National Action Plan for Health Security (NAPHS), 2017-2021

1 STATE OF ERITREA MINISTRY OF HEALTH NATIONAL ACTION PLAN FOR HEALTH SECURITY (NAPHS), 2017-2021 June 2017 2 Table of Contents ACCRONYMS/ ABBREVIATIONS ..................................................................................................................... 3 Foreword ....................................................................................................................................................... 6 Acknowledgement ........................................................................................................................................ 8 EXECUTIVE SUMMARY .................................................................................................................................. 9 BACKGROUND/CONTEXT ............................................................................................................................ 12 Situation Analysis (Burden of PHEs in terms or morbidity mortality ...................................................... 12 Political and Socio-economic context ..................................................................................................... 13 Situational Analysis: IHR and other complementary assessments ......................................................... 14 Risk profiling of public health threats ..................................................................................................... 17 Eritrea journey from IHR JEE to Country Planning .................................................................................. 18 Figure 2. Eritrea journey from IHR JEE to Country Planning ................................................................... 18 VISION, MISSION, OBJECTIVES, GUIDING PRINCIPLES AND CORE VALUES ................................................. 19 METHODOLOGY FOR THE DEVELOPMENT OF THE NAPHS ......................................................................... 21 Planning and costing workshop, Asmara, 4-6, April, 2017 ..................................................................... 21 Objectives of the SPP workshop ............................................................................................................. 21 Outcomes ................................................................................................................................................ 22 Cost Driver exercise ................................................................................................................................ 22 Costing of the action plan ....................................................................................................................... 23 Prioritisation of activities by technical areas .......................................................................................... 23 Linkage with other programmes/initiatives ........................................................................................... 24 Applying Sector wide approach to implement National Health Security Plan ....................................... 24 MAJOR COMPONENTS OF THE NAPHS ....................................................................................................... 25 DELIVERY OF THE NAPHS ............................................................................................................................ 25 ANNEXES: .................................................................................................................................................... 28 Annex 1: Monitoring and evaluation of the plan ................................................................................... 28 Annex 2: List of Key Recommendations/Priority action for each Technical Area .................................. 34 Annex 3: Roles and Responsibilities ....................................................................................................... 41 Annex 4Attendance of Workshop ........................................................................................................... 46 Annex 5: Key Technical Areas and experts .............................................................................................. 50 Annex 6: Detailed Implementation Plan of the Health Security ............................................................. 53 3 ACCRONYMS/ ABBREVIATIONS AAR----------------After Action Review ACHS----------------Asmara College of Health Science ADG---------------- Acting Director General AEFI---------------- Adverse Event Following Immunization AFRO----------------Africa Regional Office AMR---------------- Anti Microbial Resistance DG-------------------- Director General DHS ---------------- Demographic Health Survey DPC---------------- Disease Prevention and Control DPT---------------- District Prioritization Tool DQA----------------Data Quality Audit EAT-------------- External Assessment Team EDF--------------- Eritrean Defense Force EHU---------------- Environmental Health Unit EOC--------------- Emergency Operating Center EOC--------------- Emergency operating Center EPI ----------------Expanded Program of Immunization EPR-----------------Epidemic Preparedness and Response ERCAA------------Eritrean Civil Aviation Agency ESI-----------------Eritrean Standard Institution EU---------------- European Union FAO------------ -- Food and Agriculture Organization FELTP-------------- Veterinary Field Epidemiology laboratory Training Program FETP--------------Veterinary Field Epidemiology Training Program FGM------------- Female Genital Mutilation HAC--------------Hamelmalo Agriculture Collage HCAI------------ Health Care Associated Infection HCW------------------ Health Care Worker HIV----------------Human Immune Virus HMIS----------------Health Management Information System HQ----------------Head Quarter HRD----------------Human Resource Development HRH---------------- Human Resource for Health HS-------------------- Health System HSSDP II ------------ Health Sectors Strategic Development Plan - Second HWF----------------Health Work Force ICT---------------- Information and Communication Technology IDSR----------------Integrated Disease Surveillance and Response IHR (2005) -------------- International Health Regulation 2005 IMR-----------------Infant Mortality Rate 4 IMS----------------- Information Management System JEE-------------------- Joint External Evaluation LB ---------------- Live Births MCG----------------Multisectoral Coordinating Group MCM---------------- Medical Counter Measures MDG---------------- Millennium Development Goal MOFA---------------- Ministry of Foreign Affaires MLWE---------------- Ministry of Land Water and Environment MMR ----------------- Maternal Mortality Rate MMR----------------- Ministry of Marine Resources MOA---------------- Ministry Of Agriculture MOE---------------- Ministry of Education MOF----------------Ministry of Finance MOFA----------------Ministry of Foreign Affaires MOH----------------- Ministry of Health MOI---------------Ministry of Information MOLG---------------- Ministry of Local Government MOTC ----------------Ministry of Transportation and Communications MOTI----------------Ministry of Trade and Industry NAPHS----------------National Action Plan for Health Security NBTC----------------National Blood Transfusion Center NBTS---------------- National Blood Transfusion Services NEPRTC ------------- National Epidemic Preparedness and Response Committee NFP----------------National Focal Point NHL---------------- National Health Laboratory NMFA-------------- National Medicines and Food Administration NPO----------------National Program Officer NSA----------------- National Security Agency OIE-------------- World Organization for Animal Health PH------------------- Public Health PHEIC--------------- Public Health Emergency of International Concern PHEMC----------- Public Health Emergency Management Committee PHEOC---------------- Public Health Emergency Operating Center PHO---------------- Public Health Officer PH----------------Public Health PIRI----------------Periodic Intensified Routine Immunization POE----------------- Point of Entry PPE---------------- Personal Protective Equipment PV----------------Pharmaco Vigilance QA----------------Quality Assurance QCL----------------Quality Control Laboratory SARS---------------- Severe Acute Respiratory Syndrome 5 SDD----------------Solar Direct Drive SDG---------------- Sustainable Development Goal SOP----------------Standard Operating Procedure SPP---------------- Strategic Partnership Portal SRS---------------- Southern Red Sea TB ------------------ Tuberculosis TWG----------------Technical Working Group UHC------------------ Universal Health Coverage UN ------------------ United Nation UNFPA-------------- UN Family and Population Agency UNICEF------------- UN International Children and Education Fund, WCO---------------- WHO Country Office WHO----------------- World Health Organization 6 Foreword The International Health Regulation (IHR (2005)) represents a binding international legal agreement involving countries across the globe. The aim is to help the international community to prevent and respond to acute public health risks that have the potential to cross borders and make threat to people worldwide. In line with IHR, the purpose and scope of Eritrea’s five Years National Action Plan for Health Security (NAPHS: - 2017 – 2021) is to prevent, protect, control and provide a public health response to the International Spread of diseases. The Government of Eritrea has been and will continue to be committed to the health of its people. Among other things, this has been demonstrated by the remarkable achievement seen in the progress made in the health Millennium Development Goals. The remarkable achievements in the Health MDGs is the result of many interventions and achievements within and outside the health sectors, including the complementary and mutually reinforcing strategies such as political commitment, investing in social and economic development, providing quality health care, multi-sectoral approach to health, strong community involvement, and having very supportive international partnerships. These achievements would further activate the ongoing emphasis and momentum on our health positive results, including effective implementation of this national action plan for health security in line with the second health sectors strategic development plan (HSSDP-II 2017 - 2021). The 5 Years’ plan will cover 19 key technical areas under the four core components (categories) of prevent, detect, respond and other IHR-related hazards and points of entry. The NAPHS will help in intensifying and maintaining the capacity for prevention, rapid detection, verification and responding to health risks, both diseases and other events. It will also help in effectively utilizing WHO tools and directives on implementing the National Action Plan that support to develop core capacities for surveillance, preparedness and response towards all public health emergencies. Furthermore, it will help in identifying the