National Guidelines on Epidemic Preparedness and Response

Objectives

The framework aims to reduce morbidity, mortality, disability, case numbers, geographical spread and outbreak duration from epidemic-prone communicable diseases by strengthening preparedness, early detection, rapid investigation, coordinated response and effective control at national, provincial, district, facility and community levels.[1][2]It addresses both established epidemic-prone diseases and novel or re-emerging pathogens, while linking immediate outbreak containment with longer-term prevention of transmission.[3][4]

• Strengthen functioning outbreak response teams with clear roles, responsibilities and terms of reference throughout the health system.[5]
• Develop prioritised lists of epidemic-prone, elimination or eradication-targeted, and other public-health-concern diseases, using historical trends, likely impact, spread potential, seasonality, epidemiology and available resources to guide priorities.[5][6]
• Prepare disease-specific Epidemic Preparedness and Response plans that define interventions, activities, human and financial resource needs, time frames, and monitoring and evaluation indicators.[2][5]
• Maintain sensitive surveillance, locally appropriate alert and epidemic thresholds, laboratory confirmation and standard clinical and community case definitions to detect potential outbreaks promptly.[6][7]
• Investigate suspected outbreaks rapidly, including reports from health services, communities, leaders and media, and assess transmission, severity, affected populations, geographical extent and resource requirements.[8][9][10]
• Strengthen case management, referral, infection prevention and control, active case finding, emergency immunisation where relevant, health-worker competence, and access to treatment and essential supplies.[4][11]
• Protect communities through risk communication, public education, safe water, sanitation, hygiene, food safety, vector control, mosquito-bite prevention and culturally appropriate measures to reduce transmission at gatherings and burials.[12][13][14]
• Use epidemiological analysis by time, place and person to identify transmission patterns, infection sources, populations at risk and areas requiring targeted intervention, and to assess whether cases and deaths are declining.[15][16]

Implementation

Implementation relies on a coordinated, multisectoral and multidisciplinary delivery model led through national, provincial, district and sub-district health structures, with outbreak response teams responsible for preparedness, investigation, response planning, resource mobilisation, documentation and review.[5][17]The framework aligns epidemic preparedness with national health responsibilities, disaster-risk reduction and cooperative intergovernmental coordination.[2]

• Establish national, provincial and district outbreak response committees that bring together communicable-disease control, surveillance and epidemiology, laboratory services, environmental health, health promotion, clinical care, infection control, pharmacy, finance, communications, emergency medical services and disaster management.[5]
• Engage external partners and affected communities, including local government, water, education, agriculture, social-development, defence, non-governmental and international organisations, public entities, civic structures, traditional and community leaders.[5][17]
• Chair response structures through senior or delegated officials able to make immediate decisions, meet daily initially during outbreaks, reduce meeting frequency as control is established, and maintain routine core and extended-team meetings outside outbreaks.[17][6]
• Report priority epidemic-prone diseases weekly, notify suspected outbreaks within 48 hours, maintain logs of rumours and suspected outbreaks, and use alert thresholds to trigger investigation and readiness while epidemic thresholds trigger a definite public-health response.[6][7][18]
• Prepare field investigations through staffing, travel, supervision, reporting lines, community engagement, authorisations, communications, rapid-response kits, safe specimen collection and transport, and agreed data-collection variables.[19]
• Use line lists, case-based forms, epidemic curves, spot maps, tables and graphs to analyse cases and deaths, identify clusters and trends, and assess the timeliness of detection, notification, investigation and response.[20][15][16]
• Deploy district teams to verify rumours, investigate cases, coordinate action plans, support health facilities, review surveillance trends, alert neighbouring districts, assign responsibilities and adapt interventions as operational problems emerge.[17][4]
• Maintain contingency plans and initial stocks of medicines, vaccines, treatment supplies, protective materials, specimen-collection items, transport and communications resources; districts at risk are expected to hold sufficient initial stock for at least 100 people per week, subject to disease burden, resources and infrastructure.[4][11]
• Communicate through trusted leaders, community organisations, schools, health centres and mass media, with a designated spokesperson and consistent messages approved by the Epidemic Response Committee.[12]
• Monitor preparedness, reporting timeliness and completeness, case confirmation, response-team functioning, investigations, resource use, prevention and control activities, supervision, training and feedback before, during and after outbreaks.[21]Reporting completeness and timeliness are calculated as reports received divided by reports expected, expressed as percentages, with effective surveillance expected to approach 100% for both measures.[18]
• Evaluate whether planned objectives were achieved, compare annual objectives with results, identify gaps and lessons, recommend improvements, and provide feedback to facilities, managers and political structures.[22][23]

