National Action Plan for Health Security of Sri Lanka 2019-2023

2 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Census 1981 - Percentage of Population Based on Population Census 2001 - Percentage of Population Based on Population Census 2012 (5% Sample) - Percentage of Population Figure 2: Percentage of Population in Sri Lanka by age and sex in 1981, 2001 and 2012 (Source: Ministry of Health 2015) National Action Plan for Health Security of Sri Lanka: 2019 - 2023 3 1.3 Government of Sri Lanka Sri Lanka is a democratic republic with an executive presidency. Under the 1978 constitution, the head of state and government is the President. Parliamentary and presidential elections are held every six years. Parliament has a single chamber with 225 members. Members are directly elected, but vacant seats occurring during the life of a Parliament go to nominees of the party holding the seat. Ministers are appointed by the President, who chairs the cabinet and appoints the independent judiciary. Amendments may be made to the constitution, subject to a two-thirds majority in Parliament; however, to amend certain entrenched articles of the constitution approval in a national referendum is also required. The constitution provides for Provincial Councils constitute the intermediate level of government that was established within the existing governmental system which was comprised of two levels, national and local. The establishment of a Provincial Council in every province provided for a set of structures and positions with authority to exercise powers and functions at the provincial level, which also define the roles, responsibilities and relationships of a Provincial Council. It is to be noted that Provincial Councils do not function in isolation, and were established within the framework of the existing system of government, bringing about changes in its structure and functioning. 1.4 Implementation of International Health Regulations (IHR)-2005 in Sri Lanka Since the implementation of IHR -2005 in 2007, Sri Lanka has made a remarkable progress in implementing and developing IHR core capacities. In 2012 and 2014, Sri Lanka has requested for extensions to achieve IHR core capacities and fulfilled those capacities in 2016. As IHR implementation is a dynamic process it is important to critically look at the implementation status periodicallyand progress continuously. WHO committee on Ebola outbreak has identified key 12 recommendations to improve IHR implementation in countries. As one key recommendation, the new IHR monitoring framework had been adopted by World Health Organization (WHO) in 2016. One key component of this new IHR monitoring and evaluation framework is the Joint External Evaluation (JEE) along with IHR annual reporting, after action review and simulation exercises. The global movementof evaluating health security situation in countries via voluntary JEE process was initiated by WHO and supported by Centre for Disease Control and Prevention of USA and other international agencies and governments. The main objective of JEE is to identify the gaps in the health security which enabling countries to plan for better secure future. 1.4.1 National Steering Committee on IHR- 2005 Ministry of Healthy, Sri Lanka created the National Steering Committee on IHR-2005 with the involvement of health and non-health members in 2016. The need to conduct the JEE to review IHR implementation status was discussed at the first meeting of the National Steering Committee under the chairmanship of Director General Health Services in August 2016. In the latter part of 2016, Ministry of Health has requested from WHO to assist technically and financially to conduct JEE.

4 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Figure 3: IHR steering committee meeting conducted on 16th January 2018 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 5

