National Action Plan for Health Security 2019-2023

1 Acute Watery Diarrhea (AWD) 5- Very high

2 Measles 4- High

3 Yellow fever 4- High

4 Dengue 4- High

5 Chikungunya 2- Low

6 Anthrax 4- High 5

7 Rabies 4- High

8 Typhoid 3- Moderate

9 Dysentery 3- Moderate

10 Typhus 2- Low

11 Relapsing fever 3- Moderate

12 Ebola Virus Disease (EVD) 2- Low

13 Influenza pandemic 2- Low

14 Middle East Respiratory Syndrome 3- Moderate Coronavirus (MERS-CoV)

15 Severe Acute Respiratory 3- Moderate Syndrome (SARS)

16 Scabies 4- High

17 Brucellosis 4- High

18 Rubella 4- High

19 Meningitis 4- High

20 Severe Acute Malnutrition 4- High

21 Flooding 4- High Figure 1. Calculated Risk Index of Hazards for Risk Assessment Exercise Vulnerability and Capacity Analysis Based on the hazard analysis findings the multisectoral team selected the major national public health emergency hazards and conducted a vulnerability and capacity assessment on each hazard. Community and health system perspectives were considered when assessing the capacities and vulnerabilities of the selected priority hazards. Parameters and indicators for both capacity and vulnerability were developed by the multisectoral experts. Using the available data sources, which included surveillance reports, data from national surveys, and other 6 administrative reports, capacities and vulnerabilities were identified and quantified for each priority hazard. The key findings are summarized in Figures 2 and 3. Figure 2. Calculated Vulnerability Index of Selected Priority Hazards Figure 3. Calculated Capacity Index of Selected Priority Hazards 7 SWOT Analysis and Situational Assessment of Existing Capacity In order to identify the strengths and weaknesses across all relevant areas, including governance and political commitment, human resource, and infrastructure, a situational assessment was conducted. Possible opportunities and threats were also identified during this SWOT analysis, the outcome of which is provided in Table 2. Table 2. Strength, Weakness, Opportunities, and Threats Assessment (SWOT) No Perspectives Situational Assessment Strength Weakness Opportunities Threats

1 Governance  Strong political  Competing priorities-  The focus  Conflicts in and political engagement during Inadequate attention for given by neighboring environment public health public health emergency global countries and emergency response (PHE) preparedness political and influx of  Improved  Poor awareness and health refugees parliamentary ownership of political communities  Political engagement in leaders on public health for public instability in health security security health Horn of Africa  Public health  Gaps in legal frameworks emergencies and risk of security is for implementation and public terrorism addressed by the coordinated public health health country strategic emergency management emergency plan (GTP II) and managemen aligned sectorial t plans

2 Coordination  Presence of the  Limited collaboration and  Expanding  Presences of and national disaster risk coordination among private sectorial partnership management different sectors and sector and emerging and commission to stakeholders development existing coordinate national  Inadequate partners competing response for PHE communication among  Interest of priorities  Presence of different sectors external multisectoral Public  Unclear role and academic Health Emergency responsibility of PHEM institutes Management structures and (PHEM) structures at  Weak performance of organization different levels multisectoral PHEM s to work on  Establishment of the structures at different public health National One Health levels security Steering Committee  Limited partnership with  Existing private sector and multisectoral professional associations biannual food security and health risk assessment

3 Financial  Government  Inadequate financial  Presence of  Economic resource and commitment to resource international inflation and financial allocate greater  Weak resource support for fast change in administratio proportion of budget mobilization scheme IHR world n for development  Delay in procurement implementati economy sectors and procurement system on (such as  Strong financial  Weak financial efficiency Global auditing system and utilization Health Security 8 Agenda fund)

4 Human  Presence of  Inequitable distribution of  Improvemen  Skilled human resource and community workers human power t of local resource drain human at the health and  Inadequate human universities resource agricultural sectors power for specialized to management  Expansion of case management and partnership Ethiopian Field subject matter experts with Epidemiology and  Inadequate human international Laboratory Training power for chemical and academic Program radiological hazards institutes  Expansion of  Poor coordination to  Availability academic institutes utilize human resources of at different level for international effective PHEM training  Compromised quality of opportunities human power production  Lack of motivation and commitment of human resource

5 Infrastructure  Expansion of health  Inequitable distribution of  Focus given  Geographic and facilities all over the health infrastructures for challenges to technology country  Poor quality and infrastructur expand  Expansion in road, interruption in power and e infrastructure electric power, and communication facilities development and communication  Limitations in diagnostic  Intercountry technologies infrastructures equipment and cooperation  Infrastructure  Improvement in capabilities for damages due diagnostic  Inadequate veterinary infrastructur to natural equipment and facilities e incidents capabilities  Inadequate facilities to development  Government deliver specialized care commitment for  Limited transportation infrastructure facilities for emergency development management (such as search and rescue)  PHEM system is not supported with automated system

6 Natural  Presence and  Inadequate  Focus given  Difficult environment coordination of preparedness level to for impact of landscapes of national metrology reduce impact of climate climate the country agency change change  Impact of  The national  Limited capacity of impact on climate strategic plan national metrology developing change (such incorporates agency countries as effect of El strategies for climate  Limited coordination of and green Niño) change resilience sectors for response of economy  Recurrent system natural hazards drought  Continuous  Limited capacity on multisectoral risk search and rescue and assessment to emergency medical team anticipate effect of climate change on food security and health

7 Community  Improvement in  Difficulties to address the  Presence of  Sporadic conditions health seeking health needs of development conflicts behavior pastoralist community partners  Impact of  Reduction in  Poor knowledge and working on climate illiteracy status practice on disease community- change 9  Improvement in prevention based health leading to poverty index  Cultural taboos and care internal  Establishment of harmful traditional  Improved immigration community health practices engagement  Change in development army of private global  Strong informal sector on economy community community affecting structures that can health affordability of be used for health services health services communication

8 Systems for  Availability of early  Weak early warning  Support from  Presences of public health warning system at system at different international emerging and security different sectors sectors community existing  Designated IHR  Gaps in standardization to develop competing focal person of activities and systems PHEM priorities  Presences of for public health security system  High turnover surveillance system  Weak surveillance  focus given of senior staff for selected human system for selected by WHO to and animal events human and animal strengthen  Operational PHEOC events IHR and  Absence of strong public health surveillance system for emergency chemical and radiological managemen hazards t system in  Gaps in standardization member of sectorial and inter countries sectorial activities and systems for PHE response Risk Appraisal and Key Management In order to account for any potential risk which may jeopardize the plan and its implementation, a risk appraisal was conducted whereby possible risk mitigation interventions were identified, which is provided in the table below (Table 3). Table 3. Key Uncertainty and Assumptions Associated with the Plan Category Uncertainty/Risk Assumptions/Intervention Governance and political  Conflicts in neighboring  Implementation of refuge basic social service environment countries and influx of framework refugees  Engagement of the United Nations High  Political instability in Commissioner for Refugees and the Administration horn of Africa and risk of for Refugees and Returnees Affairs terrorism Coordination and  Presences of sectorial  Full use of PHEM surveillance system and sharing partnership emerging and existing weekly epidemiology report with One Health competing priorities partners and other stakeholders  Strengthening One Health platform  Establishment of National Health Security Council Financial resource and  Economic inflation and  Creating strong partnership with relevant sectors financial administration fast change in world and international organizations economy Human resource and  Skilled human resource  Implementation of plans which have been developed human resource drain on workforce management 10 Infrastructure and  Geographic challenges  Regular review of reporting coverage in the PHEM technology to expand infrastructure surveillance system and providing support to close technologies gaps with respective health bureaus and districts  Infrastructure damages  Provide report of internet capacity to health bureaus due to natural incidents and districts to Ministry of Communication and Information Technology and other relevant stakeholders to support expanded infrastructure and bandwidth  Regular review of reporting coverage and PHEM surveillance system at all levels  Strengthening the Health Service Extension Program for Community and Event-Based Surveillance Natural environment  Difficult landscapes of  Strengthening the Health Service Extension the country Program for Community and Event-Based  Impact of climate Surveillance change (such as effect of El Niño)  Recurrent drought Community conditions  Sporadic conflicts  Implementation of health insurance at community  Impact of climate level change leading to internal immigration  Change in global economy affecting affordability of health services Systems for public health  Presences of emerging  Full use of PHEM surveillance system and data security and existing competing sharing with One Health partners and other priorities stakeholders  High turnover of senior  Implementation of Event-Based Surveillance System staff  Strengthening preparedness and surveillance through One Health approach  Implementation of plans which have been developed on workforce Moreover, to understand the current situation with regards to IHR (2005) implementation, a situational assessment of the key policy technical areas was conducted, the outcome of which is summarized in Table 4. Table 4. Situational Assessment for IHR (2005) Implementation, Key Policy Technical Areas Sub-Indicator Status Name of document(s) in which this is present Notes/key text (Y/N) Preparedness and coordination National Health Security No  Draft document Under development Council Coordination at all levels Yes Terms of reference (TOR) on the following:  National Disaster Risk Management Taskforce  Public Health Emergency Management Taskforce Coordination at national Yes TOR on the following: level  One Health Steering Committee endorsed Memorandum of Understanding (MOU)  Antimicrobial resistance  Zoonotic diseases (anthrax, rabies, highly 11 pathogenic avian influenza)  Linking public health with Law enforcement Risk profile/assessments Yes  Performance of Veterinary Sector (PVS) Diarrheal diseases,  evaluation and analysis vaccine preventable  Joint External Evaluation of IHR Capacities of diseases, hemorrhagic the Federal Democratic Republic of Ethiopia fevers, and zoonotic  Vulnerability Risk Assessment and diseases were Mapping/WHO Strategic Tool for Assessing prioritized in the Risk NAPHS Preparedness at all Yes  National and Regional Epidemic Preparedness levels and Response Plan for Public Health Emergencies Preparedness at national Yes  National One Health Strategic Plan level  National Anthrax Prevention and Control Strategic Plan (2018–2022)  National Rabies Elimination Strategic Plan  Highly pathogenic avian influenza preparedness plan  National AMR Plan Detection capacity and communication Early warning system Yes  National Disaster Risk Management Early Warning System  Public Health Emergency Management Guidelines Event-based Yes  Draft guideline on Event Based Surveillance surveillance System  Draft Guideline on Community Based Surveillance System Disease surveillance Yes  Public Health Emergency Management Guidelines Laboratory surveillance Yes  Public Health Emergency Management Guidelines Risk communication Yes  Draft Public Health Emergency Risk Communication Guideline Response capacity Rapid response team Yes  Draft Technical Manual  Draft Administration Manual Emergency Operation Yes  National Emergency Operation Centre Regional-level disaster Center and Incident Guideline developed by Disaster Risk risk management and Management System Management Commission (NDRMC) PHEOCs are in the  National Public Health Emergency Operation process of Center (PHEOC) establishment Linking public health and Yes  Draft Manual for Management of Bio-threats law enforcement Summary of JEE and PVS Assessments The Joint External Evaluation (JEE) of the core IHR capacities of IHR conducted in 2016 has highlighted some of the existing strengths and identified major gaps in some of the country’s capacities. The strongest capacity was observed for the action package “National Legislation, Policy, and Financing” with demonstrated capacity observed for all indicators under this action package. On the other hand, no capacity was identified for the action package “Chemical 12 Hazards” making it one of the poorest performing thematic area. The comprehensive summary of the Ethiopian JEE can be found under Appendix A. Based on the Performance of Veterinary Sector (PVS) evaluation, professional staffing in central and regional veterinary service is adequate, but varies at the woreda and sub-woreda level. Additionally, there is stability of structures and sustainability of policies, operational funding and veterinary laboratory diagnosis at central and regional level. Despite this, some key gaps still exist and should be the focus for the immediate future. The following areas were identified as having key gaps during PVS Evaluation:  Professional competency (veterinary and paraprofessionals)  Veterinary service chain of command between federal and regional bureaus  Enacting the new legislation for the veterinary statutory body  Limited field staff technical capacity  Consistency of slaughterhouse hygiene and inspection  Residue testing  Animal product (milk) safety  Livestock and product traceability Current Status and Progress on Prevention, Detection, and Response Endemic and epidemic infectious diseases, emergence of newly discovered pathogens, drug resistance, and outbreaks of emerging and re-emerging zoonotic diseases are causing substantial personal and economic loss in the human, livestock, and environment sub-sectors of the country. In Ethiopia, the human and animal sectors have their own surveillance systems at all levels that help to anticipate prevention, preparation for, early detection and response for health emergencies in their respective sectors. Approach Followed to Develop the NAPHS The development of the NAPHS was a multi-stage process involving advocacy, capacity building activities, frequent multi-sector meetings, review of and aligning with existing plans and guidelines. The core activities carried out as part of the NAPHS development included:  Capacity building of the country by WHO on Training of Trainers on National Action Plan for Health Security in Nairobi, Kenya (October, 2017)  Advocacy work for technical and leadership team on the need for development of NAPHS on different forums  Dissemination of the planning matrix and JEE findings among stakeholders during different forums, and email communication by the National Steering Committee Chairperson  Preplanning workshop preparation by members of line ministries including o Preparation and review of documents, assessments, and plans o Review of JEE findings, existing sectoral plans, global, regional and national strategies, vulnerability and risk assessment mapping documents, epidemic 13 preparedness and response plan, assessment findings and achievements made after the JEE evaluation o Sectoral exercises supported by partners on the following: Prioritization of JEE findings, updating JEE score, and use of planning matrix o Analysis of reference materials available in the Global Health Security Agenda library and WHO/IHR website  Conducted workshop on NAPHS development (November, 2017) o Opening remark made by the State Minster of Health o The workshop was attended by the leadership team of line ministries o Seventy-one multidisciplinary experts from invited stakeholders attended, and contributed to the planning exercise o Formation of four groups (each with chair and secretary from line ministries) taking in to consideration the pool of experts and sector representation for the components of IHR  Capacity building for two officers from the Government (including the IHR focal person) on the NAPHS Monitoring and Evaluation, (December, 2017)  Conducted workshop to review and cost the NAPHS, April 30-May 2, 2018  Prioritization of activities carried out by selected experts from each sectors following the costing exercise. All the prioritization from the sectors were reviewed and updated in a consultative meeting held (June, 2018).  Frequent consultative meetings between the chairs and secretaries of the four groups to review work done by the wider team and to ensure incorporation of the inputs and comments 14 CHAPTER 3. STRATEGIC FRAME-WORK AND IMPLEMENTATION APPROACH Vision and Mission of the National Action Plan for Health Security Vision of the National Action Plan for Health Security A nation with secured capacity that ensures community resilience for public health threats and their impacts Mission of the National Action Plan for Health Security To improve the health, social, and economic status by reducing health security threats through multisectoral coordination, quality human infrastructure and financial resources, and health management system that assures continuous community participation and engagement Strategic Pillars of the NAPHS The following three pillars were identified as being necessary for the achievement of the aforementioned vision of the NAPHS. Preparedness and Coordination In this strategic thematic area, the focus is on continuous and sustainable improvement in multisectoral coordination. This includes: public and law enforcement sectors, national health security system with legal and policy guidance, and the One Health platform. The thematic area also includes developing national preparedness capacity to national health security threats, through improvement in medical counter measure system and filling the potential gaps in human, financial and medical facilities, and supplies. Detection Capacity and Communication This thematic area is aimed at developing the national anticipation and early detection capacities for multihazard (biological, chemical, radiological, and environmental) health security threats. All relevant sectors are expected to improve the capabilities in surveillance, analysis, and diagnostic infrastructure and system in all segment of the country including at points of entry with improved public risk communication and coordinated and clear system for within and among sectors. Response Capacity The purpose of this thematic area is to strengthen and sustain the response capacity at all levels to incidences of multihazard national health security threats. All relevant sectors are expected to develop and expand the technical, leadership, coordination, and infrastructure for incident management system and Emergency Operation Centers (EOCs). The thematic area also includes developing national-, regional-, and district-level response capacity and systems. 15 Vision A Nation with Secured Capacity that Ensures Community Resilience for Public Health Threats and Their Impacts Preparedness and Detection Response Coordination Capacity and Capacity Communication Core Values Community First Sense of Urgency Collaboration Continuous Improvement Accountability Integrity Leadership Sustainability Transparency Adaptability Equality and Inclusion Figure 4. The National Action Plan for Health Security Strategic Management House Strategic Objectives and Description The above mentioned three strategic pillars further align with more than 74 objectives under the