priorities needed to meet the IHR commitments and obligations. The spread of infectious diseases is not only limited to human beings as vast majority of epidemics arise on the interface between human and animal health. Thus, health security not only requires strong alliance among nations, but also strong partnerships, cooperation and collaborations among the different sectors, especially between the sectors of human health, animal health and Environment, as “One Health” Approach. Finally, I would like to re-affirm that the Government of the State of Eritrea will continue to endeavour to protect the health of its people and work together with the international 7 communities in health emergencies and other health related programs in translating the strategic plan into an effective action plan. Amina Nurhussien Minister of Health 8 Acknowledgement The Ministry of Health (MOH) would like to recognize and appreciate the commitment of the government of Eritrea for the relentless efforts exerted, so far, to prevent and protect its people from any disease outbreaks or events that might have occurred in-country or imported from outside of the country. At this juncture, it has created enabling environment to develop this National Action Plan for Health Security (NAPHS) that will serve the purpose during the period 2017 to 2021. Similarly, the MOH is thankful for the commitment and hard work of the various professionals from the different line ministries, other sectors and UN country offices that have contributed to the realization of this document. Equivalent appreciations and thanks also go to WHO Headquarter, WHO/AFRO and WHO Country Office, as one WHO, for the technical and financial support provided all the way through before, during and after the workshop. Our special gratitude goes to: Dr. Josephine Namboze, WHO Eritrea Representative; Mr. Ludy Suryantoro, WHO/HQ; Dr. Ambrose Talusina, WHO/AFRO; Dr. Sohel Saikat, WHO/HQ; Mr. Paul Verboon, WHO/HQ; Mr.Glen Lolong, WHO/HQ; Dr.Weigong ZHOU, WHO/HQ; Dr.Ogochukwu CHUKWUJEKWU, WHO/AFRO; Dr. Yohannes Ghebrat, WHO Eritrea; and Ms.Winta M. Bairu, WHO Eritrea Intern. The MOH also recognizes the senior management staffs of the MOH who have contributed invaluable inputs at the different stages of the development of this strategic plan. Last but not least, the MOH acknowledges the high commitment and coordination exerted by Mr. Tekle Tewolde, the IHR Focal Point and the Manager for the Quarantine & Inspection Unit, and his staff in the development of this plan. Dr.AndeberhanTesfazion Act. DG Department of Public Health 9 EXECUTIVE SUMMARY Following the adoption of the IHR (2005) in 2009, Eritrea has been monitoring its core capacities implementation using the WHO IHR monitoring Questionnaire and submitted reports to WHO on an annual basis. In 2016, Eritrea conducted Self-assessment using the WHO based standard assessment tool that was followed by a Joint External Evaluation. A multi-sectoral team of experts (nominated by JEE secretariat) participated in the week long assessment which took place from October 3rd to 8th 2016, in Asmara Eritrea. Eritrea is the fifth country to volunteer for the JEE, after Tanzania, Ethiopia, Mozambique and Liberia. All the 19 action packages/technical areas were assessed. The findings demonstrated that although there has been major progress, gaps still exist in key core technical areas. Out of the 48 indicators, Eritrea had scored 8 (16.7%) Green (Demonstrated/sustainable Capacity), 30 (62.5%) Yellow (Limited/Developed capacity), and 10 (20.8%) red (No capacity) on the Joint External Evaluation. Except measles coverage under immunization which has scored 5 (Sustainable capacity), majority lie between limited to developed capacity. As a follow up to the JEE in January 2017, WHO was requested to support in the development of a National Action Plan for Health Security which was materialized in April 2017 through a costing working session with WHO and country experts. This plan aims to reduce morbidity, mortality, disability and socio-economic disruptions due to public health threats and to contribute to the Sustainable Development Goal ≠3 (SDG – 3). Specifically it aims at: i) strengthening and sustaining the capacity of Eritrea to prevent outbreaks and other health emergencies; ii) strengthen and sustain the capacity of Eritrea to promptly detect and confirm outbreaks; iii) strengthen and sustain the capacity of Eritrea to promptly respond to and recover from the negative effects of outbreaks and health emergencies. The national action plan will align all activities with the “One Health approach” and broader health system strengthening with whole of government/whole of society approach; map existing and potential domestic and external financing to support the delivery of the national action plan and strengthen institutional framework to support Health Security and One Health implementation. The implementation of the plan will consider a set of guiding principles and core values such as country ownership and leadership; community participation; gender and human rights principles; 10 equity in access to services; strengthening partnerships; fostering inter-sectoral collaboration; evidence-led; shared responsibility; transparency; resilience and dynamism. The 5 Year plan (2017 – 2021) will cover 19 key technical areas under the four core components (categories) of prevent, detect, respond and other IHR-related hazards and points of entry with a total cost of USD 53,695,733. The major costs being on the Response component (39.9%), followed by Hazards (28.3%), Detect (17.2%); and then Prevent (14.6%) of the total cost estimate. The main cost drivers of the National Action Plan for Health Security in Eritrea include the Medical Countermeasures (rehabilitation of the PHARMECOR Section); the Points of Entry; immunization and workforce development. The main cost drivers per JEE thematic areas are presented below: Core Component Cost Drivers PREVENT • To reduce the incidence of zoonotic diseases by routine immunization. (Immunization) • Equip the AMR standard designated diagnostic labs at zoba-level with Lab supplies (media, reagents, discs, drugs, standard organisms, and standard Lab equipment). (2 labs Mendefera and Barentu) (AMR) • Establish toxicological lab and equip it with both human and instrumental resources (Food Safety) DETECT • Train 12 epidemiologists (MSc) in 5 years; Train 20 animal health epidemiologists in 5 years (Workforce Development) • Training for HCW on EPI hazard concept (Training 50 Participants (10 trainings per year total 500 participants) 10 days (HWF) • Training 40 participants (5 times per year) every year 10 days RESPOND • Maintenance of the PHARMECOR infrastructure (hire 1 engineer) 1 national at 4,5 and 6 Zobas at 1Million USD including Cold chain structure; Backup generator USD 300K, 2018 • IT system for 10 national, 4 each zoba connection with EOC and 1000 per month 11 • Transportation, procurement 4 trucks 4.5 tons truck USD 30K, 2 trucks 2018, 2trucks 2020; • Design and build 1 standardized EOC (1 national) with its ICT equipment furniture (Em. Resp) • 58 sub zoba Training 1 per year 30 participant 5 special perdiem conference package 3 days car rent 1 (Risk Com) OTHER IHR-RELATED HAZARDS AND POINTS OF ENTRY • Establish and equip the isolation facilities with relevant equipment and issue at least 2 ambulances/emergency boats for every PHEIC at the POE accordingly. • Procure radiation energy equipment and facilities for different sectors of the country actively engaged in the peaceful use of radiation source for diagnosis and treatment in Public Health, Food and Agriculture, Mining and National land/sea control Agency together with other private sectors in the nation. • Establish a radio-nuclear detection unit. • Establish One Standard National Poison Control Centre 12 BACKGROUND/CONTEXT Eritrea Country profile Situation Analysis (Burden of PHEs in terms or morbidity mortality The aim of the National Health Sector goal is to ensure that by 2021, ‘essential quality health and health related services are efficiently and equitably available to all Eritreans, in line to their specific individual, and communal health needs’. The MOH has been exerting rigorous efforts to improve access and utilization to health services. To-date, Life expectancy at birth has significantly improved from a low of 49 in 1995 to 64.7 years in 2015. Life expectancy in females stands at 67 years while for males it stands at 62.4 years in Eritrea. Infant and child mortality have shown significant reductions. IMR was 72/1000 in 1995, 48/1000 in 2002 and 42/1000 in 2010 and declining to 34/1,000 in 2015. Similar impressive figures have been realized in the country for the U5MR, declining from 136/1000 in 1995, going down to 93/1000 in 2002, 63/1000 in 2010 and 47/1000 by the end of 2015. Eritrea has been very successful in reducing the Maternal Mortality Rate (MMR) from the extremely high 998/100,000 in 1995 (DHS) to 752/100,000 in 2002 (DHS) to 486/100,000 in 2010EPHS) . The all-cause mortality remains high at 1,297/100,000. The major contributor to this is non communicable conditions, whose mortality is responsible for 671/100,000 persons as compared to communicable conditions (506/100,000 persons) and violence / injuries (119 / 100,000 persons). This is a reflection that the country is dealing with a dual disease burden of NCDs and CDs although the non-communicable disease has out striped the communicable diseases. According to Global Health Statistics report 2016, mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory is on the rise with the cause of premature death (under age 70) is mainly due to cardiovascular disease (37%), cancer (27%), other NCDs (23%) respiratory disease at 8% and diabetes at 4%. According to the Millennium Development Goals (MDG) Report, the maternal mortality decreased from 1509 maternal deaths/100,000 Live births in 1990 to 501 maternal deaths/100,000 Live Births(LB) by the end of 2015 which is significant reduction (68.4%) while it fell slightly less than the 75% expected reduction. Although the country did not achieve the target, nevertheless, it was counted as one of the few countries in sub-Saharan Africa that made significant progress towards attainment of the target. Similarly, child mortality reduced from 217/1000LB to 47/1000LB classifying Eritrea among the 10 countries in sub Saharan Africa to achieve the MDG4 which is to reduce child mortality rate by two thirds between 1990 and 2015. The total fertility, though it reduced from 6.1 in 1995 to 4.8 in 2002 according to the Eritrea demographic and health surveys, it has remained stable only reducing marginally to 4.7 by 2015. Looking at specific contributors to disease burden, there have been improvements in the incidence, prevalence and mortality due to communicable diseases mainly HIV, TB and Malaria and many of the vaccine preventable diseases. 