6 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 2. RISK PROFILING OF PUBLIC HEALTH HAZARDS IN SRI LANKA The Disaster Management Act No. 13 of 2005 (Parliament of the Democratic Socialist Republic of Sri Lanka, 2005) provides the basis for the identification of public health threats in Sri Lanka. The Disaster Management Act recognizes 21 types of events which could become public health threats. In addition to the above 21 types of events, certain additional threats have been considered during the risk profiling of public health threats in Sri Lanka. The list of public health hazards considered are listed in Table 2. Table 2: List of public health hazards of Sri Lanka Category 1 - Natural hazards Category 2 Man-made hazards Category 3 Biological hazards Category 4 Complex hazards Floods Fire Epidemics Civil or internal strife Drought Forest fire Animal diseases Terrorist attacks Landslides Land transportation accidents Plant diseases Extreme heat Water transportation accidents Extreme cold Air transportation accidents Cyclone Chemical accidents Lightening Industrial accidents Tornado Radio-nuclear accidents Earthquake Construction failure Tsunami Oil spill Coastal erosion Salt water intrusion 2.1 Methodology of risk profiling of public health threats in Sri Lanka The unit of the public health risk profiling was the country. The country level risk profiling was based on the district level risk profiling of public health threats through a multi-stakeholder consultative process. Following equation was used for the risk profiling: Impact x Frequency x Vulnerability x Exposure .............. Risk = Equation 1 Capacity Scoring system presented in Table 3 was used for impact, frequency, vulnerability, exposure, and capacity. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 7 Table 3: Scoring system used for impact, frequency, vulnerability, exposure and capacity Score Definition 1 1 - Very low 2 2 - Low 3 3 - Moderate 4 4 - High 5 5 - Very high The existing risk maps were used while when information was not available, expert judgement was used. Risk score was calculated with the use of the risk equation 1. Risk square was presented as a percentage for the ease of comparison. Based on the risk scores as percentages, ranking of the hazards was done. In addition, based on the cumulative score as percentages for each category, category-wise ranking was also done. The public health risk profile of Sri Lanka will be updated as per the new information available. 2.2 Results of rsk profiling of public health threats in Sri Lanka Hazard wise profiling of public health risk for Sri Lanka is shown in Table 4 and the prioritization of public health risk score for different hazards are shown in Figure 4. As per Table 4 and Figure 4, the top ten priority public health risk scores were reported for the following hazards, in the descending order: epidemics, floods, drought, lightening, land transportation accidents, landslides, fire, chemical accidents, tsunami and cyclone

8 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Table 4: Hazard-wise profiling of public health risk for Sri Lanka Cateogry Hazard Impact Frequency Vlunerability Capacity Exposure Risk Score out of 100 Flood 3 4 5 5 5 9.6 Drought 3 4 3 2 3 8.64 Landslides 3 3 4 4 2 2.88 Extreme heat 1 2 1 2 3 0.48 Natural Hazards Extreme cold 1 1 1 1 1 0.16 1 Cyclone 4 1 2 4 3 0.96 Lightening 2 3 3 2 3 4.32 Tornado 1 2 1 2 3 0.48 Earthquake 1 1 1 1 1 0.16 Tsunami 5 1 5 4 1 1 Coastal Erosion 1 1 2 1 1 0.32 Salt Water Intrusion 1 1 2 1 1 0.32 Fire 2 3 3 3 3 2.88 Forest Fire 1 2 2 3 3 0.64 Land Transprtation Accident 3 3 3 4 4 4.32 Man-made Hazards Water Transprtation Accident 1 1 1 4 2 0.24 Air Transprtation Accident 1 1 1 4 1 0.08 2 Chemical Accidents 2 1 3 3 1 1.44 Industrial Accidents 2 1 1 3 1 0.32 Radio - Nuclear Accidents 1 1 1 2 1 0.12 Construction Failure 1 1 1 4 1 0.24 Oil Spill 1 1 1 2 1 0.24 Epidemics 4 5 5 5 5 16 Complex Biological

3 Animal Diseases 2 1 1 1 1 0.08 Plant Diseases 2 1 1 1 2 0.32 Hazards Hazards

4 Civil or Internal Strife 2 1 2 4 3 0.64 Terrorist Attack 2 1 1 3 1 0.32 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 9 0 2 4 6 8 10 12 16 Epidemics Floods Drought Lightening Land transportation accidents Landslides Fire Chemical accidents Tsunami Cyclone Forest Fire Civil or internal strife Exterme heat Tornado Coastal erosion Salt water intrusion Industrial accidents Plant diseases Terrorist attacks Water transportation accidents Construction failure Oil spill Extreme cold Earthquake Radio-nuclear accidents Aire transportation accidents Animal diseases Figure 4: Prioritization of public health risk scores of Sri Lanka

