National Action Plan for Health Security

Objectives

South Sudan’s National Action Plan for Health Security (NAPHS), covering January 2020 to December 2024, is a national framework to build sustainable capacity to prevent, prepare for, detect and respond promptly to public health threats in accordance with the International Health Regulations (2005).[1][2]Its vision is a safe and resilient nation, and its mission is to strengthen national and subnational capacities across all International Health Regulations technical areas.[3]The overarching goal is to advance national development through a One Health strategy protecting human, livestock, wildlife and environmental health.[1][3]

• Strengthen prevention, detection, confirmation, response and recovery capacities for epidemics, emergencies, disasters and other public-health events, including at subnational level and designated points of entry.[4]
• Address gaps identified by the October 2017 Joint External Evaluation, which highlighted risks to public health, the environment and the economy, alongside weaknesses in International Health Regulations core capacities.[5][6]
• Improve preparedness for emerging, re-emerging and cross-border threats, including Ebola virus disease, cholera and other outbreaks in a context of floods, displacement, food insecurity and recurrent disease events.[1][5]
• Establish health-emergency risk assessment and management aligned with One Health, all-hazards, whole-of-government and whole-of-society principles.[3][7]
• Strengthen multisectoral disaster risk management, surveillance, laboratory systems, immunisation, antimicrobial resistance control, zoonotic-disease management, food safety, biosafety, biosecurity, workforce development, preparedness and emergency response.[4][8][9][7]
• Improve water and sanitation in cholera hotspot areas and secure sustainable, predictable investment for cholera prevention and control.[5][4]
• Develop national capacity for public health and security coordination, medical countermeasures and personnel deployment, risk communication, points of entry, chemical events and radiation emergencies.[3][10][11]
• Map domestic and external financing, build strategic partnerships and establish monitoring and evaluation arrangements for health security.[3]

Implementation

Implementation uses a multisectoral One Health model led by government and supported by development and implementing partners.[1][7]The Ministry of Cabinet Affairs coordinates government-wide implementation and chairs the National Steering Committee for Health Security, while the Ministry of Health manages the secretariat, chairs the Technical Committee and provides national leadership for health emergency coordination.[2][5][6]The plan links health-security actions with national budgeting, planning and implementation cycles, including humanitarian and Ebola response planning, universal health coverage and health-related Sustainable Development Goals.[12]

• Coordinate implementation through the National Steering Committee, Technical Committee, Technical Working Groups and a suitably resourced secretariat, preferably under the International Health Regulations National Focal Point.[13][14][12]
• Engage ministries and agencies responsible for health, finance, defence, interior, justice, humanitarian affairs, environment, agriculture, livestock, transport, water, petroleum, wildlife, security and disaster management, alongside the Drug and Food Control Agency.[15][4]
• Involve the World Health Organization, UNICEF, the International Organization for Migration, United Nations agencies, donors, non-governmental partners, state health authorities, laboratories, emergency operations personnel and security and defence health services.[15][16]
• Develop a One Health policy and integrated multisectoral platforms to coordinate ministries, departments and agencies working on human, animal and environmental health interventions.[4][12]
• Use Joint External Evaluation recommendations across 19 technical areas, the 2018 Service Availability and Readiness Assessment, benchmarking, stakeholder consultation and validation and costing workshops to prioritise feasible interventions.[7]
• Prepare annual operational plans, cost activities, integrate them into sectoral budgets and annual ministry budget requests, and mobilise additional domestic and partner resources through advocacy, partnership forums, grant applications and strategic partnerships.[13][12][17]
• Strengthen legal and policy foundations by reviewing legislation for alignment with the International Health Regulations, expediting pending public- and animal-health bills, and developing cross-border agreements and collaboration mechanisms.[12][17]
• Build workforce and operational readiness through training, simulation exercises, after-action reviews and phased technical assistance. A national Ebola preparedness full-scale simulation was conducted in Jubek, Torit and Yei River on 14 August 2019, while after-action reviews are intended to identify lessons and improvements following significant events.[4][8][17]

Governance is intended to connect the NAPHS with sector development plans, emergency preparedness and response plans, and disease-specific programmes.[14]Technical Working Groups submit resolutions to the Technical Committee, which synthesises recommendations, provides feedback and reports progress to the Steering Committee.[13][14]Membership is expected to provide relevant expertise, equitable stakeholder representation, decision-making authority, gender balance, transparency and management of conflicts of interest.[12]

Monitoring combines routine reporting, committee review and learning-oriented assessment. Implementing agencies are expected to submit monthly reports to the Ministry of Health secretariat for analysis and consolidation before strategic consideration by the Steering Committee.[6][12]Technical Working Groups meet monthly, the Technical Committee quarterly and the Steering Committee semi-annually; annual performance reviews and a midterm review planned for the first half of 2023 provide additional review points.[12][17]The plan also envisages a detailed monitoring and evaluation mechanism tracking activities and milestones, supported by transparent reporting, continuous improvement and adjustments based on lessons, evidence and changing threats.[7][12][17]

