National One Health Operational Plan 2024-2027

2011. These efforts have included the establishment of a “four-way link task force” with a focus on sharing data between the Ministry of Health and Population (MOHP) and the Ministry of Agriculture and Land Rec- lamation (MOALR) at all levels to assess the situation for the main zoonotic diseases, specifically avian influenza and MERS-CoV. The four-way link task force evolved to become the One Health Technical Advisory Group, and in this form, it includes other stakeholders such as the Ministry of Environment (MOE) and universities to cover all priority zoonotic diseases, endemic and emerging, as well as antimicrobial resistance (AMR). Although these national efforts have led to some goals being achieved, gaps remain, including the need to establish strong governance structures and implement routine coordination and communication between different sectors. 1 National One Health Operational Plan 2024 - 2027 The National One Health Strategic Framework 2023–2027 was en- dorsed and launched by the GOE in April 2023 with the support of different national and international institutions (the Ministry of Health and Population, the Ministry of Agriculture and Land Reclamation, the Ministry of Environment, the Ministry of Higher Education and Scien- tific Research, the Ministry of Local Development, the Egyptian Drug Authority, the National Food Safety Authority, the World Health Orga- nization, and the Food and Agriculture Organization of the United Na- tions) and it guides the implementation of One Health via five priority themes and seven different technical pillars to be covered within each theme, each with a range of medium- and long-term outcomes. These outcomes are designed to support the attainment of anticipated results and contribute to the desired impact. 2 National One Health Operational Plan 2024 - 2027 National One Health Strategic Framework The National One Health Strategic Framework is structured around five themes, based on the international One Health Joint Plan of Action and the regional One Health Operational Framework, and creates a framework that unifies systems and capabilities in order to improve and accelerate the implementation of One Health, enhance human, animal, and plant health and contribute to sustainable development objectives. The five main themes are: enhancing One Health capacities that en- sure collaborative and coordinated activities to prevent health threats; controlling and eliminating zoonotic and vector-borne diseases; joint as- sessment, management, and communication of risks affecting food and water safety; curbing the silent pandemic of antimicrobial resistance; and integrating the environment into One Health (Figure 1). The objective of the One Health approach is to enhance Egypt’s ca- pacity for prevention, prediction, identification, and response to health threats, as well as to enhance human, animal, plant, and environmen- tal health. It also aims to promote the well-being of all, achieve the Sustainable Development Goals (SDGs), and combat threats to global health security and ecosystems. The outbreak of the COVID-19 pandemic has highlighted the need for early detection, risk assessment, and effective response to potential threats to global health security, as well as the need to strengthen One Health strategies and actions plans. As climate change continues to accelerate, with a detrimental effect on various health-related sectors, it is essential to create integrated national plans to ensure a rapid and coordinated response to emergencies. 3 National One Health Operational Plan 2024 - 2027 Enhancing One Health capacities that ensure collaborative and coordinated activities to prevent health threats Controlling Integrating the and environment eliminating into zoonotic and One Health vector borne diseases Strengthening the joint as- Curbing the sessment, man- silent pandemic agement and of Antimicrobial communication Resistance of risks affecting (AMR) food and water safety risks Figure 1: Themes of the Egypt’s National One Health Strategic Framework 2023–2027 4 National One Health Operational Plan 2024 - 2027 The strategic framework includes the technical pillars that highlight the operational directions that guide the drafting and formulation of the operational plan. The activities under the operational plan should be followed and implemented using the One Health approach to en- hance system integration and foster collaboration between all sectors involved in One Health (Figure 2). Figure 2: Technical pillars of Egypt’s National One Health Strategic Framework 2023–2027 5 National One Health Operational Plan 2024 - 2027 Progress on One Health Implementation Since the endorsement of the National One Health Strategic Frame- work 2023–2027 in April 2023, several meetings have been held with relevant stakeholders. This has included stakeholder mapping for each technical working group and its terms of reference (TORs), and prepa- ration of detailed activities and indicators under each thematic area (curbing the silent pandemic of antimicrobial resistance; controlling and eliminating zoonotic and vector-borne diseases; joint assessment, management, and communication of risks affecting food and water safety; and integrating the environment into One Health) to achieve optimal health outcomes. Establishing the One Health Governance Structure Governance and leadership” is the first technical pillar that was ad- dressed during the process of formulating the strategy. A new gover- nance structure with detailed TORs was endorsed by five ministries and multiple heads of national agencies (Figure 3). Figure 3: One Health governance structure 6 National One Health