10 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 3. JOINT EXTERNAL EVALUATION AND DEVELOPMENT OF NATIONAL ACTION PLAN FOR HEALTH SECURITY 3.1 Arrangements for Joint External Evaluation Sri Lanka initiated the preliminary work on JEE of IHR implementation in January 2017. Co-National Focal Points of IHR-2005 in Sri Lanka are the Directorate of Quarantine Unit and Epidemiology Unit of Ministry of Health. Ministry of Health led the activity of identifying the main stakeholders for 19 areas of JEE and other related stakeholders from different sectors in Sri Lanka (Annex 1). Quarantine Unit which was the point of contact for JEE mission initiated the process by disseminating the JEE tool (World Health Organization, 2016) to all the stakeholders with necessary instructions. Main stakeholders were instructed to get the assistance of other relevant stakeholders when filling the JEE Tool. Several small group discussions were conducted by the Doctors of Quarantine Unit with the main stakeholders to discuss about the relevant sections of JEE Tool. This was a tedious process but had an advantage of having one to one discussion with the main stakeholders to clarify their doubts and queries. During the small group meetings main stakeholders were asked to complete the self-evaluation JEE tool (World Health Organization, 2016) with the discussion with other relevant stakeholders., Preliminary meeting was conducted on 04th of April 2017 with the involvement of the IHR focal point in WHO/SEARO, WHO/ Sri Lanka and stakeholders in Sri Lanka. As the stakeholders had an idea about the JEE tool, they could get a clear picture after the preliminary meeting. JEE was scheduled to be conducted in June 2017. Sri Lanka had experience severe outbreak of Dengue fever and severe flood situation during this period. Despite this difficult situation, country decided to conduct the JEE. IHR Co-National focal point of the Quarantine Unit had the opportunity to participate JEE mission in Myanmar which conducted from 3rd-8th May 2017. This was an excellent opportunity to experience the JEE process and it was tremendously helped to plan the JEE process in Sri Lanka. 3.2 Joint External Evaluation JEE was conducted from 19th -23rd of June 2017. Each main stakeholder was instructed to identify a presenter and they were given the PowerPoint format to present during the session. There had been technical sessions and discussions on 19 technical areas and three field visits (Medical Research Institute, Port Health Office of Colombo Seaport and National Institute for Infectious Diseases) during 5 days. Senior medical administrators and Consultants were invited to chair each session in order to get the support of higher government officials and to make them aware about the whole process. In addition, WHO team leader was appointed to co-chair each session. During the JEE, scores were given for each indicator after coming to consensus with the local counterpart. Final briefing session was chaired by the Secretary of Health and team leader of WHO presented the priority actions and recommendations. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 11 Secretary of Health requested from stakeholders to prepare Five Year National Action Plan for Health Security (NAPHS) based on the gaps identified during the JEE and during other routine evaluations. Score for each indicator in each technical area is shown in Annex 2. It was mentioned that the JEE will be conducted once in every five years. Draft of the JEE report was shared among the stakeholders and after getting their comments, the final report was published by the World Health Organization in August 2017 (World Health Organization, 2017) The published JEE report was tabled at National Steering Committee Meeting on International Health Regulations -2005 which was chaired by Deputy Director General – Laboratory Services on 19th of September 2017. Joint External Evaluation of International Health Regulations (2005) Ministry of Health, Nutrition & Indigenous Medicine Implementation Satus in Sri Lanka.

19-23 June 2017, Colombo, Sri Lanka Figure 5: Participants of Joint External Evaluation of Sri Lanka