Monitoring & Evaluation

Monitoring and accountability are organised around a multisectoral governance structure, periodic implementation reporting and International Health Regulations (IHR) assessment processes. The National Steering Committee for Health Security provides overall oversight, while the Technical Committee, supported by Technical Working Groups and the Ministry of Health secretariat, coordinates implementation, reviews progress and escalates findings for strategic decision-making.[2][13][14]

• Require implementing ministries, departments, agencies and partners to submit monthly implementation reports to the Ministry of Health secretariat for analysis and consolidation before submission to the National Steering Committee.[6][12]
• Review implementation through monthly Technical Working Group meetings, quarterly Technical Committee meetings and semiannual Steering Committee meetings; conduct annual performance reviews with broader stakeholder participation.[12]
• Undertake a planned midterm review during the first half of 2023 and develop a detailed monitoring and evaluation plan to track activities and milestones.[12][17]
• Use the IHR Monitoring and Evaluation Framework, including the Joint External Evaluation (JEE), to guide implementation of core capacities; this framework emphasises country ownership, World Health Organization leadership, active partnership, transparent reporting and mutual accountability.[4]
• Anchor priority-setting and progress assessment in the October 2017 JEE and the 2018 Service Availability and Readiness Assessment, which identified weaknesses in core preparedness and response capacities.[7]
• Assess capacities across legislation, policy and financing; IHR coordination; antimicrobial resistance; zoonotic diseases; food safety; biosafety and biosecurity; immunisation; laboratory systems; surveillance; reporting; workforce development; preparedness; emergency operations; risk communication; points of entry; chemical events; and radiation emergencies.[8][9][3]
• Test operational readiness through multisectoral simulation exercises and after-action reviews. Exercises assess the practicality, adequacy, sufficiency and efficiency of emergency plans, procedures, coordination and communication mechanisms.[4]
• Conduct after-action reviews within three months of significant events and at least annually to identify good practice, lessons, constraints and required improvements.[8]
• Use resource mapping to monitor progress in completing health-security activities and implementing the National Action Plan for Health Security.[13]
• Review and adjust plans, strategies and activities continuously in response to lessons learnt, new evidence, emerging threats, policy changes and legislative developments.[7]

The supplied material does not provide a complete quantitative indicator framework, indicator baselines or targets, surveillance thresholds, reporting templates, performance scorecards, evaluation methodology or accountability sanctions. Some JEE indicator fields are listed, but most scores are absent from the extract; the exception is a score of 2 for implementation of case-management procedures for IHR-relevant hazards.[8][9][3]

At technical-area level, monitoring arrangements remain incomplete. Radiation-emergency preparedness refers to surveillance, detection, response planning and a functional simulation exercise, but specifies no indicators or reporting arrangements.[18]Risk communication has no comprehensive monitoring framework and lacks formal systems to monitor or address media coverage, rumours and misinformation; proposed assessments, workshops and simulations could test arrangements but have no defined measures or reporting requirements.[19][20]

Costing & Financing

The National Action Plan for Health Security (NAPHS) for January 2020 to December 2024 is estimated to cost approximately 70 million United States dollars, or about 6 United States dollars per capita.[2]Implementation for 2020 to 2024 is also described as only 25% funded, making resource mapping and mobilisation central requirements.[6]

• Mobilise domestic government annual budget allocations, donor contributions, sector budgets and additional resources from government and partners.[13]
• Integrate costed activities into relevant ministries’ annual budget requests and link the plan to national budgeting, planning and humanitarian-response cycles.[13][12]
• Map existing and prospective domestic and external financing, and use partnership forums, grant applications, strategic partnerships and high-level advocacy to address investment and capacity gaps.[3][13][14]
• Strengthen advocacy for dedicated and sustainable domestic emergency financing, as a dedicated government emergency budget was not readily identifiable despite government support for recent cholera outbreaks.[21]
• Secure sustainable and predictable investment for cholera prevention and control, including improved water sources and sanitation facilities in hotspot areas.[4]
• Seek technical and financial support for radiation-emergency surveillance, detection and response capacity at national and subnational levels.[18]

The plan presents prevention, early detection and preparedness as investments expected to reduce the human and economic costs of emergency response and disruption.[2][5]A validation and costing workshop held from 16 to 20 September 2019 reviewed assessment recommendations, prioritised feasible interventions across 19 technical areas and costed agreed activities.[7]

Itemised activity budgets are provided for selected legal, cross-border coordination, IHR budgeting, medical-countermeasure, risk-communication and radiation-emergency activities.[21][19][20][18]However, the supplied material does not specify financing commitments by source, detailed programme-wide allocations, a quantified remaining funding gap, expenditure schedules, or economic assumptions beyond the overall estimate, funded share and listed activity costs.[6][7]