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

Objectives

Eritrea’s five-year National Action Plan for Health Security (2017–2021) provides a nationally led framework for meeting International Health Regulations (2005) obligations, aligned with the second Health Sector Strategic Development Plan, Sustainable Development Goal 3 and universal health coverage. Its vision is a secure, resilient nation in which communities are protected from threats to health and well-being; its mission is to build and sustain optimal core capacities across 19 health-security technical areas.[1][2][3]The overarching goal is to minimise human and animal morbidity and mortality, reduce disability and socio-economic disruption from public health threats, and prevent, detect, respond to and recover from outbreaks and other emergencies.[2][3]

• Strengthen and sustain national capacities to prevent outbreaks and other hazards, promptly detect and verify events, and deliver effective response and recovery.[1][2]
• Organise action across 19 technical areas under prevention, detection, response, and other International Health Regulations-related hazards and points of entry.[1][2]
• Prevent and reduce International Health Regulations hazards, detect all-hazard threats rapidly, maintain capacities at designated points of entry, and manage chemical, radiological and nuclear emergencies.[3][4]
• Strengthen legislation, financing, multisectoral coordination, antimicrobial resistance, zoonotic disease control, food safety, biosafety, biosecurity, immunisation, laboratory systems, surveillance, reporting, workforce development, preparedness and emergency operations.[5][6][7][8][9]
• Apply One Health, whole-of-government and whole-of-society approaches that link human, animal and environmental health, while promoting equity, gender mainstreaming, human rights, community participation, evidence-led action, transparency and resilience.[2][10]

Priority capacity investments include immunisation for hard-to-reach and nomadic populations, antimicrobial-resistance laboratories and stewardship, food-safety toxicology, zoonotic surveillance, electronic real-time reporting, epidemiology and health-worker training, emergency operations centres, medical countermeasures, risk communication, preparedness at points of entry, and chemical and radiation safety.[11][12][13][14][15][4]The plan also seeks to strengthen legal and institutional foundations, notably by establishing a Public Health Act that incorporates International Health Regulations requirements and supports coordination across sectors and administrative levels.[5][16]

Implementation

Implementation is led by the State of Eritrea under Ministry of Health guidance and political oversight, using a sector-wide, phased and costed delivery model. A multisectoral high-level technical group is accountable to the Ministry of Development, while the National Multi-Agency Taskforce for the Action Plan coordinates stakeholders, links plans across administrative levels and manages delivery risks.[3][17][18]Activities are phased across year 1, year 2 and years 3–5, subject to resource availability, mobilisation and assignment of responsible ministries or offices.[17]

• Coordinate delivery through the Ministry of Health, line ministries, communities, development partners, academia, private-sector actors, United Nations agencies and the World Health Organization.[1][10][18]
• Maintain national, zoba and sub-zoba International Health Regulations coordination arrangements, supported by standard operating procedures for cross-sector information sharing under One Health principles.[5][6][16]
• Strengthen the International Health Regulations national focal point, technical working group and high-level public health emergency coordination body through clear mandates, terms of reference, resources and communication pathways.[16]
• Use technical subcommittees and designated experts from health, agriculture, security, local government, finance, customs, transport, education and other relevant authorities to lead technical workstreams.[19][20][8][9]
• Develop a One Health and One Government implementation roadmap, review milestones and contingencies, and secure ownership across sectors.[21]

Operational delivery combines health-system strengthening with targeted emergency preparedness. Core actions include establishing interoperable electronic reporting and surveillance systems; training epidemiologists, veterinarians, laboratory staff and rapid-response teams; improving specimen referral, laboratory quality and diagnostic capacity; strengthening vaccine management, cold-chain infrastructure and waste disposal; and expanding community, event-based and cross-border surveillance.[22][13][14][23][24]Emergency readiness actions include establishing or identifying Public Health Emergency Operations Centre infrastructure from national to zoba levels, developing multi-hazard plans and case-management guidance, maintaining critical supplies, improving transport and isolation facilities, and conducting simulation exercises.[14][15][25][26]

Points-of-entry measures cover screening, isolation, safe referral and transfer of ill travellers, conveyance inspection, all-hazard surveillance, communications, ambulances, emergency boats and continuity-of-operations systems.[27][28]Chemical and radiation measures include national toxicology, poison-control, hazardous-waste disposal, radio-nuclear detection and radiation-safety capacities, supported by policy development, specialist training, equipment and facilities.[15][4][29][30][31][32]

