National Action Plan For Health Security Of Cabo Verde 2022–2026

Objectives

Cabo Verde’s National Action Plan for Health Security (NAPHS) 2022–2026 is a five-year strategic framework to strengthen national and global health security through a multisectoral One Health approach linking human, animal and environmental health.[1][2]Its vision is a healthy, resilient nation able to prevent, detect and respond effectively to public health threats, while its mission is to protect the population and strengthen resilience in line with the International Health Regulations (2005).[3]The overarching objective is to reduce morbidity, mortality and adverse socio-economic consequences associated with public health threats.[2][3]

• Strengthen and sustain capacities to prevent threats, detect them promptly and respond rapidly to epidemics, epizootics, natural disasters and other public health emergencies.[1][4][3]
• Apply the International Health Regulations framework across 19 technical areas, grouped under prevention, detection, response and other International Health Regulations capacities.[2][5]
• Address gaps identified through the 2019 Joint External Evaluation, public-health risk assessments, State Party Self-Assessment Annual Reports, after-action reviews and other national assessments.[1][6][5]
• Strengthen integrated preparedness for infectious outbreaks, waterborne disease, climate and environmental hazards, drought, volcanic events, chemical events, radiological or nuclear emergencies and other disasters.[4][7][8]
• Develop and monitor contingency plans for risks classified as very high or high, using integrated multi-risk arrangements for coordination, chains of command and communications.[9]
• Strengthen institutional and regulatory arrangements, intersectoral coordination, funding-source mapping and alignment with the Strategic Plan for Sustainable Development, the Sustainable Development Goals and African Union Agenda 2063.[10]
• Prioritise health-system resilience through human resources, infrastructure, health technologies, information systems, community engagement, health promotion and emergency management.[11]

Implementation

Implementation is designed as a government-led, multisectoral and intersectoral process coordinated through the Ministry of Health, the National Coordinating Instance and the National Institute of Public Health.[1][10]The National Coordinating Instance serves as the One Health platform bringing together human, animal and environmental health sectors, while the Multisectoral Technical Team for the Management of Public Health Emergencies provides technical and operational support.[12]Development of the plan involved cross-sector workshops in October 2021, preparation of the narrative by a secretariat group, and a costing workshop in April 2022.[3]

• Coordinate delivery through existing multisectoral mechanisms to optimise resources, avoid duplication and improve cooperation between health, agriculture, environment, internal administration, finance, transport, water and sanitation, civil protection and regulatory institutions.[5][12]
• Engage municipal health offices, local political leaders and city councils in implementation spanning human, animal and environmental health.[12]
• Involve development partners, the World Health Organization, technical institutions, communities, civil society, media and private organisations in technical support, financing, implementation, public communication, feedback and community participation.[12][13]
• Designate focal points for each technical area to form a multisectoral follow-up core, promote ownership and facilitate interoperability across the plan’s technical areas.[14]
• Strengthen operational capacity through recruitment and training of doctors, nurses and laboratory technicians, field epidemiology training, and expansion of virology laboratory capacity from one laboratory to four laboratories across different islands.[12][11]
• Develop standard operating procedures, preparedness and contingency plans, risk maps, surveillance and reporting systems, laboratory capability, communication arrangements and response mechanisms for identified hazards.[4][8]
• Address implementation risks through political endorsement, clear institutional roles, coordination with island-level health delegations and institutional representatives, transport support, stakeholder communication, timely financing and workforce development.[15][12]

Monitoring and evaluation are to be conducted by a multisectoral follow-up core under supervision of the National Coordinating Instance, using a logical model and activity-level indicators.[2][14]The monitoring tool includes process and outcome indicators, collection frequencies and verification sources, with progress reviewed through biannual and annual meetings involving focal points, ministries, implementing institutions and development partners.[14]Annual International Health Regulations capacity reports are to use the State Party Annual Self-Assessment Tool; after-action reviews should follow each public-health event; and at least one national simulation exercise should be conducted each year.[14]A 2024 Joint External Evaluation is intended to inform the plan’s mid-term evaluation and recommendations for the remaining implementation period.[16]

The five-year plan is costed at 2,783,928,058 Cabo Verdean escudos, equivalent to 26,263,472 United States dollars.[17]Only 17% of budgeted activities have identified funding, leaving 83% unfunded.[17]The Ministry of Health is expected to advocate for domestic allocations through the General State Budget and mobilise external resources from development partners and donors, with participation by other ministries considered essential because the plan is cross-cutting.[17]