46 JEE indicators of the 19 action packages indicated in the IHR to improve health security. The proposed objectives were based on recommendations stated in the JEE assessment report. The impact-level target of the NAPHS by 2023 is to attain a demonstrable capacity of IHR requirements to detect, prevent, and respond to different health security issues. To achieve this and other impact and outcome targets set for the coming five years, a set of activities have been identified under each objective of the four main IHR health security thematic areas (Prevent, Detect, Response, and Other Hazards). Some of the objectives and proposed activities are indicated below with the detailed activity plan provided in Appendix C. Prevent To achieve demonstrable capacity in preventing health threats, a set of objectives and activities are planned under the action packages of national legislation, policy, and financing; IHR coordination, communication, and advocacy; antimicrobial resistance; zoonotic disease; food 16 safety; biosafety and biosecurity; and immunization. These include:  Strengthen and operationalize a sustainable multisectoral coordination and collaboration mechanism for IHR implementation  Review and incorporate newly developed/revised legislation for facilitation of IHR implementation in all stakeholders’ key protocols, standards, guidelines, and standard operating procedures (SOP)  Establish information communication mechanisms between sectors and neighboring countries  Establish antimicrobial resistance (AMR) surveillance system from the human-animal- environment interface (ecosystem)  Establish antibiotic stewardship program in at least 400 health facilities  Revision of directives, guidelines, and prescription requirements for rational use of antimicrobial medicines in humans  Strengthen legal requirements for prescription on use of antimicrobial medicines in animals, based on their rational use  Enhance the linkage between the surveillance system, information communication, and diagnostic laboratory system within the public health sector and between the public and animal health and improvement of the workforce development  Establish an interagency strategy, plan, or mechanism for zoonotic diseases prevention, detection, and control at the federal and subnational level  Improve a mechanism to detect, report, investigate, and trace back foodborne disease outbreaks and expand the laboratory testing capacity and monitoring activities for food safety issues  Improve capacity and compliance on biosafety and biosecurity system by developing legislation and policy documents, training personnel, monitoring laboratory facilities, and protecting the environment  Improving the national Immunization program by expanding vaccination coverage for measles to 95% and introducing yellow fever and meningitis vaccines in the routine immunization program  Enhancing the vaccination for rabies and anthrax in animals, improving vaccine supply chain management, increasing the availability of appropriate cold chain equipment in health posts from 23% to 53%, and increasing the local capacity of human and animal vaccine production Detect The capacity to detect public health threats will be sustained in Ethiopia by implementing the proposed objectives and activities under the action packages of National Laboratory System, Real-Time Surveillance, Reporting, and Workforce Development. These include:  Strengthen and expand laboratory capacity for detection of identified priority diseases, specimen referral, and transport system at national and international and quality management system in human and animal laboratories at all levels  Enhance the real-time surveillance system through establishing a fully functional event- based surveillance system, implementing interconnected and interoperable electronic reporting and surveillance data sharing system between relevant line ministries, strengthening the public health syndromic surveillance system specifically for influenza, 17 acute febrile illness, febrile rash cases, and acute flaccid paralysis, and training of health care workers, surveillance officers, and community educators  Improve the workforce capacity through short-term trainings, drill exercises, expansion of field epidemiology training program and frontline field epidemiology training program training programs, doctoral programs in Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) on medical, laboratory and veterinary track in eight universities in order to have one field epidemiologist in each woreda. Respond The IHR core response capacities focus on the following action packages: preparedness, emergency response operations, linking public health and security authorities, medical countermeasures and personnel deployment, and risk communication. The major plans proposed under this thematic area include:  Improving the multihazard emergency preparedness, public health emergency coordination, risk assessment, and risk mitigation system at national and regional levels through engagement of different sectors and partners, establishment of rapid response teams, identification of priority hazards and preparedness plans, fulfillment of logistics and supplies, etc.  Enhance the Emergency Operation Center (EOC) workforce and logistics and coordination activities through the establishment of regional EOC and formulation of guidance and protocols and trainings.  Improving the coordination in early detection and multisectoral rapid response capacity in public health and law enforcement sectors toward biothreats at national and regional level through joint investigation and responses, information sharing, and communications and by increasing detection capacity in both sectors.  Strengthening the process of sending and receiving medical countermeasures (MCM) during a public health emergency by developing guiding protocols on MCM stockpiling, deployment, and operational plan for response; deploying personnel, building partnerships, and mapping resources within country and international partners; identifying and building capacity of points of contact at relevant multisectoral organizations and international partners; developing a strategic framework to nationally prioritize resources and investments in MCM; and establishing one national and four regional emergency hubs for storage of MCM.  Improving the risk communication systems in emergency situations by establishing a risk communication coordination mechanism among government sectors, partners, and other stakeholders and availing of necessary supplies, information sharing, mapping of relevant resources sites, and interlinked information system. Other Under the action packages of points of entry, chemical events, and radiation emergencies, various activities are planned with the aim of achieving demonstrable capacity based on the IHR requirements. The major proposed plans include:  Enhancing the core capacities in response to public health emergencies at Point of Entry (POE) to early detect and prevent the introduction of hazardous materials/products and 18 monitor and control imported products, immigration of risk groups, and so on. This will be achieved by: o Training law enforcement staff, custom inspectors, and healthcare workers; providing community awareness on hazardous imported products o Expanding and strengthening the facilities diagnostic system (mini-laboratories and clinics), inspection system, and movement control management system at POE sites o Establishing a cargo scanning system (radiation portal monitoring device) o Developing legislation protocols for certification for Public Health Emergencies of International Concern (PHEIC) and Transboundary Animal Diseases (TAD) o Establishing a cross-border collaboration and coordination mechanism with neighboring countries o Formulating a rapid response team at POE for emergency situations  Establishing human isolation and quarantine center while improving and expansion of quarantine stations for animals  Establishing mechanisms and core capacity for detecting, managing and responding to chemical events or emergencies in the nation. The core capacities in this action package will be achieved by: o Training on chemical events surveillance o Creating awareness about chemical events for the general public o Availing 24/7 reporting mechanism for community reports (poison center free hotline) and health system report (using electronic reporting tool) o Conducting risk profile (risk assessments) for chemical agents in the nation and prepare preparedness and response plan o Strengthening laboratory diagnostic capacity for potential chemical agents o Establishing poison centers at major hospitals o Developing chemical hazard management guideline and reporting tools o Establishing a chemical incident control zones (access control points and delineating a contamination reduction corridor)  Establishment of chemical disposal facility at national level  Improving the national capacity for detecting and responding to radiological and nuclear emergencies. The capacities will be achieved by: o Developing guidelines, protocols, and radiological and nuclear emergency response plan o Conducting a regular risk analysis o Providing radiation detection device, protective devices and supplies, and personal protective equipment for emergency response to the national radiation authority and POEs o Improving waste storage and processing facilities (including the laboratory for conditioning of radioactive sources)  Improving laboratory capacity to perform systematic analysis of radiation samples using bioassays, biological dosimeter by cytogenetic analysis, and electron spin resonance or other bio-dosimetry analytical tests 19 Key Assumptions for NAPHS Development and Implementation To understand and prepare for internal and external risks and to capitalize on existing internal and external enablers, a situational assessment was conducted to ensure effective and efficient design and implementation of the national health security action plan. Based on the situational assessment findings (indicated in Chapter 2), key assumptions crucial for development and successful implementation of the NAPHS are summarized below:  Political commitment and leadership for implementation of the NAPHS will be improved through continuous strategic engagement, awareness development, and advocacy.  Multisectorial coordination and collaboration with local and international stakeholders will be strengthened on planning, implementation, monitoring, and evaluation of the plan by building and systematizing existing multisectoral platforms at all levels.  Government commitment to allocate financial resources will be strengthened and effective partnership and resource mobilization will be conducted to cover the budget deficit for implementation of the national health security plan.  Existing effort to develop human resources and infrastructure will continue, and improvements will be made on quality and equitable distribution.  Planning, implementation, monitoring, and evaluation of the national health security plan will be based on strong community engagement and community demand.  Environmental, climatic, and human-made challenges, such as internal and external conflicts, are assumed to be expanding. Due focus has been given to these issues during planning and their impact will also be considered during the implementation of the plan.  Planning and costing of the NAPHS is aligned with the national policies, strategies, and financial regulations. The costing also considers Ethiopia’s socioeconomic growth demand and the situations in the global economy for the next five years (2019–2023). Linkage and Interoperability of the NAPHS with Other Strategies The NAPHS has made necessary consideration for alignment with HSTP, GTP II, the Ethiopian Public Health Institute’s Second Strategic Management Plan (EPHI-2nd SPM), Veterinary Sector Transformation Plan, and other relevant documents including the integration into planning and budget cycle. The synergy and match between the strategic plans, in particular with the Livestock Master Plan, is mandatory for financing, priority issues, and delivery of services. The national One Health platform, which has been coordinating and actively involved in the NAPHS planning process, has also played a significant role in ensuring the incorporation of critical programmatic areas and activities, and the right level of linkage among the key One Health sectors. A brief summary of the desktop review of the alignment of NAPHS with other relevant national plans/document is provided in Table 5. 20 Table 5: The Synergy and Match Between NAPHS and Other National Strategic Plans No NAPHS Other Strategies

1 National Legislation, CB4: Enhance policy and procedures Policy, and Financing Development of policies, standards, laws, manuals and operational procedures for betterment of the health of all Ethiopians Enhance veterinary governance, in line with the World Organization for Animal Health (OIE) PVS Pathway (MOA, GTP II) [3,11]

2 IHR Coordination, P2: Improve health emergency risk management Communication, and Strengthen health sector and multispectral coordination Advocacy mechanisms to facilitate joint action on risk reduction, response, and recovery CB3: Enhance communication, collaboration, and partnership (EPHI-2nd-SPM) [13]

3 Antimicrobial Resistance P4: Improve regulatory system Implement measures and programs to tackle antimicrobial resistance Strengthen the knowledge and evidence on antimicrobial use and resistance through one-health surveillance and research (Strategic plan on containment and prevention of AMR) Administer and control the quality, safety and efficacy of veterinary drugs and biological products (MOA-GTP II, VDFACA, EFMHACA) [14,15,18]

4 Zoonotic Disease P2: Strengthen health sector and multisectoral coordination mechanisms to facilitate joint action on risk reduction, prevention, response of infectious diseases Strengthen veterinary public health services to combat zoonotic diseases (MOA-GTP II, LMP) [11, 15] Strengthen livestock disease surveillance and information systems (MOA-GTP II, LMP & NAHS) [11, 15] Strengthen veterinary public health services to combat zoonotic diseases (MOA-GTP II, LMP & NAHS) [11, 15]

5 Food Safety P4: Improve regulatory system Build and maintain adequate food systems and infrastructures to respond to and manage food safety risks along the entire food chain, including during emergencies (EFMAHACA) [16]

6 Biosafety and P2: Education and information to build culture of health, Biosecurity safety, and resilience and following good management practice [17]

7 Immunization P1: Improve Equitable Access to Quality Health Services Increase the proportion of fully immunized children, from 86% to 95% Development and technology transfer of a reliable 21 thermostable vaccine against major livestock diseases (MOA- GTP II, LMP & NAHS) [11, 15]

8 National Laboratory CB1: Enhance Use of Technology and Innovation System Strengthen the human and laboratory capacity of research institutions and linkages with industries and linkage of lab networks with surveillance P2: Strengthen real-time surveillance and event monitoring mechanisms (EPHI-2nd-SPM) [13] C3: Increase and maintain quality assured laboratories [13] P5: Enhance laboratory quality management system implementation (EPHI-2nd-SPM) [13] P6: Strengthening laboratory capacity for referral and backup testing services (EPHI-2nd-SPM) [13] Improve national capacity for early detection and response to animal health emergencies (MOA-GTP II, LMP & NAHS) [11, 15]

9 Real Time Surveillance CB1: Enhance use of technology and innovation Use of e-Health services (e-HMIS, EMR, M-health) Telemedicine and tele-education Strengthen survey and surveillance systems P2:Improve health emergency risk management Strengthen real-time surveillance and event monitoring mechanisms (like e-surveillance and linkage of lab networks for surveillance) P1: Improve public health surveillance system (EPHI-2nd-SPM) [12] Strengthen livestock disease surveillance and information systems (MOA-GTP II, LMP & NAHS) [11, 15]

10 Reporting P8: Improve research and evidence for decision making strengthen routine reporting and performance monitoring and health information systems (EPHI-2nd-SPM) [13]

11 Workforce Development CB2: Improve development and management of HRH availability of adequate, competent, motivated and committed health professionals, increase stock of health workforce disaggregated by cadres and regions) from the current 0.8/1000 to 1.6/1000 CB1: Improve Human Resource Development, management and Governance (EPHI-2nd-SPM) [13]

12 Preparedness P2: Improve health emergency risk management, enhance regular risk assessment and early warning, emergency preparedness for effective health system response and recovery P7: Increase government budget allocation to the health sector P4: Improve public health emergency preparedness (EPHI-2nd- SPM) [13]

13 Emergency Response P2: Improve health emergency risk management, establish EOC 22 C2: Improve public health emergency response and rehabilitation (EPHI-2nd-SPM) [13] Improve national capacity for early detection and response to animal health emergencies (MOA-GTP II, LMP & NAHS) [11, 15]

14 Linking Public Health Not available and Security Authorities

15 Medical P5: Improve supply chain and logistics management, rational countermeasures and use of medicines (EPHI-2nd-SPM) [13] Personnel Deployment

16 Risk Communication P2: Improve health emergency risk management, enhance regular risk assessment and early warning

17 Points of Entry Strengthen the quarantine and inspection system to reduce the risk of introducing and disseminating livestock diseases through the export and import of livestock and livestock products

