilities and authorities.[19]

Resource mobilisation includes costed preparedness and response plans, partner coordination, emergency medicines and supplies, and human, material, financial and infrastructure support.[2][19][13]No monetary budget totals, funding sources, funding gaps or economic assumptions are specified.[2][13]

Monitoring & Evaluation

The framework establishes an integrated epidemic preparedness and response monitoring system centred on sensitive surveillance, rapid notification, investigation, analysis, feedback and systematic documentation. It requires monitoring before, during and after outbreaks, but quantitative targets are only partly specified and vary across activities.[1][24]

• Maintain functional surveillance and an Early Warning System, with weekly reporting on priority epidemic-prone conditions during both epidemic and non-epidemic periods.[2][13]
• Report suspected immediately reportable diseases to the national office within 48 hours of presentation at a health facility, while submitting weekly and monthly summary reports.[21]
• Apply locally appropriate alert and epidemic thresholds, expressed as cases per week or month, to trigger investigation or a definite response; review thresholds periodically in light of disease trends, seasonality and local epidemiology.[3][4]
• Monitor reporting timeliness, completeness and accuracy, following up missing or late facility reports. Timeliness is calculated as reports sent on time divided by reports expected, multiplied by 100; completeness is calculated as expected reports less reports not received, divided by expected reports, multiplied by 100.[21][15]
• Record and investigate rumours, suspected cases and confirmed outbreaks using agreed logs, line lists and case-based forms, including variables on time, place, person, symptoms, risk factors, laboratory findings, outcomes and reporter details.[6][9][7]
• Analyse epidemic curves, spot maps, case counts, deaths, geographic distribution, risk factors and demographic characteristics to identify affected populations, clusters, transmission patterns, sources of infection and priorities for control.[22][23][25]
• Assess response timeliness by monitoring intervals from first known case and facility presentation to investigation, response initiation and notification of provincial and national authorities.[22]
• Review cases, deaths, geographic spread and case fatality rates at the relevant reporting frequency, and investigate apparent changes by considering reporting coverage, case definitions, seasonality, screening, treatment programmes, population movement and service quality.[23][7]
• Use case fatality rates as an outcome measure, calculated by dividing deaths by reported cases and multiplying by 100.[23]
• Monitor implementation of control measures and resource use, including drugs, vaccines, supplies, disinfectants, logistics, staff and financial resources.[2]
• Use monitoring tools to assign planned and completed activities, responsible persons and due dates across coordination, treatment, surveillance, health promotion, environmental health, laboratory services, communication and logistics.[20]
• Conduct monthly district and local-municipality monitoring visits, reviewing preparedness, detection, reporting, investigation, response, data quality, use of surveillance information, readiness, supervision, training, resource availability and feedback.[20]
• Define indicators using specified numerators and denominators, compare results with recommended standards or targets, and use findings to assess progress and service quality.[24]
• Provide feedback and on-the-job training through support visits, agree corrective actions for identified problems, and report evaluation findings to health facilities and authorities.[24][19]
• Document each outbreak systematically, covering investigation, findings, response, impact, lessons learnt, conclusions, recommendations and feedback.[19]
• Report strategic surveillance and response information to senior managers, political heads, Parliament and Cabinet.[13]

Accountability is primarily operational: outbreak response teams and communicable disease control functions coordinate investigations, data use, feedback and reporting. The framework does not consistently specify formal accountability instruments, universal performance targets or reporting schedules beyond the stated disease-notification and surveillance procedures.[2][19][15]

Costing & Financing

Financing provisions focus on planning, mobilisation and operational readiness rather than quantified budgets. A costed epidemic preparedness and response plan of action is required to guide resource allocation, while human, material, financial and infrastructure resources are to be mobilised for timely prevention and response.[2][19]

• Prepare a costed preparedness and response plan to support appropriate resource allocations.[2]
• Mobilise and coordinate human, material and financial resources, including partner assistance, and monitor their utilisation during prevention and control activities.[2]
• Provide additional and emergency financial support when needed for outbreak preparedness and response.[13]
• Check fund availability during operational planning, secure emergency stocks rapidly, borrow supplies from other services or non-governmental organisations where necessary, and consider feasible low-cost alternatives when local supplies are unavailable.[7][8]
• Maintain contingency stocks in outbreak-risk districts, with depot capacity to manage at least 100 people per week, subject to disease burden, stock type, available resources and infrastructure.[12]
• Plan vaccine availability before epidemics, maintain supplies of medicines and equipment, and assess future supply requirements through response monitoring.[12][20][13]

No monetary amounts, budget ceilings, expenditure estimates, financing-source breakdowns, funding-gap estimates, economic assumptions or cost-effectiveness measures are specified in the supplied sections.[2][13]