Joint National Action Plan for Health Security

Objectives

Liberia’s National Action Plan for Health Security 2018–2022 is a five-year, country-led framework to attain and sustain the minimum core capacities required under the International Health Regulations (2005), contribute to Sustainable Development Goal 3, and build a resilient nation able to prevent, detect, respond to and recover from threats affecting people, animals and the environment.[1][2]Its overarching goal is to reduce morbidity, mortality, disability and socio-economic disruption caused by public health threats, including epidemic-prone disease, zoonoses, food safety risks, chemical incidents, radiological and nuclear hazards, and risks associated with points of entry.[3][4][5][6]

• Strengthen prevention, detection, confirmation, response and recovery capacities across 19 technical areas organised within Prevent, Detect, Respond, and other International Health Regulations-related hazards and points of entry.[7]
• Build resilient health systems by improving universal access to safe, quality services; laboratory capacity; surveillance; immunisation; infection prevention and control; workforce capability; and emergency preparedness.[2][8]
• Apply a One Health approach to coordinate human, animal, wildlife and environmental health action, including antimicrobial resistance, zoonotic disease, food safety, biosafety and biosecurity.[7][5][9]
• Strengthen legislation, financing, institutional arrangements and accountable governance for health security, including finalisation and implementation of the revised Public Health Law.[10][2][11]
• Prioritise equity, community participation, gender and human rights, country ownership, transparency, partnership, evidence-led planning, resilience and sustainability.[7][2]
• Address weaknesses exposed by the Ebola virus disease crisis, particularly gaps in essential services, community trust, health-system resilience and protection of poor and low-income communities.[4]

Implementation

Implementation uses a whole-of-government, whole-of-society and multisectoral One Health delivery model led by the Ministry of Health and the National Public Health Institute of Liberia, working with line ministries, agencies, communities, academia, the private sector and development partners.[3][7][12]The One Health Coordination Platform is the principal coordination mechanism, comprising an Inter-Ministerial Committee, Technical Committee and Technical Working Groups, with a Secretariat under the Office of the Vice-President.[13]

• Coordinate national leadership through the Vice-President-chaired One Health Coordination Platform Ministerial Steering Committee, which supports political commitment, cross-sector collaboration and domestic and external resource mobilisation.[14]
• Deliver services through national, county and district health structures, with County Health Officers and District Health Officers leading subnational health services and the National Public Health Institute of Liberia providing expert support for laboratories, surveillance, infection prevention and control, epidemic control and outbreak response.[8]
• Align interventions with the National Health Investment Plan 2015–2021, the national health policy and plan, Global Health Security Agenda, Regional Disease Surveillance Systems Enhancement initiative, Joint External Evaluation findings, After Action Reviews, simulation exercises and other assessments.[1][12][14]
• Prioritise feasible, costed interventions through technical-area gap analysis, assessment scores, expert review, plenary discussion, resource availability and complementarity with existing human, animal and environmental health activities.[12]
• Strengthen operational readiness by maintaining Emergency Operations Centres and the Incident Management System, developing multi-hazard and contingency plans, training rapid response teams, conducting hazard mapping, pre-positioning supplies and formalising collaboration with security and emergency services.[8][15][16]
• Expand surveillance and diagnostic systems through community-based and facility reporting, animal and environmental surveillance, interoperable electronic reporting, sentinel sites, regional laboratories, specimen-referral networks, laboratory quality systems and external quality assurance.[5][17][18][19][20]
• Strengthen prevention through antimicrobial resistance surveillance and infection prevention and control, food safety laboratories and surveillance, laboratory licensing, biobanking, biosafety training, immunisation outreach, cold-chain investment and vaccine data-quality improvement.[9][21][22][23][24][25]
• Prepare points of entry through port-health contingency planning, coordination with neighbouring countries, traveller screening, referral arrangements, vaccination capacity and simulation exercises.[6][26][27][28]
• Monitor delivery through a results framework with baselines, indicators and targets; a work-plan dashboard updated monthly or quarterly; annual joint supervision; annual reporting to the World Health Assembly; annual national and county simulation exercises; After Action Reviews after public health events; a 2019 mid-term review; and a follow-up Joint External Evaluation planned for 2021.[13][29]
• Track priority targets including a functional national One Health coordination mechanism, five institutions with International Health Regulations focal points, 100% timely response to zoonotic outbreaks within 48 hours, three regional diagnostic laboratories, 15 counties with rapid response teams and functional Emergency Operations Centres, and 75% of designated points of entry adequately equipped by 2021.[11][9][30][31][6]
• Cost interventions at US$154,948,676 for 2018–2022, with the largest allocation assigned to Detect at US$101,108,705; map domestic and external finance, align costing with the national budget cycle, and pursue annual government allocations supplemented by donor contributions.[7][1][14]