18 Chemical Events P5: Integrated pharmaceutical waste management

19 Radiation Emergencies Improving the radiation protection capacity (Ethiopian Radiation Protection Authority ) Additional documents reviewed and considered in the preparation of the NAPHS include, internal assessment of the EFETP workforce development program [19], Global Health Security Agenda (GHSA) action packages [20], national public health laboratory safety guideline [21], national prevention and control plans on anthrax and rabies [22,23], and the national public health emergency management guideline [24]. National Health Security Stakeholders and Coordination Mechanism The preparation and implementation of NAPHS involves the support from a wide variety of stakeholders, including international development partners and local partners, through the global leadership of WHO and country ownership at all levels. The FMOH is primarily responsible for ensuring IHR 2005 ownership and coordination of implementation toward ensuring national health security. The FMOH is mandated to undertake the coordination and monitoring of IHR implementation in the country through its technical wing, the Ethiopian Public Health Institute, based on the IHR Implementation EPHI Regulation No. 301/2013, which states: “implement International Health Regulations on grave Public Health Emergencies having implications of International crisis.” The overall implementation of the plan will be monitored through the IHR monitoring framework which includes the State Parties Self-Assessment Annual Reporting (SPAR), Joint External Evaluation (JEE), Simulation Exercise (SimEx) and After Action Review (AAR). The implementation and monitoring of the National Action Plan for Health Security (NAPHS) requires multisectoral engagement and a multisectoral coordination mechanism at all levels of the administrative system, including the regional states. The national One Health coordination 23 platform which has been functional since August 2016 played a significant role in engaging the relevant sectors in the development process of the NAPHS and SPAR 2018. In order to ensure a more sustainable national multisectoral coordination mechanism, the country has already proposed the establishment of National Health Security Council (NHSC) structure under the Prime Minister’s Office to oversee and provide guidance to National Health Security Management and the implementation of NAPHS. The members of the National Health Security Council represent more than 16 relevant government sectors (line ministries/parties), and include the FDRE Communication Commission, the National Intelligence and Security Agency, and the Ministry of Federal Affairs. It has been recommended that the sustainable One Health platform can also be located under the proposed NHSC secretariat, which will have a clear set of roles and responsibilities in coordinating the planning and implementation of One Health-related multisectoral activities through the One Health approach. The NAPHS development process can be recognized as effective multisectoral experience in the country, in which relevant competent multidisciplinary experts, drawn from at least 11 sectors, have been engaged in the preparation of the plan. Accordingly, the health security stakeholders involved in the NAPHS preparation include: FMOH (EPHI; Food, Medicine, and Health Control and Administration Authority [FMHACA]; Pharmaceutical Fund and Supply Agency [PFSA]); Ministry of Agriculture (National Animal Health Diagnostics and Investigation Centre, National Veterinary Institute, Veterinary Drug and Feed Administration and Control Authority); Ethiopian Ministry of Defense; Ministry of Peace (Federal Police Commission, National intelligence); Ministry of Innovation and Technology; Ministry of Education (including Higher Education Institutes); Environment, Forest ,and Climate Change Commission (relevant directorate and Wildlife Conservation Authority); Ethiopian Radiation Protection Authority; Ministry of Trade and Industry; National Custom Authority; Ministry of Finance and Economic Cooperation; and Ethiopian Civil Aviation Authority?. The National Disaster Risk Management Commission (NDRMC) is also one of the key health security stakeholders that has been involved in the NAPHS development, as health threats due to diseases are part of disasters. The NDRMC is responsible for national disaster management, based on the National Policy and Strategy on Disaster Risk Management (July 2013) through the involvement of multiple sectors. United Nations agencies, WHO at all levels, the Food and Agriculture Organization of the United Nations (FAO)–Ethiopia, and partners—USAID, U.S. CDC, Africa CDC, PHE, China CDC—have been actively engaged in the NAPHS development process and have provided all of the required support. The responsible key health security sectors for the implementation of the different activities under the NAPHS are given in the comprehensive objectives and activities summary provided in Appendix C. 24 CHAPTER 4. IMPLEMENTATION PLAN Strategic Objectives of Implementation Plan The NAPHS implementation plan serves as a framework to help guide the nation and facilitate collaboration and coordination among stakeholders in their pursuit of advancing the current state of national health security. The implementation plan elaborates on the priorities introduced in the NAPHS by describing specific implementation activities on which stakeholders might collaborate to address those priorities over the next five years (2019 to 2023). It is important to recognize that each activity described in the plan is subject to the availability of funds and resources. The strategic objectives (Table 6) were identified based on expert opinion and desk review, JEE recommendations, PVS recommendations, existing risk appraisals (SWOT analysis), the identified priorities in the national plans (like HSTP, Livestock Master Plan, GTP II, and other relevant documents), the IHR and OIE core capacities, review of relevant documents like the Global Health Security Agenda milestone library, and other countries’ experience. Table 6. Proposed Objectives of the NAPHS based on JEE Indicators JEE Indicator Objective/Strategic Initiatives National Legislation, Policy, and Financing Legislation, laws, regulations, P.1.1a. Review and identify gaps from all national legislation in all relevant administrative requirements, stockholders that will facilitate the IHR implementation by 2019 policies, or other government instruments in place for P.1.1b. Monitor adoption and incorporation of additional policies within all implementation of IHR stakeholder’s national sector plan to facilitate the core and expanded functions of the IHR National Focal Point by 2019 The state can demonstrate P.1.2a. Establish and operationalize the national public health security council and that it has adjusted and technical working group to strengthen multisectoral coordination and collaboration for aligned its domestic IHR implementation by 2019 legislation, policies, and administrative arrangements P.1.2b. Review and incorporate newly developed/revised legislatives for facilitation to enable compliance with the of IHR implementation in all stakeholders’ key protocols, standards, guidelines, and IHR (2005) standard operating procedures (SOP) and provide training/refreshment training across all relevant sectors by 2019 IHR Coordination, Communication, and Advocacy A functional mechanism is P.2.1a. Increase awareness about IHR implementation across sectors established for the coordination and integration P.2.1b. Strengthen the multisectoral coordination between all stakeholders at of relevant sectors in the national level 2019 implementation of IHR. P.2.1c. Establish information communication mechanism between sectors and neighboring countries by 2019 Antimicrobial Resistance Antimicrobial resistance P.3.1. Establish AMR surveillance system from the human-animal-environment detection system in place interface (Ecosystem) Surveillance of infections P.3.2. Establish a functioning sentinel sites for public and animal health AMR caused by AMR pathogens surveillance system Health care-associated P.3.3a. Establish a functioning sentinel sites for public and animal health AMR 25 infection (HCAI) prevention surveillance system and control programs P.3.3b. Establish formal plans and systematic implementation measures of biosecurity and hygiene in animal health sector and farms Antimicrobial stewardship P.3.4a. Establish antibiotic stewardship program in at least 400 health facilities activities P.3.4b. Revision of directives, guidelines and prescription requirements for use of antimicrobial medicines in human P.3.4c. Strengthen legal requirement for prescription on use of antimicrobial medicines in animals based on their rational use Zoonotic Disease (General Objective: To prevent and reduce the likelihood of outbreaks and other public health hazards and events defined by IHR (2005)). Surveillance systems in place P.4.1a. Establish linkage between the public and animal health surveillance systems for priority zoonotic by 2020 diseases/pathogens P.4.1b. Establish linkage between the public and animal health diagnostic laboratory systems and sharing of zoonotic disease information and laboratory specimens Veterinary or Animal Health P.4.2a. Enhance the workforce capacity of public health staff in controlling zoonotic Workforce diseases coming from animal to human populations P.4.2b. Engage veterinary sector with public health at the subnational and field level Mechanisms for responding P.4.3a. Establish an interagency strategy, plan, or mechanism for zoonotic diseases to zoonoses and potential prevention, detection, and control at the federal and subnational levels zoonoses are established P.4.3b. Enhance reporting of zoonotic diseases from the community to animal health workers P.4.3c. Establish an integrated zoonotic diseases reporting system from the communities to the federal level Food Safety Mechanisms for multisectoral P.5.1a. Enhance relevant multisectoral collaboration and information sharing among collaboration are established at least four sectors involved in food safety to ensure rapid response to food safety emergencies and P.5.1b. Establish a mechanism to detect, report, investigate, and trace foodborne outbreaks of foodborne disease outbreaks diseases Biosafety and Biosecurity Whole-of-government P.6.1a. Develop a comprehensive human and animal health biosafety and biosafety and biosecurity biosecurity legislation and policy document system is in place for human, animal, and agriculture P.6.1b. Promote national biosafety and biosecurity system facilities Biosafety and biosecurity P.6.2a. Improve capacity and compliance on biosafety and biosecurity system training and practices P.6.2b. Enhance biosafety and biosecurity practices Immunization Vaccine coverage (e.g., P.7.1a. Achieve measles coverage of at least 95% nationally and in all woredas by measles) as part of national 2021 program P.7.1b. Introduce yellow fever and meningitis vaccines in the routine immunization program by 2020 P.7.1.c. Vaccinate 70% of the dogs and increase anthrax vaccination coverage P.7.1d. Strengthen the coordination and joint implementation of human and animal health service delivery strategies in pastoralist regions or communities 26 Vaccine coverage (measles) P.7.2a. Strengthen data archiving, analysis and use for action at all levels by year as part of national program 2023 P.7.2b. Strengthen the existing laboratory and establish capacity to diagnose vaccine preventable diseases by 2020 and beyond National vaccine access and P.7.3a. Strengthen human resource capacity by designating cold chain focal persons delivery at all levels by 2021 P.7.3b. Train 100% of cold chain focal persons and EPI officers on vaccine supply chain management by 2021 P.7.3d. Increase availability of appropriate cold chain equipment in health posts from 23% to 53% by 2023 P.7.3e. Mobilize resource for 47% of health posts to equip them with SDD refrigerators P.7.3e. Increase local capacity of human and animal vaccines production from two to nine by the year 2023 P.7.3f. Strengthen vaccine (human and veterinary) regulatory system National Laboratory System Laboratory testing for D.1.1. Strengthen and expand laboratory capacity for detection of identified priority detection of priority diseases diseases for both public health and veterinary Specimen referral and D.1.2a. Strengthen specimen referral and transport system at national and transport system international D.1.2b. Strengthen data sharing on zoonotic diseases between human and animal health Effective modern point of care D.1.3. Establish/strengthen system for tier-specific diagnostic testing and laboratory-based diagnostics Laboratory quality system D.1.4. Strengthen Quality Management System in human and animal laboratories at all level Real-Time Surveillance Indicator and event-based D.2.1. Establishing a fully functional event-based surveillance system by 2021 surveillance systems Interoperable, interconnected, D.2.2. Establish/strengthen surveillance data reporting and multisectoral data sharing electronic real-time reporting system Establish interconnected and interoperable surveillance data sharing system system between relevant line ministries Integration and analysis of D.2.3. Improve capacity for surveillance data analysis and consumption for action at surveillance data district level by 2023 Syndromic surveillance D.2.4. Strengthen the public health syndromic surveillance system systems Reporting System for efficient reporting D.3.1. Formalize information sharing mechanism between line ministries, to WHO and OIE stakeholders, and regional and international organizations by 2019 Reporting network and D.3.2. Strengthen the national public health council and multisectoral protocols in country reporting/information sharing system by 2019 Workforce Development Human resources are D.4.1. Train 20 PhD graduates (EFELTP, entomology, and laboratory) and 400 available to implement IHR advanced EFELTP on medical, laboratory, and veterinary track in eight universities core capacity requirements in order to have one field epidemiologist in each woreda between 2019-2023 Field Epidemiology Training D.4.2. Updating and Follow up of database of FETP fellows every year from 2019- 27 Program (FETP) or other 2023 applied epidemiology training program in place Workforce strategy D.4.3a. Ensure the workforce strategy takes into account the needs of human and animal health (“One Health” approach). D.4.3b. Expand FETP training program D.4.3c. Enhance front line FETP Preparedness Multihazard national public R.1.1a. Improve multihazard emergency preparedness at national and regional level health emergency by the end of 2022 preparedness and response plan is developed and R.1.1b. Improve public health emergency coordination at national and regional level implemented by the end of 2022 Priority public health risks and R.1.2. Improve risk assessment and risk mitigation system by the end of 2022 resources are mapped and utilized Emergency Response Operations Capacity to Activate R.2.1. Ensure the legal authority and guidance group exists determine the levels of Emergency Operations PHEOC activation to respond to any public health event at federal and regional levels by 2023 Emergency Operations R.2.2. Ensure availability of validated PHEOC procedures and plans at federal and Centre Operating Procedures regional levels by 2023 and Plan Emergency Operations R.2.3. Institute and operationalize PHEOC with regular training and simulation Program exercises program to test its capability to any public health event at federal and regional levels by 2023 Case management R.2.4. Develop the case management approach for chemical and nuclear events and procedures are implemented integrate with existing incidence management for IHR relevant hazards Linking Public Health and Security Authorities Public health and security R.3.1a. Improving coordination mechanism between law enforcement and public authorities (e.g. Law health sectors (public and animal health and security authorities and others) enforcement, border control, customs) are linked during a R.3.1b. Improving early detection and multisectoral rapid response capacity in public suspect or confirmed health and law enforcement sectors towards biothreats at national and regional biological event levels Medical Countermeasures and Personnel Deployment System is in place for sending R.4.1a. Strengthen a system for sending or receiving MCMs from outside Ethiopia by and receiving MCMs during a 2019 public health emergency R.4.1b. Build a storage facility for bulk items System is in place for sending R.4.2. Strengthen a system for sending and receiving health personnel during a and receiving health public health emergency personnel during a public health emergency Risk Communication Risk communication systems R.5.1. Operationalize risk communication coordination mechanism between FMOH, (plans, mechanisms, etc.) MOA and MOFEC by end of 2019 Internal and partner R.5.2. Establish risk communication coordination mechanism among government, 28 communication and partners, and other stakeholders like private health facilities, private schools, and coordination civil society organizations by mid 2020 Public communication R.5.3. Strengthen the multisectoral multimedia approaches of risk communication in reaching out to the community by 2019–2021 Communication engagement R.5.4. Strengthen community engagement in emergencies preparedness, prevention with affected communities and control responses through engaging relevant actors by the year 2021 Dynamic listening and rumor R.5.5. Strengthen and operationalize rumor or public listening communication system management and communication activities by the year 2022 Points of Entry Routine capacities are POE.1.1a. Improve the controlling mechanism to manage people movement, animal established at POE movement and goods through ground crossing in line with WHO IHR core capacity POE.1.1b. Strengthening existing collaboration and coordination between different levels of the public health sector and other stakeholders (federal, regional, zonal, and woreda levels) Effective public health POE.2. Improve the public health response system at Point of Entry response at POE Chemical Events Mechanisms are established CE.1a. Improve preparedness for chemical hazards by risk profiling of potential and functioning for detecting chemical agents to early detect, report, and timely respond to chemical hazards and responding to chemical events or emergencies CE.1b. Facilitate and standardize the coordination and information communication of chemical events during detection, reporting, and response Enabling environment is in CE.2a. Establish mechanism for coordination and information sharing to early detect place for management of and response for chemical events chemical events CE.2b. Provide a free and confidential hotline service, treatment management advice about chemical agents (household products, medicines, pesticides, etc.) Radiation Emergencies Mechanisms are established RE.1. improve the coordination and information communication between National and functioning for detecting radiological and nuclear emergency team in detection, reporting, and response to and responding to radiological radiological and nuclear emergencies and nuclear emergencies Enabling environment is in RE.2. Revise and improve the communication and coordination mechanism among place for management of the Ethiopian Radiation Protection Authority, medical device department, and radiation emergencies national focal point Priority Activities The prioritization of proposed activities under each strategic pillar considered the existing capacity in the country, critical gaps in the existing system, the country’s financial capacity, activities considered to be critical to achieving the IHR requirements, expert opinion, and the priorities of interest of each sector. The overall five-year plan is composed of short-term plans (expected to be implemented in two years) and long-term plans (expected to be implemented in the remaining three-year period, 2021–2023). Most of the long-term plans are expansions of activities in the regions. In the first two-year period (2019–2020), all activities are aimed to make the enabling environment stronger for better coordination, information sharing, and collaboration among the relevant sectors under each indicator. The short-term priority activities under the main domains are aimed to improve the capacity to prevent, detect, respond, and others, as summarized down below. 29 Prevent During the 2019–2020 implementation period, the major targets under each indicator aim to attain the demonstrable capacity in preventing the health threats. This includes:  Revised and updated version of all the relevant legislatives, regulations, key protocols, guidelines, and standard operating procedures (SOP) for facilitation of IHR implementation in all stakeholders will be in place by 2019–2020.  Functional and sustainable national coordination platform and technical working groups (TWGs) will be in place to strengthen multispectral coordination and collaboration for IHR implementation by 2019.  Regular coordination of meetings for the national coordination platform and TWG based on the protocol.  Sensitization and awareness creation (advocacy) about IHR implementation across sectors.  Produce and distribute monthly national public health council bulletin based on monthly summary report of all relevant stakeholders and monthly activities done.  Functional AMR surveillance system in place (at least 32 AMR sentinel sites) from the human-animal-environment interface (ecosystem) by 2020.  Provision of supplies for Anti-microbial Susceptibility Test (AST) to public health clinical and diagnostic facilities (35 public health laboratories).  Provision of supplies for AST testing to animal health clinical and diagnostic facilities (15 animal health laboratories).  Conduct internal and external quality assurance testing for biological, food, environmental, and clinical samples and report results to stakeholders.  Develop and implement strategies for monitoring national AMR and drug-resistant TB burden  Develop an integrated AMR surveillance plan including reporting to the WHO and OIE (human, animal, plant, and environment).  Antibiotic stewardship program will be in place in 400 health facilities.  National multisectoral strategic plans for prevention, detection, and control of common zoonotic diseases at the federal and subnational level to be documented by 2020.  Functional mechanism to detect, report, investigate, and trace back foodborne disease outbreaks will be in place at national level by 2020.  Expand the laboratory testing capacity and monitoring activities for food safety issues in 10 regions by 2020.  Improved capacity and compliance on biosafety and biosecurity system at federal and regional level by 2019–2020.  National immunization vaccination coverage for measles to be 95% attained in all regions by 2020.  Routine immunization program for yellow fever and meningitis to be implemented starting from 2019–2020.  Vaccination coverage for rabies and anthrax in animals reaches 30% and 90%, respectively, by 2020.  Distribution of cell culture human rabies vaccine in all regions to address at least 50% of victims by 2020. 30  Avail appropriate cold chain equipment in health posts from 23% to 53% within the short term plan time frame. Detect The proposed priority activities to improve the detection capacity towards the public health security in Ethiopia aim to attain a demonstrable capacity. These include:  Efficient laboratory capacity for detection of identified priority diseases, specimen referral, and transport system at federal and regional level (two at federal and 10 at regional level in public health and veterinary sector) by 2019–2020.  Manuals, guidelines, and SOPs for specimen referral and transport system, laboratory testing for all selected priority disease conditions in place by 2020.  Fully functional Biosafety level 3 (BSL3) mobile laboratory capable of detecting highly pathogenic organisms (including highly pathogenic avian influenza, Ebola virus disease, anthrax) by 2020.  Efficient quality management system in public health and veterinary laboratories at all level based on international standards by 2020.  Fully functional event-based surveillance system in public health sector by 2020,  Fully functional, interoperable, electronic surveillance system in public health and veterinary sector in 2019–2020.  Functional interconnected and interoperable electronic reporting and surveillance data sharing system between relevant line ministries by 2021.  Syndromic surveillance system specifically for influenza, acute febrile illness, febrile rash cases, and acute flaccid paralysis will be in place in all regions in 2019–2020.  Trained healthcare workers and surveillance officers in both sectors (at least five in each district) by 2020.  Improved work force capacity through short-term trainings, drill exercises, FETP and front line FETP training programs, PhD programs in EFELTP on medical, laboratory, and veterinary track in eight universities targeting one field epidemiologist in each district. Respond The proposed plans under these thematic area aims to have at least a demonstrated response capacity for health security threats. This includes:  Functional multihazard emergency preparedness and contingency plan, public health emergency coordination mechanism, risk assessment, and risk mitigation system at federal and regional levels by 2019–2020.  Trained multidisciplinary rapid response teams will be in place in each districts by 2020.  