12 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 3.2.1 Cross cutting recommendations of JEE 1. Strengthen multi-sectoral engagement and foster a true One Health approach ∙ Establishes or enhances mechanisms to promote systematic collaboration between the human health, animal health and other relevant sectors on technical and policy areas. 2. Enhance surveillances ∙ Integrates the surveillance efforts of the human and animal health sectors, across all levels of government and specially at the national level ∙ Improves the quality and management of data, considering the use of enhanced electronic reporting tools and registries to facilitate the rapid collection, exchange, analysis and use of health data. New information technology has enabled the development of electronic patient registries covering clinical and laboratory data from all levels and sectors of the healthcare system. This allows real-time surveillance and reporting activities as well as linkages with other sources of data. 3. Ensure sustainable and scalable health security through improved documentation ∙ Develops, finalizes and formally approves national plans, memoranda of understanding, standard operating procedures and other administrative mechanisms that facilitate and formalize implementation, communication and coordination across sectors, while maintaining the flexibility to adapt to situations as they develop ∙ Implements these administrative mechanisms to empower all relevant sectors and ensure a One Health and multi hazard approach, contributing to business continuity and Sri Lanka’s ability to respond to unexpected events and large scale emergencies 3.3 Vision, Mission, Objectives of the National Action Plan for Health Security Vision A safer nation through strengthened capacities for public health security Mission To contribute towards a safer nation by strengthening core capacities and capabilities to prevent, detect and respond to public health threats efficiently and effectively adopting a multi-stakeholder approach. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 13 Objectives 1. To build and sustain multi-stakeholder engagement to attain IHR core capacities through consultation and consensus. 2. To ensure comprehensive risk assessment to support decision-making before incidents and during response and recovery operations 3. To strengthen and maintain national core capacities and contribute to the achievement of sustainable development goals. 4. To align activities among stakeholders adopting a ‘one health approach’ to engage the human, animal and agriculture sectors 5. To assimilate results based monitoring and evaluation for national health security. 3.3.1 Guiding principles and core values of National Action Plan for Health Security Country ownership and leadership The National Focal Points for IHR and the National Steering Committee will coordinate and support the implementation of activities in line with the national guidelines Evidence based practice Policies, programmes and activities will be based on evidence generated scientifically at national and international levels Strengthening partnerships and collaborations All relevant stakeholders of the government and non-government sectors will be partners of the national planning process. Gender equity and human rights Gender and human rights principles that ensure incorporation of gender equity and human rights perspectives into policies and programmes. 3.3.2 Platform for National Action Plan for Health Security – linkage with existing plan; interplay between relevant sectors enablers Many of the existing parliamentary Acts, policies, strategies and plans that links with the NAPHS is given below. 1. Quarantine and Prevention of Disease Ordinance (1897) 2. Notifiable Disease List (last gazetted in 2014 3. Food Act (1980), amended in 1991 4. Animal Diseases Act (1992) 5. Plant Protection Act (1999) and Seeds Act (2003) 6. Civil Aviation Act (2010) 7. Sri Lanka Ports Authority Act (1979)

14 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 8. Sri Lanka Disaster Management Act (2005) 9. National Environmental Act (2000) 10.National Authority on Tobacco and Alcohol Act, No. 27 of 2006 11.Ministry of Health Master Plan 2017-2025 12.National Strategic Plan for Combating AMR 13.Circular on the national external quality assurance programme 14.Veterinary Public Health Concept Paper 15.Veterinary Surgeons and Practitioners Act 16.World Organization for Animal Health PVS Gap Analysis of the Veterinary Services of Sri Lanka (2011) 17.Biosafety Manual for medical laboratories- second Edition 18.Enforcement of Private Medical Institutions (registration) Act (2006) 19.National Immunization Hand book 20.National Immunization Policy 21.Comprehensive multiyear plan for immunization (2017–2021) 22.National guidelines on Influenza, dengue, leptospirosis, gonococcus 23.National External Quality Assessment Scheme in Bacteriology 24.National influenza pandemic plan 25.Polio outbreak preparedness and response plan 26.National Health Strategic Master Plan (2017-2025) 27.Health facility survey (2015) 28.National Disaster Management Plan (2013—2017) 29.Sri Lanka Comprehensive Disaster Management Programme (2014—2018) 30.Strategic Plan for Health Sector Disasters and Emergency Management 31.National Medicinal Policy 32.Public Health Contingency Plan for Sea Ports 33.Public Health Contingency Plan for Airports 34.Standard operating procedures for prevention, early warning and response to public health events at points of entry 35.Action Plan for Sound Management of Chemicals in Sri Lanka 36.Radiation Emergency Management Plan (draft) 3.4 Preparation of National Action Plan for Health Security of Sri Lanka Each main stakeholder was instructed to prepare five year action plans after discussing with other stakeholders based on JEE recommendations and other priority areas according to the excel format and guidance given by WHO (World Health Organization, 2018). A three day workshop was conducted on 20-22nd March 2018 to discuss the action plans with the involvement of Focal points of WHO SEARO and WHO Sri Lanka. All relevant stakeholders were invited to attend for discussion. The costing of the activities of NAPHS was done by respective units based on guidelines National Action Plan for Health Security of Sri Lanka: 2019 - 2023 15 given and experiences on preparing national budget. Planning and costing of activities were difficult in some instances such as: involvement of multiple units; amendment of the legislations; long term activities; uncertainty about the sub activities. In such instances an approximate figure for costing was used. Each unit is expected to find funds from the Government and donor agencies. Draft NAPHS was submitted to Director General of Health Services during the 4th National Steering Committee Meeting on International Health Regulations -2005 held on 21/08/2018. All the steering committee members were given a copy of NAPHS to further discuss with relevant higher officials of the respective units and to obtained their comments prior to finalization. Cost estimation for activities in each area is shown in Table 5. Table 5: Total cost estimation of each technical area No. Technical area Estimated cost (Rs.)