13 Political and Socio-economic context Eritrea has a number of health related Articlesin Eritrean Transitional Civil and Penal Codes and other laws in hierarchy legislations.TheNational Health Policy and the Health Sector Strategic Plan II (2017-2021)and other sub sector policies/guidelines are also supporting documents to implement IHR. The country has conducted the IHR core capacities assessment in 2010, identified the gaps and developed an action plan for the period 2012-2014, which was subsequently updated to cover the period 2014-2016. The country conducted an assessment of almost 40 legal instruments (Codes, Proclamations, Regulations, Legal Notices, and Conventions) to find out Articles that help/impede the implementation of IHR. Out of the articles reviewed, 10 of them were seen to enforce the implementation of IHR 2005. One example is the Eritrean Transitional Civil Code and Eritrean Transitional Criminal Code, proclamations, regulations and Policies have Articles that help the implementation of IHR. The Health sector policy and other sub sector policies/guidelines have various sections that support the implementation of IHR. A major gap is the lack of a Public Health Act in the country, which is crucial for adequate implementation of IHR and also key in bringing together multisectoralstakeholders. The high level commitment and leadership in the implementation of the IHR 2005, is an opportunity for ensuring sustainable funding for IHR implementation and should be exploited to strengthen the one health approach. Health policy and systems: Progress towards achievement of international and national targets The national health sector policy is based on the principles of provision of essential health care services for all at all ages under the overall global directions of Sustainable Development Goals especially SDG 3 and the principles of Universal Health Coverage (UHC). The national health system spins under the 6 pillars of HS namely human resources for health, procurement, supply and logistics system, medicines administration and regulation, biomedical and infrastructure engineering, laboratory and imaging services, blood transfusion services and legal affairs. There exists a Human Resources for Health strategic plan (2012–2016) which is currently being implemented. Human resources for health are recognized as pillars but despite regular production and recruitment of new health workers, the staffing norms are not yet met, especially for specialists at hospital level, including surgeons, radiologists, internists, etc. Looking at infrastructure, current data show that there are 28 hospitals, 53 health centres and 186 health stations. There exists the National Medicines and Food Administration (NMFA), a body of the Ministry of Health that regulates the quality of pharmaceuticals and medical supplies in the country to ensure that the public has access to quality, safe, efficacious and affordable pharmaceuticals and medical supplies. At present there are a total of 47 staff members of whom only 16 are skilled and semi-skilled technicians on Biomedical Engineering. Currently, there are 5 levels of laboratories, constituting 1 National Health Laboratory (NHL); 4National Referral Hospital Laboratories; 6 Zoba Regional Hospital Laboratories; 20 hospital laboratories; and 43 community hospital laboratories in the country. The country has a National 14 Blood Transfusion Policy of 2011 that guides the work of the National Blood Transfusion Services (NBTS) in Eritrea. There is one National Blood Transfusion Center (NBTC) at the capital Asmara, and one Regional Blood Transfusion centre at Gash-Barka. At the hospital level, there are blood banks where refrigerators and standby generators are necessary prerequisites. Currently, the capacity for blood production is 10,000 blood units per year about 2,000 less of the annual target. There has been no National Health Act or Regulation but there are several proclamations on control of drugs, cosmetics and sanitary items, tobacco control, control of private practice and control of female genital mutilation (FGM) etc. During the period of the implementation of the HSSDP I the health issues were covered by the civil and penal codes. The Legal office, however, has limited expertise in medico-legal issues. It has not developed a strategic plan nor does it have annual operational plan. In 1996, a first health financing policy was developed, and revised in 1998, in order to cover various aspects of interest including the cost sharing through levying of user fees. This version of the health financing policy was again revised in 2007, in order to have a more comprehensive policy incorporating a deeper consideration of the key health financing functions: revenue collection mechanisms, revenue pooling and risk management, and resource allocation and purchasing. Currently, health services in the country are highly subsidized by the government but other mechanisms have to be established to ensure universal health coverage and national health security. Situational Analysis: IHR and other complementary assessments JEE assessment of the 19 packages) A multi-sectoral team of experts (nominated by JEE secretariat) participated in the week long assessment which took place from October 3rd to 8th 2016, in Asmara Eritrea. Eritrea was the fifth country to volunteer for the JEE, after Tanzania, Ethiopia, Mozambique and Liberia. All the 19 action packages/technical areas were assessed. Eritrea first completed a self-assessment using the JEE tool. The results of this assessment, including host country self-assessed scores for the 19 Action Packages, were then presented to the External Assessment Team (EAT). The EAT and host country experts then participated in a facilitated discussion to jointly assess Eritrea’s current strengths, areas which need strengthening, and priority actions; scores were developed through a process of consensus. Action Package scores, supporting information, and specific recommendations for priority actions are provided under the Action Package sections of this report. The results of the assessment and observations of the Host Country’s Health Security preparedness in the context of IHR were presented to Minister of Health (Hon. MinisterAminaNurhussien), senior government officials from different ministries in Eritrea and the WHO Country Representative (Dr Josephine Namboze). Here under is a summary of the JEE scores for the state of Eritrea. Table 1: Summary scores from IHR JEE, October 2016 15 CAPACITIES INDICATORS SCORE National Legislation, Policy and Financing P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government instruments in place are sufficient for implementation of IHR. 2 P.1.2 The state can demonstrate that it has adjusted and aligned its domestic legislation, policies and administrative arrangements to enable compliance with the IHR (2005) 2 IHR Coordination, Communication and Advocacy P.2.1 A functional mechanism is established for the coordination and integration of relevant sectors in the implementation of IHR. 2 Antimicrobial Resistance P.3.1 Antimicrobial resistance (AMR) detection 1 P.3.2 Surveillance of infections caused by AMR pathogens 1 P.3.3 Healthcare associated infection (HCAI) prevention and control programs 3 P.3.4 Antimicrobial stewardship activities 2 Zoonotic Disease P.4.1 Surveillance systems in place for priority zoonotic diseases/pathogens 3 P.4.2 Veterinary or Animal Health Workforce 4 P.4.3 Mechanisms for responding to zoonoses and potential zoonoses are established and functional 2 Food Safety P.5.1 Mechanisms are established and functioning for detecting and responding to foodborne disease and food contamination. 2 Biosafety and Biosecurity P.6.1 Whole-of-Government biosafety and biosecurity system is in place for human, animal, and agriculture facilities 2 P.6.2 Biosafety and biosecurity training and practices 2 Immunization P.7.1 Vaccine coverage (measles) as part of national program 5 P.7.2 National vaccine access and delivery 4 National Laboratory System D.1.1 Laboratory testing for detection of priority diseases 4 D.1.2 Specimen referral and transport system 3 D.1.3 Effective modern point of care and laboratory based diagnostics 3 D.1.4 Laboratory Quality System 2 D.2.1 Indicator and event based surveillance systems 3 16 CAPACITIES INDICATORS SCORE Real-Time Surveillance D.2.2 Inter-operable, interconnected, electronic real-time reporting system 2 D.2.3 Analysis of surveillance data 4 D.2.4 Syndromic surveillance systems 4 Reporting D.3.1 System for efficient reporting to WHO, FAO and OIE 2 D.3.2 Reporting network and protocols in country 2 Workforce Development D.4.1 Human resources are available to implement IHR core capacity requirements 3 D.4.2 Field Epidemiology Training Program or other applied epidemiology training program in place 3 D.4.3 Workforce strategy 4 Preparedness R.1.1 Multi-hazard National Public Health Emergency Preparedness and Response Plan is developed and implemented 2 R.1.2 Priority public health risks and resources are mapped and utilized. 1 Emergency Response Operations R.2.1 Capacity to Activate Emergency Operations 1 R.2.2 Emergency Operations Center Operating Procedures and Plans 1 R.2.3 Emergency Operations Program 1 R.2.4 Case management procedures are implemented for IHR relevant hazards. 2 Linking Public Health and Security Authorities R.3.1 Public Health and Security Authorities, (e.g. Law Enforcement, Border Control, Customs) are linked during a suspect or confirmed biological event 3 Medical Countermeasures and Personnel Deployment R.4.1 System is in place for sending and receiving medical countermeasures during a public health emergency 2 R.4.2 System is in place for sending and receiving health personnel during a public health emergency 2 Risk Communication R.5.1 Risk Communication Systems (plans, mechanisms, etc.) 2 R.5.2 Internal and Partner Communication and Coordination 3 R.5.3 Public Communication 3 R.5.4 Communication Engagement with Affected Communities 4 17 CAPACITIES INDICATORS SCORE R.5.5 Dynamic Listening and Rumour Management 3 Points of Entry (PoE) PoE.1 Routine capacities are established at PoE. 3 PoE.2 Effective Public Health Response at Points of Entry 1 Chemical Events 1 Mechanisms are established and functioning for detecting and responding to chemical events or emergencies. 2 2 Enabling environment is in place for management of chemical Events 1 Radiation Emergencies .1 Mechanisms are established and functioning for detecting and responding to radiological and nuclear emergencies. 1 .2 Enabling environment is in place for management of Radiation Emergencies 1 Out of the 48 indicators, Eritrea has scored 8 green, 30 yellow and ten red on the Joint External Evaluation (Figure 1.) Figure 1. Status of indicators INDICATORS STATUS 8(16.7%) GREEN 30 (62.5%) YELLOW 10 (20.8%) RED Risk profiling of public health threats Joint Risk assessment for meningitis outbreak in Eritrea was carried out through the support of WHO experts using a District Prioritization Tool (DPT) during the period 8 – 12 August 2016. 