Preparedness and contingency plans, outbreak investigation, and response guidelines and SOPs will be documented for each of identified priority hazards.  Fully functional EOC in 10 regions by 2020.  Functional coordination mechanism between public health and law enforcement sectors in place for early detection and multisectoral rapid response to biothreats at federal and regional levels.  Guiding protocols on MCM stockpiling, deployment, and operational plan for response and deployment of personnel in place in 2020. 31  Functional emergency hubs for storage of MCM by 2020. Other Under the action packages of points of entry, chemical events, and radiation emergencies, the target is to achieve a demonstrable capacity based on the IHR requirements. Some of the targets include:  At least four international airports and 12 cross-border POE attain the minimum IHR requirements by 2020.  More than 160 trained law enforcement, custom inspectors, and healthcare workers.  Functional cargo scanning system (radiation portal monitoring device) in 80% of POEs by 2023.  Endorsed and functional national legislation/protocols for certification for PHOIC and TAD.  Functional cross-border collaboration and coordination mechanism with neighboring countries.  Functional rapid response team at all POE for emergency situations by 2020.  Functional human isolation and quarantine centers in four airports and six cross-border POEs by 2022.  Functional quarantine stations for animals at six cross-border sites by 2020.  At least 80 trained experts on chemical events surveillance by 2020.  Functional 24/7 reporting mechanism for community reports (poison center free hotline) and health system report (using electronic reporting tool) by 2021.  Chemical risk profile at national level documented by 2020.  Preparedness and response plan for chemical events will be in place by 2020.  At least one functional laboratory for detection of potential chemical agents.  Thirty functional poison centers at major hospitals (10 at federal hospitals) and regional hospitals (two in each region) by 2020.  Chemical hazard management guidelines and reporting tools in place by 2020.  Endorsed guidelines and protocols for detecting and responding to radiological and nuclear emergencies and radiological and nuclear emergency response plan.  Conduct a regular risk analysis every year.  Fully functional waste storage and processing facility (including the laboratory for conditioning of radioactive sources) by 2020.  Functional laboratory capacity to perform systematic analysis of radiation samples using bioassays, biological dosimeter by cytogenetic analysis, and electron spin resonance or other bio-dosimetry analytical tests by 2020. 32 CHAPTER 5. COSTING AND FINANCIAL PLAN Costing Strategy The costing of this strategic plan is based on the existing financial governance regulations on the country. The costing inputs were generated by using the Emergency Costing Tool Questionnaire and inserted in the appropriate cells in the tool. The detailed estimation for basic inputs for costing is presented in Appendix E. The following points taken in to consideration during the estimation of the cost:  The costing inputs for the calculation of training, meetings and workshops  The costing inputs for the calculation of supervisory visits  The costing inputs for calculation of medical supplies and other logistics/ materials (lump sum)  The Current values (selling price at local and international market) for supplies and equipment The estimated cost for each action package is further categorized in the main cost drivers by each year of implementation period Budget and Financial Plan A total of 10,141,031,373 birr (368,764,777 USD) will be required for the implementation of the proposed activities under the 19 action packages—including immunization, which is 77% of the total cost—for the next five years. Considering the majority of the cost for immunization activities already budgeted, an estimated 2,328,000,793 birr (84,654,574 USD) is required for the remaining 18 action packages. The detailed budget breakdown for each activity is presented in the planning matrix. In comparison to the budget estimations for similar kind of national action plan by other countries, the estimation in this plan is relatively low and reasonable. The high population of Ethiopia, which is more than 95 million (the second most highly populated country in Africa); the limited capacity in the country for preventing, detecting, and responding to health security threats; the wide geographical area; recurrent outbreaks and health threats; and the potential high risks for emergencies and other factors are taken in to consideration in the estimated high but reasonable costs. The summary of budget breakdown is presented in the table below. Table 7. Total Cost of NAPHS per Year of Implementation for the 19 Action Packages (2019–2023) Total Cost per Year of Implementation (Local Total Total IHR Action Currency) Estimated Estimated Cost (ETB) Cost Packages 2019 2020 2021 2022 2023 (USD) National 4,060,500 4,615,000 2,258,250 1,815,000 2,258,250 15,007,000 545,709 Legislation 33 IHR 1,118,500 5,835,000 885,000 885,000 5,953,750 14,677,250 533,718 Coordination Antimicrobial 55,131,606 74,183,406 62,671,106 68,465,306 55,053,906 315,505,330 11,472,921 Resistance Zoonotic 8,188,850 43,197,200 35,723,300 22,153,000 34,582,800 143,845,150 5,230,733 Disease Food Safety 360,000 25,022,588 22,182,884 24,123,108 21,934,836 93,623,416 3,404,488 Biosafety and 17,960,580 9,226,930 7,249,680 6,330,680 6,615,680 47,383,550 1,723,038 Biosecurity Immunization 1,362,825,69 1,815,936,57 1,399,198,75 2,166,947,55 1,068,122,00 7,813,030,580 284,110,20 6 9 5 0 0 3 National 25,086,873 95,504,825 29,771,498 26,212,400 6,426,400 183,001,996 6,654,618 Laboratory System Real-Time 268,392,336 121,085,260 27,440,870 26,758,905 27,221,705 470,899,076 17,123,603 Surveillance Reporting 1,256,000 530,000 730,000 530,000 730,000 3,776,000 137,309 Workforce 104,211,160 150,841,480 109,656,480 109,917,480 110,178,480 584,805,080 21,265,639 Development Preparedness 2,527,757 23,892,132 51,685,165 40,027,757 38,954,543 157,087,354 5,712,267 Emergency 24,829,547 24,874,997 20,760,032 20,760,032 21,070,582 112,295,191 4,083,461 Response Operations Linking Public 1,666,000 1,646,000 2,545,000 577,000 1,489,000 7,923,000 288,109 Health and Security Authorities Medical 10,139,750 6,915,250 7,011,000 7,424,750 8,282,250 39,773,000 1,446,291 Countermeasur es and Personnel Deployment Risk 13,333,100 10,929,150 10,788,800 11,751,700 10,788,800 57,591,550 2,094,238 Communication Points of Entry 1,292,600 7,814,100 7,290,100 9,402,100 6,690,100 32,489,000 1,181,418 Chemical 2,146,750 3,957,750 3,887,000 4,157,600 3,837,300 17,986,400 654,051 Events Radiation 958,300 8,772,150 8,091,000 6,483,000 6,027,000 30,331,450 1,102,962 Emergencies Total 1,905,485,90 2,434,779,79 1,809,825,92 2,554,722,36 1,436,217,38 10,141,031,37 368,764,77 5 7 0 9 2 3 7 Cost Breakdown by Core Components over Years Of the total estimated cost in the five-year period, the highest budget (83% of total cost) is for the proposed activities aiming to improve the capacity to prevent health security threats (8,443,072,276 birr/ 307,020,810 USD), followed by the capacity to detect and respond. Of the total cost for the prevention capacity, the majority is for the proposed activities under immunization, followed by AMR and zoonotic disease action packages. Table 8. Summary of Budget Breakdown by Core Components of NAPHS Core Total Cost per Year of Implementation (Local Currency) TOTAL TOTAL Components (local (USD) 2019 2020 2021 2022 2023 currency) Prevent 1,449,645,73 1,978,016,7 1,530,168,97 2,290,719,64 1,194,521,22 8,443,072,276 307,020,81 2 03 5 4 2 0 34 Detect 398,946,369 367,961,565 167,598,848 163,418,785 144,556,585 1,242,482,152 45,181,169 Response 52,496,154 68,257,529 92,789,997 80,541,239 80,585,175 374,670,095 13,624,367 Other 4,397,650 20,544,000 19,268,100 20,042,700 16,554,400 80,806,850 2,938,431 Total 1,905,485,90 2,434,779,7 1,809,825,92 2,554,722,36 1,436,217,38 10,141,031,37 368,764,77 5 97 0 9 2 3 7 The estimated total cost by each implementation year shows a fairly stable yearly trend of 19%, 22%, 19%, 24%, 16% of the total cost in a period from 2019–2023 (indicated in the figure below). Figure 5. Annual Trend Estimated Cost by Implementation Period (2019–2023) Figure 6. Comparison of Estimated Cost by Core IHR Components or Thematic Areas 35 Cost Breakdown by Technical Areas of Core Components (Excluding Immunization) Excluding immunization, the six other action packages within the capacity to prevent health security threats would require an estimated cost of 630,041,696 birr (22,910,607 USD) over a five-year implementation period. Of which, the majority is for AMR (11, 472,921 USD) and for zoonotic disease technical areas. The primary cost drivers under the detection components are workforce development, real-time surveillance, and national laboratory system action packages. The very limited capacity in this component in both sectors requires significant activities and resources to improve the detection capacity for any health security threats (Figure 7). NAPHS Cost Summary Under Prevent Health Security Threats Capacity Immunization Anti-Microbial Resistance 11,472,921 284,110,203 Food Safety 3,404,488 Biosafety and Biosecurity 1,723,038 National Legislation, Policy and… 538,982 IHR Coordination Communication and… 505,082 Zoonotic Disease 5,230,732 NAPHS COST SUMMARY UNDER DETECTCTION CAPACITY Workforce Development 21,265,639 Reporting 137,309 Real Time Surveillance 17,123,602 National Laboratory System 6,654,618 Figure 7. Cost Breakdown by Thematic Areas of Prevent and Detect 36 The proposed activities under preparedness, Emergency response Operation and the risk communication are the main cost drivers under the response component. In the remaining IHR related hazards, the activities proposed to be implemented in the POE technical area are the main cost drivers followed by radiation emergencies. Considering that Ethiopia has several cross border POEs and is one of air transport hubs in Africa, this estimation is reasonable (Figure 8). Figure 8. Cost Breakdown by Thematic Areas of Response and Others 37 Budget Summary Of the total estimated cost, the highest budget item is for proposed activities aiming to improve the capacity to prevent health security threats, followed by the capacity to detect and respond. The main cost drivers of the 18 technical areas (excluding immunization) are workforce development, real-time surveillance, AMR, and preparedness technical areas, which account for 30%, 15 %, 11%, and 9%, respectively, of the total cost (Figure 9). Whereas, the main cost driver of the total budget (around 77%) is immunization, the majority of which is for the routine vaccination program for measles, polio, meningitis, and yellow fever. The allocated budget by Gavi, The Vaccine Alliance does not include proposed vaccination activities for rabies, anthrax, and animal vaccination. A summary of the main cost drivers for each thematic area is provided in Table 9. Table 9. The Main Cost Drivers per JEE Thematic Area Core Component Cost Drivers Prevent  Immunization for human and animal vaccine preventable diseases  Procurement of vaccines, supplies, and materials  Trainings and workshops for the development of relevant documents, protocols, and others  Community awareness and advocacy activities Detect  Procurement and establishment of laboratory supplies and materials (veterinary and human labs)  Establishment of BSL3 laboratory at national level  Improvement of sample collection and referral system  Training of various professionals in different subjects  Workforce development activities Respond  Establishment of EOC in all regions  Procurement of medical supplies for emergency situations  Trainings, workshops, and drill exercises of multidisciplinary professionals on emergency responses  Coordination and information-sharing mechanisms  Improvement of risk communication system Other IHR-related  Improvement of more than 15 POES hazards and points of  Establishment of additional six POEs entry  Establishment of isolation and quarantine centers at all POE sites  Establishment of mini-laboratories and mini-clinics at POEs  Procurement of supplies and materials/equipment  Improvement of radiation detection and waste disposal capacity  Procurement of radiation detection equipment  Establishment of poison centers  Building chemical poisons/waste disposal facility at national level  Trainings, workshops, and drill exercises 38 Figure 9. Compression of Cost Breakdown by Technical Areas (Excluding Immunization) 39 CHAPTER 6. MONITORING AND EVALUATION FRAMEWORK Purpose The purpose of monitoring and evaluation framework is to monitor the progress and effective implementation of the proposed activities toward the improvement of national health security. The framework also assesses the relevance, effectiveness, and impact of activities in the light of the objectives in strengthening the capacity to prevent and respond to health security threats. Specific indicators are identified based on the national action plan for health security planning matrix. Strategies Progress toward the attainment of the targets set out in this national action plan will be evaluated quarterly, annually, at midterm, and end term. To assess the interim progress of the targets, the following methods will be used:  Routine collection of data through surveillance systems in human and animal health  Midterm and annual reviews/assessments and reporting  After-action reviews, exercises, and simulations  JEEs and other relevant assessments like the PVS  Periodic supervision and facility-based surveys/assessments  Final program review will be undertaken before development of the next action plan Note: The baseline achievements until 2017 are indicated in Appendix B as a summary of health security capacities and change in capacity (Ethiopia JEE and AH scores). The general description of the monitoring and evaluation framework presented in Table 10. 40 Table 10. Monitoring and Evaluation Framework Technical area Indicator Data Milestone Target Source 2019 2020 2021 2022 2023 National policy, Availability of Updated All national Relevant legislation, regulation, legislation, and legislative national legislation in all and administrative requirements financing frameworks policies and relevant and other government that facilitate legislation stockholders that instruments that facilitate the IHR documents facilitate the IHR necessary coordination among implementation implementation the different governmental and in all sectors reviewed nongovernmental entities Adopting • Available involved in IHR (2005) additional legislations reform implementation are in place. policies or newly prepared to developed National Health legislation Sector Plan to protocol • facilitate the Incorporate core and Prepared expanded legislation, functions of regulations and IHR national other instruments focal point mandating the automatic applicability of the IHR (2005) in health sector and other sector plans IHR Availability of Technical National public Annual updates on the status of coordination, multisectoral reports, health security IHR implementation to communication coordinating TORs, council and stakeholders across all relevant and advocacy mechanisms at MOUs technical working sectors conducted each level group A functional Technical Formal information reports information communication communication mechanism mechanism between between sectors sectors and and neighboring neighboring countries in place countries in place 41 High-level Assessment • High-level Effectiveness of multisectoral advocacy and report advocacy and response activities using awareness awareness previously defined criteria is activities activities evaluated conducted conducted across across sectors sectors on on specific specific policies policies and and SOPs for IHR SOPs for IHR implementation implementation Antimicrobial Available AMR Technical • AMR • Assess Designated laboratories have resistance surveillance reports surveillance existing AMR conducted detection and system capable system in place detection reporting of all priority AMR of testing from capable of testing capacity pathogens human, animal, from the human- using WHO's and animal- and FAO's environment environment GLASS and interface ATLASS (ecosystem) tools An available Technical • Functioning Designated sentinel sites have functioning reports sentinel sites conducted surveillance of sentinel sites established for infections caused by all priority for public and public and animal AMR pathogens animal health health AMR AMR surveillance surveillance system Antibiotic Technical • Directives, • Antibiotic Designated facilities have stewardship reports, guidelines and stewardship conducted all HCAI programs programs guidelines prescription program in at implemented in requirements for least 400 400 health use of health facilities antimicrobial facilities (government medicines in established and private) human revised Formal plans HCAI plan • Formal plans • Develop Designated Antimicrobial stewardship and systematic and systematic antimicrobial centers have adherence is monitored and implementation implementation restriction conducted all regulated of biosecurity measures of policy at each antimicrobial and hygiene in biosecurity and health facility stewardship place in the hygiene in animal practices animal health health sector and sectors and farms available farms 42 Food Safety Available Technical • Enhanced Timely and systematic intersectoral reports relevant information exchange between coordination for multisectoral food safety authorities, at least six collaboration surveillance units, and other agencies and relevant sectors regarding food (FMHACA, information safety events established MOA, MOA, sharing EPHI, VDFACA among at and MoT) least four involved in food sectors safety involved in food safety Functioning Technical • Available mechanism in reports mechanisms to place to detect, detect, report, report, investigate, and investigate, and trace back trace back foodborne foodborne disease outbreaks disease outbreaks Zoonotic Available Technical • Linkage •Available A preparedness and response diseases linkage reports, between mechanism plan is in place to coordinate between public TOR, MOU public and for sharing of animal and health agencies, and animal animal health zoonotic sectors, and other stakeholders health diagnostic disease to effectively respond to priority diagnostic laboratory information zoonotic outbreaks laboratory systems and systems and established laboratory sharing of specimens disease information and laboratory specimens Engagement of Technical • Veterinary A joint FMOH and MOA plan to veterinary reports sector strengthen animal health sector with engaged with workforce programs is in place public health public health sector at all at subnational level and field level 43 Available Strategic • Prepare Timely (as defined by national strategic plan plans interagency standards) response to more for strategy, plan, or than 80% of zoonotic events of multidisciplinar mechanism for potential national and y interagency zoonotic diseases international public health response prevention, concern teams in the detection, and event of a control at the suspected federal and zoonotic subnational level disease outbreak Well- Technical • Available • Integrated • Pilot A monitoring and evaluation established reports Established zoonotic serological assessment of One Health action zoonotic system for diseases diagnostics in response to zoonotic surveillance reporting of reporting capacity for outbreaks is complete system zoonotic diseases system from at least one addressing from the the of the community community to community to prioritized level in place animal health the federal zoonotic workers level diseases for humans and livestock in target regional laboratories Training Technical • Workforce program reports capacity building available to activities for public health public health staff staff in in controlling controlling zoonotic diseases zoonotic coming from diseases animal to human coming from population animal populations Biosafety and Available Technical • Multisectoral Sustainable biosafety and biosecurity multisectoral reports, national biosafety biosecurity system is in place national TOR, MOU and biosecurity biosafety and team established biosecurity team to enhance 44 collaboration and information sharing Biosafety and Technical • Improved Incorporate •Implement a sustainable training program, biosecurity reports capacity and Biosafety and comprehensi training-of-trainers program, and training and compliance on Biosecurity in ve biosafety common curriculum practices in Biosafety and pre-service and place Biosecurity training biosecurity system program system • Enhanced biosafety and biosecurity practices Available Legislation • Comprehensive National plans for biosafety and comprehensive and policy human and biosecurity functioning and national document animal health compliance are strengthened legislation biosafety and document for biosecurity animal and legislation and human policy document biosecurity that prepared cover all the existing gaps in biosafety Vaccine Technical • Available • Introduce • Measles • Strengthen data archiving, coverage reports coordination yellow fever coverage of at analysis, and use for action at all (measles) as platform and Joint and least 95% levels by year 2023 part of national implementation meningitis nationally and in program plan for human vaccines in all woredas and animal health the routine service delivery immunization strategies in program by pastoralist regions 2019 or communities • Vaccinate 70% of the dogs and also increase anthrax vaccination coverage to strengthen the existing laboratory and 45 establish capacity to diagnose vaccine preventable diseases Improved Technical • Strengthen • Strengthen • Increase availability of national reports vaccine (human human resource appropriate cold chain equipment vaccine access and veterinary) capacity and in health posts from 23% to 53% and delivery regulatory system training on supply by 2022 mechanism chain • Increase availability of management appropriate cold chain equipment/ technology in health posts from 23% to 53% • Increase local capacity of human and animal vaccines production from two to nine by the year • Increase local capacity of human and animal vaccines production from two to nine National Laboratory Technical • Strengthen and Procedures are in place for rapid laboratory testing for reports expand laboratory virologic assessment of cluster of system detection of capacity for cases priority detection of diseases in identified priority place diseases for both public health and veterinary Available Technical • Strengthen Performing modern molecular system for reports information and serological techniques as Specimen sharing and part of a national system of referral and specimen sample referral and confirmatory transportation referral and diagnostics transport system at national and international 46 Available Technical • Available Rapid and accurate point of care Effective reports fully functional diagnostics as defined by tier modern point of system for specific diagnostic testing care and tier-specific strategies laboratory- diagnostic based testing for diagnostics animal health labs Available Technical • Available strong quality laboratory reports management system in human quality and animal laboratories at all monitoring level by 2022 system Real-time Strong indicator Technical • Establishing a • Guidelines surveillance and event- reports, fully functional implemented based guidelines, event-based for event surveillance SOPs surveillance confirmation, systems in system verification, place assessment, and notification Available Technical • Interconnected • Plans Interoperable, interconnected, interoperable, reports and interoperable developed with electronic real-time reporting interconnected, surveillance data country system, including both public electronic real- sharing system commitment to a health or veterinary surveillance time reporting between relevant sustainable systems, which is sustained by system line ministries in funding plan for the government and is capable of place interoperable, sharing data with relevant interconnected, stakeholders according to electronic real- country policies and international time reporting obligations system Analysis of Technical Data is compiled, Systematic reporting; dedicated surveillance reports, analyzed for team in place for data analysis, data for publications trends, risk assessment, and reporting generating summarized for information for decision making, decision and shared with making process stakeholders Available Technical • Available strong Regular feedback of syndromic syndromic reports, public health surveillance results to all levels surveillance publications syndromic and other relevant stakeholders systems in surveillance is disseminated place system 47 Reporting Available Technical • Fully Demonstrated ability to identify a reporting reports, functional potential PHEIC and file a report network and protocols reporting within 24 hours, and similarly to protocols in network and the OIE for relevant zoonotic country protocols disease, and has a multisectoral developed process in place for assessing potential events for reporting System in Technical • Available formal A sustainable process for place for reports information maintaining and improving efficient sharing reporting and communication reporting to mechanism capabilities and communication WHO, FAO and between line mechanisms that are backed by OIE ministries, established documentation (e.g., stakeholders, and protocols, regulations, regional