1 National Legislation, Policy and Financing 1,950,000

2 IHR Coordination, Communication and Advocacy 1,600,000

3 Antimicrobial resistance 90,000,000

4 Zoonotic Disease 637,700,000

4 Food Safety 1,273,100,000

6 Biosafety and Biosecurity 174,420,000

7 Immunizations 1,000,000

8 National Laboratory System 147,000,000

9 Real Time Surveillance 40,000,000

10 Reporting 1,000,000

11 Workforce Development 21,220,000

12 Preparedness 28,300,000

13 Emergency response operation 15,700,500

14 Linking Public Health and Security Authorities 6,000,000

15 Medical Counter measures and Personnel Deployment 125,100,000

16 Risk Communication 6,825,000

17 Points of Entry (PoE) 179,400,000

18 Chemical Events 1,045,500,000

19 Radiation Emergencies 11,300,000 Total 3,807,115,500

16 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Workshop to develop five year national Action plan for health security to Strength the implementation of Ministry of Health, Nutrition & Indigenous Medicine international health regulations (2005) Jointly Organized by Ministry of Health and WHO, Sri Lanka 20-21-22 March 2018 Hotel Taj Samudra (Crystal Ball Room) Figure 6: Participants of the Workshop to develop National Action Plan for Health Security 3.4.1 Implementation, Monitoring and Evaluation of activities of National Action Plan for Health Security NAPHS is a multi-stakeholder medium term action plan with a results-based approach. The NAPHS implementation and monitoring of the overall plan and sectoral plans are critical to achieve desired results. The NAPHS is encompass four important components of IHR monitoring and evaluation framework; annual reporting, after action reviews, simulation exercise and Joint external evaluations. Overall coordination of NAPHS will be done by National Co Focal Points of IHR-2005 in Sri Lanka. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 17 3.4.1.1 Implementation of NAPHS The implementation of NAPHS is whole of government responsibility and commitment. the respective ministries, departments and units will include the activities in the plan with in their annual work plan. The activities in the NAPHS will be implemented in phase wise. The NAPHS will be funded mainly through government funds, whereas selected projects will be funded by donors. 3.4.1.2 Monitoring of the NAPHS The monitoring of NAPHS activities will be based on agreed upon indicators / milestones mentioned in the activity plans. The responsibility of monitoring sectoral / cross sectoral activities of NAPHS is lies with main stakeholder of each technical area. The overall monitoring of the NAPHS will be done by national IHR steering committee headed by DGHS. Quarantine unit will function as a secretariat of the IHR steering committee and collate necessary information from the stakeholders. In addition, most of the activities will be monitored through routine monitoring systems of the respective departments, units and institutions. 3.4.1.2.1 Monitoring Framework The Key Performance Indicators identified within the NAPHS will be used to monitor the progress of implementation of NAPHS 3.4.1.2.2 Monitoring and reporting frequency The main stakeholders for each technical area will be report every 6 months to IHR steering committee. the progress of the NAPHS will be published annually. 3.4.1.3 Evaluations of the NAPHS The end evaluation and midterm evaluations of the NAPHS will be carried out as IHR joint external evaluation with the WHO. Table 6 shows the responsibility and frequency of monitoring and evaluation of NAPHS. Table 6: Responsibility and frequency of monitoring and evaluation of NAPHS Level of monitoring and evaluation Responsibility Frequency National Level IHR steering committee Every 6 months Ministerial level / Department level Head of the department and Main Stakeholder Every quarter Unit level Head of the unit Every quarter

