National Action Plan For Health Security (NAPHS), 2017-2021

Objectives

Eritrea’s 2017–2021 National Action Plan for Health Security (NAPHS) aims to build and sustain the core capacities required under the International Health Regulations (2005), reducing morbidity, mortality, disability and socio-economic disruption from public health threats while contributing to Sustainable Development Goal 3 and universal health coverage.[1][2][3][4]The plan seeks a resilient nation able to prevent, detect, verify, respond to and recover from disease outbreaks, other public health emergencies, chemical events, radiation emergencies and hazards at points of entry.[5][2][4]

• Strengthen and sustain capacity to prevent outbreaks and other health emergencies, including through immunisation, antimicrobial-resistance control, food safety, zoonotic-disease surveillance, biosafety and biosecurity.[2][6][7][8]
• Improve rapid detection, confirmation, surveillance, laboratory systems, real-time reporting and public-health workforce capacity.[5][2][9][10]
• Build effective response and recovery systems, including preparedness planning, emergency operations, risk communication, medical countermeasures, personnel deployment and coordination between public health and security authorities.[2][11][12][13]
• Maintain capacity at designated points of entry and strengthen readiness for chemical and radiation emergencies.[4][12][14][15]
• Apply One Health, health-system strengthening, equity, gender mainstreaming, human rights, community participation, evidence-led action, transparency and resilience as guiding principles.[2][16][17]

Implementation

Implementation uses a whole-of-government, whole-of-society and One Health model, aligning the NAPHS with the Health Sector Strategic Development Plan II, relevant health programmes, and animal-health and environmental plans.[2][16][17]It is based on Eritrea’s 2016 Joint External Evaluation and a subsequent multisectoral priority-setting, sequencing and costing process, supported by the World Health Organization (WHO).[2][16][18]The Ministry of Health leads delivery, supported by a multisectoral high-level technical group accountable to the Ministry of Development and a national coordination platform for aligning sectors, plans, risks and stakeholders.[17][19]

• Coordinate implementation through the Ministry of Health, relevant line ministries, local government, agriculture, security, customs, transport, finance, environmental authorities, communities, development partners, United Nations agencies and WHO.[5][20][21][22]
• Use the National Steering Committee for Health Security and the Public Health Emergency Management Committee to provide strategic leadership, identify barriers, mobilise resources, support epidemic preparedness and response, and monitor implementation and expenditure.[20][21]
• Strengthen the International Health Regulations National Focal Point, technical working groups and Public Health Emergency Coordination arrangements through defined mandates, terms of reference, standard operating procedures and information-sharing protocols.[23][24]
• Develop national-to-zoba operational capacity through emergency operations centres, electronic reporting systems, laboratories, cold-chain and storage infrastructure, transport, isolation facilities, supply-chain systems and equipped points of entry.[25][26][27][28][14]
• Train epidemiologists, laboratory staff, veterinary personnel, rapid-response teams, health workers, emergency-operations staff, risk-communication practitioners and radiation-safety professionals.[29][9][30][31][32][15]
• Formalise cross-border and intersectoral cooperation through memoranda of understanding, technical committees, joint planning, information sharing and simulation exercises.[10][12][33][34]

Monitoring is intended to align with the global International Health Regulations monitoring and evaluation framework and to be integrated into Health Sector Strategic Development Plan II review processes at sub-zoba, zoba and national levels.[19][6]Annual reporting is intended to track core capacities and meet reporting obligations to the World Health Assembly, while joint review meetings once or twice a year provide a forum to assess progress and performance.[19][6]The plan also provides for annual simulation exercises, after-action reviews following public health events, a mid-term review, and a second Joint External Evaluation as part of end evaluation.[6]

• Track indicators on legislation, coordination, laboratory capability, surveillance, reporting completeness and timeliness, outbreak response, workforce coverage, immunisation, point-of-entry readiness, chemical-event preparedness and radiation-emergency capacity.[6][7][8][23][24]
• Use sources including the Integrated Disease Surveillance and Response database, laboratory records, Ministry of Health reports, Joint External Evaluation findings and programme records.[23][24]
• Cost activities through prioritisation, sequencing, assessment of feasibility and expected impact, and distinction between domestic and external funding.[17][19]
• Mobilise domestic resources and engage development partners through a budget and financial plan, cost categories and budget-gap analysis.[4][18][19]