and legislation.) international organizations Workforce Human Technical • 100 PHD Multidisciplinary HR capacity is development resources are reports Graduates available as required at relevant available to (EFELTP, levels of public health system implement IHR Entomiology, and core capacity Laboratory) and requirements 400 Advanced EFELTP on Medical, Laboratory and Veterinary Track in 8 universities Applied Technical • Available Three levels of FETP (basic, epidemiology reports database of FETP intermediate, and advanced) or training fellows capable of comparable applied program in tracking the epidemiology training program(s) place such as fellows in place FETP Workforce Technical • Ensure the • To improve Public health workforce retention strategy in reports, workforce workforce is tracked, and plans are in place place for strategic strategy takes into capacity to provide continuous education improving the documents account the across the and retain and promote qualified human needs of human country by workforce within the national resource in the and animal health including from system country (One Health lab and 48 approach). zoonosis field Preparedness Multihazard Public • Public health Appropriate legal instruments are national public health emergency in place to enact critical legal and health emergency coordination at administrative measures for emergency preparedne national and emergency legislation, preparedness ss and regional levels in administrative regulations, non- and response response place legislative guidelines or plan is plan standards, and non-legislative developed and agreements or arrangements implemented Priority public Technical • Available The national risk profile and health risks and reports generic resources are assessed regularly resources are emergency to accommodate emerging mapped and preparedness threats utilized and response plan at the FMOH that would address all public health risks identified in Ethiopia Emergency Capacity to Technical • Define the levels Database of PHEOC SMEs for response activate reports, of PHEOC preparedness and response is operations emergency SOPs activation, developed operations in designate a place person to manage the PHEOC facilities and Rooster staff who support EOC functions • Available national implementation plan for strengthening and functioning PHEOC 49 Emergency Technical • Available SOPs Response plans are in place that operations reports, and required describe scaled levels of center SOPs manuals for response with resource operating PHEOC operation requirements for each level and procedures and procedures for acquiring plans available additional resources Strategies in Strategic • Specific training EOC activates a coordinated place to documents and exercise emergency response or exercise strengthen programs and within 120 minutes of the emergency materials for identification of a public health operations PHEOC and emergency; response uses program surge staffs in operations, logistic, and planning place functions Case Case • Available case • Plans Appropriate staff and resources management manageme management implemented to (as defined by the country) is in procedures are nt (chemical (chemical and establish case place in management of relevant implemented and nuclear nuclear hazard) management IHR-related emergencies for IHR- hazard) protocols system that is relevant protocols integrated into an hazards interoperable, interconnected, electronic real- time reporting system Linking public Available Technical • Improved • At least one Public health and security health and linkage reports, coordination public health authorities engage in a joint security between public TOR, MOU mechanism emergency training program to orient, authorities health and and between law response or exercise, and institutionalize security protocols enforcement and exercise is knowledge of MOU or other authorities, (manuals) public health conducted that agreements (e.g. law sectors (public included enforcement, and animal health information border control, and security sharing with customs) authorities and security during a others) authorities using suspect or • Improved early the formal confirmed detection and protocol or MOU biological event multisectoral rapid response capacity in public health and law enforcement sectors toward 50 biothreats at national and regional levels Medical System is in Technical • National MCM • At least one Capacity of emergency Countermeasur place for reports, technical working response OR a deployment of MCM response to es and sending and TOR, MOU group established formal exercise emerging infectious diseases is Personnel receiving MCM • Available system or simulation tested Deployment during a public for sending or within the health receiving MCMs previous year in emergency and PCM from which MCM were outside Ethiopia sent or received • Built a storage by the country facility for bulk items System is in Guidelines • Strengthen a • Measurable Criteria and procedures for place for and system for success criteria sending and receiving health sending and technical sending and to document personnel AND has participated receiving health reports receiving health progress of in an exercise or response with personnel personnel during countermeasure regional and international during a public a public health response are partners health emergency determined emergency Risk Available risk Technical • Functional • Multisectorial Effective, regular, and inclusive communication communication reports, communication communication communication coordination with systems (plans, TOR, MOU coordination coordination is partners and stakeholders mechanisms, mechanism tested either including definition of roles, etc.) between FMOH through actual sharing of resources, and joint and MOLS, emergencies or action plans MOGAC, and simulation MOFEC exercises and updated 51 Internal and Technical • Establish The government, partners, and partner reports, risk diverse media outlets are communication TOR, MOU communicatio engaged in robust and and n coordination increasingly responsive coordination mechanism collaboration to provide health mechanism in among advice place government, partners and other stakeholders like private health facilities, private schools, and civil society Available Technical • Public Communities are equal partners mechanism in reports communication in risk communication process as place for public plan is adapted evidenced by the review of a communication to after action simulation exercise or tested by a reports from real health emergency exercises and lessons learned from actual emergencies System in Technical • A clear function • Community Communication mechanism for place for reports to receive engagement in analyzing and monitoring rumors communication audience emergencies and/or misinformation is engagement feedback or preparedness, incorporated into information with affected questions during prevention, and management communities exercises and control Dynamic Technical emergencies responses listening and reports rumor management in place Port of entry Routine Technical • Personnel are • Improved • Establish • SOP for referral Bilateral or multilateral capacities are reports trained in the the controlling cargo to public health agreements or arrangements established at decision-making mechanism to scanning or medical concerning the prevention, POE instrument and manage system authorities for detection, and response to application of the people (radiation safe isolation and international transmission of assessment and movement, portal transport of infectious diseases at POE are notification of animal monitoring suspected ill developed 52 events that may movement, device) at travelers in place, constitute a public and goods selected POE including security health emergency through and law of international ground enforcement concern (PHEIC) crossing in measures for line with WHO potentially non- IHR core compliant capacity travelers (especially in the areas that share similar language and culture) Available Technical • Available • Appropriate • Communication Effective detection, prevention, coordination reports, coordination and data strategies for and response capacity for public and TOR, MOU collaboration both management public health health emergencies at all POEs collaboration between the and reporting communications both between different levels of of records with security law the different the public health captured authorities, levels of the sector during entry travelers, travel public health and exit industries, and sector – screening general public federal, integrated into developed and regional, and public health implemented local (POEs) surveillance and with other system stakeholders Effective public Technical • Available health reports effective public response at health response POEs in place system at POEs Chemical event Mechanisms Technical • Guidelines and • Develop • Adequately Adequately resourced poison are established reports, SOPs to detect emergency resourced health center (s) are in place at national and functioning TOR, MOU, and respond to response facilities and and regional levels for detecting guidelines, chemical events plan that clinical centers and responding and in place defines the with the capacity to chemical protocols • Available roles and to manage events or capacity for early responsibilitie patients of emergencies detect, report, and s of relevant chemical timely respond for agencies in emergencies are identified potential place in place chemical agents including inventory of major hazard 53 sites and facilities Enabling Technical • Available • Chemical Outcome and evaluation of environment is reports coordination and incident control exercises and drills under a in place for information zones chemical emergency plan is management of sharing implemented to performed chemical mechanism for establish access Events early detection control points and response to and delineating a chemical events contamination • Established reduction corridor poison center Radiological Mechanisms Technical • Improved •Conduct Risk • Radiation A mechanism is in place to emergencies are established reports preparedness for analysis to monitoring exists access health facilities with and functioning chemical hazards provide basis for radiation capacity to manage patients of for detecting by risk profiling of for a graded emergencies that radiation emergencies and responding potential chemical approach to may constitute a to radiological agents to early preparedness public health and nuclear detect, report and response for event of emergencies timely respond for nuclear and international chemical hazards radiological concern emergencies Enabling Technical • Available • Relevant Outcome and evaluation of environment is reports, coordination and personnel are exercises and drills under a in place for TOR, MOU information trained for radiation emergency plan is management of communication emergency performed radiation between line response to emergencies ministers or nuclear and agencies working radiological in chemical emergencies, agents and have and are taking focal person part in regular training, drills, and exercises 54 REFERENCES 1. 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Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF. 13. Ethiopian Public Health Institute. The 2nd BSC Based EPHI’s Strategic Management Plan (2015/16 to 2019/20) 14. Veterinary Drug and Feed Administration. Control Proclamation No. 728-2011 (2011) 15. MOA (2013). Ethiopia Animal Health Strategy 16. Food, Medicine, and Healthcare Administration and Control Authority (FMHACA). (2016). Food safety regulation and its challenges. Addis Ababa: FMHACA. 17. Government of Ethiopia National Disaster Rick Management Commission. (2018). Ethiopia humanitarian and disaster resilience plan, 2018. Addis Ababa: Government of Ethiopia. 18. Food, Medicine, and Healthcare Administration and Control Authority (FMHACA). (2015). Strategy for the prevention and containment of antimicrobial resistance for Ethiopia: Second edition, 2015 to 2020. Addis Ababa: FMHACA. 19. Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP). Current Status of EFELTP and Technical Area Questions on Work Force Development for Global Health Security Agenda Internal Assessment. Tatek Bogale, EFELTP Program Director 20. Global Health Security Agenda (GHSA). (2016). GHSA Standardized Milestone Library. Amsterdam, The Netherlands: GHSA. Available from https://www.ghsagenda.org/docs/default-source/default-document-library/GHSA-Milestone- Library.pdf 21. Health and Safety Guidelines for Public Health Laboratories in Ethiopia, 1st Edition 22. National strategic plan for Prevention and Control of Anthrax (2018-2013) 23. National strategic plan for the Control and Elimination of Rabies (2018-2030) 24. Ethiopian Public Health Institute (EPHI). Public Health Emergency Management (PHEM) Guidelines for Ethiopia. 2012 55 APPENDIX A. LIST OF STRATEGIC AREAS AND JEE INDICATORS, LEVEL OF CAPACITY No Capacity Demonstrated Capacity (Score = 4) Element Limited Capacity (Score = 2) Developed Capacity (Score = 3) (Score =1) P.1.1 Legislation, laws, regulations, administrative requirements, policies, or other government instruments in place are sufficient for National implementation of IHR Legislation, Policy, and Financing 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) IHR P.2.1 A functional mechanism is Coordination, established for the coordination and Communication integration of relevant sectors in the and Advocacy implementation of IHR P.3.2 Surveillance of infections Prevent caused by AMR pathogens Antimicrobial P.3.3 Health care-associated Resistance infection prevention and control P.3.1 AMR detection (AMR) programs P.3.4 Antimicrobial stewardship activities P.4.3 Mechanisms for responding to infectious Zoonotic P.4.2 Veterinary or animal health P.4.1 Surveillance systems in place for priority zoonoses and potential Disease workforce zoonotic diseases/pathogens zoonoses are established and functional P.5.1 Mechanisms are Food Safety established and functioning for detecting and responding to foodborne disease and food 56 contamination P.6.1 Whole-of-government biosafety and biosecurity Biosafety and system is in place for human, Biosecurity animal, and agriculture facilities P.6.2 Biosafety and biosecurity training and practices P.7.1 Vaccine coverage (measles) as Immunization P.7.2 National vaccine access and delivery part of national program D.1.2 Specimen referral and transport National system D.1.1 Laboratory testing for detection of priority Laboratory D.1.4 Laboratory quality system D.1.3 Effective modern point of care diseases System and laboratory-based diagnostics D.2.1 Indicator and event-based D.2.2 Inter-operable, surveillance systems Real-Time interconnected, electronic real- D.2.4 Syndromic surveillance systems Surveillance Detect time reporting system D.2.3 Analysis of surveillance data D.3.2 Reporting network and D.3.1 System for efficient reporting to Reporting protocols in country WHO, FAO, and OIE D.4.1 Human resources are available Workforce to implement IHR core capacity D.4.2 Applied epidemiology training program in Development requirements place such as FETP D.4.3 Workforce strategy R.1.1 Multihazard national public R.1.2 Priority public health risks health emergency preparedness and Preparedness and resources are mapped and response plan is developed and utilized implemented Respond R.2.1 Capacity to activate R.2.2 emergency operations Emergency Emergency operations R.2.3 Emergency operations Response center operating program Operations procedures and plans R.2.4 Case management procedures are implemented 57 for IHR relevant hazards R.2.1 Public health and security Linking Public authorities, (e.g. law Health and enforcement, border control, Security customs) are linked during a Authorities suspect or confirmed biological event Medical R.4.2 System is in place for Countermeasure sending and receiving health R.4.1 System is in place for sending and receiving s (MCM) and personnel during a public MCM during a public health emergency Personnel health emergency Deployment R.5.1 Risk communication systems (plans, mechanisms, etc.) R.5.2 Internal and partner Risk communication and coordination R.5.3 Public communication Communication R.5.4 Communication engagement with affected communities R.5.5 Dynamic listening and rumor management PoE.1 Routine capacities are established at POE Points of Entry (POEs) Other IHR-Related Hazards and POEs PoE.2 Effective public health response at POE CE.1 Mechanisms are established and functioning for detecting and responding to chemical events Chemical Events or emergencies CE.2 Enabling environment is in place for management of chemical events. 58 RE.2 Enabling environment is in RE.1 Mechanisms are established Radiation place for and functioning for detecting and Emergencies management of responding to radiological and nuclear radiation emergencies emergencies 59 APPENDIX B. SUMMARY OF HEALTH SECURITY CAPACITIES AND CHANGE IN CAPACITY (ETHIOPIA JEE AND AH SCORES) Processes JEE Technical Accomplishments and Progress from JEE March 2016 to NAPHS November Indicator and AH Area 2018 scores P.3.1 - Antimicrobial AH: 2  Ethiopian Public Health Institute (EPHI) and three prioritized Phase 1 AMR resistance (AMR) sentinel sites received training for clinicians and laboratories to learn sample detection PH: 3 collection and diagnostics in line with the national AMR plan.  Capacity increased from 2 to 3 because EPHI launched the implementation of the national AMR surveillance plan, with supplies, training, and mentoring initiated for Phase 1 sentinel sites. Antimicrobial Resistance P.3.2 - Surveillance of  The four Phase 1 sites report better integration between clinical sample infections caused by 2 collection and laboratory confirmation and are inputting data into a global- AMR pathogens standard AMR surveillance database. Prevent  Priority surveillance pathogens are E. coli, K. pneumoniae, S. aureus, and Carbapenem-resistant Acinetobacter spp, Pseudomonas aureginosa, and Enterobactericeae spp. P.3.3 - Health care-  The Federal Ministry of Health (FMOH) Medical Services Directorate associated infection established a Clean and Safe Hospital (CASH) program; evaluation and 2 (HCAI) prevention and impact of CASH is pending. control programs AH: 1  FMOH Food, Medicine, and Health Control and Administration Authority P.3.4 - Antimicrobial (FMHACA) drafted protocols and standard operating procedures (SOPs) for stewardship activities PH: 2 AMR stewardship. 60  Ethiopian Public Health Institute (EPHI), Ministry of Agriculture (MOA), National Animal Health Diagnostics and Investigation Center (NAHDIC), Ethiopia Wild Life Conservation Authority, universities, and other zoonotic disease partners received technical assistance to improve surveillance of rabies and brucellosis.  Anthrax, avian influenza, Ebola, and severe acute respiratory syndrome (SARS) also remain on the list of public health reportable diseases which are received weekly by EPHI.  The animal health score increase from 2 to 3 reflects U.S. Government evolving understanding of the historic animal health syndromic surveillance P.4.1 - Surveillance system combined with 2017 improvements, which include: fifty additional systems in place for AH: 2 MOA staff members trained on electronic syndromic surveillance reporting priority zoonotic PH: 4 using PDAs. Zoonotic Disease diseases/pathogens  MOA staff received training of trainers involving 100 provincial and laboratory epidemiologists on the use of Animal Disease Notification and Investigation System (ADNIS) and Disease Outbreak and Vaccination Report (DOVAR) disease reporting systems, and MOA conducted a gap assessment of its current zoonotic diseases/pathogen surveillance system to identity areas for improvement.  In addition, zoonotic disease surveillance was conducted in Awash and Bati regions along the animal value chain, collecting samples from 352 animals (140 bats and 212 non-human primates), almost half of which were sampled after April 1. Testing of samples has been initiated.  One Health student club members at Jimma University trained 19 farm owners and their employees on common zoonotic diseases and AMR. P.4.2 - Veterinary or  Thirty-four faculties from Mekelle University College of Health Sciences and 3 animal health workforce Veterinary Medicine were trained on infectious disease management.  Jimma and Mekelle universities provided field attachments where 74 multidisciplinary students identified community challenges at the human, 61 animal, environment interface and came up with educational interventions. o Mekelle University students targeted 330 households for their interventions.  Six veterinary science faculty members from three Ethiopian universities are currently studying at Michigan State University and Iowa State University through USDA's Faculty Exchange Program (FEP). o Through this FEP activity, the fellows are working with U.S. university faculty to enhance their current knowledge of veterinary medicine teaching methodology and research skills. o They have opportunities to participate in classroom discussions, learn new teaching methods, and gain experience in research practices related to veterinary science. o At the end of the program, fellows are expected to revise and modernize their course outlines and introduce new material and teaching methodologies into their classes in Ethiopia.  Multisector partners (animal health, public health, and security) received technical support to improve response capacities. o In particular, training was provided to multisector partners on zoonotic disease risk mapping.  Multisector partners drafted guidelines for responding to bio-risk threats, and over 100 clinicians and epidemiologists received training for rapid response teams. 2 P.4.3 - Mechanisms for  One Health Steering Committee (OHSC) formed for multisectoral ministries responding to zoonosis with TOR. and potential zoonosis are established and  OHSC performed self-assessment of its organizational structure and functional performance to inform capacity development plans.  Multisectoral technical working groups (TWGs) developed national rabies and anthrax eradication plans. 62  Capacity increased from 2 to 3 because the national Biosafety and Biosecurity) is being developed with monitoring of facilities, finalizing legislation, and finalizing requirements for regulations.  EPHI’s and NAHDIC’s biosafety and biosecurity teams received training on P.6.1 - Whole-of- developing a laboratory inspection and registration program. government biosafety and biosecurity system is in 2 o The EPHI BSS team has begun initial inspections and registration of place for human, animal, public health laboratories. Biosafety and Biosecurity and agriculture facilities  Ethiopia select hazardous pathogens and toxins  The technical working group received technical assistance on drafting legislation for the national biosafety program. o The draft legislation document is being reviewed by ministry leaders.  Capacity increased from 2 to 3 because the BSS training and oversight activities became more established for public health.  EPHI’s 11 biomedical engineers received training on biosafety cabinet certification and provided indirect training support for regional laboratory P.6.2 - Biosafety and personnel on biosafety and biosecurity practices. biosecurity training and 2 practices o Two of the engineers passed the written examination for NSF International certification and will attempt the practical exam in FY18Q1.  Biosafety officers from EPHI who received bio-risk training at Sandia National Laboratories used the Sandia curriculum to deliver training to more than 50 laboratory technicians at animal health and public health laboratories.  Official estimates from Ethiopia on immunization coverage is 96%, but the P.7.1 - Vaccine coverage Immunization results from the August 2017 Demographic and Household Survey are (measles) as part of 3 approximately half the rate. national program P.7.2 National vaccine 4 access and delivery 63  Laboratory technicians at EPHI and NAHDIC received training, technical assistance, and supplies to support laboratory detection of rabies, brucellosis, cholera, E. coli, K. pneumoniae, A. baumannii, S. aureus, and P. aureginosa  A FAO Laboratory Mapping Tool was used by NAHDIC to assess the capacity of four subnational labs (Mekelle, Jijiga, Yabello, and Assela) to identity target areas of support. D.1.1 - Laboratory testing  Lab equipment, sampling materials, and consumables were provided to for detection of priority 4 NAHDIC to improve biosafety and biosecurity and sample handling and diseases storage.  Diagnostic highly pathogenic avian influenza primers and probes were also provided for avian influenza surveillance. National Laboratory System  Proficiency test panels were provided to NAHDIC to assess the performance of brucellosis diagnosis using Rose Bengal Plate Test and Complement Fixation Test. Detect o Proficiency test panels were sent to the ANSES lab in France.  EPHI established a specimen transport system in collaboration with the Ethiopian Postal Service. o Inclusion of animal health labs is pending. D.1.2 - Specimen referral AH: 2  Eleven trainees from Ethiopia and 10 from other African countries were and transport system PH: 3 trained and certified on safe and appropriate packaging of specimens for air transport.  An assessment on specimen transport was done on eight of the regional animal health laboratories.  NAHDIC and EPHI received test kits and laboratory supplies for brucellosis, D.1.3 - Effective modern cholera, E. coli, K. pneumoniae, A. baumannii, S. aureus, and P. aureginosa. point of care and 3 laboratory-based diagnostics  EPHI also received technical assistance on procurement, media production, and quality control for ongoing mechanisms for laboratory supplies. 