Operational Plan 2024 - 2027 The first level is the One Health Ministerial Committee, the highest mul- tisectoral level of One Health. Its role will be linked to the adoption of policies, formulation of decisions, and supervision of their implementation in coordination with all relevant ministries and governmental bodies. Members of this committee include ministers, heads of agencies, and other high-level decision-makers representing all relevant ministries and government institutions. The second level is the Supreme Coordination Committee for One Health. This committee will play an important role in ensuring that the collaboration is successful and generates effective joint actions. The main task of the supreme coordination committee is to provide strategic and technical advice on issues related to the themes of One Health, to follow up on action plans, and to coordinate between the various technical teams. It will also be responsible for linking the ministerial committee and different technical teams. The members of the supreme coordina- tion committee include executive leaders, senior technical experts, and One Health focal points from the relevant ministries and institutions. The third level is the technical working groups (TWGs), which consist of technical staff representing relevant ministries and bodies that work on coordinating and directing implementation of the operational plan. 7 National One Health Operational Plan 2024 - 2027 Methodology The methodology for developing the operational plan for the Nation- al One Health Strategic Framework 2023–2027 involves a systemat- ic approach aimed at engaging relevant stakeholders and ensuring comprehensive monitoring and evaluation mechanisms. The first step involved convening a meeting in June 2023 with key stakeholders to conduct stakeholder mapping for each TWG. This meeting identified the relevant stakeholders from various sectors and was followed by the drafting of TORs for each TWG. A three-day national consultation workshop was conducted in August 2023 in collaboration with relevant ministries and with the support of WHO and FAO to discuss a draft of proposed activities and support the technical working groups in identifying available capabilities, assessing needs, and then reaching a consensus on the preliminary activities, based on the technical pillars of the National One Health Strategic Framework, to establish or strengthen their One Health mechanism. After drafting the outline of the One Health Operational Plan 2024– 2027 and finalizing its activities, a Monitoring and Evaluation (M&E) workshop was conducted in January 2024 to establish the M&E frame- work for the operational plan. This workshop focused on defining key performance indicators, setting targets, and outlining data collection and analysis methodologies. 8 National One Health Operational Plan 2024 - 2027 Finally, a consensus workshop was organized to finalize the One Health Operational Plan 2024–2027 and the M&E framework. This workshop aimed to bring together the main stakeholders from different sectors to review and refine the operational plan, ensuring alignment with One Health strategic goals and objectives. Additionally, group discussions were held to draft detailed standard operating procedures (SOPs) for the TWGs, providing clear guidance on implementation processes and facilitating the smooth execution of activities. 9 National One Health Operational Plan 2024 - 2027 The following tables will represent the activities included in the operational plan: A. Governance and Leadership Goal: Formalize the coordination mechanism for One Health 2 2024 2025 2026 2027 Activities: 0 2 3 A.1. Formalize the SCC and TWGs A.1.1. Conduct stakeholder mapping A.1.2. Identify members from relevant sectors for the SCC and for each TWG A.1.3. Formulate a database for the assigned members A.2. Operationalization and convening of SCC A.2.1. Conduct a roundtable discussion with the main focal points (human, animal, environment, and others): - Advise on strategic directions to be prioritized - Determine leadership, governance, and working arrangements for the SCC and TWGs - Document all decisions made in a formal governance record and obtain endorsement from all members - Encourage focal points to contribute their perspectives and ideas 10 National One Health Operational Plan 2024 - 2027 A.3. Operationalization and convening of TWGs A.3.1. Finalize, disseminate and endorse TORs A.3.2. Conduct meetings for relevant stakeholders: -Develop the main activities and tasks for the quarter and provide feedback and follow-up regarding the tasks and activities achieved -Develop work protocols and technical documents -Develop the necessary corrective actions to support the implementation plan -Provide technical support on all relevant aspects to different stakeholders concerned with the implementation plan A.4. Establishing a conducive environment for the successful implementation of OH approach A.4.1. Adopt and implement a set of memorandums of understanding (MOUs) to support collaboration and coordination under the OH approach A.4.2. Convene a meeting with parliamentary authorities to get support for the OH approach A.4.3. Review, update and develop national legislation to provide the needed legal foundation for all OH-related sectors 11 National One Health Operational Plan 2024 - 2027 A.4.4. Develop economic investment case studies on OH to boost support for political prioritization A.4.5. Develop policy and communication briefs for policy-makers to raise awareness of the interconnectedness of human, animal and environmental health A.5. Resource mobilization A.5.1. Mapping of existing/potential domestic funding relevant to OH technical areas and