National Action Plan For Health Security (NAPHS) 2018-2022

Objectives

Myanmar’s National Action Plan for Health Security 2018–2022 provides a five-year framework for implementing the International Health Regulations (2005), strengthening national capacity to prevent, detect, protect against, control and respond to domestic and international public-health risks.[1]Its vision is health and wellbeing security through universal health coverage and a resilient health system that can adapt to outbreaks, risks and other emergencies.[2]The mission is to sustain national multisectoral capacity for preventing public-health emergencies and reducing human and animal morbidity and mortality associated with health threats.[3]

• Strengthen prevention capacities for food safety, antimicrobial resistance, zoonoses, biosafety and biosecurity, immunisation, legislation, workforce development and risk communication.[4][5]
• Improve detection through laboratory systems, specimen referral, quality assurance, real-time surveillance, electronic reporting, data analysis and One Health information sharing.[6][7][8]
• Establish effective response capacities through multi-hazard preparedness, emergency operations, medical countermeasures, personnel deployment, public-health and security coordination, and communication with communities.[3][9]
• Maintain core capacities at designated points of entry and develop preparedness for chemical, radiological and nuclear emergencies.[3][10][11]
• Apply a One Health approach linking human, animal and environmental health sectors, while supporting national health-system strengthening, universal health coverage and sustainable development.[1][12]

The plan covers 19 technical areas grouped around prevention, detection, response, and International Health Regulations-related hazards and points of entry.[1]Priorities include developing multisectoral systems for food safety, zoonotic-event preparedness, antimicrobial-resistance surveillance and stewardship, laboratory coordination and accreditation, immunisation supply chains, and integrated health information systems.[4][13][14][15]

It also aims to strengthen a functional national and international response system for all public-health events through public health emergency operations, exercises, cross-border collaboration, risk communication, civil-military coordination and arrangements for receiving or sending health personnel and medical countermeasures.[16][17][18][19][20]

Implementation

Implementation is intended to be country-led by the Ministry of Health and Sports, with domestic resource commitments and oversight spanning planning, implementation, monitoring, supervision and evaluation.[3]The plan uses Joint External Evaluation findings, nationally prioritised activities, complementary assessments and existing sectoral strategies to identify actions, outcomes, milestones and a costed workplan.[3][12][21]

• Coordinate strategic oversight through the National Cross-Government Steering Committee for Health Security, supported by the Technical Strategy Group for Public Health Emergency Preparedness and technical working groups.[3][22]
• Engage relevant ministries, state and regional authorities, laboratories, universities, communities, development partners, United Nations agencies, civil society and the private sector in multisectoral delivery.[23][12][24]
• Use the National Action Plan for Health Security as a platform to map activities, reduce duplication across technical areas and promote coordination at all administrative levels.[12][21]
• Develop legislation, memoranda of understanding, standard operating procedures, guidance, training modules, national plans and operational handbooks to formalise preparedness and response arrangements.[25][26][27]
• Build capacity through workforce planning, applied epidemiology training, laboratory strengthening, simulations, table-top and functional exercises, supervision, community engagement and risk communication.[2][9][28][29]

Operational delivery combines national and subnational implementation. Examples include strengthening emergency operations centres under an Incident Management System, conducting at least one table-top and one functional exercise annually, developing multi-hazard preparedness plans, and equipping laboratories, points of entry and surveillance systems.[9][17][30][10]Stakeholders are expected to work across human health, animal health, wildlife, environmental, security, customs, immigration and border-management functions where risks span sectors or countries.[4][31][32]

Monitoring is to use global International Health Regulations and national health-plan frameworks, focal persons for technical areas, Activity Monitoring Tables, regular coordination meetings and monitoring integrated with existing programmes where possible.[33]Activities are intended to have outcome indicators, time-bound targets and milestones, with annual reviews, a midterm evaluation, end-of-plan evaluation and a subsequent Joint External Evaluation informing the next five-year plan.[21][34]The plan does not specify a fully consolidated indicator dictionary, standard reporting template or a single detailed accountability process in the supplied material.[21][33]