64 D.1.4 - Laboratory quality  EPHI’s microbiology lab earned accreditation by Ethiopian standards agency. 2 system  Capacity increased from 2 to 3 because the public health surveillance systems are in place to detect outbreaks. D.2.1 - Indicator and  EPHI prepares and posts online data from indicator-based surveillance event-based surveillance 3 system in the weekly epidemiology bulletin. systems (EBS) o Online publication was suspended for about a year but resumed in July 2017.  EPHI has designated a surveillance officer to initiate collection of data in line with the EBS guidelines, with full implementation expected in 2018/19. Real-Time Surveillance D.2.2 - Interoperable, FMOH began collecting requirements, including IDSR variables, for the DHIS2 interconnected, electronic system that is expected for national implementation. 2 real-time reporting system  EPHI continues to analyze national disease data reported weekly from about 79% of health centers. D.2.3 - Analysis of AH: 2  In July, EPHI resumed online publishing of the weekly epidemiology bulletin surveillance data which makes public health data available to broader audiences. PH: 3  Rabies and anthrax data from human and animal cases have initially been shared in technical working groups.  EPHI received technical assistance to establish an acute febrile illness AH: 2 sentinel surveillance network and developed a draft plan to establish the acute febrile illness network. D.2.4 - Syndromic surveillance systems  The animal health score increase from 2 to 3 reflects U.S. Government evolving understanding of the historic animal health syndromic surveillance PH: 4 system combined with 2017 improvements (see milestones of Zoonotic Disease Action Package 4.1) 65 D.3.1 - System for  The public health EOC received technical assistance for data management, efficient reporting to 3 analysis, and situational reporting, and encouraged reporting to partners. WHO, FAO and OIE Reporting  Capacity increased from 2 to 3 because the public health data has become more accessible to multisector partners.  EPHI continues to analyze national disease data reported weekly from about D.3.2 - Reporting network 2 79% of health centers. and protocols in country  In July 2017, EPHI resumed online publishing of the weekly epidemiology bulletin which makes public health data available to broader audiences, particularly One Health partners.  Resident advisors of the FMOH’s Field Epidemiology Training Program (FETP) received training, mentoring, and technical assistance to and to physicians enrolled in EPHI’s advanced cohort.  FMOH and EPHI hosted the FETP annual scientific conference where more D.4.1 - Human resources than 200 residents presented on outbreak investigations and surveillance are available to system evaluations. 3 implement IHR core Workforce Development capacity requirements  One Health core competencies were integrated into 26 undergraduate and postgraduate course modules in both Jimma and Mekelle universities.  A multidisciplinary group of 57 final year graduate students from Jimma and Mekelle Universities received certification training on One Health approaches in infectious disease management. D.4.2 - FETP or other  EPHI assigned FETP residents to rapid response teams for the acute watery applied epidemiology 4 diarrhea outbreak managed by the EOC. training program in place  MOA and NAHDIC staffs attended a FETPV needs assessment workshop.  FMOH has a national workforce strategic plan in the Human Resources D.4.3 - Workforce Development Plan (HRDP) to guide the development of skills, geographic 3 distribution, and educational requirements. strategy o The FETP program is a component of the HRDP. 66  EPHI’s EOC received technical assistance on medical epidemiology, emergency management, and informatics to activate in August 2017 for the R.2.1 - Capacity to national acute watery diarrhea outbreak. activate emergency 2 operations  The EOC team also received training and participated in a table top exercise with public health emergency management officers and other multisector partners. Emergency Response Operations R.2.2 - Emergency  EPHI’s EOC staff received technical assistance on the development of SOPs, operations center and for templates for situational reports, briefings, and other functions. 1 operating procedures and  The new SOPs, reports, and briefings were used during August 2017 plans response to acute watery diarrhea.  Public health responders from EPHI, MOA, and Federal Police participated in a tabletop exercise for a public health emergency to better understand roles Response and responsibilities during a response. R.2.3 - Emergency 2 o It also resulted in the development of refined data collection forms operations program and report templates.  The new response modalities, forms, and templates were used during the August 2017 response to acute watery diarrhea. R.2.4 - Case  EPHI has published online case management guidelines for measles and management procedures cholera. 2 are implemented for IHR-  The cholera guidelines were reviewed by partners participating in the EOC relevant hazards response to acute watery diarrhea in June 2017. R.3.1 - Public health and  The multisectoral TWG for public health security received technical Linking Public security authorities, (e.g. assistance to draft guidelines on the management of bio threats. Health and law enforcement, border o The agencies that participated included Ministry of Livestock and control, customs) are 2 Security linked during a suspect or Fisheries, Veterinary Drug and Feed Administration and Control confirmed biological Authority, Ministry of National Defense, Federal Police, Addis Ababa Authorities Police, and FMOH. event 67 Medical Countermeasures and  EPHI hosted a multi-sector consultative meeting to finalize the agency’s MCM R.4.1 - System is in place Supply Chain Guidelines. for sending and receiving 4  FMOH distributed measles vaccine from approximately June–August 2017, MCM during a public health emergency primarily in Somali region, in order to respond to emerging measles vaccination campaign.  Personnel Deployment EPHI developed and provided initial training on rapid response teams to R.4.2 - System is in place about 60 health officers. for sending and receiving 2 o Rapid response teams deploy domestically to assist with field health personnel during a public health emergency investigations and emergency management at regional and subnational levels. 68 APPENDIX C. NATIONAL ACTION PLAN FOR HEALTH SECURITY ACTIVITY PLAN JEE Indicator Objective Summary of Planned Respons Year of Activities at National Level ible implementation (Strategic Actions) authorit 2 2 2 2022 2 y(s) 0 0 0 0 1 2 2 2 9 0 1 3 National Legislation, Policy, and Financing Legislation, laws, regulations, To review and identify gaps from all national Identification and FMOH X X X X X administrative requirements, policies, or legislation in all relevant stockholders that will engagement of all relevant EPHI other government instruments in place for facilitate the IHR implementation by 2018/19 stakeholders not available in implementation of IHR the existing list Establishing intersectorial FMOH X legislative assessment EPHI committee Collect, review, and identify FMOH X and submitted gaps related EPHI to all relevant stakeholders’ legislations Reviewing and prepare FMOH X appropriate legislation EPHI protocol based on identified legislation gaps Consultative workshop on FMOH X prepared legislation reform EPHI or newly developed legislation protocol with law units of every line ministers and finalize the legislation protocol Submit prepared legislation FMOH X reform or newly developed EPHI legislation protocol for council of ministers for approval Organize high-level FMOH X X X X X 69 workshop for endorsement EPHI and incorporation of the developed legislation in the existing protocol of all relevant stakeholders To monitor adoption and incorporation of Review and identify the gaps FMOH X X X X additional policies within all stakeholders’ for availability of EPHI national sector plan to facilitate the core and recommended policies on expanded functions of the IHR national focal national sectorial plan of all point by 2018/19 sectors Prepare recommended FMOH X X X X legislation, regulations, and EPHI other instruments mandating the automatic applicability of the IHR (2005) The state can demonstrate that it has To establish and operationalize the national Establish national public FMOH X adjusted and aligned its domestic public health security council and technical health security council and EPHI legislation, policies, and administrative working group to strengthen multisectoral technical working group arrangements to enable compliance with coordination and collaboration for IHR Preparing protocols for FMOH X the IHR (2005) implementation by 2018/19 coordination and EPHI collaboration mechanism, Assign focal persons for All X proper communication in all sectors line ministries under the council Organize workshop to All X X X X X introduce the prepared sectors protocols for IHR from all under the relevant sectors council Establishing formal FMOH X X X X X communication and EPHI collaboration mechanism for information exchange during normal and emergency situations Conducting regular FMOH X X X X X simulation/tabletop exercises EPHI to test and be familiarize with existing procedures Organize annual review FMOH X X X X X meeting to review activities EPHI done Review and incorporate newly developed/ Identify and revise key X revised legislatives for facilitation of IHR protocols, standards, 70 implementation in all stakeholders’ key guidelines, and SOPs across protocols, standards, guidelines, and SOPs all relevant sectors for newly and provide training/ refreshment training developed/revised policies across all relevant sectors by 2018/19 Printing and distribution of FMOH X the revised documents IHR Coordination, Communication, and Advocacy A functional mechanism is established for Increase awareness about IHR implementation IHR advocacy activities for FMOH X X X X X the coordination and integration of across sectors high-level managers at all EPHI relevant sectors in the implementation of relevant stakeholders IHR Sensitization and awareness All X X X X X creation for staff members sectors working in all relevant under the stakeholders council Prepare or revise IHR FMOH X X sensitization and advocacy EPHI materials Printing and distribution of FMOH X X IHR sensitization and EPHI advocacy materials Strengthen the multisectoral coordination Regular coordination FMOH X X X X X between all stakeholders in national health meeting for national health EPHI council by 2018/19 council based on the protocol Regular trachnical working FMOH X X X X X group meetings based on the EPHI protocol Monitoring and evaluation on FMOH X X X X X incorporation status and EPHI functionality of the legislation in all relevant stakeholders’ protocol Establish information communication Preparing protocols for FMOH X mechanism between sectors and neighboring communication (across EPHI countries by 2018/19 sectors, countries, regional partner organizations, and general public) for information sharing Produce and distribute FMOH X X X X X monthly national public EPHI health council bulletin based on monthly data summary report of all relevant stakeholders and monthly 71 activities done Organize workshop for FMOH X X X X X annual report production EPHI Produce and distribute FMOH X X X X X annual national public health EPHI council bulletin Conducting regular FMOH X X X X X simulation/tabletop exercises EPHI to test and be familiarize with existing procedures Antimicrobial Resistance Antimicrobial resistance (AMR) detection Establish AMR surveillance system from the Assess existing AMR EPHI/MO X X system in place human-animal-environment interface detection capacity using A (ecosystem) WHO's and FAO's GLASS MOAL X X and ATLASS tools Develop sustainable FMOH X laboratory supply chain management plan Train lab personnel of public EPHI X X health labs on AMR detection Train veterinary lab NAHDIC X X personnel of both human and animal labs on AMR detection Provision of supplies for AST EPHI X X testing to public health clinical and diagnostic facilities (35 public health laboratories) Provision of supplies for AST NAHDIC X X testing to animal health clinical and diagnostic facilities (15 animal health laboratories) Conduct internal and EPHI X X X X X external quality assurance NAHDIC X X X X X testing for biological, food, environmental, and clinical samples and results are reported to stakeholders Strategies for monitoring FMOH X X X X national AMR and drug- 72 resistant tuberculosis burden are developed and implemented. Surveillance of infections caused by AMR Establish a functioning sentinel sites for public Develop SOPs, protocols, EPHI X X pathogens and animal health AMR surveillance system and databases for AMR surveillance Establish AMR surveillance EPHI/NA X X X X X at pilot or representative HDIC regional referral hospitals, food microbiology, and animal health laboratories Develop and initiate training EPHI/NA X X X X X programs on data collection HDIC and reporting of AMR at EPHI/NA X X X national and regional levels HDIC Develop an integrated AMR EPHI X X surveillance plan including reporting to the WHO and OIE (human, animal, plant and environment) Preform pre- and post- FMOH X X X X X marketing quality surveillance of antimicrobials (import, use, pharmacovigilance) for both human and animal use Conduct antimicrobials FMOH X rational use evaluation in public and animal health facilities Healthcare associated infection (HCAI) Establish a functioning sentinel sites for public Provide regular in-service FMOH X X X X X prevention and control programs and animal health AMR surveillance system IPC training programs, including AMR prevention programs at 15 designated facilities Conduct 400 regular FMOH X X X X X supportive supervision and establish motivation strategy to sustain IPC Establish formal plans and systematic Conduct regular supportive MOAL X X X X X implementation measures of biosecurity and supervision and establish hygiene in animal health sector and farms motivation strategy to sustain biosecurity and hygiene measures in animal farms 73 Enforce implementation of MOAL X X X X X biosafety and biosecurity measures in the livestock and poultry farms Antimicrobial stewardship activities Establish antibiotic stewardship program in at Finalize (endorse, print, and FMHACA X least 400 health facilities distribute) the national antimicrobial stewardship guidelines Conduct orientation on the FMHACA X X national antimicrobial stewardship guidelines and its program to 400 health facilities' CEO and directors Implement the national FMHACA X X X X X antimicrobial stewardship program including monitoring of antimicrobial use, education/communication, and other interventions to improve antibiotic use in 400 health facilities Support FMHACA X X X X X benchmark/experience sharing between the health facilities implementing the program Train experts at each health FMHACA X X X X X facility and establish stewardship committee Prepare and distribute FMHACA X X X X X Information, education, and communication materials on drug resistance and drug use Develop/adapt SOPs and FMHACA X X X X X protocols to monitor antimicrobial use in humans Conduct regular supportive FMHACA X X X X X supervision and establish motivation strategy to sustain ASP Revision of directives, guidelines and Develop medicine retail FMHACA X X prescription requirements for use of outlet national standard antimicrobial medicines in human Finalize, print and distribute FMHACA X Rational medicine use 74 directives Develop antimicrobial FMHACA x restriction policy at each health facility Revise, print and FMHACA x disseminate medicine list (over-the-counter [OTC] list and prescription medicine list) based on health care facility level Revise, print and FMHACA X X disseminate standard treatment guideline and medicine formulary Provide training of trainers FMHACA X X X X X for inspectors on rational medicine use and auditing Inspection Conduct orientations on FMHACA X X X X regulatory measures and auditing inspection for retail outlet owners Develop/adapt and distribute FMHACA X X X X X IEC/BCC materials on awareness creation among the public and Health professional Conduct regular and FMHACA X X X X X announced/unannounced auditing inspection and implement legal measures to assess rational medicine use Strengthen legal requirement for prescription Develop veterinary drugs VDFACA X on use of antimicrobial medicines in animal retail outlet national based on their rational use standards Develop, print, and distribute MOAL X rational medicine use directives Implement the developed VDFACA X X X X X national rational veterinary drug use manual for animal health professionals at animal veterinary clinics Prepare and distribute VDFACA X X X X X 75 Information, education, and communication materials on drug resistance and drug use Establish an antimicrobial VDFACA X use database in the animal health sector Develop/adapt SOPs and VDFACA X X X X X protocols to monitor antimicrobial use in the animal health sector Revise print and disseminate VDFACA X X veterinary drug list (OTC and with prescription drug list) based on animal health facility level Revise, print, and VDFACA X X disseminate standard animal treatment guideline and medicine formulary Provide training of trainers VDFACA X X X X X for inspectors on rational medicine use and auditing inspection Conduct orientations on VDFACA X X X X X regulatory measures and auditing inspection for retail outlet owners Develop/adapt, print and VDFACA X X X X distribute IEC/BCC materials on awareness creation public and animal health professionals Zoonotic Disease (General Objective: To prevent and reduce the likelihood of outbreaks and other public health hazards and events defined by IHR (2005)) Surveillance systems in place for priority Establish linkage between the public and Develop and endorse a FMOH X zoonotic diseases/pathogens animal health surveillance systems by 2019/20 memorandum of understanding (MOU) between sector ministries on surveillance, reporting, and data sharing between federal line ministers and subnational states**** 76 Develop a joint zoonotic MOAL X diseases risk assessment plan Develop and endorse a MOAL X national multisectoral zoonotic surveillance strategic plan*** Prepare SOP for data MOAL X analysis to improve One Health action*** Establish an interoperable EPHI/MO X X national surveillance ALMOAL database to record, monitor, and report zoonotic outbreaks to stakeholders*** Establish linkage between the public and Assess the existing public EPHI/MO X animal health diagnostic laboratory systems and animal health laboratory ALMOAL and sharing of zoonotic disease information capacity at national and sub EPHI/MO X and laboratory specimens national level AL Develop national zoonotic NAHDIC X diseases diagnostics laboratory development master plan (accreditation and standardization, ISO 17025 certification, workforce) Provide laboratory training EPHI X X X X X (serologic and molecular diagnostic capacity) for public and animal health staff diagnostic and reporting priority zoonotic diseases at the national level and in selected regions Provide laboratory training NAHDIC X X X X X (serologic and molecular diagnostic capacity) for public and animal health staff diagnostic and reporting priority zoonotic diseases at the national level and in selected regions Provision of laboratory MOAL/E X X X supplies and equipment to PHI 77 enhance diagnosis of prioritized zoonotic diseases in animals and humans at the subnational and national level Pilot serological diagnostics NAHDIC X X X capacity for at least one of the prioritized zoonotic diseases for humans and livestock in target regional laboratories Develop intersectorial data MOAL/E X X sharing mechanism at PHI federal and regional levels (interoperable Laboratory Information Management System) Veterinary or Animal Health Workforce Enhance the workforce capacity of public Conduct training needs EPHI X X health staff in controlling zoonotic diseases assessment of public health coming from animal to human population training institutions on zoonotic diseases Prepare protocols for EPHI X X X zoonotic disease control to public health staff Provide training on One EPHI X X X X Health concepts within national zoonotic diseases prevention and control training programs Engage veterinary sector with public health at Include FETP recruitment FMOH the subnational and field level and training for the animal health workforce Facilitate regular experience MOAL X X X X X sharing (e.g., planning, information, surveillance, sample collection, response) at regional and field level for both public and animal health sectors (workshop, annual One Health Days) Build capacity of animal MOAL X X X X X control officer workforce capacity in target areas by provision of the necessary 78 equipment for animal capture, euthanasia, and appropriate sample collection Build capacity of animal MOAL control officer workforce capacity in target areas training on animal capture, euthanasia, and appropriate sample collection Provide training to animal, EPHI/MO X X X wildlife, and environment AL workforce in IHR competency and One Health approach Train on FETP the pubic, EPHI X X X X animal and wildlife health sectors to manage ongoing surveillance capacity Mechanisms for responding to zoonoses Establish an interagency strategy, plan or Revise and integrate the MOAL X and potential zoonoses are established mechanism for zoonotic diseases prevention, animal health strategy and and functional detection and control at the federal and plan based on the OIE PVS subnational level assessments and tools Develop methods for MOAL X determining estimates of animal (domestic and wild reservoir) populations within the country Develop programs and MOAL X X X X educate the community on zoonotic diseases prevention, control, and zoonotic spill-overs Prepare and conduct risk EPHI X assessment of PHEIC using developed and validated guidelines and tools Produce zoonotic diseases EPHI/MO X prevention and control AL strategy for selected zoonotic diseases Assess and map high-risk EPHI/MO X zoonotic diseases at AL human/animal interfaces 79 based on surveillance data from the public and animal health sectors Develop an interagency TOR EPHI/MO X for zoonotic diseases AL response team/task force at the federal and regional level Establish multisectoral rapid MOAL X response team at the federal and regional level Develop procedures and EPHI/MO X plans to investigate and AL confirm suspected zoonotic outbreaks and other One Health events Formulate zoonotic diseases EPHI/MO X preparedness and response AL plan to coordinate animal and public health agencies, sectors, and other stakeholders Conduct simulation and EPHI X training exercises to test capacity of emergency deployment capacities to detect and respond to zoonotic diseases Prepare technical response EPHI X X X X guidelines for district rapid response teams to respond to zoonotic outbreaks Enhance reporting of zoonotic diseases from Prepare plan for reporting of MOAL X the community to animal health workers zoonotic diseases from the community to animal health workers Establish linkages among MOAL X X X X X designated reporting facilities, decision-making sectors, and communities to strengthen diseases surveillance capacity (MOU, SOP, directives, training, incentives) Establish an integrated zoonotic diseases Establish an integrated MOAL X X X X 80 reporting system from the grass root to the zoonotic diseases reporting federal level system at the grass root level (animal and health extension workers) Standardize community case MOAL X definitions and reporting formats for animal disease events that can be easily understandable and easy for reporting of animal disease events Conduct social MOAL X X X X mobilization/community awareness by using various methods (social medias, public gatherings, schools, home to home, leaflets/brochures) Train animal and health EPHI X X X X extension workers on event based/community-based surveillance system and reporting mechanism based on the standardized case definitions Food Safety Mechanisms for multisectoral Enhance relevant multisectoral collaboration Assess the existing food FMOH X collaboration are established to ensure and information sharing among at least four safety related policy issues rapid response to food safety sectors involved in food safety and activities conducted so emergencies and outbreaks of foodborne far diseases Develop food safety strategy FMOH X X X and policy document Develop guidelines/manuals FMOH X X on the surveillance, assessment, and management of priority food safety events Develop and print IEC/BCC FMOH X X X X X materials and mass media on food safety Establish a mechanism to detect, report, Train a multisectoral and FMOH,M X X X X X investigatem and trace back foodborne multidisciplinary team to OAL, disease outbreaks investigate and respond to MOAL,M food safety issues ECCF 81 (international training of trainers) Develop risk-based FMOH X X surveillance plans involving different sectors of government for response to food safety emergencies Conduct provision of sample FMOH X X X X X collection, transport, storage, and laboratory testing requirements among the sectors to proactively investigate and prevent food safety emergencies Plan and implement HACCP FMOH/F X X based food safety MHACA management for food producers (both primary & secondary producers), food processors, and handlers at various