Monitoring & Evaluation

The framework establishes a comprehensive monitoring and evaluation approach for epidemic preparedness and response, centred on sensitive surveillance, early warning, prompt investigation, timely reporting, analysis of outbreak data, review of response performance, and feedback to health authorities and facilities.[2][14][22]

• Maintain functional surveillance systems for priority infectious and epidemic-prone diseases, using clinical and community case definitions, laboratory confirmation where appropriate, and reporting from health facilities, communities and other information sources.[5][7][8]
• Report priority epidemic-prone diseases weekly and adjust priority lists to local epidemiology and seasonal conditions.[6]Monitor weekly and monthly summary reports, while requiring provincial reports of suspected immediately reportable diseases to reach national level within 48 hours of presentation at a health facility.[20]
• Record rumours, suspected outbreaks and verified outbreaks in structured logs, including case counts, locations, notification dates, investigation dates and investigation outcomes.[24][18]
• Use alert thresholds to trigger further investigation, review of historical data, laboratory confirmation, intensified trend monitoring, contingency readiness and notification of relevant programme managers and outbreak response teams.[6][7]Use epidemic thresholds to initiate a definite public-health response.[7]
• Establish and periodically revise thresholds through review of five-year trends where available, baseline disease burden, seasonal variation and changing epidemiological patterns, expressed as cases per week or month.[7]
• Analyse cases, deaths, geographic distribution and case-fatality rates by time, place and person, using line lists, epidemic curves, histograms, spot maps and tables to identify clusters, exposure patterns, transmission, populations at risk and service gaps.[20][15][16]
• Assess reporting timeliness and completeness, including indicators calculated from reports expected and reports received, and use these findings to improve reporting performance at district and health-facility levels.[18]
• Measure preparedness and response through input, process, output and outcome indicators in disease-specific plans, with clearly defined numerators and denominators where relevant.[2][22]One cited example is the proportion of facilities maintaining trend lines for priority diseases.[22]
• Track preparedness, detection, reporting, investigation, response, data completeness and timeliness, use of surveillance data, prevention and control activities, training, supervision, resources, feedback and the functioning of response teams and plans.[21]
• Review implementation of outbreak-control actions, resource utilisation, investigations, documentation and preparedness plans, including regular assessment of disease trends before epidemic seasons in at-risk districts.[17][6]
• Evaluate whether objectives were achieved, identify gaps, compare annual objectives with results, assess report quality and community perceptions, document lessons learnt, recommend improvements and provide feedback to facilities, senior managers and political structures.[22][23]
• Use supportive visits, tailored checklists, on-the-job training and follow-up of agreed actions to verify standards and resolve operational problems.[21]

Accountability is primarily operational: outbreak response teams, health authorities, supervisory structures and the National Health Council have surveillance, monitoring, coordination or advisory responsibilities.[2][5]The extracts do not set out a single detailed national indicator catalogue, audit process or uniform evaluation timetable beyond the specified reporting frequencies, thresholds, supervisory visits and outbreak documentation requirements.[2][22]

Costing & Financing

Financing provisions are largely resource-oriented rather than budgeted. Epidemic Preparedness and Response plans are expected to specify required human and financial resources and to be costed so that appropriate allocations can be made and resources mobilised for prevention, preparedness and control.[2][17]

• Identify human, material and financial requirements in disease-specific preparedness and response plans, including implementation time frames and monitoring arrangements.[2][5]
• Mobilise resources for infrastructure, personnel, medicines, vaccines, laboratory capacity, logistics, equipment, transport, communications, emergency medical services and other outbreak-response requirements.[23][25][26]
• Maintain emergency supplies and district contingency stocks for initial outbreak management, including medicines, vaccines, treatment supplies, specimen-collection materials, disinfectants and protective equipment.[4][11]Depots are recommended to hold minimum stock sufficient for at least 100 people per week, subject to disease burden, available resources and infrastructure.[11]
• Monitor use of medicines, vaccines, supplies, logistics and human and financial resources as part of outbreak-control oversight.[17]
• Seek supplies from higher administrative levels, borrow from other services or organisations, or use practical low-cost substitutes when local supplies are unavailable.[4]
• Advocate for additional resources where shortages may be contributing to increasing case numbers.[24]
• Provide additional and emergency financial support through assigned finance functions as part of preparedness responsibilities.[23][25]

No supplied extract provides a monetary budget, cost estimate, funding allocation, financing source, quantified funding gap, currency-denominated commitment, costing methodology or economic assumption.[17][4][25]Resource availability is nevertheless identified as a consideration in deciding whether and how to investigate and respond to outbreaks.[8][10]