mapping of potential international funds relevant to OH technical areas A.5.2. Develop resource mobilization strategy including partnerships, international organizations and the private sector 12 National One Health Operational Plan 2024 - 2027 B. Enhancing One Health Capacities Goal: Strengthening capacities to support the effective implementation of the One Health approach 2 2024 2025 2026 2027 Activities: 0 2 3 B.1. Develop OH capacity building for staff working on OH-related areas B.1.1. Prepare the training curriculum with the subject matter experts (SMEs) B.1.2. Develop/update training material for OH-related topics B.1.3. Train the assigned staff on the documents developed B.2. Develop partnerships with schools of medicine, veterinary science, and other relevant academic faculties to integrate OH modules into curricula for undergraduate and postgraduate students B.2.1. Establish agreements to promote for the implementation of OH programmes B.2.2. Develop and integrate OH modules into curricula 13 National One Health Operational Plan 2024 - 2027 C. Surveillance, Early Warning and Joint Risk Assessment Goal: Develop a coordinated multisectoral surveillance system 2 2024 2025 2026 2027 Activities: 0 2 3 C.1. Joint risk assessment at national and governorate levels C.1.1. Conduct OH prioritization exercise to determine priority health threats (definite number for health threats) C.1.2. Adapt tools for joint risk assessment C.1.3. Enhance capabilities of professional staff on joint risk assessment C.1.4. Conduct a joint risk assessment for prioritized threats at governorate level C.1.5. Regularly review and update joint risk assessments to adapt to changing conditions and emerging pathogens or threats C.2. Coordinated multisectoral surveillance system (Epi & Lab) for collection, analysis and dissemination of data among different sectors C.2.1. Map existing surveillance systems (guidelines and other surveillance technical documents) and analyse the opportunities for coordinated surveillance of priority threats C.2.2. Develop coordinated surveillance guidelines in animal, human and environmental health sectors (including information-sharing) 14 National One Health Operational Plan 2024 - 2027 C.2.3. Develop and disseminate surveillance reports annually and convene information- sharing fora or bulletin for stakeholders C.3. Strengthen early warning systems for rapid detection and response to priority health threats C.3.1. Analyse the opportunities for the establishment of an emergency operation centre for detection, notification and response to priority health threats C.3.2. Enhance capacities of professional staff on using public health intelligence and EIOS systems to improve health threat detection C.4. Targeted joint sentinel surveillance for priority threats C.4.1. Selection and baseline assessment of joint sentinel surveillance sites for priority threats C.4.2. Support the selected sites with needed equipment/logistics C.4.3. Develop tools/platform for integrated sentinel surveillance data collection C.4.4. On-the-job training for staff at selected integrated surveillance sites 15 National One Health Operational Plan 2024 - 2027 D. Joint Planning for Preparedness and Response Goal: Enhance preparedness and response to outbreaks and public health events 2 2024 2025 2026 2027 Activities: 0 2 3 D.1. Establish One Health Rapid Response Team (OH-RRT) for responding to key priority diseases/events D.1.1. Formulating SOPs and TORs for OH-RRT D.1.2. Develop and update OH contingency plan for priority areas D.1.3. Nomination of OH-RRT members from different relevant sectors D.1.4. Developing a roster for OH-RRT D.2. Enhance capacities of OH-RRT D.2.1. Develop and maintain joint trainings for OH-RRT D.2.2. Review and evaluate capacities through simulation exercises or other available tools to test the contingency plans (OH joint response) 16 National One Health Operational Plan 2024 - 2027 E. Effective Risk Communication and Community Engagement Goal: Raise and enhance awareness regarding One Health and priority health threats 2 2024 2025 2026 2027 Activities: 0 2 3 E.1. Review, update and endorse different joint communication strategies E.1.1. Conduct different studies (KAP- behavioural insights) into priority threats using OH approach E.1.2. Draft/update the risk communication and community engagement (RCCE) strategies for priority threats E.2. Improve perception and awareness in terms of knowledge, attitude, behaviours and practices E.2.1. Review and produce risk communication and harmonized awareness materials targeted at different audiences using adapted communication channels related to OH priority threats E.2.2. Conduct workshops for media representatives to orient them on the messages related to OH priority areas in human health, animal health and agricultural sectors E.2.3. Conduct awareness campaigns and community meetings for target communities (farmers, breeders, etc.) and engage target communities in supporting behaviour change in relation to OH, integrating their feedback into the OH approach 17 National One Health Operational Plan 2024 - 2027 E.2.4. Conduct RCCE and social and behavioural change (SBC) education activities for OH workforce and community workers such as conferences, workshops, seminars and dialogues at national and governorate levels 18 National One Health Operational Plan 2024 - 2027 F. Cross-Border Partnership and Networking Goal: Establishing partnerships and networking with neighbouring countries, other countries, and international organizations 2 2024 2025 2026 2027 Activities: 0 2 3 F.1. Conducting/participating in cross-border OH activities F.1.1. Facilitate/participate in conferences and webinars to review/share