Monitoring & Evaluation

The National Action Plan for Health Security uses the International Health Regulations (2005) monitoring and evaluation architecture, Joint External Evaluation findings, annual reporting to the World Health Assembly, and a One Health coordination mechanism to track progress in national health-security capacity.[32][13][29]

• Use a results framework with indicators, baselines, annual milestones and targets across legislation, financing, coordination, surveillance, laboratories, immunisation, workforce development, preparedness and response.[13][33][30][34]
• Maintain a monitoring tool and dashboard linked to workplans, updated monthly or quarterly, and share findings with the Inter-Ministerial Steering Committee and development partners quarterly or semi-annually.[13]
• Conduct annual joint supervision led by the Ministry of Health, the National Public Health Institute of Liberia, the One Health Secretariat and partners to verify performance against targets.[13]
• Report annually on International Health Regulations core capacities to the World Health Assembly and strengthen reporting to the World Health Organization and World Organisation for Animal Health.[32][5][13]
• Conduct at least one national and county simulation exercise annually, undertake an After Action Review after every public health event, complete a locally led mid-term review in 2019, and undertake a follow-up Joint External Evaluation in 2021 as part of end evaluation.[13][29]
• Monitor surveillance and laboratory performance through data-quality audits, supportive supervision, routine feedback, timely reporting, sentinel surveillance, specimen quality, laboratory quality systems and referral-network functionality.[18][35][19][36][20]
• Track assessment performance across 48 Joint External Evaluation indicators, of which 11 were rated green, 26 yellow and 11 red; no indicator received the highest sustainable-capacity score.[37]
• Measure specified implementation targets, including functional One Health coordination, International Health Regulations focal points, timely zoonotic outbreak response, immunisation coverage, trained rapid response teams, emergency operations centres, equipped points of entry and radiological-response capacity.[11][9][38][15][6][31]

Costing & Financing

The plan costed interventions for 2018 to 2022 at US$154,948,676, with the Detect category accounting for the largest share.[7]It combines national budget-cycle alignment, domestic resource mobilisation, donor contributions, financing-source mapping and activity-level costing, although many implementation tables do not identify currency, funding source, funding gap or economic assumptions.[1][14][29]

• Allocate US$101,108,705 to Detect, US$24,771,843 to Prevent, US$21,141,244 to Respond, and US$7,370,885 to other International Health Regulations-related hazards and points of entry.[7]
• Create a dedicated budget line for International Health Regulations implementation and advocate for funding across health, agriculture, food and drugs, commerce, justice, environmental protection and defence institutions.[17][11]
• Increase the national budget-line indicator for the action plan from 5% in 2019 to 15% in 2022; the source does not provide a monetary value or currency for these percentages.[33]
• Coordinate resource mobilisation and map existing domestic and external financing through the One Health Coordination Platform, with annual government allocations to line ministries supplemented by donor contributions.[14][29]
• Recognise that several activity tables contain zero-value, available or to-be-determined entries, so these do not demonstrate confirmed financing.[6][26]