A Review Of Joint External Evaluations And National Action Plans For Health Security In 13 Countries From A Health Systems Perspective

Public health emergencies continually reinforce the need for an integrated approach to health systems strengthening, underpinned by a public health approach, helping to build health systems resilience. As part of a collaboration between the USAID Office of the Health Systems and the WHO Integrated Health Services Department, a strategic meeting was convened on 14 April 2021. This had wide-ranging representation which included WHO Deputy Director-General, Executive leadership from USAID, IANPHI and WFPHA. The overarching aim was to examine this topic together and identify actionable steps to build an integrated approach to health system strengthening that brings together health security, humanitarian, disease-specific and life-course-specific programmes. The specific objectives of the meeting were to: facilitate strategic discussions on prevailing practices in health systems resilience for health protection and high-quality health services, to determine actionable next steps for global guidance; inform policy options for WHO, USAID and partners to maximize joint country support for health systems resilience; and identify immediate priorities for next steps following the meeting. To inform and support the proceedings of this meeting, complementary desk reviews were conducted to synthesise evidence, and inform the discussions and way forward. Together, this package consists of (i) a technical meeting report and (ii) two complementary desk reviews. The package was co-developed with and has received concurrence from the USAID Office of the Health Systems.

Since its independence was restored in 1991, Estonia has restructured its public health and health security landscape, and joined the European Union (EU) in 2004. Since this, and despite its relatively small geographical size and population, the country's economic growth and the importance of Estonia and Estonians in the development of the information and communication technology (ICT) sector has been much remarked upon. This has brought about interest in the development and uptake of ICT solutions within the health sector, and considerable upgrades to health provision and infrastructure. Due to Estonia's geographical position, health security will always be of significant interest to the country and much has been achieved in the last 20 years. With this combination of factors, the WHO Joint External Evaluation (JEE) in Estonia was deemed of interest not only to Estonia but also as an example of how a small, now highly developed country can work to improve its health security. A further point of interest is that Estonia has, in general, a widely spaced population with low density; another challenge to providing services which needs to be overcome. During the JEE mission to Estonia, capacities in 19 technical areas were evaluated through a peer-to-peer collaborative process that brought subject matter experts together with members of the external assessment team. The team was composed of representatives from 10 Member States, international organizations or academic institutions, engaged in a week-long series of technical discussions and on-site visits. The primary objective of the assessment was to compile a comprehensive array of evidence, encapsulating evaluations, reviews and other relevant insights. The aim was to equip Estonian authorities with actionable information for improving implementation of the International Health Regulations (IHR) 2005, encompassing cost estimates, high-level commitment and accountability. While the assessment itself can facilitate knowledge exchange and networking, it does not improve health security capacities per se. Therefore, identified priority recommendations should be captured in a National Action Plan for Health Security (NAPHS), which in turn drives translation of priorities into concrete technical activities. The external team acknowledges that many recommendations deal with establishing committees, action plans and strategies, all of which may be crucial steps for capacity development, but nevertheless need to be streamlined given constraints on human resource capacity.

This report represents a focused review of the essential public health functions (EPHFs) in Ireland with respect to policy and planning, infrastructure, service delivery and coordination and integration. This work was developed through a collaboration between the WHO and the Department of Health in Ireland. The report offers perspectives to strengthen public health through improved stewardship, coordination and integration and operationalization of the EPHFs.

The Working for Health five-year action plan for health employment and inclusive economic growth (2017–2021) draws on the recommendations of the report of the United Nations High-level Commission on Health Employment and Economic Growth. It is delivered principally through the joint intersectoral W4H programme and its Multi-Partner Trust Fund (MPTF) in partnership with WHO, ILO and OECD. A major part of its objectives is to stimulate workforce actions in alignment with national, regional and global strategies and plans. These actions are delivered at country and regional level through multisectoral Member State-led collaboration and catalytic technical and financial support. Other joint W4H work includes developing and adapting key global public goods, including an international platform for health worker mobility, an interagency data exchange platform, an ILO and OECD approach to anticipating the skills needs of health workers, and a methodology for measuring employment impact. This document presents the findings of an independent end-of-project review of the Working for Health five-year action plan for health employment and inclusive economic growth (2017–2021) Working for Health Multi Partner Trust Fund over the first action plan period. This included direct support to 13 countries, two economic regions and three global projects. The review is based on the evaluation criteria of relevance, efficiency, effectiveness, impact and sustainability. The review also looks to the future of sustaining investment and support for implementation of subsequent projects under the new Working for Health 2022–2030 Action Plan and its MPTF, which was extended by Member States at the Seventy-fifth World Health Assembly in May 2022.

The Health Systems for Health Security (HSforHS) Framework guides developing capacities for International Health Regulations (IHR), and components in health systems and other sectors that work in synergy to meet the demands imposed by health emergencies. HSforHS offers an innovative and country-focused approach that builds on the lessons learned from recent health emergencies, including the COVID-19 Pandemic. The HSforHS Framework complements existing concepts and tools that support capacity-building for global health security. The HSforHS Framework is structured to: Support stakeholders to better understand what Health Systems for Health Security entails, Delineate the essential components of health systems and other sectors that play an important role in health security, Explain how countries can define, prioritize and monitor the actions and investments in health security, health systems and other sectors that can support multisectoral and multidisciplinary management of health emergencies, Help partners and donors better support countries in strengthening their health security capacities, and Highlight challenges related to the implementation of the HSforHS Framework.

The guidance is to support countries in achieving alignment of disease/hazard plans and emergency preparedness and response plans with broader health security planning such as National Action Plans for Health Security (NAPHS). The target audience is WHO Member States, technical teams and partners that require support to effectively align disease and hazard-specific planning with broader health security planning in order to address current health emergency risks while building longer-term health emergency preparedness capacities.

Modernizing Global Health Security to Prevent, Detect, and Respond explores—through thoughtful, thorough, and diverse scientific review and analyses—factors that have led to recent public health emergencies and offers a vision for a better protected global environment. The authors consider the history of global health security, governance, and legal structures with an eye toward novel approaches for the present and future. The book presents a vision for a more protected and safer global public health future (with the actions needed to achieve it) to prevent, detect, and respond to (re)emerging threats. Its aim is to chart a way forward with the understanding that future pandemics must and can be prevented. Major topics examined from a public health perspective include global health security; the growing concept of One Health; epidemic and pandemic prevention, detection, and response; reviews of past (e.g., Ebola, MERS-CoV, Zika, and COVID-19) public health emergencies of international concern; roles of information and communication technology; humanmade public health threats; and legal and ethical issues (e.g., viral sovereignty, trust, and transparency). Modernizing Global Health Security to Prevent, Detect, and Respond provides the academic substance and quality for researchers and practitioners to deeply understand the why of health emergencies, and most importantly—what we can and should do now to prepare. Highlights (re)emerging past and future threats to public health (e.g., climate change, antibiotic resistance, failures of societal sectors to work together) Discusses new visions for global health security in each chapter Considers how to leverage technological innovations to advance public health Includes practical examples through case studies from around the world