the accomplishments, success stories and lessons learned F.1.2. Develop a framework for cross- border collaboration on priority areas and adopt MOUs to support collaboration across countries F.1.3 Facilitate/participate in workshops/simulation exercises with neighbouring countries to strengthen and enhance the concept of OH at the local and international levels 19 National One Health Operational Plan 2024 - 2027 G. Applied Research and Innovation Goal: Support the One Health research agenda for Egypt and advocate for innovative and sustainable solutions 2 2024 2025 2026 2027 Activities: 0 2 3 G.1. Develop a OH research priority agenda G.1.1. Identify the main partners from the relevant governmental and research sectors G.1.2. Convene key stakeholders' meeting/ workshop to identify research gaps G.1.3. Conduct a workshop to set priorities and plan roadmap for the application of the research papers G.1.4. Prepare concept notes and proposals to conduct applied research in the areas. identified G.1.5. Explore available funds to support the OH research priority agenda G.2. Advocate for innovative and sustainable solutions G.2.1. Establish partnerships, conduct workshops and advocate for funding to support the introduction of innovative and sustainable solutions to reduce priority health risks G.2.2. Launch a call for proposals for innovative and sustainable solutions related to OH 20 National One Health Operational Plan 2024 - 2027 One Health Monitoring and Evaluation Framwork I. Theory of Change A theory of change framework is a systematic approach that helps organizations express their vision for change, identify the intended re- sults, and plan the necessary actions to achieve them. It acts as a road- map that articulates the relationship between inputs, activities, outputs and outcomes. Organizations can comprehensively understand how change occurs by outlining these connections and strategically plan- ning their interventions. 1 The theory of change underlying the One Health Operational Plan 2024–2027 takes the view that One Health, as an integrated, multi-sec- toral, holistic, and transdisciplinary approach, has the potential to solve pressing health challenges. Effective implementation of One Health at all levels can make significant contributions to the envisaged impact and outcomes of the operational plan and achieve sustainable and lasting results. The theory of change is supported by three pathways that can bring about significant and sustainable change in terms of the expected in- termediate and long-term outcomes. 1 For more information, see: https://www.sopact.com/guides/monitoring-and-evaluation-tools 21 National One Health Operational Plan 2024 - 2027 The thee pathways are : • Pathway 1: Policy, legislation, advocacy and financing. This pathway encompasses all aspects of policy development, political will, enabling regulatory frameworks, investment, and the institutionalization of inter- sectoral governance. • Pathway 2: Organizational development, implementation and sectoral integration. This pathway encompasses all aspects of One Health im- plementation, including scaling up capacity development, community engagement and mobilization for action, multisectoral coordination, collaboration and communication, and the equitable integration of sec- tors. • Pathway 3: Data, evidence, and knowledge. This pathway deals with strengthening the scientific evidence base and translating knowledge into data for evidence, technical tools, protocols and guidelines, infor- mation, and surveillance systems. Based on this theory of change, the One Health Operational Plan 2024–2027 has two Results (R) and four Intermediate Results (IRs): • Result 1: Improved health of humans, animals, plants, and the envi- ronment while identifying sustainable system-wide One Health solu- tions that allow our ecosystems to thrive in harmony. • Result 2: Reduced risk and impact of health threats at the human– animal–plant–environment interface using a One Health approach efficiently, effectively and equitably. 22 National One Health Operational Plan 2024 - 2027 To achieve these results, the One Health Operational Plan will accel- erate action towards four key Intermediate Results: • Intermediate Result 1: Effective collaboration and synergy to build ad- vocacy and political will and leverage investment for an evidence-based One Health approach. • Intermediate Result 2: Improved coordination, communication, and alignment of One Health activi- ties and capacity-building efforts, in- cluding the provision of technical support, normative frameworks, re- search, education, and guidance. • Intermediate Result 3: Strengthened cross-sectoral capacity to co-de- sign and implement inclusive and equitable multilevel work plans and strategies in line with One Health principles. • Intermediate Result 4: Improved and harmonized One Health tools, technologies, and practices that integrate data and knowledge are de- veloped, disseminated, and utilized. 23 National One Health Operational Plan 2024 - 2027 II. Monitoring and Evaluation Framework Structure The National One Health Operational Plan 2024-2027 is built around seven outputs, or action tracks, for achieving expected intermediate outcomes. Each specific objective is associated with the implementation of several actions, each with a set of specific activities, clear delivera- bles, and a timeline. The action tracks are considered the first building block of the theory of change. The action tracks and their actions collectively drive change in the outcomes of the One Health Operational Plan and contribute to the desired impact. The following diagram shows the expected impact, outcomes, and outputs of the operational plan. 24