18 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 4. ACTIVITIES OF NATIONAL ACTION PLAN FOR HEALTH SECURITY PREVENT PREVENT 1. National Legislation, Policy and Financing Adequate legal framework for States Parties to support and enable the implementation of all their obligations and rights made by the IHR should have been available within the country. Therefore this technical area makes sure that availability of legislation and financing in place in all relevant sectors to support IHR implementation including core capacity development and maintenance. There are two indicators under the national legislation, policy and financing technical area and scores achieved during the Joint External Evaluation (JEE) are as follows. JEE Indicator JEE Score P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government Score 4 instruments in place for implementation of IHR P.1.2 Legislation, policies and administrative arrangements enable compliance with the IHR (2005) Score 3 Recommendations for priority 1. Update the Quarantine and Prevention of Disease Ordinance with amendments that were recently approved by actions Sri Lanka’s cabinet, in order to bring the legislation up to date with IHR requirements. 2. Formalize, through regular meetings and established terms of reference, coordination between IHR focal points within the various line ministries as an administrative requirement for IHR implementation. 3. Establish a multisectoral technical working group to further assess the legal system and administrative arrangements in relation to the IHR across the whole of government, and, where necessary, adjust laws, regulations and administrative practices in order to enable IHR implementation. 4. Document and publish the administrative arrangements and policies from various sectors in order to further encourage cross-sectoral collaboration. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 19 JEE Indicator P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government instruments in place for implementation of IHR. JEE Scores Score 4 Objective 1.1.1 To develop and assess the need for changes in other parts of national legislation in order to have capability across government to implement the IHR. No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones (Strategic actions) including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Incorporate the Cabinet DDG-PHS-1, ∙ Amended quarantine and approved legal amendments Chief Legal Officer, disease prevention act. to quarantine and disease National Focal Points (NFP) prevention act of Sri Lanka. of IHR-2005 (Director/ √ √ √ Quarantine Unit and Chief Epidemiologist)/ Ministry of Health

02 Formalize National steering DDG-PHS-1, ∙ Amended quarantine and committee on IHR 2005, Chief Legal Officer, disease prevention act. identify relevant committee NFP of IHR-2005/ Ministry of members from different Health ∙ Formulated roles and √ √ sectors and define their roles responsibilities of the and responsibilities. National Focal Points of IHR-2005.

20 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator P.1.2 Legislation, policies and administrative arrangements enable compliance with the IHR (2005) JEE Scores Score 3 PREVENT Objective 1.1.1 To establish a multisectoral group for further adjustments to laws and regulations to fully comply with the IHR-2005 No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones (Strategic actions) including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a multi sectoral DGHS, ∙ Established group group for further adjustments DDG-PHS-1, to laws and regulations Legal Officer to fully comply with the IHR- NFP of IHR-2005/ Ministry of √ √ √ √ √ 2005 and conduct meetings Health Heads of other units/ Ministries

02 Map the existing legal DGHS, ∙ Completed report on provisions, policies and DDG-PHS-1, the legal provisions, administrative arrangements Legal Officer policies and administrative relevant to implementation NFP of IHR-2005/ Ministry of arrangements relevant √ √ of IHR and suggest areas Health to implementation of IHR to be addressed in specific with suggestions legislation and policies to comply with IHR-2005.

03 Review and revision of Responsible authorities of ∙ Reviewed report. existing legislation, policies relevant stakeholder units ∙ Revised legislation, and administrative strategies policies and administrative related to IHR by relevant strategies related to IHR √ √ stakeholders

04 Amendment of specific Responsible authorities of ∙ Issued circulars / administrative arrangements relevant stakeholder units administrative documents √ √ √ √ by relevant stakeholders in line with IHR National Action Plan for Health Security of Sri Lanka: 2019 - 2023 21 2. IHR Coordination, Communication and Advocacy The effective implementation of the IHR (2005) requires multisectoral/multidisciplinary approaches through national partnerships for effective alert and response systems. There for coordination of nationwide resources, including the sustainable functioning of a National IHR Focal points (Quarantine Unit and Epidemiology Unit) which are act as national centers IHR (2005) communications is a key requisite for IHR (2005) implementation. There is one indicator under IHR Coordination, Communication and Advocacy technical area and score achieved during JEE is as follows. JEE Indicator JEE Score P.2.1 A functional mechanism is established for the coordination and integration of relevant sectors in Score 2 the implementation of IHR Recommendations for priority 1. Draft and formalize terms of reference for the National IHR Steering Committee, including roles and responsibilities actions and frequency of meetings; and formulate an action plan for the committee. 2. The National IHR Steering Committee should participate fully in completing the IHR annual questionnaire. 3. Hold an annual meeting of the National IHR Steering Committee to inform members about IHR updates.