18 The DPT output highlights a very high risk level in the southern part of Eritrea bordering Ethiopia, an area traditionally prone to meningococcal disease. Similarly, the DPT identified two other areas with very high risk levels for which the historical knowledge and interpretation is not as straightforward: respectively in the Anseba and the Northern Red Sea Zones. The DPT output also highlights a high risk level in the eastern part of Eritrea bordering Sudan. This area is not exactly matching any similar high risk area directly across the border in Sudan, although the neighbouring states of Sudan includes high and very high risk areas. Eritrea journey from IHR JEE to Country Planning Eritrea has adapted and started implementation of the IHR (2005) in 2009 subsequent to a national assessment that was followed by the development of a three year action plan (2009 – 2012). Monitoring was carried out using an annual report till 2016 when an internal self assessment was carried out in August 2016 in line to the guidelines of WHO. In October 2016, the country requested voluntarily WHO to assist conduct a Joint External Evaluation on the 19 technical areas identified as important components of the Global Health security. Relevant recommendations were passed following the assessment and currently the country is in the process of development of a 5 Year National Action Plan for Health Security (2017 – 2021). Figure 2. Eritrea journey from IHR JEE to Country Planning 19 VISION, MISSION, OBJECTIVES, GUIDING PRINCIPLES AND CORE VALUES Vision: A nation that is secure and resilient in the face of diverse incidents with health consequences with people in all communities enjoying a high level of security against threats to their health and well-being. Mission: To build and sustain the optimum core capacities in the 19 technical areas for health security. Goal: To minimize human and animal morbidity and mortality associated with all public health events. General Objectives 1. To prevent and reduce the likelihood of outbreaks and all public health hazards and events defined by IHR (2005). 2. To promptly detect threats (due to all hazards) to save lives and ensure proper control measures. 3. To establish a functional system for effective multi-sectoral national and international response to all public health events. 4. To establish and maintain the core capacities at designated points of entry for routine and timely detection and prompt effective response of any potential hazards. 5. To develop and sustain optimum capacity to prevent, detect and manage chemical events and radiation emergencies. Guiding Principles and Core Values 1. Country ownership and leadership: the state of Eritrea will provide political and technical oversight for all phases of the NAPHS (planning, implementation and M and E), including committing domestic resources to finance the NAPHS. 20 2. Equity, gender mainstreaming and human rights will be promoted in the implementation of this plan. The plan will address all population groups, regardless of their location, ethnicity, gender, age, social, economic, cultural, and political status. 3. Community engagement: The community is a crucial unit in addressing health security. Individuals in households with adequate knowledge and skills about prevention of illnesses are able to take timely corrective measures and maintain a healthy lifestyle. Therefore, empowering individuals and households by reaching them through various social groupings can improve people’s lifestyles which in turn can improve the individuals’ overall health status. Community engagement will be through a participatory approach in development and implementation of culturally acceptable and scientifically sound risk communication strategies. 4. Partnership, inter-sectoral and multi-disciplinary collaboration: The partnership principle will be facilitated through inter-sectoral collaboration at community, sub-zoba and zoba levels on the one hand, and involvement of the wide spectrum of all relevant stakeholders at national level. This entails partnership with other government departments, sectors, development partners, and academia. 5. Efficiency: The implementation of this NAPHS will foster rationalisation of inputs to ensure maximum outputs and outcomes and value for money (VfM). 6. One Health Approach: One Health is an approach that addresses public health events such as high impact infectious diseases arising at the intersection of human, animal (domestic and wildlife), and environmental interface. Humans and animals share the same eco-system and the opportunities for spill-over of diseases are increasing with modern trends in globalization, rapid population growth, climate change, economic development, mass urbanization, and increasing demand for animal sourced foods. Current evidence, indicate that about 75% of the new diseases that have affected humans over the past 10 years have been caused by pathogens originating from an animal or from products of animal origin. This NAPHS is underpinned on the one health approach and will ensure that all phases take into consideration the one health approach. 7. Alignment and ensuring synergies with UHC and SDGs: Efforts to build and sustain the IHR core capacities in the state of Eritrea will be based on horizontal rather than vertical approaches for sustainable and resilent health systems that can with stand the shocks from outbreaks and other health emergencies. The implementation this plan will be done in synergy with the implementation of strategies to achieve sustainable development goal 21 number 3 (SDG-3). The opportunities offered by this NAPHS and UHC 2030 will be harnessed to influence and guide the implementation. 8. Evidence led and taking into consideration innovations: The implementation of this NAPHS will take into account emerging trends, risks and health innovations, as well as, inter country, regional, sub-regional and cross-border cooperation to reinforce timely information sharing and coordinated interventions. METHODOLOGY FOR THE DEVELOPMENT OF THE NAPHS Following the completion of the IHR JEE in October 2016, a situation analysis was conducted by the State of Eritrea involving multiple stakeholders. This was to ensure that the planning process takes into account all the available information and that a coordinated approach is in the place between different sectors of the government and ministries during the planning and implementation of national action plan for health security. This consultative exercise led to setting priorities and objectives based on the result of the situation analysis and resulted in an agreed set of activities under JEE 19 technical areas. Planning and costing workshop, Asmara, 4-6, April, 2017 The three levels of WHO (WCO, RO, HQ) worked with the state of Eritrea and other health development partners to facilitate further reviews of priorities to formulate 5-year National Action Plan for Health Security. The participants at the planning workshop are indicated in Annex 4. Objectives of the SPP workshop 1. Describe activities based on IHR JEE and other complementary recommendation and outline a “one health” “one government” implementation roadmap in coordination with all partners and key stakeholders in Eritrea 2. Secure necessary consultation among the representatives of different line ministries and administrative levels as to promote effective inclusion and multi-sectoral buy-in as necessary to develop and operationalise the NAPHS 3. Apply a transparent process to cost priority activities for their inclusion in national plan for health security and consideration for funding (domestic/external) 4. Identify and account for uncertainty, assumptions associated with the NAPHS in particular on costing and key risks that have significance to the Plan and its operationalization, 5. Develop M&E of the NAPHS commensurate with its phased implementation, 22 6. Develop an outline strategy for advocacy and communication for domestic and external funding Outcomes 1. Completed detailed plan agreed with all relevant stakeholders 2. Factor in systematic review of the process to develop the NAPHS and improve the necessary aspects as appropriate during the course of its development 3. Costing of all relevant activities and develop different scenarios to facilitate resource mobilisation (domestic and other sources) 4. Document step by step process involves in costing and refinement of planning 5. Clarify strategy for risk management and contingency to maintain the course of the Plan During the workshop multi-sectroal breakout sessions reviewed the priority activities, objectives, targets and milestones. The criteria used to undertake the reviews are indicated in box 1 below: Box 1. Criteria used to review the priorities • Based on the listed priorities for 19 technical areas, are there any critical (technical) gaps that need to be addressed? • Whether the activities stated to achieve the key priority are realistic, relevant and achievable with the milestones and measures in planning context • Whether activities listed to address priority/gap will develop the health security capacity in a sustainable way in consideration of health systems strengthening and sector wide development Cost Driver exercise • Application of cost drivers on key priorities identified i.e. to categorise them into big costs, small costs or in between • From these priorities of large cost, what would be the major activities and inputs for implementation? 23 • Of the activities assumed to have a high cost, which are in the Government of Eritrea budget? Of those that are not, are there any development partners who have shown interest in these? Costing of the action plan The last two days of the workshop were dedicated to final reviews of the priorities, sequencing and costing to formulate 5-year National Action Plan for Health Security. The criteria applied are indicated in box 2 below. Box 2. Criteria for final review, sequencing and costing • Are the activities considered for costing realistic, measurable and will they exert impact and efficiency to corresponding objective(s)? • Has the technical area adequately considered the activities that will allow the country to demonstrate progress from lower to higher scores? • Does the plan allow the country to maintain the capacities in areas where it has showed demonstrated capacities (Scores – 4-5)? • Do the activities under this technical area identify and include other sectors and levels for their participation to deliver the plan underpinning on the “One Health approach, health system strengthening-, equity as and where applicable? • Do the activities follow a sequential or phased approach (year 1, 2, 3-5) for the plan operationalization commensurate with resource availability and mobilisation by utilising ongoing financial outlook? • Does the technical area utilise the best available data to categorise activities in terms of domestic vs external funding? • Has a responsible ministry or ministries/Office or offices been identified to take forward agreed activities? Prioritisation of activities by technical areas National consultative process including the two workshops has led to come up with a confirmed list of objectives, target, impact, summary of planned activities, inputs including unit costs for consideration into estimated costing. For unit costs, Government procurement guidelines were used and where data not available, other authoritative sources such as WHO procurement reference are used. Completed detailed plan is given in Annex 5. 