1. Activation of Activation of the SCC and TWGs. 1. Formalized and 1. Egypt better

2. Establishment of a conducive environment for the effective coordination able to prevent, successful implementation of a One Health approach. mechanism for One predict, detect

3. Establishment of a process for resource mobilization. Health. and respond to

4. Capacity building on One Health approach for staff 2. Improved capacities health threats working in One Health-related areas. of professional staff on and improve the

5. One Health module developed and embedded into One Health approach health of the related academic faculties' curricula. to support effective humans,

6. Joint risk assessment developed at national and implementation. animals, plants, governorate levels. 3. Raised community and the

7. Coordinated multisectoral surveillance system (Epi & awareness regarding environment Lab) for collection, analysis and dissemination of data One Health and priority while among different sectors. health threats. contributing to

8. Strengthened early warning systems for rapid 4. Established sustainable 25 detection and response to health threats. partnerships and development

9. Joint sentinel surveillance sites for priority threats networking with established. neighbouring countries,

10. Capacity building of staff on joint sentinel other countries, and surveillance. National One Health Operational Plan 2024 - 2027 international

11. One Health Rapid Response Team established to organizations. respond to key priority diseases/events.

12. Capacity building of staff on One Health Rapid Response Team.

13. Raised awareness of media representatives on One Health.

14. Community awareness activities conducted.

15. Capacity building of health professionals on RCCE and SBC.

16. Development of One Health research priority agenda. National One Health Operational Plan 2024 - 2027 III. Monitoring Plan Timely and consistent collection of relevant, reliable data to monitor the progress of performance indicators against established targets is a key element to a successful monitoring strategy. Quality data facilitates informed judgments on overall performance and provides quantitative and qualitative information for further analyses, including the identifi- cation of necessary adaptations to project design or implementation. The monitoring plan measures performance at three levels: (1) out- put-level indicators that reflect the quantity or completion of activity, such as individuals trained, (2) outcome-level indicators that measure project achievements, and (3) impact indicator level that measure the long term and sustainable effects of the plan on its target population. The following tables present a range of indicators at the output and outcome levels. 26 National One Health Operational Plan 2024 - 2027 A. Output Indicators Output 1 Activation of Activation of the SCC and TWGs Completeness of the activation process of the SCC and Indicator TWGs The process of SCC and TWG activation includes the achievement of the following steps: Step 1: Conduct stakeholder mapping. Step 2: Development of committees’ TORs. Definition Step 3: Identify members from relevant sectors for SCC and each TWG. Step 4: Formulate a database for the assigned mem- bers. For each step: Completeness of each step = 1 Non-completeness of each step = 0 Equation Total result: N: Number of completed steps D: Number of committees (5) * Number of steps (4) * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation By committee/working group Frequency Monthly Unit of Measure Percentage 27 National One Health Operational Plan 2024 - 2027 40% Baseline Date December 2023 January 2024 50% Milestone February 2024 75% March 2024 100% Target 100% by the end of March 2024. 28 National One Health Operational Plan 2024 - 2027 Establishment of a conducive environment for the Output 2 successful implementation of a One Health approach Completing the process of establishing a conducive en- Indicator vironment for the successful implementation of a OH approach The process will include the following steps: Step 1: Adopt and implement a set of inter-agency MOUs to support collaboration and coordination under the OH approach. Step 2: Convene a meeting with parliamentary authori- Definition ties to get support for the OH approach. Step 3: Update national legislation to provide the need- ed legal foundation for all OH-related sectors. Step 4: Develop economic investment case studies on OH to boost support for political prioritization. For each step: Completeness of each step = 1 Non-completeness of each step = 0 Equation Total result: N: Number of completed steps D: Number of steps * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation None 29 National One Health Operational Plan 2024 - 2027 Frequency Annual Unit of Measure Percentage Baseline Zero. Date January 2024 December 2024 25% December 2025 50% December 2026 75% December 2027 100% Target 100% by the end of December 2027. 30 National One Health Operational Plan 2024 - 2027 Establishment of a process for resource mobiliza- Output 3 tion Completing the process of establishing resource mobi- Indicator lization The process of resource mobilization will include the following steps: Step 1: Mapping of existing/potential domestic funding relevant to OH technical areas and mapping of potential Definition international funds relevant to OH technical areas. Step 2: Develop a resource mobilization strategy includ- ing partnerships, international organizations and private sector. For each step: Completeness of each step = 1 Non-completeness of each step = 0 Equation Total result: N: Number of completed steps D: Number of steps * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Annual 31 National One Health Operational Plan 2024 - 2027 Unit of Measure Percentage Baseline Zero. Date January 2024 December 2025 50% Milestone December 2027 100% Target 100% by the end of December 2027. 