The estimated five-year implementation cost is USD 53,695,733, with the Ministry of Health expected to allocate USD 14,068,282, or 26.2%, through its programmes including the NAPHS.[19]Response represents 39.9% of the estimated cost, other International Health Regulations-related hazards and points of entry 28.3%, detection 17.2%, and prevention 14.6%.[2]The source identifies budget-gap analysis and donor engagement but does not quantify the remaining funding gap or confirm committed external financing.[17][19]

Monitoring & Evaluation

Monitoring and evaluation are anchored in the International Health Regulations (2005) monitoring and evaluation framework, annual reporting on core-capacity development, and incorporation of principal indicators into the Health Sector Strategic Development Plan II review system at sub-zoba, zoba and national levels.[19][6]Eritrea had previously used the World Health Organization monitoring questionnaire and submitted annual International Health Regulations reports, while the 2016 Joint External Evaluation assessed all 19 technical areas.[2]

• Assess capacity using 48 Joint External Evaluation indicators across prevention, detection, response, points of entry, chemical events and radiation emergencies; the 2016 results comprised 8 green, 30 yellow and 10 red indicators.[11]
• Review progress through joint sector meetings once or twice yearly, with the multisectoral high-level technical group responsible for administering, monitoring and evaluating implementation.[19]
• Conduct at least one simulation exercise annually, including an annual radiation-emergency simulation, and complete after-action reviews after public health events to identify good practice and lessons.[6]
• Undertake a mid-term review to identify bottlenecks and guide the latter implementation period, and use a second Joint External Evaluation as part of the end evaluation.[6]
• Track indicators covering legislation, coordination, information sharing, laboratory designation and performance, surveillance functionality, reporting completeness and timeliness, response within 48 hours, facility and workforce coverage, food-borne disease prevalence and immunisation coverage.[6][7][8]
• Use surveillance data from the Integrated Disease Surveillance and Response database, laboratory records, Ministry of Health reports, health-promotion records, Joint External Evaluation reports and other programme reports.[23][24]
• Maintain electronic indicator-based reporting, community-based and event-based surveillance, weekly epidemiological bulletins, rumour logging and cross-border surveillance where feasible.[9][10]
• Monitor strategic-plan implementation, programme budgets and expenditure through the National Steering Committee for Health Security, which also provides guidance on identified and emerging risks.[20]

Costing & Financing

The estimated five-year implementation cost is USD 53,695,733, with response accounting for 39.9%, other International Health Regulations-related hazards and points of entry for 28.3%, detection for 17.2%, and prevention for 14.6%.[2]The Ministry of Health allocation is reported as USD 14,068,282, equivalent to 26.2% of the estimated total.[19]

• Prioritise financing for medical countermeasures, rehabilitation of PHARMECOR infrastructure, points of entry, immunisation, workforce development, cold-chain capacity, emergency operations, isolation facilities, transport, laboratory capacity, chemical-event preparedness and radiation safety.[29][9][12]
• Mobilise domestic resources under state ownership and leadership, while considering external funding and development-partner engagement for activities outside the government budget.[4][18]
• Prepare budget and financial plans covering intervention summaries, cost categories and budget-gap analysis, with financing discussions through working groups, sector-wide processes and donor engagement.[19]
• Apply transparent costing through prioritisation, sequencing, assessment of realism and expected impact, identification of major inputs, and use of government procurement guidance or authoritative sources where unit-cost information is unavailable.[17]
• Track the proportion of total plan costs mobilised, for which the monitoring table reports values of 48.4%, 27.4%, 13.2% and 11.1%; the extract does not associate these figures with specific years or financing sources.[6]
• Establish a defined budget line for International Health Regulations implementation and provide adequate multisectoral financing.[24]
• Recognise that numerous activity-level cost entries have no stated currency or are affected by extraction artefacts; no confirmed overall funding gap or comprehensive list of committed external funders is specified.[18][35][36]