Financing is framed around sustainable national funding, identification of potential sources, alignment with the national budget cycle, engagement of development partners and private-sector participation, and matching resources to priority gaps.[12][21]Development and technical support involved the World Health Organization, Food and Agriculture Organization of the United Nations, United States Agency for International Development, Asian Development Bank, World Bank, United States Centers for Disease Control and Prevention and other partners.[35]The supplied material contains many activity-level estimates and records that the Asian Development Bank’s Greater Mekong Subregion project was expected to contribute nearly 10% of implementation, but it does not provide a reliable consolidated total budget or quantified overall funding gap.[21]

Monitoring & Evaluation

The National Action Plan for Health Security (2018-2022) uses the International Health Regulations (2005) monitoring and evaluation framework, Joint External Evaluation findings, technical-area indicators, milestones and activity monitoring to track implementation across prevention, detection, response, points of entry, chemical events and radiation emergencies.[2][3][33]Monitoring is intended to be integrated with existing programmes where possible and coordinated through focal persons, the National Cross Government Steering Committee and the International Health Regulations National Focal Point.[33]

• Use Joint External Evaluation assessments, which recorded 2 green, 33 yellow and 13 red scores among 48 indicators, to prioritise activities and assess progress in core capacities.[2][3]
• Track implementation against time-bound milestones and desired outcome indicators through regularly updated Activity Monitoring Tables, with progress, constraints and gaps reviewed in monitoring and coordination meetings.[21][33]
• Monitor surveillance and reporting capacities through indicator-based and event-based surveillance, electronic reporting, data integration, laboratory testing, specimen referral, syndromic surveillance and One Health information sharing between human, animal and environmental sectors.[6][4][8]
• Conduct annual reporting on International Health Regulations core capacities, annual reviews, a midterm evaluation, an end-of-plan evaluation, after-action reviews following emergencies, and a further Joint External Evaluation in the fifth year.[34]
• Test preparedness through at least one table-top exercise and one functional exercise each year, alongside simulations for public health emergencies, chemical events, radiation emergencies, points of entry and civil-military coordination.[9][36][27]
• Assess technical implementation through activity and output measures, including trained personnel, meetings held, plans and standard operating procedures completed, laboratories functioning, databases established, reporting timeliness, vaccination coverage, emergency exercises and deployment mechanisms.[13][15][37][38]
• Use risk communication monitoring to assess public-information effectiveness, feedback mechanisms, community engagement, media surveillance and rumour verification, with messaging adjusted in response to findings.[39][29]

The supplied material provides substantial activity-level monitoring arrangements but does not consistently specify standardised reporting templates, quantitative outcome targets, reporting intervals or a single formal accountability framework across all technical areas.[21][33][34]

Costing & Financing

The plan envisages a five-year costed workplan aligned with Joint External Evaluation priorities, national plans and Myanmar’s budget cycle, with domestic financing intended to support sustainability and development partners expected to help address resource gaps.[12][21][3]However, the supplied material does not provide one reliable consolidated plan budget or quantified financing gap, and many activity tables have incomplete currency labels or OCR-affected headings.[12][21][40]

• Mobilise domestic resources, potential donor support and private-sector engagement, and submit the plan and budget for inclusion in the 2019 national budget.[12][21]
• Draw on financial development support from the United States Agency for International Development, the Pandemic Influenza Preparedness Framework, Infectious Hazard Management, the World Health Organization Health Emergencies Programme, Gavi Health Systems Strengthening 2 Grant, the Asian Development Bank, UNICEF, the Food and Agriculture Organization and other partners where identified.[35][15][41][42]
• Address public-financing constraints, as health expenditure was reported at 1.8% of gross domestic product in 2013, government health expenditure at 3.65% of general government expenditure, and household out-of-pocket payments at 79% of health-care financing.[43]
• Fund priority capacities including laboratories, surveillance and databases, antimicrobial resistance, One Health coordination, workforce development, emergency operations, medical countermeasures, risk communication, points of entry, chemical-event management and radiation preparedness.[4][9][21]
• Apply activity-level cost assumptions for consultancy, meetings, training, per diems, travel, equipment, printing, dissemination, laboratory systems and emergency supplies, while recognising that many source tables do not identify confirmed allocations or funding gaps.[44][13][45][30]

The Asian Development Bank Greater Mekong Subregion project was expected to contribute nearly 10% of plan implementation, but the source does not state the overall plan cost against which that contribution would be calculated.[21]