32 National One Health Operational Plan 2024 - 2027 Capacity building on One Health approach for staff Output 4 working in One Health-related areas Indicator Percentage of staff trained on OH approach Staff trained on the educational material developed to build and enhance the knowledge, attitude and skills for Definition the OH approach. Staff associated with the MOHP, MOALR, and MOE. N: Number of trained staff Equation D: Number of staff that are planned to be trained Type of Indicator Output Data Source Training attendance records Disaggregation By sex, area of work, and geographic location Frequency Semi-annual Unit of Measure Percentage Baseline Zero. Date January 2024 Q2 2024 90% Q4 2024 90% Q2 2025 90% Q4 2025 90% Milestone Q2 2026 90% Q4 2026 90% Q2 2027 90% Q4 2027 90% Target 90% by the end of every year. 33 National One Health Operational Plan 2024 - 2027 One Health module developed and embedded into Output 5 the related academic faculties’ curricula Indicator Percentage of university faculties teaching OH module Development of OH module and approval of Ministry of Higher Education and Scientific Research for it to be Definition embedded in the curriculum of any of the following fac- ulties: medicine, veterinary science, dentistry, pharma- ceutical science, agriculture, science, and nursing. Total result: N = Number of university faculties with OH module add- Equation ed to curriculum D = Number of university faculties that are planned to teach OH * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Annual Unit of Measure Percentage Baseline Zero. Date January 2024 December 2026 1 of 2: 50% Milestone December 2027 2 of 2: 100% Target 2 faculties (100%) by the end of December 2027. 34 National One Health Operational Plan 2024 - 2027 Joint risk assessment developed at national and Output 6 governorate levels Completing the process of joint risk assessment devel- Indicator opment at national and governorate levels The process of developing joint risk assessment will include the following steps: Step 1: Conduct OH prioritization exercise to determine priority health threats Definition Step 2: Adapt tools for joint risk assessment Step 3: Enhance capabilities of professional staff on joint risk assessment Step 4: Conduct a joint risk assessment for prioritized threats at governorate level For each step: Completeness of each step = 1 Non-completeness of each step = 0 Equation Total result: N: Number of completed steps D: Number of steps * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Annual 35 National One Health Operational Plan 2024 - 2027 Unit of Measure Percentage Baseline Zero. Date January 2024 2024 25% 2025 50% Milestone 2026 75% 2027 100% Target 100% by the end of December 2027. 36 National One Health Operational Plan 2024 - 2027 Coordinated multisectoral surveillance system Output 7 (Epi & Lab) for collection, analysis and dissemina- tion of data among different sectors Indicator A Development of multisectoral surveillance guidelines Develop coordinated surveillance guidelines that involve Definition animal, human and environmental health sectors Yes = Guidelines developed Equation No = Guidelines not developed Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Annual Unit of Measure Binary Baseline No. Date January 2024 Milestone - Target By the end of December 2025. 37 National One Health Operational Plan 2024 - 2027 Coordinated multisectoral surveillance system Output 7 (Epi & Lab) for collection, analysis and dissemina- tion of data among different sectors Indicator B Development of multisectoral surveillance reports Develop and disseminate surveillance reports annual- Definition ly and convene information-sharing fora or bulletin for stakeholders Yes = Surveillance reports developed and shared Equation No = Surveillance reports neither developed nor shared Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Annual Unit of Measure Binary Baseline No. Date January 2024 Milestone - Target By the end of December 2027. 38 National One Health Operational Plan 2024 - 2027 Strengthened early warning systems for rapid detec- Output 8 tion and response to health threats Percentage of staff trained on early warning systems for Indicator rapid detection and response to health threats Staff trained on the educational material developed to Definition build and enhance the early warning systems for rapid detection and response to health threats Total result: Equation N: Number of trained staff D: Number of staff that are planned to be trained Type of Indicator Output Data Source Training attendance records Disaggregation By sex, area of work, and geographic location Frequency Semi-annual Unit of Measure Percentage Baseline Zero. Date January 2024 Q2 2024 90% Q4 2024 90% Q2 2025 90% Q4 2025 90% Milestone Q2 2026 90% Q4 2026 90% Q2 2027 90% Q4 2027 90% Target 90% by the end of every year. 39 National One Health Operational Plan 2024 - 2027 Joint sentinel surveillance sites for priority threats Output 9 established Establishment of one functioning joint sentinel surveil- Indicator lance site Joint sentinel surveillance sites should be functional, in- cluding being: • Identified Definition • Assessed • Equipped • Staffed by qualified, trained staff. Yes = Functioning joint sentinel surveillance site Equation No = No functioning joint sentinel surveillance site Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Annual Unit of Measure Binary Baseline No. Date January 2024 Milestone - Target By the end of December 2027. 