levels Implementation of food FMOH/F X X X X inspection and control MHACA services with qualified personnel Improve the laboratory EPHI/FM X X X X X capacity at national and OH regional levels Upgrading consumers EPHI/FM X X X X awareness and knowledge OH about food safety issues through proper training for positive feedback on public health improvement Biosafety and Biosecurity Whole-of-government biosafety and Develop a comprehensive human and animal Develop and disseminate FMOH X biosecurity system is in place for human, health Biosafety and biosecurity legislation national B&B legislation animal, and agriculture facilities and policy document (proclamation, regulation, directives ) for human and animal health and ecosystem Develop and disseminate FMOH/E X national B&B guidelines, PHI manuals, and SOPs for 82 human and animal health and ecosystem Develop and disseminate MOAL/N X national B&B guidelines AHDIC manuals, and SOPs for human and animal health and ecosystem Update the Ethiopia’s FMOH/E X Selected Hazardous PHI Pathogens and Toxins (ESHPT) list Establish data management MOAL/N X X structure for inventory control AHDIC and risk mapping of facilities housing ESHPT (including military and private sectors) Establish data management FMOH/E X X structure for inventory control PHI and risk mapping of facilities housing ESHPT (including military and private sectors) Establish regulatory unit for FMOH/E X X ESHPT regulation PHI/FMH ACA Establish regulatory unit for MOAL/N X X ESHPT regulation AHDIC Identify, register, license, FMOH/E X X X X X and regulate facilities PHI/FMH housing dangerous ACA pathogens and toxins (ESHPT) in Ethiopia (including military and private sectors) Identify, register, license, MOAL/N X X X X X and regulate facilities AHDIC/V housing dangerous DFACA pathogens and toxins (ESHPT) in Ethiopia (including military and private sectors) Promote National Biosafety and Biosecurity Implement comprehensive All labs X X X X system biosafety and biosecurity system Form a multisectoral FMOH/E X X 83 National Biosafety and PHI Biosecurity Steering committee to enhance collaboration, partnership, and information sharing Strengthen a multisectoral FMOH/E X X National Biosafety and PHI Biosecurity technical working group to support implementation Biosafety and biosecurity training and Improve capacity and compliance on Develop/revise the biosafety FMOH/E X X practices Biosafety and Biosecurity system and biosecurity training PHI materials Incorporate biosafety and MOAL/N X X X X biosecurity in pre-service AHDIC training program Provide training of trainers FMOH/E X X on biosafety and biosecurity PHI at national and regional levels Support the rollout of training MOAL/N X X X X to regional health facilities AHDIC (Veterinary) Support the rollout of training MOAL X X X X to regional health facilities (Agriculture) Support the rollout of training EWCA X X X X to regional health facilities (Wild life) Enhance Biosafety and Biosecurity practices Develop/revise hazardous FMOH/F X X waste disposal guideline MHACA including medical/lab devices disposal system Strengthen national capacity EPHI X X X X X for Biosafety Cabinet calibration Conduct Biosafety Cabinet EPHI X X X X maintenance Support/build capacity of EPHI X X X X facilities handling hazardous pathogens to fulfil the biosafety and Biosecurity requirements 84 Support/build capacity of NAHDIC X X X X facilities handling hazardous pathogens to fulfil the biosafety and biosecurity requirements Immunization Vaccine coverage (measles) as part of Achieve measles coverage of at least 95% Introduce measles FMOH X X X X national program nationally and in all woredas by 2020/21 and containing vaccine (MCV2) beyond in the second year of life and Introduce yellow fever and meningitis vaccines strengthen service delivery in the routine immunization program by MCV1 and MCV2 2019/20) Implement components of FMOH X Vaccinate 70% of the dogs and also increase the Reaching Every District anthrax vaccination coverage (RED) approach Strengthen the coordination and Joint comprehensively and implementation of human and animal health implement periodic service delivery strategies in pastoralist intensified routine regions or communities immunization (PIRI) strategies in low performing woredas Conduct measles campaign FMOH X in 2019 targeting 14 million children under five years Conduct measles/rubella FMOH X campaign 2021 targeting 43 and MOE million children under fifteen years Enhance community FMOH X X X X engagement to create awareness and improve utilization Incorporate immunization in FMOH X curricular and extracurricular and MOE activity Foster public-private FMOH X X X X partnership in and immunization/health MOFEC Introduce yellow fever FMOH X X X vaccine in the routine immunization program Introduce meningococcal FMOH X X X X meningitis vaccine against sero-type A in the routine 85 immunization program Vaccinate 70% of dogs to MOAL X eliminate rabies by 2030 Enhance anthrax vaccination MOAL X X X X coverage for food animals from 25% to 36% Strengthen and establish FMOH X X X X coordination mechanism and NVI between human and animal health service delivery Identify activities that can be FMOH X X X X integrated for joint implementation and monitoring Vaccine coverage (measles) as part of To strengthen data archiving, analysis and use Support implementation of FMOH national program for action at all levels by year 2022/23 DHIS2 and eCHIS (digitization) Conduct coverage surveys FMOH, X and data quality reviews EPHI To strengthen the existing laboratory and Strengthen the existing three FMOH / X X establish capacity to diagnose Vaccine measles laboratory and EPHI Preventable Diseases by 2019/20 and beyond establish additional three laboratories to increase geographic access to laboratory services Strengthen the national EPHI X laboratory capacity to X conduct genotyping for measles Strengthen capacity of the EPHI X national polio laboratory X Strengthen the capacity of X laboratories to diagnose X diseases targeted with new vaccines (Rota, PBM) Strengthen the capacity of EPHI X 10 sentinel laboratories to X diagnose meningococcal meningitis Strengthen capacity of the EPHI X national laboratory to X conduct confirmatory test for yellow fever 86 Establish laboratory capacity MOAL X for diagnosis of zoonotic and X diseases (anthrax, rabies, NAHID leptospirosis, brucellosis) National vaccine access and delivery To strengthen Human resource capacity by Designate cold chain focal PFSA X X X X designating cold chain focal persons at all persons at all levels levels by 2020/21 Train 300 cold chain officers PFSA X X X X per year on cold chain and vaccine management training Increase availability of appropriate cold chain Procurement of on grid ice- PFSA X X X X equipment in health posts from 23% to 53% by lined refrigerators, Direct 2022/23 Drive Solar refrigerators, Mobilize resource for 47% of health posts to spare parts, and continuous equip them with SDD refrigerators temperature monitoring devices Procurement of Direct Drive PFSA X X X X Solar refrigerators, spare parts, and continuous temperature monitoring devices Procurement of continuous PFSA X X X X temperature monitoring devices Procurement of voltage PFSA X X X X regulators Procurement of spare parts PFSA X X X X Mobilize resource to procure FMOH X X X X SDD refrigerators for 7785 health posts (47% of the health posts) To increase local capacity of human and Develop and promote MOLH/N X animal vaccines production from two to nine by national strategy and plan of VI the year 2022/23 action for human and animal vaccine manufacturing in Ethiopia Promote human resource FMOH/N X development in vaccine VI development and production technology involving various disciplines to support local production of vaccine Establish/strengthen the FMOH/N X X national vaccine research 87 and development centers VI with appropriate technical and financial support Establish and strengthen FMHACA X X X X linkage between research /VDFAC X and development institute, A academia and vaccine manufacturers Strengthen vaccine (human and veterinary) Strengthen strategic vaccine FMHACA X regulatory system registration and licensing /VDFAC A Establish central (human and FMHACA X X veterinary) vaccine quality /VDFAC control laboratories A Strengthen AEFI monitoring FMHACA X X and post marketing /VDFAC surveillance system A Strengthen vaccine supply FMHACA X X chain inspection /VDFAC A Strengthen vaccine clinical FMHACA X X trial control and monitoring /VDFAC X A Establish vaccine regulatory FMHACA X X X information system and X VDFACA National Laboratory System Laboratory testing for detection of priority Strengthen and expand laboratory capacity for Capacitate the existing FMOH X diseases detection of identified priority diseases for both mobile BSL3 laboratories at X public health and veterinary EPHI Establish a mobile BSL3 MOAL X laboratory at NAHDIC X Expand BSL3 laboratories at MOAL X NAHDIC X Strengthen the linkage in EWCA detecting wild animal X disease with other laboratories 88 Establish a laboratory for EWCA X X X X wild life disease detection at X national level Strengthen detecting FMOH X X X X capacity of Anthrax at EPHI X Strengthen detecting MOAL X capacity of anthrax at X NAHDIC Strengthen viral hemorrhagic FMOH X fever (VHF) and Arbo X viruses’ detection capability in a laboratory. Expand the National FMOH/E X Influenza Laboratory (NIL) to PHI X National Influenza Center (NIC) Strengthen hepatitis A and E FMOH X detection capability in public X health laboratory Strengthen foodborne enteric FMOH X pathogens (FBEP) detection X capability in public health labs Strengthen animal origin NAHDIC X foodborne enteric pathogens X detection capability in animal health labs Train laboratory FMOH professionals on anthrax, X X VHF, and Arbo viruses, hepatitis and FBEP Establish rabies detecting NAHDIC X X X X laboratory at NAHDIC X Strengthen capability of FMOH(E X detecting rabies EPHI PHI) X Enhancing brucellosis FMOH(E X detection capability in a PHI) X public health laboratories Enhancing brucellosis NAHDIC X detection capability in animal X health laboratories Establishing leptospirosis NAHDIC X detection capability in public X 89 health laboratories Establishing the leptospirosis NAHDIC X detection capability in animal X health laboratories Strengthen bovine NAHDIC X tuberculosis (TB) detection X capability in animal health laboratories Strengthen RVF detection NAHDIC X capacity in animal health X laboratories Strengthen avian influenza MOAL X detecting capability in animal (NAHDIC X health laboratories ) Train laboratory MOAL X professionals on rabies, (NAHDIC X brucellosis, anthrax, Bovine ) TB, Rift Valley fever, avian influenza Specimen referral and transport system Strengthen specimen referral and transport Mapping public health FMOH system at national and international specimen referral network (EPHI) X system within and out of the country Mapping animal health MOAL specimen referral network (NAHDIC X system within and out of the ) country Develop public health FMOH specimen collection, (EPHI) X X packaging, referral, and transport guideline and tools Develop animal health MOAL specimen collection, (NAHDIC X X packaging, referral, and ) transport guideline and tools Train public health laboratory FMOH personnel on specimen (EPHI) X X collection, packaging, referral, transport, and handling Train animal health NAHDIC laboratory personnel on X X specimen collection, packaging, shipping, and 90 handling Availing triple packaging FMOH X X X X materials for public health (EPHI) X specimen transportation Availing triple packaging NAHDIC X X X X materials for animal health X specimen transportation Train specimen referral and NAHDIC X X X X transport courier (postal X system) International training and FMOH experience sharing for staff (EPHI) X working in public health national laboratory International training and NAHDIC experience sharing for staff X working in animal health national laboratory Strengthen data sharing on zoonotic diseases Develop data sharing FMOH between human and animal health protocol between FMOH and X MOAL NAHDIC Establish electronic/web- X X based data sharing at NAHDIC X NAHDIC Train staff on data FMOH X X management and data sharing NAHDIC Effective modern point of care and Establish/strengthen system for tier specific Revise tier-specific FMOH laboratory-based diagnostics diagnostic testing diagnostic test at public (EPHI) X health lab Sensitization of public health FMOH stakeholders on their system (EPHI) X at all levels Establish tier-specific MOAL diagnostic test at animal (NAHDIC X health laboratories ) Sensitization of stakeholders MOAL on their system at all levels (NAHDIC X ) Expand GeneXpert utilization FMOH to viral load detection for HIV (EPHI) 91 and hepatitis B and C Train laboratory FMOH X X X X professionals in viral load (EPHI) X detection for HIV and hepatitis B and C using GeneXpert Consultative meeting on FMOH selection and evaluation of (EPHI) multi-testing point of care/emerging technologies for priority disease in the market. Establish committee and FMOH conduct for post-market (EPHI)/F evaluation on diagnostic MHACA testing technologies Conduct post market FMOH X X X X evaluation for selected (EPHI) diagnostic test kits Laboratory Quality System Strengthen Quality Management System Create awareness on QMS FMOH/M (QMS) in human and Animal laboratories at all for top management and OAL X level technical staff Update and prepare policy, FMOH guidelines, and SOPs for X QMS implementation Update and prepare policy, MOAL X guidelines, and SOPs for X QMS implementation Promote and/or enforce FMOH X laboratory certification and X accreditation Improve quality test result EPHI/NA X through participating HDIC X proficiency tests in selected diseases/test methods Promote and/or enforce MOAL X X X laboratory certification and accreditation Regular supportive MOAL X X supervision on QMS X Regular supportive FMOH X X X supervision on QMS Real Time Surveillance 92 Indicator and event-based surveillance Establishing a fully functional EBS system by Review and finalize the EPHI X (EBS) systems 2020/21 federal event-based surveillance SOPs Print and distribute the EPHI X federal event-based surveillance SOPs Review and finalize the EPHI X regional and community event-based surveillance SOPs Print and distribute the EPHI X regional and community event-based surveillance guideline SOPs Develop integrated refresher EPHI X training (IRT PHEM) module for health extension workers Train human health workers, EPHI X X X X X and focal persons on implementing EBS guideline Train animal health workers, MOAL X X X X X and focal persons on implementing EBS guideline Regular update (once every EPHI X X X two years) the SOPs based on the lessons learned Conduct annual performance EPHI X X X X X review meetings on implementation of EBS Develop SOP, guideline and EPHI X reporting format for establishment of surveillance at 14 POE Print and distribute the EPHI surveillance guideline for POEs Conduct training on FMOH X surveillance system at 14 POE Procure and supply FMOH X X surveillance sites with IT equipment for POEs Interoperable, interconnected, electronic Establish/strengthen surveillance data Develop and endorse MOU EPHI X 93 real-time reporting system reporting and multisectoral data sharing between relevant ministries system to have linked surveillance Establish interconnected and interoperable data sharing system surveillance data sharing system between Assess the current EPHI X relevant line ministries surveillance system in each MOAL X sector EFCCC X EWCA X Develop/revise manual EPHI X X (guidelines/SOPs, reporting format) Print and distribute the EPHI integrated surveillance guideline Train experts from each EPHI X X X sectors at all level (national, regional, woreda, kebele, or district level) on surveillance activities Procurement and distribution EPHI X X X of one desktop computer for all woredas surveillance officers and health facilities for DHIS2/AGIS and overall surveillance activities Procure and provide tablet EPHI X X for eCHIS for health posts Install and operationalize the EPHI X X servers of different capabilities with its accessory at each relevant sector Develop an application for FMOH X X linkage of multisectoral surveillance data and servers Train national, regional, FMOH X X X zonal, and woreda level personnel on surveillance officers on electronic reporting platforms Conduct annual review EPHI X X X meetings on the multisectoral surveillance 94 system Integration and analysis of surveillance Improve capacity for surveillance data analysis Conduct weekly audit of EPHI X X X X X data and consumption for action at district level by surveillance report and MOAL X X X X X 2022/23 provide feedback at all levels Develop protocols and tools EPHI X for conducting national and regional surveillance data quality assessment Conduct annual national and EPHI X X X X regional surveillance data MOAL X X X X quality assessment Provide training on FMOH X X X X surveillance data analysis and data use for woreda level surveillance officers across different relevant sectors Linking laboratory data within EPHI EPHI Consultative workshop for linking different laboratory data within the EPHI Linking laboratory and EPHI X PHEM data through the DHIS2 system development of software for linking data to DHIS2 Produce data use/data EPHI X sharing policy Syndromic surveillance systems Strengthen the public health syndromic Conduct workshop for EPHI X surveillance system standardization and finalization of the national guidelines for syndrome surveillance in humans Conduct workshop for MOAL X standardization and finalization of the national guidelines for syndrome surveillance in animals Print and distribute the EPHI X guideline for syndrome surveillance for public health and animal health 95 Print and distribute the MOAL X guideline for syndromic surveillance for public health and animal health Conduct training on the EPHI X X X syndromic surveillance activities for human health Conduct training on the MOAL X X X syndromic surveillance activities for animal health workers Procure and supply animal MOAL X X health surveillance sites with sample transportation material and lab equipment (cold box, scalpel, personal protective equipment, detergent, etc.) Establish acute febrile illness EPHI X X X X X sentinel surveillance system at 10 selected sites Improve and Expand existing EPHI X X X X X ILI/SARI sentinel sites Maintain existing EPHI X X X X X surveillance activities for febrile rash cases, and acute flaccid paralysis Conduct community FMOH X X X X X education on syndromic diseases conditions Reporting System for efficient reporting to WHO, To formalize information sharing mechanism Prepare information sharing FMOH X X X X X FAO, and OIE between line ministries, stakeholders and format, TOR, and MOU for regional and international organizations by information sharing between 2018/19 line ministries, regional, and international organizations Conduct high-level workshop FMOH X X X X X for introducing prepared format, TOR, and MOU for information sharing and signatory Conduct simulation FMOH X X X X X exercises to test the 96 functionality of information sharing system between the line ministries Update the information FMOH X X X X X sharing TOR based on the lessons learned from real event and simulation exercises Develop for database a FMOH X X X X multisectoral data documentation Reporting network and protocols in Strengthen the national public health council Develop a multisectoral FMOH X X X X X country and multisectoral reporting/information sharing taskforce and TWGs system by 2018/19 (veterinary drug and animal feed administration) Operationalize the protocols FMOH X X X X and processes for multisectoral coordination in reporting Operationalize the reporting FMOH X X X X mechanism at all level within 24 hours, from lower levels to national level Workforce Development Human resources are available to Train 400 PhD graduates(EFELTP, Train 250 advanced FETP FMOH X X X X implement IHR core capacity entomology and laboratory) and 400 advanced medical and laboratory track X requirements EFELTP on medical, laboratory, and veterinary (for 200 woreda, zonal, and track in eight universities in order to have one health facilities) field epidemiologist in each woreda between Train 150 advanced FETP MOAL X X X X 2018/19-2022/23 veterinary track (for one X veterinary graduate per zone) Train 150 advanced FETP MOE X X X X veterinary track (for one X veterinary graduate per zone) Train 400 PhD candidates on FMOH X X X X field epidemiology, entomology, emergency operating officers, and laboratory in eight universities 97 Train 400 PhD candidates on MOE X X X X field epidemiology, entomology, emergency operating officers, and laboratory in eight universities Performance Evaluation of FMOH X X X X the Program and Training X Need Assessment Field Epidemiology Training Program or Updating and follow up of database of FETP Hire one data manager FMOH X X X X other applied epidemiology training fellows Every Year from 2018/19-2022/23 X program in place Establishing EFELTP alumni FMOH X X X X X Workforce strategy Ensure the workforce strategy takes into Expanding FETP-Veterinary FMOH/M X X X X account the needs of human and animal to other seven universities OE X health (One Health approach) Training on One Health and FMOH X X X X IHR for 100 graduates per X Year CPD for 200 graduates 30 FMOH X X X X Hours per year per one X EFELTP graduate Annual scientific conference FMOH X X X X X International travel to present FMOH their abstracts X Publication of scientific FMOH X X X X works of residents and X graduates Expand FETP Expanding the FETP- FMOH X X X Laboratory Track to other X seven universities Establishing 10 laboratory FMOH X X X track field bases X Establishing 10 veterinary MOAL X X X track field bases X Advisory Council and FMOH X X X X technical working group X meeting Workshop to review the FMOH X X existing operational manual, X mentors, supervisors and resident manual Assess country's capacity for FMOH X 98 One Health workforce X including physicians, veterinarians, biostatisticians, laboratory technologist, livestock professionals, and wildlife veterinarians Maintain eight resident FMOH X advisors and 10 program X coordinators Hire one scientific writer FMOH X X Vehicles for laboratory field FMOH X bases X Vehicles for veterinary field MOAL X X bases Revision of benefit package FMOH/M of human health OE/MOF professionals and animal EC health professionals To enhance Front Line FETP Mentor Workshop for FETP- EPHI/RH X X X X Frontline Bs 2 workshops (30 mentors) per year for five years A total of 300 mentors to be trained in the five years Train 1500 frontline public EPHI/RH X X X X health officer in field Bs epidemiology Workshop 1 training (five days) On-job mentoring 1 (six weeks) Workshop 2 training (five days) on-job mentoring 3 (six weeks) Workshop 3 training (two days) Mentors Payment EPHI/RH X X X X A total of 300 mentors (five Bs mentees per mentor) 99 Preparedness Multihazard national public health Improve multihazard emergency preparedness Conduct annual national and FMOH/E X X X X X emergency preparedness and response at national and regional level by the end of regional epidemic PHI, plan is developed and implemented 2021/22 preparedness and response RHBs plan for selected priority hazards Mobilize financial resources FMOH/E X X X X X based on the national PHI, epidemic preparedness and RHBs response plan Train national and regional FMOH/E X X X X X public health rapid response PHI, teams with a simulation RHBs exercise Prepare for and avail FMOH/E X X X X medical supplies (drugs, PHI, supplies, and vaccines) for RHBs, priority public health hazards PFSA identified by yearly epidemic preparedness and response plan Establish public health FMOH/E X X X emergency medical and PHI supplies store at national level and regional levels Improve public health emergency coordination Revitalize multisectoral and FMOH/E X X X X at national and regional level by the end of all hazard inclusive national PHI, 2021/22 PHEM technical working RHBs group Develop national emergency FMOH/E X X coordination protocol to PHI, outline the role and RHBs responsibilities and scope of each structure Conduct regular local FMOH/E X X X officials introductory and PHI, advocacy workshops RHBs Identify gaps and avail one FMOH X desktop computer for all woredas surveillance officers for DHIS and overall surveillance activities Procure server with its FMOH/E X 100 accessory at the national PHI PHEM Incorporate the national FMOH/E X reporting formats in the PHI national integrated HMIS/DHIS system Train national, regional, FMOH/E X X zonal and woreda PHEM PHI officers on DHIS platform Conduct midterm evaluation FMOH/E X to assess the challenges of PHI the system Priority public health risks and resources Improve risk assessment and risk mitigation Strength national risk FMOH/E X X X X are mapped and utilized system by the end of 2021/22 assessment capacity through PHI providing international risk management trainings Develop national risk FMOH/E X X assessment technical guide PHI and tools (for national risk assessment and woreda risk profile) Train national, regional, and FMOH/E X X X X woreda PHEM officers and PHI on national risk assessment technical guide and tools Conduct annual national and FMOH/E X X X X regional risk assessment on PHI selected priority hazards and develop risk profile and mapping Support 80% of woredas to FMOH/E X X conduct Multi sectorial and PHI, multihazard risk profile RHBs and woreda HO Develop and revise national FMOH/E X X X PHE risk mitigation PHI strategies Emergency Response Operations Capacity to activate emergency Ensure