Following the recent conclusion of the second joint external evaluation (JEE), which assesses Nigeria’s capacities under the International Health Regulations (IHR) to combat public health threats, the World Health Organisation has cautioned, saying the score of 54 per cent is insufficient and not sustainable.
Senior advisor at the Global JEE Secretariat of the World Health Organisation (WHO), Dr. Henk Jan Ormel expressed his apprehensions about the sustainability of this score during the evaluation’s conclusion in Abuja on Friday.
A joint external evaluation (JEE) is a voluntary and collaborative process aimed at assessing a country’s ability to prevent, detect, and respond to public health risks, whether arising naturally or due to deliberate or accidental events. This evaluation holds significant importance, given the critical role public health preparedness plays in safeguarding a nation’s well-being.
To provide context, Nigeria had undergone its first JEE in 2017, scoring a mere 39 per cent. These evaluations adhere to global standards that gauge a country’s readiness to address potential public health threats. Spearheaded by the Nigeria Centre for Disease Control (NCDC) as the IHR National Focal Point, this evaluation involves close collaboration with various ministries, departments and agencies (MDAs) responsible for national health security. Normally spanning a five-year period, the process includes a midterm assessment to track progress, identify gaps and prioritise improvements in the initial two years.
During his address, Ormel emphasised the urgency for Nigeria to strive for improvement, stressing that sustaining the current orange colour-coded score was insufficient for a nation of Nigeria’s stature. He presented a comprehensive overview of their findings from the assessment of Nigeria’s International Health Regulation core capacities. These insights were drawn from their visits to select sites across the nation, which Ormel highlighted as a crucial component of the evaluation process.
In his words, “The evidence presented during this evaluation underscored existing challenges.” He further elaborated that numerous areas required strengthening, notably coordination among various MDAs, including health, agriculture and environment sectors, as well as national, federal, state and local communities, both public-private and national-international.
Ormel also emphasised the need to prioritise the implementation of strategic actions. The conclusion of the extensive evaluation process saw him presenting the external evaluator’s feedback and recommendations for each technical area. These areas include prevent (P), detect (D), respond (R) and International Health Regulations (IHR) related hazards and points of entry border health core capabilities.
His presentation called for several priority actions, including the development of a framework to monitor and ensure accountability mechanisms for both IHR and the National Action Plan for Health Security (NAPHS) across ministries, departments, and agencies at various levels. Moreover, he underlined the importance of operationalising the health emergency financing mechanism of the Basic Health Care Provision Fund (BHCPF) at sub-national levels.
Ormel highlighted the noteworthy responses of the National Emergency Operation Center (EOC), which had addressed over 23 events in recent years. These instances, he noted, presented opportunities to learn from both challenges and successes. Among the priority actions proposed were the expansion of the Public Health Emergency Operations Centre’s (PHEOC) scope, incorporating inter and after-action reviews as routine aspects of responses and spearheading applied practical research initiatives.
Addressing the legal aspects, the lead of the WHO JEE mission team’s legal instruments team, Dr. Sarah Emami commended the significant progress made in the country’s health laws. She outlined forthcoming priority actions, which include subnational legal assessments of health laws, revising necessary legal instruments for IHR implementation and securing dedicated budgets for these activities, among others. While acknowledging the country’s dedicated workforce, she underscored the challenge of a comparatively large population that the limited workforce serves.
Dr. Kazi Noore Alam, who was a part of the WHO JEE mission team, delved into the discussion on the technical area, which includes indicators for IHR cooperation, national IHR focal point functions, and advocacy. He echoed the necessity to not only bolster in-country capacity but also to assess and improve the National Action Plan for Health Security (NAPHS), including subnational health security assessment exercises.
A co-lead of the technical areas for the WHO JEE mission team, Dr. Makamure Tendai delved into antimicrobial resistance as a critical concern. Priority actions highlighted included finalising and implementing the National Antimicrobial Resistance Action Plan 2.0, advocating for a dedicated domestic budget and establishing an integrated antimicrobial resistance surveillance system.
Dr. Richard Garfield addressed the challenge in zoonotic institutional development and organisational capacity, advocating for a strengthened One Health surveillance and analysis platform. He also stressed the importance of reviewing outbreaks to refine identification and reporting protocols, as well as implementing animal identification practices.
The issue of food security was discussed by Garfield, who highlighted the necessity to develop self-study training materials for investigating potential food-borne illnesses. He called for the integration of food-borne illness into the Integrated Disease Surveillance and Response (IDSR) database and the creation of food-borne and food-safety materials in collaboration with health communications.
Regarding vaccination efforts, Garfield called for improved data management and collaborations with primary and secondary medical facilities to identify populations missing priority vaccines. Communication materials combating vaccine misinformation were also deemed essential.
Dr. Geoffrey Jagero, who was a part of the WHO JEE mission team, underscored the importance of training professionals in biological risk management across sectors and levels. He highlighted the need for a biosecurity framework and a code of conduct for life scientists, particularly for Dual Use Research of Concern (DURC).
The challenge of bridging public health and security authority was explored by Dr. Jagero, emphasising the empowerment of the Office of the National Security Adviser (ONSA) for effective decision-making, real-time data visualisation and joint investigations.
A member of the WHO JEE mission team, Mrs. Vachel Lake Harris stressed the critical nature of risk communication and community engagement (RCCE). She advocated for enhanced collaboration across sectors and emphasised the need to empower subnational levels for coordinated and sustained implementation of one health RCCE.
Leader of the port of entry team, Dr. Buba Manjang pointed to the importance of integrating port health with radiological and chemical surveillance systems. Cross-border collaboration and data sharing were also emphasised, alongside the need to update port health services and guidelines.
Dr. Catherine Nyamazana discussed the necessity of establishing an effective policy and regulatory framework for chemical event management. She urged the integration of chemical surveillance into existing health surveillance systems and collaboration with relevant bodies to train health workers in responding to nuclear and radiological emergencies.
The second JEE, as described, plays a pivotal role in gauging a country’s progress in achieving IHR core capacities. It offers an avenue for countries to address capacity-building needs, revise action plans, and prioritise preparedness initiatives. Furthermore, it fosters trust, transparency and mutual accountability between national governments and international partners, thereby contributing to a more resilient global health landscape.