24 Linkage with other programmes/initiatives Eritrea, like many countries, is developing NAPHS that will be implemented within broader HSS. It is therefore necessary that plans should be reviewed to ensure that priorities across sectors/areas of work are captured but also to avoid unnecessary duplications. By nature and to bring synergies, the state of Eritrea National Health Security Plan is going to be linked with many on-going initiatives across all levels and these include; • The health sector development plan II • Strategic plans of other relevant health programs • Other sectors’ plans including animal health and environment Applying Sector wide approach to implement National Health Security Plan Sector-Wide Approach (SWAp) is an approach to international development that "brings together governments, donors and other stakeholders within any sector. It is characterized by a set of operating principles rather than a specific package of policies or activities. There are persuasive arguments for supporting a sector-wide approach (SWAp) as opposed to the traditional project approach: increased health sector coordination, stronger national leadership and ownership, and strengthened countrywide management and delivery systems. These are variously claimed to reduce duplication, lower transaction costs, increase equity and sustainability, and improve aid effectiveness and health sector efficiency. ASWAp explicitly mandates the ministry of health with the leadership. However, this role has been partly problematic in other countries owing to limited leadership capacity, poor relationship with the ministry of finance, slow shift of ownership, change of senior management, little ministry of health leverage to secure additional funds, and low priority of cross-sectoral collaboration. The SWApapproach is not yet the practice in Eritrea. Thus, adequate emphasis in financing andbuilding the managerial capacity of the MOH and other relevant ministries should be encouraged to implement the NAPHS. Monitoring and evaluation of the health sector has become institutionalized. The once or twice yearly joint review meeting is an important instrument providing an open forum to https://en.wikipedia.org/wiki/International development https://en.wikipedia.org/wiki/Government https://en.wikipedia.org/wiki/Donation https://en.wikipedia.org/wiki/Project stakeholder 25 review the progress and performance of the National Action Plan for Health Security (NAPHS). MAJOR COMPONENTS OF THE NAPHS • Planning matrix of priorities – short term (12 months) to long term (> 12 months) • Costing of activities and summary categorisation • Financing of National Action Plan (WG, SPP and further donors engagements) • Risk appraisal and management (WG) • Platform for National Action Plan – linkage with existing plan; interplay between relevant sectors; enablers • Contribution to Health System Strengthening and UHC DELIVERY OF THE NAPHS • Roles and responsibilities of key stakeholders - National Multi-Agency Taskforce for Action Plan • Coordination mechanisms • The SPP workshop identified the need for a coordination platform to map and ensure interplay between multiple sectors and other existing plans at all administrative levels of the country. The plan will be implemented under the guidance of the MOH and a multisectoral high level technical group, accountable to the Ministry of Development, with representatives from all relevant line ministries, WHO and other UN agencies, will be formed to administer the plan, and to monitor and evaluate its implementation. • Framework for delivery of action plan o National coordination o Alignment internal stakeholders o SPP o Alignment external stakeholders • Risk appraisal and management (MS) • Monitoring and evaluation of the Plan • Budget and Financial Plan (Annex 5) o Budget Summary by interventions o Budget summary by cost categories o Budget gap analysis: Overall, in the coming 5 Years period, of the estimated USD 53,695,733 for the implementation of the National Action Plan for the Health Security, the MOH will allocate 26.2% (14,068,282/ 53,695,733) for the implementation of all the programs within the MOH including for the NAPHS. 26 Fig. 3.Allocation of Funds by Technical Areas of the NAPHS 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 Other IHR related hazards Response Detect Prevent 15,184,826 21,414,511 9,257,718 7,838,678 Technical Areas Groups 27 Fig. 4 Fig. 5: Distribution of Cost by Year- NAPHS 0 4000000 8000000 12000000 18. Chemical Events 4. Zoonotic Disease 19. Radiation Emergencies 2. IHR Coordination Communication and Advocacy 8. National Laboratory System 1. National Legislation, Policy and Financing 6. Biosafety and Biosecurity 13. Emergency Response Operations 14. Linking Public Health and Security Authorities 5. Food Safety 16. Risk Communication 3. Anti-Microbial Resistance 7. Immunization 9. Real Time Surveillance 12. Preparedness 17. Points of Entry (PoE) 10. Reporting 15. Medical Countermeasures and Personnel… 11. Workforce Development 19 Technical Areas 0 5000000 10000000 15000000 20000000 25000000 30000000 2017 2018 2019 2020 2021 Estimated Cost per year 28 ANNEXES: Annex 1: Monitoring and evaluation of the plan The National Action plan for Health Security will be monitored throughout its life through the mechanisms identified below, according the major elements of the global IHR M&E framework. In addition, the major indicators will be included in the M&E plan of the HSSDP II and reviewed as part of the overall sector review processes, using the same mechanisms at sub-zoba, zoba and national levels. o Annual Reporting––the country will continue to report annually on the development of the main IHR (2005) core capacities as their obligation to report annually to the World Health Assembly on the implementation of IHR (2005). For other process related indicators, these will be reported and reviewed as part of the sector review processes in Eritrea. The major indicators and milestones to be used for annual monitoring are listed in the table 1 below. o Simulation Exercises – Eritrea will conduct at least one simulation exercise annually to test the functionality of the system in a non-event environment and to validate the functional capacities of a system. In addition, there will be one simulation exercise specific for radiation emergencies annually. The findings of exercises can provide a more operational view of the level of capacities across the nineteen technical areas. o After Action Review - An after action review (AAR) is a qualitative review of actions taken to respond to an emergency as a means of identifying best practices and lessons learned. Eritrea will include these in the M&E framework and conduct an after action review following any public health event in the country. o The Joint External Evaluations – The initial JEE provided key recommendations that guided the development of the national actions plan for health security. A second JEE will be conducted as part of the end-evaluation of the NAPHS. There will also be a mid-term review of the plan to assess progress, identify bottlenecks to implementation and provide recommendations to guide implementation in the later half of the plan period. Table 2. Indicators and milestones for Eritrea NAPHS Technical area Indicator Data Source Baseline Milestone Target 2017 2018 2019 2020 2021 P R E V E N T National policy, legislation and financing Availability of Public Health Act that incorporates IHR (2005) requirements MoH PH law drafted by June 2018; enacted by Dec 2018 PH law fully enforced Proportion of total cost of the national action plan mobilized MoH financial records 4.3% 48.4% 27.4% 13.2% 11.1% 29 Technical area Indicator Data Source Baseline Milestone Target 2017 2018 2019 2020 2021 IHR coordination, communicatio n and advocacy Availability of multisectoral coordinating mechanisms at each level 2 at national level 6 at zoba level 58 at sub zoba level 58 at sub zoba level Number of IHR coordination meetings conducted annually Meeting minutes 12 58 116 SOPs for information sharing in place Developm ent of SOPs as on one health approach ensured SOPs for informati on sharing are in place & used Antimicrobial Resistance Number of national and zonal laboratories of human and animal health designated for AMR detection and reporting as per the recommended standard Contract agreemen t done 2 at National level (1 MoH& 1 MoA) 1 MoMR 3 Zonal (2 MoH& 1 MoA) 3 Zonal (1 MoH& 2 MoA) *09 *3 MoH, 3 MoA& 1 MoMR *2 existing labs at National level Proportion of health facilities conducting functional HCAI and prevention control Environm ental Health (MoH) training minutes 25% 50% 75% 85% 100% Proportion of veterinary clinics conducting functional HCAI and prevention control Agricultur al extension (Animal Health unit) training minutes 25% 50% 75% 85% 100% Availability of National AMR policy document NAP developed by MCG for AMR In place Food Safety Prevalence of food borne diseases MoH Report 90% 60% 20% 5% 1% Availability of food safety strategy MOH 0 available availab le availabl e available Proportion of major food handling sites that receive at least two supervision visits per year MoH 20% 40% 80% 90% 100% 30 Technical area Indicator Data Source Baseline Milestone Target 2017 2018 2019 2020 2021 Number of functional food safety laboratories at national and zonal levels MoH 1 National 1 National & 2 zonal 1 Nation al & 4 zonal 1 National & 6 zonal 1 National & 6 zonal FS Labs Zoonotic Diseases Availability of a functional zoonotic disease surveillance system in human and animal health MoA 0 In place Surveillan ce system in place & functional Propose Indicator for availability of veterinary and animal health workforce at sub-zoba level Animal and plant health division moa 85% Vet service & Man power keep in place 100% Completeness and timeliness of reporting on zoonotic diseases MoA&Mo H Every 6 months Every 6 months + annual report 90% reporti ng on time 6 months + annual timely reports Proportion of outbreaks of zoonotic diseases that are responded to within 48 hours MoA&Mo H Not achieved 60% 100% Biosafety and Biosecurity Availability of a national policy on biosafety and biosecurity MOH No B&B policy exists Policy in place 100% Proportion of staff at national and zonal reference labs trained on biosafety and biosecurity Lab records Basic lab safety training and practices 80% 100% Number of training institutions that have a training programme on biosafety and biosecurity 0 2 6 10 10 Immunization % of community Hospitals equipped with standard incinerators Zoba Annual Report 50% 60% 70% 75% 80% % of health facilities with at least two EPI trained health workers EPI annual report/ HFs assessme nt 70% 80% 85% 90% 95% Proportion of 12 month old who received