Monitoring & Evaluation

The National Action Plan for Health Security (NAPHS) monitoring and evaluation system is intended to track implementation across 19 technical areas of the International Health Regulations (2005), using a multisectoral follow-up mechanism, a logical model and activity-level indicators.[2][13][14]

• Supervise monitoring and evaluation through the National Coordination Instance and the Ministry of Health, with a multisectoral NAPHS monitoring nucleus or follow-up core comprising designated focal points for each technical area.[2][11][14]
• Apply process and outcome indicators, defined collection frequencies and verification sources within the plan’s monitoring and evaluation tool; the supplied material does not reproduce the individual indicators or numerical targets.[14]
• Hold biannual and annual review meetings with technical focal points, ministries, implementing institutions and development partners to assess implementation progress, challenges and good practices.[14]
• Prepare annual reports on development of International Health Regulations core capacities through the State Party Self-Assessment Annual Report tool.[7][14]
• Use complementary International Health Regulations assessment mechanisms, including Joint External Evaluation, annual self-assessment, after-action reviews and simulation exercises.[18][14]
• Conduct an after-action review after each public health event to identify lessons, good practices and operational challenges, building on reviews of the 2015 Zika virus and 2017 malaria epidemics.[6][7][14]
• Conduct at least one national simulation exercise each year to test International Health Regulations capabilities and identify improvements.[14]
• Use the 2024 Joint External Evaluation to inform a mid-term evaluation of NAPHS, assessing progress and recommending adjustments for the remaining implementation period.[16]
• Monitor contingency plans for risks classified as very high or high, alongside risk-matrix-based management and mitigation of implementation risks.[9][17]
• Strengthen surveillance through integrated environmental and health data, veterinary epidemiological networks, laboratory confirmation, epidemiological investigation and timely reporting of registered and emerging diseases.[19][20]

Accountability rests principally with the Ministry of Health for overall implementation management, monitoring, evaluation, compliance with international obligations and information-sharing.[11]Political leadership, multisectoral coordination and stakeholder compliance are identified as supporting accountability mechanisms.[12][11]The 2019 Joint External Evaluation identified no or limited capacity in many technical areas, including financing, laboratory systems, surveillance, emergency operations, risk communication, points of entry, biosafety, biosecurity and chemical or radiological response.[6][21]

Costing & Financing

The five-year NAPHS budget for 2022 to 2026 is 2,783,928,058 Cabo Verdean escudos, reported as equivalent to 26,263,472 United States dollars.[17]Only 17% of budgeted activities have identified funding, leaving 83% unfunded.[17]

• Allocate 474,088,192 Cabo Verdean escudos to funded activities and identify financing for 2,309,839,866 Cabo Verdean escudos of unfunded activities.[17]
• Concentrate expenditure in the Detection thematic group, which represents 65.9% of costs, followed by Other International Health Regulations areas at 15.1%, Prevention at 10.8% and Response at 8.2%.[2]
• Prioritise the National Laboratory System, Human Resources and Points of Entry, which account for 42.5%, 14.1% and 10.1% of costs respectively.[2]
• Schedule 52.9% of the budget for the first two years and prioritise urgent activities and those with existing funding during the early implementation period.[2][3]
• Mobilise domestic resources through inclusion in the State’s General Total Budget and seek external resources from development partners and donors, with participation by other ministries because NAPHS is cross-cutting.[17][13]
• Map internal and external funding sources and potential partners to finance unfunded activities, supported by a resource-mapping workshop involving government and development partners.[2][3][10]
• Manage financial risks arising from unavailable or delayed funds and changing government priorities by securing timely financing, sustaining government allocations and identifying contributing partners.[15]
• Fund radiological and nuclear emergency activities at a combined cost of 69,781,717 Cabo Verdean escudos, including risk mapping, contingency planning, training, monitoring and information-sharing.[8]

The plan was costed through a dedicated April 2022 workshop involving technical and budgeting specialists.[22][2]Although the extracts identify substantial resource needs for workforce, infrastructure, laboratories, health technologies, information systems, community engagement and emergency management, they do not specify disbursement arrangements or economic assumptions beyond the stated budget and funding status.[11][13]