40 National One Health Operational Plan 2024 - 2027 Capacity building of staff on joint sentinel surveil- Output 10 lance Indicator Percentage of staff trained on joint sentinel surveillance Staff trained on the educational material developed to Definition build capacity on joint sentinel surveillance Total result: Equation N: Number of trained staff D: Number of staff that are planned to be trained Type of Indicator Output Data Source Training attendance records Disaggregation By sex, area of work, and geographic location Frequency Semi-annual Unit of Measure Percentage Baseline Zero. Date January 2024 Q2 2024 90% Q4 2024 90% Q2 2025 90% Q4 2025 90% Milestone Q2 2026 90% Q4 2026 90% Q2 2027 90% Q4 2027 90% Target 90% by the end of every year. 41 National One Health Operational Plan 2024 - 2027 One Health Rapid Response Team established to Output 11 respond to key priority diseases/events. Indicator Completing the process of establishing OH-RRT Indicator Completing the process of establishing OH-RRT The process of establishing OH-RRT will go through the following steps: Step 1: Formulating SOPs and TOR for OH-RRT. Definition Step 2: Nomination of OH-RRT members from relevant sectors. Step 3: Developing a roster for OH-RRT. For each step: Completeness of each step = 1 Non-completeness of each step = 0 Equation Total result: N: Number of completed steps D: Number of steps * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation None Frequency Quarterly Unit of Measure Percentage Baseline Zero. Date January 2024 Q1 2024 66.6% Milestone Q2 2024 100% Target 100% by the end of June 2024. 42 National One Health Operational Plan 2024 - 2027 Capacity building of staff on One Health Rapid Re- Output 12 sponse Team Indicator Percentage of staff on OH-RRT who are trained Staff trained on the educational material developed per Definition the OH-RRT SOPs. Total result: Equation N: Number of trained staff D: Number of staff that are planned to be trained Type of Indicator Output Data Source Training attendance records Disaggregation By sex, area of work, and geographic location Frequency Semi-annual Unit of Measure Percentage Baseline Zero. Date January 2024 Q2 2024 90% Q4 2024 90% Q2 2025 90% Q4 2025 90% Milestone Q2 2026 90% Q4 2026 90% Q2 2027 90% Q4 2027 90% Target 90% by the end of every year. 43 National One Health Operational Plan 2024 - 2027 Raised awareness of media representatives on One Output 13 Health Percentage of media representative personnel trained Indicator on OH Media personnel oriented on the messages related to Definition OH priority areas in human health, animal health, and agricultural sectors. Total result: Equation N: Number of trained staff D: Number of staff that are planned to be trained Type of Indicator Output Data Source Training attendance records Disaggregation By sex and geographic location Frequency Annual Unit of Measure Percentage Baseline Zero. Date January 2024 2025 90% Milestone 2026 90% 2027 90% Target 90% by the end of every year. 44 National One Health Operational Plan 2024 - 2027 Output 14 Community awareness activities conducted Percentage of community awareness activities on OH Indicator conducted Number of community awareness campaigns and com- munity meetings of target communities (farmers, breed- Definition ers, etc.) conducted; number of target communities en- gaged to support behaviour change in relation to OH, including integrating their feedback into the OH approach. Total result: Equation N: Number of conducted awareness activities on OH D: Number of planned awareness activities on OH Type of Indicator Output Data Source Activity records Disaggregation By geographic location Frequency Annual Unit of Measure Percentage Baseline Zero. Date January 2024 2024 75% 2025 75% Milestone 2026 75% 2027 75% Target 75% by the end of every year. 45 National One Health Operational Plan 2024 - 2027 Capacity building of professional staff on RCCE and Output 15 SBC Percentage of healthcare professional staff trained on Indicator RCCE and SBC The number of health care staff from the OH workforce and community workers who have received training Definition on RCCE and participated in SBC education activities, including conferences, workshops, seminars and dia- logues at the national and governorate level. Total result: Equation N: Number of trained staff D: Number of staff that are planned to be trained Type of Indicator Output Data Source Training attendance records Disaggregation By sex and geographic location Frequency Annual Unit of Measure Percentage Baseline Zero. Date January 2024 2025 90% Milestone 2026 90% 2027 90% Target 90% by the end of every year. 46 National One Health Operational Plan 2024 - 2027 Development of One Health research priority agen- Output 16 da Completing the process of developing the OH research Indicator priority agenda The process of developing the OH research priority agen- da will include the following steps: Step 1: Identify the main partners from the relevant gov- ernmental and research sectors. Step 2: Convene key stakeholders’ meeting/workshop to identify research gaps. Definition Step 3: Conduct a workshop to set priorities/formulate the timeline for the application of the research papers. Step 4: Prepare concept notes and proposals to conduct applied research in the areas identified. Step 5: Explore available funds to support the OH re- search priority agenda. For each step: Completeness of each step = 1 Non-completeness of each step = 0 Equation Total result: N: Number of completed steps D: 5 * 100 Type of Indicator Output Data Source Monitoring sheet Disaggregation None 47 National One Health Operational Plan 2024 - 2027 Frequency Semi-annual Unit of Measure Percentage Baseline Zero. Date January 2024 Q2 2024 20% Milestone Q4 2024 60% Q2 2025 100% Target 100% by the end of June 2025. 48 National One Health Operational Plan 2024 - 2027 B. Outcome Indicators Formalized and effective coordination mechanism Outcome 1 for One Health Indicator A Competency of the coordination mechanism of OH Evaluation of the competency of the SCC and TWGs based on the following (based on the TOR): Definition