at least one dose of measles containing vaccine HMIS, Survey 83% 85% 88% 90% 95% D E T E C T National Laboratory System Availability of a national lab system of providing quality laboratory Lab records Quality laboratory confirmati Nation al lab Policy 90% 31 Technical area Indicator Data Source Baseline Milestone Target 2017 2018 2019 2020 2021 confirmation for 10 priority pathogens for human and animal health on for 6/10 priority pathogens in place Availability of a quality manual and SOP NHL Document ation SOPs available Develo pment of Quality manual 90% Proportion of laboratories with at least two people trained on IHR and GLP NHL/HR 50% 100% Proportion of specimens received at reference labs on time and in good condition Lab records 70% 100% Real Time Surveillance Proportion of administrative units with at least one volunteer trained in community or event based surveillance IDSR database 0% 30% 45% 60% 75% The proportion of epidemics detected at zonal and national level through weekly analysis of surveillance data and that were missed by the sub zoba/health facilities level IDSR database 0% 0% 0% 0% 0% Proportion of health facilities submitting complete weekly surveillance report on time to the sub-zoba/zoba level IDSR database 100% 100% 100% 100% 90% Reporting Proportion of NFP staff at national and zonal level trained on IHR/OIE reporting MOH -NFP 25% 75% 90% Proportion of potential public health events of international concern reported on time 0% 100% 100% Availability of protocols/guidelines for IHR NFPs and OIE delegates MOH-NFP 0 In place Workforce Development Availability of a field epidemiology training programme MOH HRH data base 65 40 40 40 185 32 Technical area Indicator Data Source Baseline Milestone Target 2017 2018 2019 2020 2021 Proportion of sub-zobas with at least one basic trained field epidemiologist and veterinary assistant MOH &MOA 1 Epi, 0 Vet Assist 2 Epi, 30 Vet Assist 3 Epi, 30 Vet Assist Number of zobas with at least one intermediate trained field epidemiologist and vet officer MOH & MOA 5 Epi, 0 Vet Officer 3, 20 3, 20 3, 20 14 Epi, 20 VO Propose Indicator for training on chemical and radiation hazard MOH None 2 4 6 6 R E S P O N D Preparedness Number of Risk assessments and mapping completed Assessme nt report 0 2 4 6 6 (including chemicals /hazards) Emergency Response Operations Availability of EOC /IMS procedures and plans MOH Availa ble Availability of PHEOC at national level MOH Availa ble Number of zobas and sub zobas with trained RRTs MOH 0 20 32 54 64 Linking Public Health and Security Authorities Availability of protocols for information sharing between public health and security authorities MOH Availa ble Proportion of events with joint response of public health and security authorities MOH Reports 0% 30% 40% 90% 100% Medical Countermeas ures and Personnel Deployment Availability of a national framework for receiving and sending medical counter measures MOH 0% 30% 50% 75% 100% Risk Communication Availability of risk communication guidelines H/P recorded report 0 Communi cation guideline developed Printed tested &dissemi nated In place In place No of zobas and sub-zobas with at least one focal person for health promotion trained on risk communication strategies H/P recorded report 0 20 32 54 64 Proportion of households with knowledge of public health risk mitigation and prevention H/P recorded report 0 2% 10% 20% 25% 33 Technical area Indicator Data Source Baseline Milestone Target 2017 2018 2019 2020 2021 O T H E R I H R R E LA T E D H A Z A R D S A N D P O IN T S O F E N T R Y ( P O E ) Points of Entry Proportion of designated POEs that are adequately equipped JEE Report 16.7% 50% 75% Proportion of designated POEs with adequately trained health personnel MOH Report 25% 50% 75% Proportion of designated POEs with timely access to an isolation facility MOH Report 25% 75% 100% Proportion of designated POEs that are doing routine screening for priority public health events MOH 75% 80% 100% Chemical Events Availability of a national toxicology chemical centre 0% In place Availability of guidelines for detection management and response to chemical events Availa bility of guideli nes Radiation Emergencies Number of referral health facilities with capacity to manage patients of radiation emergencies MOH Records 0 2 4 8 8 Number of radiation drills conducted with the involvement of international experts MOH Records 0 1 2 4 5 34 Annex 2: List of Key Recommendations/Priority action for each Technical Area 1. National Legislation, Policy and Financing i. Formulate the Public Health Act and incorporate/update other relevant policies and guidelines from other sectors to facilitate coordination of the implementation and sustenance of IHR across all levels. ii. Ensure adequate financing for the implementation of the IHR across all relevant sectors through the creation of a defined budget line for IHR. iii. Ensure the coordination across sectors by strengthening the existing multisectoral mechanisms that stipulate clear memoranda of understanding (MoUs). iv. Fast track the promulgation of all the legislations that is in draft form, as well as, review and update relevant policies and guidelines to incorporate IHR in all sectors. 2. IHR Coordination, Communication and Advocacy i. Strengthen the high level Public Health Emergency Coordination body to be a comprehensive, multi-hazard, multidisciplinary and multisectoral coordination body to enable the implementation and sustenance of IHR requirements across all sectors and at all levels. ii. Improve the operational capacity and mandate of the IHR NFP with the corresponding resources to fulfil IHR functions. This should be included in the comprehensive multi hazard plan that is being developed. iii. Strengthen the institutional capacity of the IHR TWG in line with its mandate and develop ToRs, roles and responsibilities, and establish information sharing pathways to adequately implement IHR and support the IHR NFP. iv. Develop Standard Operating Procedures for information sharing between Animal and Human sectors and other relevant sectors at all administrative levels under the One Health principles, v. Conduct simulation exercises to test the coordination and information sharing mechanisms 3. Antimicrobial Resistance i. Eritrea should develop a National Action Plan to address AMR. This should align with the Global Action plan for AMR, incorporating actions by all relevant sectors; particularly health, veterinary and agriculture. ii. Eritrea should establish a multi-sectoral National Task Force composed of qualified experts from the relevant sectors. iii. Eritrea should strengthen the AMR Stewardship Program within animal and public health sectors 35 iv. Develop Healthcare Associated infection prevention and control policies, strategies and guidelines within animal and public health sectors. v. Expand the AMR laboratory capacity within animal and public health sectors from national level to the Zones/Zoba and establish an AMR sentinel surveillance system within animal and public health sectors. 4. Zoonotic Disease i. Develop and disseminate the strategy and guidelines, as well as, review the reporting tools for zoonotic disease surveillance that incorporates One Health and strengthen zoonotic diseases surveillance and reporting. ii. Build technical and financial capacity for the implementation of the One Health approach at all levels. iii. Establish One Health coordination structures, TWGs, surveillance and laboratory information sharing and mechanisms for joint response to zoonotic events. 5. Food Safety i. A multi-sectorial Food Safety Strategy with specific Plan of Action should be developed in the absence of a unifying Food Safety Act. This should involve the input and participation of all relevant stakeholders, including the private sector, at all administrative levels to ensure more effective adoption of a “One Health” approach ii. Develop and operationalize an integrated Structured Food Borne Disease Surveillance System among all relevant stakeholders/functions (Food, Water, Sanitation, Trade, Public Health, Port/Customs, Agriculture) iii. Build capacity for skills of epidemiology and laboratory in Food Borne disease surveillance, detection and response provided with sufficient funding. iv. Strengthen routine monitoring and evaluation to enhance Food Safety and quality control 6. Biosafety and Biosecurity i. Bio-safety and bio-security legislation should be developed to cover all laboratory and health care sectors dealing with dangerous pathogens. ii. A multi-sectoral collaboration mechanism should be formalised and implemented and a multi-sectoral strategy and policy should be developed to ensure optimum bio-safety and bio-security of public, animal and agriculture facilities. iii. Bio-safety and bio security trainings should be strengthened and best practices should be integrated in all relevant sectors. iv. Dangerous pathogens that may pose public health concerns should be identified, listed, risk profiled and adequate control measures should be taken. 36 7. Immunization i. Strengthen periodic intensified routine immunization (PIRI) in less accessible areas and nomadic population groups. ii. Improve the quality of vaccine management, vaccine administration and data quality audits -DQA through training and supportive supervision. iii. Improve EPI waste disposal procedure as per the WHO recommended guidelines by installation of more incinerators. iv. Strengthen investigation and appropriate reporting system of Adverse Event Following Immunization (AEFI) v. The government should commit to the procurement of Solar Direct Drive (SDD) refrigerators to fill-up the electric supply gaps and to ensure sustainability. DETECT 8. National Laboratory System i. Develop a public health laboratory policy and strategic plan. ii. Establish a laboratory Quality Management and assurance system including targets for certification, accreditation and QA. iii. Establish policies and guidelines for formal linkage between the animal and human laboratories, including provisions for specimen sharing, information exchange and technical support. iv. Build technical human resource for laboratory services through formal and refresher training programs. v. Strengthen Sustainable laboratory capacity in Districts & Regions with improved guidance, SOPs, reagents, equipment and personnel 9. Real-Time Surveillance i. Develop and disseminate an IDSR electronic reporting system with an electronic database. ii. Conduct regular monitoring and evaluation of IDSR performance with periodic IDSR indicator review. iii. Expand and reinforce community based surveillance in all villages and health facilities and strengthen event based surveillance with rumour logging and monitoring and evaluation of performance. 37 iv. Where feasible, establish/strengthen cross-border surveillance with cross-border collaboration with neighbouring jurisdictions. v. Establish IDSR information sharing including regular and timely weekly epidemiological bulletins vi. Introducing and institutionalizing surveillance related training in the pre-service curriculum in institutions of health personnel training. vii. Expand the mobile SMS technology for reporting of priority disease that is in pilot phase in some of the sub-zobas to all sub-zobas. 