22 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator P.2.1 A functional mechanism is established for the coordination and integration of relevant sectors in the implementation of IHR PREVENT JEE Scores Score 2 Objective 2.1.1 To conduct IHR steering Committee Meetings and update on IHR No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones 2019 2020 2021 2022 2023 (Strategic actions) including budget line holder (Monitoring and Evaluation)

01 Conduct IHR steering DGHS, ∙ Percentage of planned Committee Meetings DDG-PHS-1, Director/ meeting conducted √ √ √ √ √ Quarantine

02 Identify two focal points DGHS, DDG-PHS-1, National ∙ Appointed two focal points from each sector to liaise Focal Points-IHR-2005/ from each sector √ √ √ √ √ with National Focal Points- Ministry of Health ∙ Formulated the roles and IHR-2005/ Ministry of Health responsibilities of the focal points Objective 2.1.2 To complete IHR annual questionnaire with the participation of all stakeholders. No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones (Strategic actions) including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Annual meeting with relevant DGHS, DDG-PHS-1, Director/ ∙ Filled IHR Annual stakeholders to fill IHR Annual Quarantine questionnaire with full √ √ √ √ √ Questionnaire participation of the stakeholders National Action Plan for Health Security of Sri Lanka: 2019 - 2023 23 3. Antimicrobial resistance Support work being coordinated by WHO, FAO and OIE to develop an integrated global package of activities to combat antimicrobial resistance, spanning human, animal, food and environmental aspects. One health approach is one of the ways to achieve this objective and in addition to that need of national comprehensive plan to combat antimicrobial resistance and strengthening of surveillance and laboratory capacity at the national and international level. There are four indicators under antimicrobial resistance technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score P.3.1. Antimicrobial resistance (AMR) detection Score 3 P.3.2. Surveillance system for infections caused by AMR pathogens Score 3 P.3.3. Healthcare associated infection (HCAI) prevention and control programs Score 3 P.3.4. Antimicrobial stewardship Activities Score 3 Recommendations for priority 1. Conduct systematic awareness programmes on AMR among target groups in the human health, veterinary, actions fisheries, and agriculture sectors. 2. Establish and expand the national AMR surveillance system to cover all priority pathogens for AMR in human health and relevant AMR pathogens (such as Salmonella, E.coli, and S. aureus) in animal health. 3. Expand healthcare acquired infections (HCAI) surveillance to include at least one additional HCAI (such as surgical site infections or ventilator-associated pneumonia). 4. Establish antibiotic stewardship programmes and strengthen legislation against unauthorized prescriptions in the human and animal health sectors.

24 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator P. 3.1 Antimicrobial resistance (AMR) detection PREVENT JEE Scores Score 3 Objective To strengthen the AMR surveillance system No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones (Strategic actions) including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Development of a system Ministry of Health, ∙ Percentage of meeting for multisectoral coordination Department of Animal held out of planned √ √ √ √ √ between human and animals Production and Health (DAPH), Ministry of fisheries and aquatic resources

02 Expand capability for AMR DAPH, Ministry of fisheries ∙ Percentage of meeting surveillance at veterinary and aquatic resources held out of planned √ √ √ √ √ laboratories ∙ AMR surveillance at veterinary laboratories

03 Designated laboratories Ministry of Health, DAPH, ∙ Detection and reporting of to conduct detection and Ministry of fisheries all priority AMR pathogens √ √ √ √ √ reporting of all priority AMR and aquatic resources, by Humans, Animal and pathogens regularly Department of agriculture Agriculture sectors National Action Plan for Health Security of Sri Lanka: 2019 - 2023 25 JEE Indicator P.3.2 Surveillance system for infections caused by AMR pathogens JEE Scores Score 3 Objective To establish a surveillance system for infections caused by AMR pathogens No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones (Strategic actions) including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establishment of the National Ministry of Health ∙ Number of hospitals Surveillance system on carrying out surveillance √ √ √ √ √ Antimicrobial resistance for out of the planned number human sector and sustain it. (Shigella has been included as a priority pathogen)