1. Frequency of meeting (30%)

2. Achievement of duties (70%) For each committee: Frequency of meetings (weight = 30%) N: Number of actual meetings conducted with atten- dance of more than or equal to 75% of all members D: Number of planned meetings as in TOR Equation Achievements (weight = 70%): N: Number of achieved duties D: Number of duties in TOR Result = Average percentage of all committees Type of Indicator Outcome Data Source Evaluation checklist Disaggregation By committee/working group Frequency Annual 49 National One Health Operational Plan 2024 - 2027 Unit of Measure Percentage Baseline Zero. Date January 2024 December 2024 75% December 2025 75% Milestone December 2026 75% December 2027 75% Target 75% by the end of every year. 50 National One Health Operational Plan 2024 - 2027 Formalized and effective coordination mechanism Outcome 1 for One Health Indicator B Effectiveness of the coordination mechanism of OH Evaluation of the effectiveness of the SCC and TWGs Definition based on the achievement of recommendations within the planned timeframe. For each committee: N: Number of achieved recommendations within the planned timeframe Equation D: Number of recommendations in the minutes of the meeting Result = Average percentage of all committees Type of Indicator Outcome Data Source Evaluation sheet Disaggregation By committee/working group Frequency Annual Unit of Measure Percentage Baseline Zero. Date January 2024 December 2024 50% December 2025 50% Milestone December 2026 50% December 2027 50% Target 50% by the end of every year. 51 National One Health Operational Plan 2024 - 2027 Improved capacities of professional staff on One Outcome 2 Health approach to support effective implementa- tion Improvement of KAP (knowledge, attitude and practic- Indicator es) or behavioural insight on OH among professional staffhealth care workers Evaluation of KAP among professional staff:

1. Before the implementation of One Health Operational Definition Plan.

2. At the end of 2027. Equation According to the study methodology Type of Indicator Outcome Data Source Study data collection sheet Disaggregation By age group, sex, and area of work Unit of Measure Percentage Baseline According to the baseline survey results Date Milestone None 30% improvement from baseline survey results by the Target end of December 2027. 52 National One Health Operational Plan 2024 - 2027 Raised community awareness regarding One Health Outcome 3 and priority health threats Improvement of KAP or behavioural insight on OH priority Indicator health threats Evaluation of the knowledge, attitude and practices among the community: Definition 1. Before the implementation of One Health Operational Plan.

2. At the end of 2027. Equation According to the study methodology Type of Indicator Outcome Data Source Study data collection sheet Disaggregation By age group and sex Frequency Annual Unit of Measure Percentage Baseline According to the baseline survey results Date Milestone None 30% improvement from baseline results by the end of Target December 2027. 53 National One Health Operational Plan 2024 - 2027 Established partnerships and networking with neigh- Outcome 4 bouring countries, other countries, or international organizations Level of coordination of OH-related areas with other coun- Indicator tries or international organizations There are three levels of OH partnership with other coun- tries and international organizations: Level 1: OH-related reports are shared sporadically between Egypt and other countries or international organizations. Definition Level 2: OH events in Egypt are organized with the par- ticipation of other countries or international organizations. Level 3: OH-related reports are shared regularly between Egypt and other countries, or between Egypt and inter- national organizations. Equation N: Level of coordination of OH Type of Indicator Outcome Data Source Evaluation checklist Disaggregation None Frequency Annual Unit of Measure Levels Baseline Zero. Date January 2024 December 2024 Level 1 December 2025 Level 1 Milestone December 2026 Level 2 December 2027 Level 3 Target Level 3 by the end of December 2027. 54 National One Health Operational Plan 2024 - 2027 IV. Evaluation Plan The One Health Operational Plan 2024–2027 evaluation will be con- ducted by the end of 2027. In order to evaluate the overall performance of the One Health Operational Plan, it is important to select the appro- priate evaluation questions before conducting the evaluation to avoid wasting scarce resources by evaluating aspects that are not of interest to end-users. Different types of evaluation questions may be important, which will also influence the selection of the evaluation type. Generally, evaluation of the One Health Operational Plan will be done against the general and specific objectives of the plan, but the first two questions that should be answered are: • Does the One Health initiative work and/or is it cost-effective? • What were the unexpected outcomes? During the evaluation of the One Health Operational Plan’s perfor- mance, the following questions may apply: If the purpose of the evaluation is about learning and finding out how to improve the One Health Operational Plan, the following questions may be important: • Are the activities being implemented as planned? • What works and what does not work? • What are the strengths and weaknesses? • What are participants’ reactions? • What works for whom in what ways, and under what conditions? • How can outcomes and impacts be increased? 55 National One Health Operational Plan 2024 - 2027 If the purpose is about the performance, the following questions may apply: • Is there a gap between the intended and actual population served? • How can quality be enhanced? • Does the One Health Operational Plan work as intended? • To what extent can outcomes be attributed to the intervention? Also, if the purpose of the evaluation is about economic efficiency, the following may be relevant: • How can costs be reduced? • Does the One Health Operational Plan deliver value for money? • Could a higher outcome be achieved at the same cost? • Is one strategy more beneficial than the other one? • How do outcomes and costs compare with other options? Moreover, taking into account the information gathered so far, the user needs to decide on the evaluation type to be used, considering the complexity of the OH initiative, its rationale, and the scope and purpose of the evaluation. Three main evaluation types need to be considered in this process: impact evaluation, non-linear impact assessment, and economic eval- uation. 56 National One Health Operational Plan 2024-2027