10. Reporting i. Building capacity among personnel in public health and animal health for assessing potential PHEICs and necessary reporting. This includes training of the human resource. ii. Test the system for reporting PHEICs to WHO and OIE through real-life events or through simulation exercises. 11. Workforce Development i. Develop and implement a comprehensive workforce development as a key component to sustain best practices of public health services for health security. A workforce gap assessment underpinning one health approach should be conducted to inform the development of the strategy ii. Increase the pool of epidemiologists with surveillance skills in all hazards at subnational level iii. Expand the current 4 month Epidemiology course to include a laboratory and veterinary cadres to complement the existing current basic epidemiology program that is being given in the ACHS. iv. The course on applied epidemiology training program given in ACHS and HAC has to be strengthened within the country to ensure more intakes in higher degreed (Doctor of Veterinary Medicine) RESPOND 12. Preparedness i. Conduct an integrated all hazard/Vulnerability risk and resource mapping. ii. Finalize the National Multi-hazard Public health emergency preparedness and response plan considering all essentials including EOCs, Community Engagement, Cross border 38 collaboration, multi-sectorial coordination platform, health infrastructure and ensure its implementation with regular exercises iii. Review the national health infrastructure for emergency response to consider establishment of permanent infection isolation facilities, iv. Build response capacity in other sectors, including: the security sector, the MOA through prioritization of the Vet-FETP, FELTP, while ensuring dedicated contingency funds for response and no stock out of critical response stocks and laboratory reagents. v. Strengthen existing EPR structures and develop relevant SOPs and review them with regular exercises 13. Emergency Response Operations i. Construct or identify dedicated infrastructure for PHEOC at national to Zoba levels equipped with relevant ICT facilities and personnel to activate emergency response. ii. Develop relevant EOC Standard Operating Procedures, Plans and case management guideline in line with IHR all hazards approach iii. Train staff in relevant competencies and conduct regular exercises and reviews. 14. Linking Public Health and Security Authorities i. Establish legal arrangements between ministries responsible for public, animal health and security authorities for integrated emergency preparedness and response. This could be included in anticipated Public Health Act. ii. Support operational integration of National Emergency Preparedness and Response Plan with security sectors and provide necessary enabling environment to support the coordination. iii. Establish mechanisms for information sharing between ministries responsible for public and animal health and security authorities at national and local levels and agree clear command and control structure and responsibilities. iv. Conduct regular simulation exercise on response to disaster or emergencies. v. Conduct training of relevant people and sectors 15. Medical Countermeasures (MCM) and Personnel Deployment i. Develop medical countermeasures and personnel deployment plan, SOPs and protocols. ii. Establish/Formalize agreements with neighbouring countries and regional organizations to ensure mutual cross boarder aid for sending and receiving surge health personnel and MCM. iii. Conduct inventory and document of existing public health emergency experts in the country that can be deployed for MCM. 39 iv. Update guidelines for licensing, monitoring and evaluating performance of deployed personnel. v. PHARMECOR`s storage facilities for bulk items needs to be elevated to the national level with stronger inventory control vi. Strengthen the capacity for supply chain management vii. Develop a formal system for sending or receiving MCM health personnel during a public health emergency from outside Eritrea 16. Risk Communication i. Adapt and incorporate IHR-specific Risk Communications components including a national multi-hazard emergency risk communication plan into existing national policies and plans. ii. Develop and strengthen IHR and Risk Communications knowledge capacities in the MOH Health Promotion dept and other national stakeholders for effective response and coordination (including SMS), iii. Review existing Health Promotion policy to integrate risk communications principles that acknowledge community risk perceptions and community participation in development of key messages. iv. Strengthen and formalise coordination and Risk communications SOPs internally, with partners and with the subnational levels v. Monitoring and evaluation of the implementation of risk communication strategies can be strengthened, which can also assist with rumour management OTHER 17. Points of Entry i. Develop the national public health emergency contingency plan for responding to public health emergencies occurring at points of entry, integrated with other PH Response plans, covering all relevant sectors and services at PoEs (e.g. immigration, transportation, security, media, agriculture etc.), and develop and disseminate to all key stakeholders. ii. Elaborate the SOPs for screening, isolation, safe referral and transfer of ill travellers to appropriate medical facilities, with MoU between health authorities and facilities for all designated PoEs within the country. iii. Strengthen the core capacities at all designated points of entry for all the staff including inspection of conveyances, agriculture programme for vectors control and organize ad hoc simulation exercises. iv. Equip the isolation facilities and increase number of ambulances for PHEIC at the POE, 40 18. Chemical Events i. Develop policy and associated statutory guidance for the surveillance and response to chemical risk and events. ii. Establish a national a chemical/toxicology unit as part of the National Disaster Response Management iii. Jointly conduct survey and assessment of hazardous substances that potentially affect human, animal health and the environment iv. Conduct assessment of resources of responding sectors and advocate for improvement in capacity and capability of each to be able to control and prevent the adverse effects of chemicals v. Establish a National Poison Control Centre and a specialized waste disposal system as well as facilities for hazardous chemicals, 19. Radiation Emergencies i. Develop optimum capacity to manage a radio-nuclear event which could involve the development of regulatory policy either of its own or as part of the Public Health Act and National Emergency Preparedness and Response Plan. ii. Strengthen the necessary resources e.g. human, infrastructure, skills to detect and response to radio-nuclear events. iii. Develop radiation safety programme 41 Annex 3: Roles and Responsibilities Roles and functions of the National Steering Committee for Health Security The National Steering Committee for Health Security will have the following roles and functions: • Provide strategic leadership in the development, implementation and sustainability of health and wellbeing of people, animals and the environment • Provide strategic advice, support and assistance in the implementation of the five years strategic plan • Monitor identified and emerging risks and provide guidance on their prevention, mitigation and management • Recognise barriers and enablers to fully implement the strategic plan • Mobilize resources • Monitor the implementation of the strategic plan • Monitor the budget and expenditure of the program • Establish committees at different levels of implementation, including Technical Working Group at National level. Role of individual members of the National Steering Committee for Health Security The role of the individual members of the National Steering Committee for Health Security is as follows: • attending regular meetings and actively participating in the committee’s work • a genuine interest in the initiatives and the outcomes being pursued in the program • being an advocate for the program’s outcomes • being committed to, and actively involved in, pursuing the program’s outcomes General Membership The National Steering Committee for Health Security shall be comprised of: • Minister of Ministry of Local Government • Minister of Ministry of Health • Minister of Ministry of Agriculture • Minister of Ministry of Land, Water and Environment • Minister of Ministry of Labor & Human Welfare • Minister of Ministry of Finance • Minister of Ministry of Education 42 • Minister of Ministry of Transport & Communications • Minister of Ministry of Marine Resources • Minister of Trade and Industry • Minister of mining and Energy • Minister of Development • Surgeon General of Ministry of Defense • National Security Agency (NSA) –, consists Security, Police , Immigration • Commission for Higher Education • Other members may be included in the committee as deemed necessary. 43 Terms of Reference for the National Epidemic Preparedness & Response Technical Committee (NEPRTC) /National Public Health Emergency Management Committee (PHEMC) I. Introduction: During the past two decades or so, the world has been challenged by many newly occurring epidemics of international concerns. Such diseases include; Influenza-like illnesses (Severe Acute Respiratory Syndrome (SARS), human influenza caused new-type (Avian influenza caused by H5N1), the Middle East Respiratory Syndrome (Novel corona virus)) and Ebola Haemorrhagic Fever. Where such epidemics occur, countries have been very keen to control them with capacities within countries and support from outside. Eritrea has always been attentive and on continuous active surveillance on such diseases by programs guided by technical committee formed in 2002. Recently, Ebola Haemorrhagic Fever has become rampant in West African Countries (Sierra Leone, Liberia, Guinea Conakry and Nigeria). Although these countries are very far from Eritrea, by consideration of volatile transportation and population movement through air, land and sea, Eritrea can still be at risk of such epidemics. It is important, therefore, to revitalize the existing technical committee with renewed scope of work. II. Composition The National Public Health Emergency Management Committee (PHEMC) will have the following members: 1. D.G. Department of Public Health (Chairperson) 2. Director, Communicable Diseases Control (Secretary) 3. Director, Health Care Service Delivery Division 4. Director, Pharmaceutical Services Division 5. Director, Environmental Health Division 6. Head, Integrated Disease Surveillance & Response (IDSR) Unit 7. Manager, National Malaria Control Program 8. Director, National Health Laboratory 9. Director, Health Promotion Division 10. Representative from the Office of Health Officer (Health Services of the Ministry of Defense) 11. Head, Quarantine and Inspection Unit/IHR Focal person 12. Representative from MOA (Veterinary) 13. Representative from MO Land, Water and Environment 14. Representative from WHO 15. Other partners can be co-opted as needed 44 III. Scope of Work 1. The committee is directly responsible to the minister of health 2. Develop /formulate Epidemic Preparedness & Response (EPR) guidelines for use at all levels for epidemic control 3. To enhance surveillance for early detection of cases and facilitate early response 4. Capacity building in terms of human resources, infrastructure, equipment and supplies. 