Monitoring is integrated with the Health Sector Strategic Development Plan II and follows the global International Health Regulations monitoring and evaluation framework. Progress is reviewed through sub-zoba, zoba and national sector reviews, once- or twice-yearly joint review meetings, annual reporting to the World Health Assembly, after-action reviews, annual simulation exercises, a mid-term review and a subsequent Joint External Evaluation.[18][5]Indicators and milestones cover legislation, financing mobilisation, coordination, laboratory performance, surveillance, immunisation, zoonotic reporting, workforce, emergency operations, risk communication, points of entry and chemical and radiation capacities, using financial, laboratory, training, health, agriculture and Health Management Information System records.[5][6][7]

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%, across its programmes including the plan.[18]Costing uses Government procurement guidance and authoritative reference sources where local data are unavailable; financing is intended to combine domestic commitments, working-group processes and further donor engagement, although the remaining funding gap and confirmed external commitments are not specified.[17][18]

Monitoring & Evaluation

The National Action Plan for Health Security uses the International Health Regulations (2005) monitoring and evaluation framework to track core capacities across 19 technical areas, linking implementation monitoring to the second Health Sector Strategic Development Plan and sector reviews at sub-zoba, zoba and national levels.[18][5]Eritrea’s baseline assessment used 48 Joint External Evaluation indicators, of which eight were green, 30 yellow and ten red.[2][22]

• Continue annual reporting on International Health Regulations core capacities to the World Health Assembly and report process indicators through national sector-review processes.[5]
• Assign the multisectoral high-level technical group responsibility for monitoring and evaluating implementation, and use once- or twice-yearly joint review meetings to assess progress and performance.[18]
• Conduct annual simulation exercises, including a separate annual radiation-emergency exercise, and use after action reviews following public health events to identify lessons and good practice.[5]
• Undertake a mid-term review to identify bottlenecks and guide the latter implementation period, followed by a second Joint External Evaluation as part of the end evaluation.[5]
• Track indicators and milestones for legislation, financing mobilisation, coordination, information sharing, antimicrobial resistance, food safety, zoonotic disease, biosafety and biosecurity, immunisation, laboratory capacity, surveillance, workforce, emergency operations, points of entry, and chemical and radiation hazards.[5][6][7]
• Use meeting minutes, financial records, laboratory and training records, health and agriculture reports, the Health Management Information System, surveys and facility assessments as data sources for selected indicators.[5][6][7]

Operational surveillance includes electronic Integrated Disease Surveillance and Response reporting, community- and event-based surveillance, weekly epidemiological bulletins, mobile short message service reporting, cross-border collaboration, laboratory quality monitoring and timely reporting of potential public health events of international concern.[12][13][14]Reported measures include 70% of specimens reaching reference laboratories on time and in good condition, 100% completeness and timeliness of weekly facility reports, and 100% timely reporting of potential public health events of international concern.[12]The plan also includes annual milestones for enactment and enforcement of a Public Health Act, establishment of surveillance and laboratory systems, timely zoonotic-disease reporting, and response to zoonotic outbreaks within 48 hours.[5][7]

The National Steering Committee for Health Security is assigned strategic leadership, risk oversight, implementation support, resource mobilisation, and programme budget and expenditure oversight.[4]However, some technical extracts do not specify complete indicator baselines and targets, consolidated reporting cycles, or independent accountability arrangements.[12][16][15][4]

Costing & Financing

The five-year National Action Plan for Health Security is estimated to cost USD 53,695,733, with the Ministry of Health expected to allocate USD 14,068,282, equivalent to 26.2% of the estimated cost for all Ministry of Health programmes including the plan.[18]The cost distribution is 39.9% for response, 28.3% for other International Health Regulations-related hazards, 17.2% for detection and 14.6% for prevention.[2]

• Apply Government procurement guidelines and, where data are unavailable, use authoritative sources such as World Health Organization procurement references; detailed costing is contained in Annex 5.[17]
• Use intervention and cost-category summaries, working groups, the planning workshop and further donor engagement to support financing and budget-gap analysis.[18]
• Map domestic and external financing, identify high-cost activities included in the Government budget, assess development-partner interest in unfunded activities, and develop alternative resource-mobilisation scenarios.[2][21]
• Monitor the proportion of total plan costs mobilised through financial records; reported mobilisation proportions are 48.4%, 27.4%, 13.2% and 11.1%.[5]
• Prioritise major cost drivers including medical countermeasures, PHARMECOR rehabilitation, points of entry, immunisation and workforce development.[11]

Activity-level tables cost laboratory, immunisation, surveillance, workforce, emergency operations, transport, risk communication, points-of-entry, chemical-hazard and radiation-safety actions.[33][34][23][26][27][32]The extracts do not quantify the remaining funding gap, confirm development-partner commitments, or provide consistent recurrent-cost, currency or wider economic assumptions for all activities.[17][18][13][14]