the legal authority and guidance group Delegate public health EPHI X X X X X operations exists determine the levels of PHEOC emergency operations activation to respond to any public health manager to manage the day- 101 event at federal and regional levels by 2022/23 to-day PHEOC activities and ensure necessary facilities and procedures are in place Develop procedures and EPHI X X X X X protocols to determine PHEOC activation criteria, levels of activation to quickly activate emergency operations and post it in the EOC Identify trained staff who will EPHI support EOC functions and and avail the roster or database RHBs in the EOC Conduct public health EPHI X X X X X emergency management technical meeting and institutionalize incident management concept/EOC for better incident management Emergency operations centre operating To ensure availability of validated PHEOC Review, finalize, and EPHI X X procedures and plan procedures and plans at federal and regional dissemination of the public levels by 2022/23 health emergency operations SOP that defines PHEOC objectives, functions, roles, and organizational structure staffing level for both peace time and emergency Adapt EOC training materials EPHI X from WHO, U.S. CDC and others for providing training for National and Regional emergency response personnel Review and finalize the EPHI X adapted EOC training materials from WHO, U.S. CDC, and others for providing training for national and regional emergency response personnel Adapt/development of EPHI X simulation exercise materials 102 for testing staff capability and test PHEOC procedures and plans Review and update PHEOC EPHI X X procedures, training, and exercise materials based on lessons from simulation and real event scenarios Ensure emergency response personnel and Conduct assessment to EPHI X X surge staff are capable of responding to public identify training needs health emergencies and specific response related to emergency capabilities are tested through regular training management/PHEOC at and exercise programs both at national and national, regional and zonal regional levels by 2022/23 levels Emergency operations program Provide training regularly to EPHI PHEOC staff based on the findings from the assessment Provide training on incident EPHI management, early detection and response to national and regional rapid response teams Provide training on incident EPHI management to advanced EFLTP graduates and other professionals who will be used as a surge staff during public health emergency Conduct orientation EPHI X X exercises (seminars) to test staff capability, plans and procedures once every two years Conduct a drill exercises to EPHI X X test staff capability, plans, and procedures once every two years Conduct assessment to EPHI X X X regions to assess leadership commitment, existing infrastructure, facilities, human power, etc. for 103 establishment of regional PHEOCs Procure and distribute EPHI X X X X X requirements based on gaps, such as laptops, printers, projectors, smart phones, internet connection devices, etc. Provide continuous EPHI X X X X X supportive supervision to regions during the establishment of regional PHEOCs Conduct after-action review EPHI X X X X X and document the report for improvement of response for each response/activation Conduct assessment to EPHI X X X X X identify training needs related to emergency management/PHEOC at national, regional, and zonal levels Case management procedures are Develop the case management approach for Develop and finalize case EPHI, X X implemented for IHR relevant hazards chemical and nuclear events and integrate management guideline with EFCCC with existing incidence management all hazard approach based on risk assessment Develop SOP to integrate EPHI, X the case management EFCCC system into the incident management system Linking Public Health and Security Authorities Public health and security authorities, Improving coordination mechanism between Validate the final TOR, MOU, EPHI/FM X (e.g. law enforcement, border control, law enforcement and public health sectors SOPs, and Manual for OH customs) are linked during a suspect or (public and animal health, security authorities, Emergency Management of confirmed biological event and others) Biothreats, in place (prepared by multidisciplinary TWG during three consecutive workshops since April–September 2017) Printing and dissemination of EPHI/FM X X Manual for Emergency OH Management of Biothreats 104 Conduct a regular review EPHI/FM X X X X meetings OH Establish Information sharing EPHI/FM X X X X mechanisms between law OH enforcement and public health sectors Improving early detection and multisectoral Develop training curriculum EPHI X rapid response capacity in public health and (training manual) for law enforcement sectors towards biothreats at biothreat emergency national and regional level management Train law enforcement and Federal X X X X public health stuffs on Joint Police Criminal Epidemiological Investigation and response Conduct drill exercises on Federal X X X X joint response to biological Police threats involving public health, regulatory and law enforcement communities Enroll the lawa enforcement FMOH X X X X communities in FETP training program Provide training-of-trainers EPHI/ X X training (international) and Federal experience sharing for Police national stuffs from public health and law enforcement sectors on the investigation and management of biothreats Assess the diagnostic Federal X capacity of existing Police laboratories in public health and law enforcement sector for forensic examination of biological threats Improve the capacity of the Federal X national public health Police laboratory and Federal police forensic laboratories with the necessary resources for diagnostic testing of selected biological threats Develop joint national Federal X 105 response plan for biothreats Police and others (chemical and radiological) Conduct evaluation Federal X X (assessment) of the Police coordinated joint detection and response plans Medical Countermeasures and Personnel Deployment System is in place for sending and To strengthen a system for sending or National MCM technical FMOH X X X X X receiving medical countermeasures receiving MCMs from outside Ethiopia by working group will be (MCM) during a public health emergency 2018/19 established and conduct regular meeting Review, identify problems, FMOH X and create options for MCM in national response plans and national and international legal and regulatory framework for procuring medical items Build partnership and FMOH X X X X X resource mapping within country and international partners Identification and capacity FMOH X building of points of contact at relevant multisectoral organizations and international partners Develop national guidance FMOH X X documents on MCM stockpiling, deployment, and operational plan for response Training and exercise for FMOH X X X X X event or hazard-specific and MCM management for infectious diseases Development of trainings, FMOH X X exercises, materials, TOR, and MOU for hazard-specific response and management of infectious diseases Conduct tabletop exercise(s) FMOH X X X X X to demonstrate decision 106 making and protocols for sending or receiving medical equipment and health personnel from another country Develop strategic framework FMOH X to nationally prioritize resources and investments in MCM To build a storage facility for bulk items Feasibility and readiness FMOH X assessment for MCM stockpiling establishment at national and regional level Establish one national and FMOH X X X X X four regional emergency hubs for storage of MCM System is in place for sending and Strengthen a system for sending and receiving Review and identify barriers FMOH X receiving health personnel during a public health personnel during a public health for sending and receiving health emergency emergency health personnel and create option for operation Conduct engagement FMOH meeting(s) to identify and X build network for national and regional partnerships for personnel deployment Develop and periodically FMOH X update protocols, SOPs, X technical guidelines, and toolkits for sending and receiving health personnel measure Development of strategic FMOH national and regional plans X for health personnel deployment Development of trainings FMOH X and exercises materials for X hazard-specific response and management plans Provide training on prepared FMOH X human personnel X X deployment protocols, SOPs, and procedures Table-top exercise and FMOH X X 107 testing for capacity of X emergency deployment of MCM response to emerging infectious diseases Develop database (roaster) FMOH X X X X X of multidisciplinary rapid response team members Monitoring and evaluation FMOH X X X X X Risk Communication Risk communication systems (plans, To operationalize risk communication Develop a and operationalize FMOH X mechanisms, etc.) coordination mechanism between FMOH and national risk communication MOLS, MOGAC, MOFEC by end of 2018/19 SOP Finalize and operationalize MOH X X national risk communication guideline Develop and operationalize a FMOH X X risk communication coordination TOR for line ministers and partners Develop national risk FMOH X communication SOP standardized training materials/manual Training and exercise on risk FMOH X X communication SOP for RHBs and line ministers and partners Internal and partner communication and To establish risk communication coordination Identify private sectors, civil FMOH X X coordination mechanism among government, partners and societies, and partners that other stakeholders like private health facilities, are in line with risk private schools and civil societies at the end communication before, by mid of 2019/20 during, and after emergencies like diseases outbreaks Conduct advocacy and FMOH X social mobilization activities to mobilize and engage relevant stakeholders Develop and operationalize a FMOH X TOR for government, partners, and other stakeholders like private 108 health facilities, private schools, and civil societies how to coordinate internal communication and how messages can be shared Provide orientation for FMOH X private and partner organization on risk communication TOR on internal and among stakeholders’ information sharing Public communication To strengthen the multisectoral multimedia Develop and operationalize FMOH X X approaches of risk communication in reaching public communication out to the community by 2018/19–2020/21 national SOP Identify the available trusted FMOH X X communication platforms at regional, zonal, or district level in all regions and city administration Develop a joint risk FMOH X X communication plan with stake holders at National, regional, zonal, woreda level (all levels) Develop public awareness or FMOH X X alert message dissemination system Develop and disseminate FMOH X X X X evidence-based alert messages that empower the community to take the desired action through mass medias, mobile phone (SMS), websites/links, local media, and educational media like plasma Communication engagement with affected To strengthen community engagement in Map relevant social FMOH X X communities emergencies preparedness, prevention and networking in the community control responses through engaging relevant that can disseminate trusted actors by the year 2020/21 messages in all regions and city administrations Train HEWs, district and FMOH X X zonal health promotion focal 109 persons, office chair persons, school supervisors, etc. in affected communities on interpersonal communication and community dialogue/conversation skills to facilitate community engagement at affected zones and districts and exercise the communication skills Develop and disseminate FMOH X X X key messages using X surveillance data that empowers the community to take the desired action Dynamic listening and rumor To strengthen and operationalize rumor or Develop a rumor listening FMOH management public listening communication system and communication tool for X communication activities by the year 2021/22 hotlines (EPHI, FMOH, FMHACA) Train the hotline counselors FMOH or Healthcare workers on X rumor collection and communication Establish rumor FMOH communication system with X private and public mass media and social media, develop media auditing tools for assigned media scanner, identify and assign relevant personnel Establish and operationalize FMOH X X X 24 hours serving toll free X hotline for rumor handling and information sharing at national level and operationalize Points of Entry Routine capacities are established at To Improve the controlling mechanism to Train law enforcement Federal X X X X POE manage people movement, animal movement, officers, defense staff, and Police and goods through ground crossing, in line custom officers on proper with WHO IHR core capacity (especially in the management of movement 110 areas that share similar language and culture) and goods Community awareness to the Federal X X X X people Police Assess the capacity of POE Custom X at cross-border and new Authority illegal entry points Strengthen the POE facilities Custom X X X based on the gaps identified Authority on the assessment (diagnostic system, inspection system, movement control management system) Develop guidelines and SOP Federal X on proper management of Police movements at borders Strengthen and expansion of Custom X X POE based on the identified Authority sites Establish cargo scanning ERPA X X X system (radiation portal monitoring device) at selected POE Train inspection FMHACA X X X X professionals at POE Train radiation monitoring ERPA X X X X professionals International training and FMOH X X experience sharing Develop legislation for FMOH X X certification for PHOIC and TAD Assessment of IHR core FMOH X X capacity requirements in the designated POEs (cross- border and airports) Strengthening existing collaboration and Establish technical Custom X X X X X coordination between different levels of the taskforce/technical working Authority public health sector and other stakeholders group involving all relevant (federal, regional, zonal and woreda level) stakeholders and organize regular meeting and information sharing Develop TOR/MOU for FMOH X 111 management of public health risks at POE Strengthen and establish Ministry X X X X cross-border collaboration of and coordination mechanism Foreign with neighboring countries Affairs Effective public health response at points To improve the public health response system Develop comprehensive EPHI X of entry at point of entry PHERCP (Public Health Emergency Response and Contingency paln) for POE, conduct workshops (consultative and validation workshop) to develop comprehensive PHERCP Formulate a rapid response FMHACA X X X X X team at POE Strengthen the collaboration FMOH X X X X X with the nearby woreda health office/health facility Train health care and EPHI X X X X environmental health professionals to be assigned at point of entry Establish human quarantine FMOH/F X X X center (isolation center) at MHACA national level and at Selected sites at regional level (at least six sites including Addis Ababa, Moyale, Diredawa, B/dar, Assossa, Gambella) Improve and expand MOAL X X quarantine stations for animals at POE-selected cross-border sites Conduct need assessment to Custom X X establish mini-laboratories in Authority the POEs (based on existing situations and other countries experience/benchmarks) Establish mini-laboratories Custom X X for inspection of goods, Authority humans, and animals at pilot 112 POEs, vaccination center for international travelers Establish a surveillance FMOH X X X system for vector borne and selected syndromic surveillance at POE Chemical Events Mechanisms are established and To Improve preparedness for chemical Training on chemical events FMOH/E X X X X functioning for detecting and responding hazards by risk profiling of potential chemical surveillance for PHEM PHI to chemical events or emergencies agents to early detect, report and timely officers respond for chemical hazards Awareness creation about FMOH/E X X chemical events for the PHI general public by using medias (especially to occupational vulnerable groups) Availing 24/7 reporting FMOH/E X X X X mechanism for community PHI reports (poison center free hotline) and health system report (using electronic reporting tool) Conduct risk profiling (risk FMOH/E X X assessment) for chemical PHI and agents in the nation and TWG prepare preparedness and response plan based on the findings Strengthening laboratory FMOH/E X X diagnostic capacity for PHI potential chemical agents in the country at national level Improve case management FMOH/E X X preparedness PHI Periodic capacity building FMOH (training or orientation) on handling, transportation, storage, and disposal of chemical agents for relevant stockholders at national level Simulation exercise/drill FMOH X X X X X exercise on detection, information communication 113 and response Periodic monitoring and FMOH X X X X X evaluation of relevant stockholders’ preparedness for chemical events Establish information sharing FMOH X X X X and reporting mechanism during regular and emergencies Risk communication and FMOH X X X X regular information dissemination through electronic bulletin Establish poison center at FMOH X X X major hospitals (for diagnosis of) chemical poisoned individuals Review and update the FMOH/F X X regulation for occupational MHACA/ chemical hazards MOLSA To facilitate and standardize the coordination Organize workshop for FMOH/E X X X X X and information communication of chemical development of TOR, MOU, PHI events during detection, reporting, and coordination, and information response sharing protocol for the national coordination taskforce and TWG Development of chemical FMOH/E X X hazard management PHI guideline, reporting tools, exercises drills for simulation and orientation/training material Develop guidelines and FMOH/E X X procedures for personnel PHI safety and waste management Printing and distribution FMOH/E X X PHI Enabling environment is in place for To establish mechanism for coordination and Establish national FMOH/E X X X X X management of chemical events information sharing to early detect and coordination task force PHI response for chemical events involving relevant sectors and organize regular meeting (establishing multisectoral coordination 114 unit) Establish technical taskforce FMOH/E X X X X X TWG involving all relevant PHI stakeholders and organize regular meeting (assigning focal units/persons from each relevant sectors) Organize high-level FMOH X X X X X workshop to discuss and decide on type, frequency and channel for information sharing Development and FMOH X X X X X dissemination of electronic information sharing tool with vertical and horizontal reporting addresses based on the protocol Prepare database for all FMOH X X X X X relevant stockholders’ address and contact address for emergency and regular communication Review and update existing FMOH X X X X X regulation on release and using chemicals, handling from industries) Establish waste disposal and FMOH X X X X X safety system Develop emergency FMOH X X response plan that defines the roles and responsibilities of relevant agencies in place including inventory of major hazard sites and facilities To provide a free and confidential hotline Avail free hotline for the FMOH X X X X service, treatment management advice about poison center chemical agents (household products, Train and assign experts for FMOH X X X X medicines, pesticides, etc.) the center Establish chemical incident FMOH X X X control zones (access control points, delineating a contamination reduction corridor) 115 Radiation Emergencies Mechanisms are established and To improve the coordination and information Endorsement of the existing ERPA X functioning for detecting and responding communication between national radiological TOR, MOU, coordination, to radiological and nuclear emergencies and nuclear emergency team in detection, and information sharing reporting and response to radiological and protocol for the national nuclear emergencies coordination task force and TWG Develop the radiological and ERPA X nuclear emergency response plan Strengthen the national, ERPA X X X X X radiological, and nuclear emergency response team Finalize radiological and ERPA/T X nuclear emergencies WG management guideline, reporting tools, exercises drills for simulation and orientation/training material (in collaboration with IAEA) Printing and distribution of ERPA X X guidelines and protocols, SOPs Train/workshop ERPA X X (international) on radiological and nuclear emergency preparedness and response for the national team Orientation/training for FMOH/E X X X X PHEM officers and clinicians PHI on the surveillance and case management Maintain focal points and ERPA X X X X X provide training on detection, reporting, response, and horizontal and vertical communication mechanism Development and ERPA X X dissemination of electronic information sharing tool with vertical and horizontal reporting addresses based on the protocol 116 Provide radiation detection ERPA X X X X device, Protective devices and supplies, and PPE for emergency response to the national radiation authority and POEs Create awareness for the ERPA X X X X community and advocacy for administrative officers Enabling environment is in place for To revise and improve the communication and Establish technical task ERPA X X X X X management of radiation emergencies coordination mechanism among ERPA, force/technical working medical device department, and national focal group involving all relevant point stakeholders and organize regular meeting and information sharing Prepare database for all ERPA X X X X X relevant stockholders’ address and contact address for emergency and regular communication Improve the waste storage ERPA X X X X X and processing facility (including the laboratory for conditioning of radioactive sources) Improve laboratory capacity ERPA X X to perform systematic analysis of radiation samples using bioassays, biological dosimeter by cytogenetic analysis, and electron spin resonance or other bio- dosimetry analytical tests Conduct risk analysis to ERPA X X provide basis for a graded approach to preparedness response for nuclear and radiological emergencies 117 APPENDIX D. BASIC INPUTS FOR COSTING What is the currency in the country? Ethiopian Birr U.S. (ETB) Dollar (USD) Exchange rate ETB to USD 27.50 1 These questions concern inputs for the calculation of training, meetings and workshops Per-diem rate for governmental higher officials (local)? 750 27.2 What is the per diem for participants that do not have to travel far (local)? 300 10.91 Per-diem rate for international travel? 9,000 327.27 What is the per diem for participants that DO have to travel far (remote)? 300 10.91 Do participants that need to travel get extra days per diem and if yes how many days? 300 10.91 What is the rent for the hall/venue/room per day (include all costs here, beamer, computer, etc.)? 1,000 36.36 What is the price per page of printout? 2 0.07 What are the costs for stationary and pen per participant? (stationary) 50 1.82 What is the cost of a lunch per participant per day? 350 12.73 What is the cost of a tea break per participant per tea break? (refreshment) 200 7.27 Extra travel cost for persons (when applicable)? 2,000 72.73 Cost per car for persons travelling from far (when applicable)? 2,500 90.91 Cost for round trip plane ticket? 4,500 163.64 These questions concern inputs for the calculation of the costs of a consultant or expert International consultants What is the per diem for an international consultant (in USD)? 8800 320 What is the daily rate/fee for an international consultant (in USD)? 45,925 1670 What is the cost of an international flight for an international consultant (in USD)? 57,750 2100 FETP mentors payment per month? 1,540 56 118 Monthly salary for scientific writer consultant 33750 1227.27 What is the per diem for a national consultant? 300 10.91 What is the daily rate/fee for a national consultant? 1,500 54.55 What is the cost for travel for a national consultant? 300 10.91 Average cost to train one veterinarian on FETP-V (field epidemiology training program veterinary 140000 5090.91 track) program? These questions concern inputs for the calculation of supervisory visit What is the per diem per supervisor? 300 10.91 What is the cost per day for a car? 1,500 54.55 What is the per diem of a driver? 300 10.91 Model zoonotic laboratory for serological diagnostics capacity 100000 3636.36 Laptop 18000 654.55 Desktop 20000 727.27 Tablet 17000 618.18 Printer 5000 181.82 Procurement of necessary equipment and supplies for animal capture, euthanasia, and appropriate 100000 3636.36 sample collection per region Cost of coping one manual/guideline 40 1.4545 Cost of 1 EVDO 2000 72.73 Software to develop database for a multisectoral data documentation 200,000 7272.73 Software for linking laboratory and PHEM data through the DHIS2 system: 500000 18181.82 development of software for linking data to DHIS2 Refrigerator for cold chain 3000 109.091 Furniture 6000 218.18 Cost of each poster printing for scientific conference 2000 72.73 Poster board rent per day 2000 72.73 International conference registration fees per each person 27000 981.82 Cost per each certificate 50 1.82 Cost of constructing one standard medical store 55000 2000 Procure medical supplies for priority public health hazards identified by the next four years epidemic preparedness and response plan exercise (lump-sum) Cost of international risk management trainings per individual 120000 4363.64 119 Estimated cost of one risk profile assessment 20000 727.27 Cost of establishing and equipping one regional PHEOC 250000 9090.91 120 2019 View publication stats