5. Prepare and develop training guidelines on disease surveillance for health workers at all levels. 6. Community sensitization and training 7. To facilitate data analysis interpretation and dissemination to stakeholders on epidemics and provide guidance for enhancing response 8. To endorse protocols for specimen collection and transportation/shipment 9. Preparation of isolation and/or quarantine 10. Prepare plans for strengthening infrastructure at entry points (land, air and sea) 11. Ensure that Personal Protection Equipment (PPE) are made available at headquarter &zonal medical offices for distribution where necessary 12. Notify occurrences of epidemics to the minister of health 13. The committee can further elaborate its scope of work with further discussions IV. Meeting The PHEMC shall have daily meeting during epidemics and once every months in normal time. Core Technical Groups Groups Technical area Responsible Person Organizati on I. Preven t 1. Legislation, laws, regulations, administrativ e requirements Tewolde Yohannes , MhariWeldu , TekleTewolde,NasirAbdelkadir MOH 2. IHR Coordination Communicati on and Advocacy TekleTewolde , AfewerkiMehreteab, EfremMengsteab, Dr. Yohannes Ghebrat MoH, MOA, MOH , WHO 45 3. Antimicrobial Resistance (AMR), surveillance and Health Care Associated Infections Mr. IyassuBahta; GhilayKahsay MullugetaAlemu Mulugeta Russom/Mehari EphremGhebremeskel MOH, MOA 4. Zoonotic Diseases and Surveillance (Animal and Human Mr. AfewerkiMehreteab , DrAraia Berhane MOA 5. Food safety - Dr. ZemuiAlemu; AngesomAraia, BiniamTekle, BereketMosazghi, NeguseGhebreslassie, MOH 6. Biosecurity & biosafety Mr. YesiefTekle, Mr. EfremGheremeskel MOH 7. Immunizatio n Mr. TewdrosYehdego MOH I. Detecti on 1. National laboratory systems Mr. Salih Said MOH 2. Real time surveillance Mr. Asmerom, DrAraia Berhane MOH 3. Reporting Mr. TekleTewolde, MrAfewerkiMehreteab MOH, MOA 4. Workforce development Dr. Berhane Debru, MrEyob MOH II. Respo nd 1. Preparedness Dr. FekremariamGhilamikael, DrAraia Berhane MOH 2. Emergency Response Operations Ms.Adiam, DrAraia Berhane MOH 3. Linking Public Health &Security authorities Dr. AndbrehanTesfasion,Mr.TesfayWoldemi chael , Mr. MinasieSmret , Mr. AbrhamDebesai, Mr. Belay Ghebrehiwet,Mr. Samson Tesfahiwet MOH, NSA, NSA, NSA, MOLG, Customs 4. Medical counter Dr. GoitomMebrahtu MOH 46 Annex 4Attendance of Workshop on Development of Eritrea's National Action Plan for Health Security Asmara Palace, 4 - 6 April 2017 Sr . N o. Name of Participant Title Organization Day 1 Day 2 Day 3 1 Abdu Yacob PHO MOH - Gash Barka √ √ √ 2 Abduselam Nassir Environmental health Head MOH - SRS √ √ √ 3 Abraham Belay MOH - EHU MOH √ √ √ 4 Abraham G/Michael Project head MOI √ √ √ 5 AdiamGhebreyohanes IDSR Staff MOH √ √ √ 6 AfewerkiMehreteab Director Min. of Agriculture √ 7 AmanuelKifle Head HMIS MOH √ √ √ 8 Amb. Mohammed Ali Hurui DG MLG √ 10 AndehaimanotKiflom PHO MOH-Debub √ √ √ 11 Dr. AraiaBerhane Director MOH √ √ √ 12 Asmerom T/giorgis IDSR Staff MOH √ √ √ 13 Assefaw G/Michael Medical Director MOH - SRS √ √ √ measures & personnel deployment 5. Risk communicati ons Mr. GhebremichaelTesfazghi, MOH IV. Other IHR related hazards & Point of Entries (POE 1. Point of Entry Mr. EfremMengsteab, MOH 2. Chemical Events Dr. Michael Ghebrehiwet MOH 3. Radiation Emergencies Dr. Michael Ghebrehiwet MOH 47 14 Batseba Michael Secretary WHO √ √ √ 15 Belay G/Hiwet Director MOLG √ √ √ 16 BereketMosazghi Unit Head MLWE/WRD √ √ √ 17 Dr. Berhana Haile Director MOH √ √ √ 18 BerhaneGebrekidan PHO MOH - Anseba √ √ √ 19 BerhaneGebretinsae DG MOH √ √ √ 20 BiniamTelkezion Industrial Program Head Mo. Trade √ √ √ 21 BiniamTsegay QCL MMR √ √ √ 22 Bun ThiLan Representative FAO √ 23 Daniel Semere Director Min. of Justice √ √ √ 24 Dr. Josephine Namboze Representative WHO √ √ √ 25 Dr.ZerabrukTesfamariam A/Professor ACHS √ √ √ Dr. AndebrhanTesfazion ADG MOH √ √ √ 27 Dr. AssefashZehaie NPO WHO √ √ √ 28 Dr. BerhaneDebru ADG of PP & HRD MOH √ √ √ 29 Dr. Ghirmai T/slassie Head of Int. hosp MOH √ √ √ 30 Dr. GoitomMebrahtu Director MOH √ √ √ 31 Dr. Kesetebrhan Solomon Regional Medical Officer MOH √ √ √ 32 Dr. KifremariamGhilamichael IDSR Head MOH √ √ √ 33 Dr. LuulBanteyrga Medical Director MOH - Anseba √ √ √ 34 Dr. Michael Ghebrehiwet Advisor MOH √ √ √ 35 Dr. YohannesGhebrat DPC WHO √ √ √ 36 Dr. ZemuyAlemu Director MOH √ √ √ 37 EfremGhebremeskel Director Min. of Agriculture √ √ √ 38 EfremMengsteab Inspection &Quarantine staff MOH √ √ √ 39 Elsa Haile Director MOFA √ 40 EsayasAnde Operations Officer WHO √ √ √ 41 EyobAsmelash Member MOFA √ √ √ 42 G/michaelTesfazghi Director MOH √ √ √ 43 Dr. GhimjaFessahaye A/Dean ACHS √ √ √ 48 44 GhirmaiMesghena Economist Mo. Finance √ √ √ 45 GhirmatsionTesfaslassie Head Facilitator Asmara Airport √ √ √ 46 HatemariamHagos Director Civil Aviation √ √ √ 47 HuruyAsfaha Public Health Officer MOH - SRS √ √ √ 48 Ibrahim Sambuli Representative UNFPA √ 49 IsayasTesfagiorgis Child Right Min. of Labour and Human Welfare √ √ √ 50 IyassuBahta Director MOH √ √ √ 51 MebrahtomHadgu ERCAA Civil Aviation √ √ √ 52 MehariMengisteab Director MOE √ √ 53 MehariWoldu Legal Advisor MOH √ √ √ 54 MehariZeregabir PV Officer MOH √ √ √ 55 MekonenFesahaye Inspection &Quarantine staff MOH √ √ √ 56 Michael Berhane Director General Min. of Transport √ √ √ 57 MogosAbraha Inspection & Quarantine Officer MOH - Gash Barka √ √ √ 58 Mrs. AminaNurhussien Minister MOH √ √ 59 Mulubrhane G/Yohannes Director DOE/Environmental √ √ √ 60 MulugetaAlemu Director MOH √ √ √ 61 Nasser Alkader Planning Staff MOH √ √ √ 62 Nicole Miller Deputy HON EU √ √ 63 NigusseGhebreslassie ESI Head ESI √ √ √ 64 Salem Mohammed Said Director NHL √ √ √ 65 Samson Tesfahawariat Unit Head Customs √ √ √ 66 SelamBerhane Information Assistant WHO √ √ √ 67 SemereGebregiorgis NPO/MPN WHO √ √ √ 68 SeyoumTeame NPPP UNFPA/MOH √ √ √ 69 Solomon Zerabruk Director MTC √ √ √ 70 Talisuna Ambrose Advisor WHO √ √ √ 71 Tareke O/Michael Public Health MOH √ √ √ 72 TekleFrezghi Director MOT √ √ √ 73 TekleTewolde NFP MOH √ √ √ 74 TemesgenAbuye MOI MOI √ 49 75 TerhasMehreteab Director MOH √ √ √ 76 TesfagabirBereketeab Quarantin Officer NOH - SRS √ √ √ 77 TesfaiKidane Massawa Quarantine MOH √ √ √ 78 Tesfai Solomon Director MOH √ √ √ 79 TesfaiWoldemichael Internal Officer National Security √ √ √ 80 TesfaiYosieph Unit Head Min. of Agriculture √ √ √ 81 TewoldeYohannes Director MOH √ √ √ 82 TzeggaiKidanemaryam Surveillance Officer WHO √ 83 WintanaBairu WHO-Intern WHO √ √ √ 84 Yemane Haile Medical Director MOH-Debub √ √ √ 85 YemaneTeadel ADG MOH √ √ √ 86 YemaneTseggai Director EDF √ √ √ 87 YoditHiruy Health Specialist UNICEF √ 88 YosiefTekle Head of Food Laboratory MOH, NHL √ √ √ 89 DanaitGebrehiwet MOI MOI √ √ 90 AmarshTsegai MOI MOI √ √ 91 YassinSaleh MOI MOI √ √ 92 AzmeraGebreslassie Data Manager WHO √ √ 93 SohelSaikat Technical Experts WHO - HQ √ √ √ 94 LudySuryantoro Technical Experts WHO - HQ √ √ √ 95 Paul Verboon Technical Experts WHO - HQ √ √ √ 96 Glen Lolong Technical Experts WHO - HQ √ √ √ 97 Dr. Weigong ZHOU Technical Experts WHO - HQ √ √ √ 98 Dr. Ogochukwu CHUKWUJEKWU Technical Experts WHO-AFRO √ √ √ 50 Annex 5: Key Technical Areas and experts Berhane Gebretinsae Health Systems, MOH Groups Technical areas Names of Subcommittee members of key technical groups Organization Preventi on 1. Legislation, laws, regulations, administrativ e requirements , Mr. Tewolde Yohannes , MehariWeldu , TekleTewolde , TesfaiYosief(MOA), NasirAbelkadir MOH, MOA 2. IHR Coordination, Communicati on and Advocacy Mr. TekleTewolde , AfewerkiMehreteab, EfremMengsteab, Dr. Yohannes Ghebrat MOH, MOA , WHO 3. Antimicrobial Resistance (AMR), surveillance and Health Care Associated Infections Mr. IyassuBahta, GhilayKahsay, MullugetaAlemu,MulugetaRussom,MehariZer agabir EphremGhebremeske MOH, MOA 4. Zoonotic Diseases and Surveillance (Animal and Human Mr. AfewerkiMehreteab , EyobTsegehannes MOA 5. Food safety Dr. ZemuiAlemu, AngesomAraia, BiniamTekle, BereketMosazghi, NeguseGhebreslassie, MOH, MOA, MOTI, MOWLE, MOTI( ESI) 6. Biosecurity & biosafety Mr. Salih Said , Mr. YesiefTekle, Mr. EfremGheremeskel MOH, MOA 51 7. Immunization Mr. TewdrosYehdego, Dr. BehanaHaile,YoditHuruy, TsegaiKidanemariam,AfewerkiMehreteab MOH, UNICEF,WHO,MOA II. Detection 1. National laboratory systems: Mr. Salih Said , Mr. YesiefTekle, Mr. EfremGheremeskel MOH,MOA 2. Real time surveillance Dr. Araia Berhane, Mr. Asmerom , Dr. FikremariamGhilamichael MOH 3. Reporting Mr. TekleTewolde , Mr. AfewerkiMehreteab, Dr. Yohannes Ghebrat MOH, MOA, WHO 4. Workforce development Dr. Berhane Debru, Mrs. TerhasMehreteab, AfewerkiMehhreteab , AmanuelKidane MOH, MOA,ACHS III. Respond 1. Preparedness Dr. FikremariamGhilamichael, Dr. Araia Berhane, Dr. Yohannes Ghebrat MOH, WHO 2. Emergency Response Operations Dr. Araia Berhane, AdiamGherehannes , Dr. FikremariamGhilamichael, Dr. Yohannes Ghebrat MOH 3. Linking Public Health &Security authorities (PHS) Dr. AndbrehanTesfasion, Mr. TesfayWoldemichael , Mr. MinasieSmret , Mr. AbrhamDebesai, Mr. Belay Ghebrehiwet ,Mr. Samson Tesfahiwet MOH,NSA,MOLG,MOF (Customs) 4. Medical counter measures & Dr. GoitomMebrahtu MOH 52 personnel deployment 5. Risk communicati ons Mr. GhebremichaelTesfazghi, AmanuelGhirmazion,MekonenFeshaye, AbrhamGhebremicael, AwetAraia MOH, MOI, UNICEF IV. Other IHR related hazards & Point of Entries (POE) 1. Point of Entry - Mr. TekleTewolde,EfremMengsteab, Solomon Zeraburuk GhirmazionTesfamariam, HabtemariamHagos, Michael Berhane, Dr.Yohannes Ghebrat MOH, MOTC 2. Chemical events Dr. Michael Ghebrehiwet, Mr. MuluberhanGhebreyohannes, BereketMosazghi, NegusseGhebreselasie MOH, MOLWE,MOTI 3. Radiation Emergencies Dr. Michael Ghebrehiwet, Dr. ZekariasMeles, Yohannes Frezghi MOH 53 Annex 6: Detailed Implementation Plan of the Health Security 1. National Legislation, Policy and Financing 2. IHR Coordination, Communication and Advocacy 54 3. Antimicrobial Resistance and 55 4. Zoonotic Diseases 56 57 5. Food Safety 58 6. Biosafety and Biosecurity 59 7. Immunization 60 8. National Laboratory System 61 9. Real Time Surveillance and 10. Reporting 62 11. Workforce Development 63 12. Preparedness 64 13. Emergency Response Operations and 14. Linking PH and Security Authorities 65 15. Medical Countermeasures and Personnel Deployment 66 16. Risk Communication 67 17. Point of Entry (POE) 68 18. Chemical Events 69 19. Radiation Emergencies