02 Establishment of the National DAPH, Ministry of fisheries ∙ Number of sites carrying Surveillance system on and aquatic resources out surveillance out of the √ √ √ √ √ Antimicrobial resistance planned number for animal (veterinary and fisheries) sector according to OIE

03 Establish the national Ministry of Health ∙ Number of sites carrying surveillance system for all out surveillance out of the √ √ √ √ √ priority pathogens in sentinel planned number sites for human sector

26 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator P. 3. 3. Healthcare associated infection (HCAI) prevention and control programs PREVENT JEE Scores Score 3 Objective To strengthen Healthcare associated infection (HCAI) prevention and control programs at national and subnational level No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation Milestones (Strategic actions) including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Formulation of national Ministry of Health ∙ Publishing document of infection control policy infection control policy √ √

02 HCAI reporting of all Ministry of Health ∙ Percentage of selected identified HCA Infection hospitals reporting all √ √ √ √ √ indicators in selected indicators out of planned hospitals

03 Awareness and training Ministry of Health, Sri Lanka ∙ Number of programmes programmes on infection College of Microbiologists conducted √ √ √ √ √ prevention and control (SLCM)

04 Development of national Ministry of Health, SLCM ∙ Publishing IPC guidelines infection prevention and √ √ √ control (IPC) guidelines

05 Strengthen practicing of Ministry of Health ∙ Availability of negative international standards for pressure rooms √ √ √ √ isolation

06 Strengthen infection control DAPH ∙ Number of sites surveillance in farms participating √ √ √ √ √ National Action Plan for Health Security of Sri Lanka: 2019 - 2023 27 JEE Indicator P.3.4 Antimicrobial stewardship Activities JEE Scores Score 3 Objective To enhance AMR stewardship activities No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conducting awareness Ministry of Health, DAPH, ∙ Percentage of programmes programmes among target groups Ministry of fisheries conducted out of planned √ √ √ √ √ i.e. administrators, technical staff, and aquatic resources, farmers and general public Department of agriculture

02 Develop legislation to ensure strict Ministry of Health, DAPH, ∙ Availability of legislations oversight and enforcement of Ministry of fisheries √ √ √ √ √ unauthorized, over-the counter sale and aquatic resources, of antibiotics in both human and Department of agriculture animal health sectors.

03 Review of prescription patterns Ministry of Health ∙ Number of hospitals and No. of sales outlets in √ √ √ √ which the audits are done

04 Introduction of prescription policies Ministry of Health ∙ Availability of policies √ √ phase wise

05 Developing Antimicrobial Ministry of Health ∙ Number of hospitals having √ √ √ √ stewardship a Antimicrobial stewardship programme

06 Improve awareness on AMR in Ministry of Health, DAPH, ∙ Percentage of programmes √ √ √ √ human, veterinary and fisheries & Ministry of fisheries conducted out of planned agriculture and aquatic resources, Department of agriculture

07 Implementation of world antibiotic Ministry of Health, DAPH, ∙ Number of activities √ √ √ √ week in national scale Ministry of fisheries conducted in antibiotic and aquatic resources, week Department of agriculture

28 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 4. Zoonotic diseases PREVENT Adopted measured behaviors, policies and/or practices to prevent and minimize the transmission of zoonotic diseases into human populations. Development of national operational frame work based on international standards, guidelines and successful existing models that specify the actions necessary to promote one health approaches to policies, practices and behaviors that could minimize the risk of zoonotic disease emergence and spread. There are three indicators under the zoonotic diseases technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score P.4.1 Surveillance systems in place for priority zoonotic diseases / pathogens Score 3 P.4.2 Veterinary or Animal Health Workforce Score 3 P.4.3 Mechanisms for responding to infectious zoonoses and potential zoonoses are established and Score 2 functional Recommendations for priority 1. Establish a veterinary public health team within the Department of Animal Health and Production with an actions appropriate allocation of human, physical and operational resources at both the central and field levels. 2. Establish a formal One Health platform, bringing together the four key ministries and agencies (Health, Animal Health and Production, Fisheries and Environment/Wildlife) with local government and private stakeholders to deliver a national zoonotic disease control strategy. 3. Design, implement and annually evaluate zoonotic disease control plans for rabies, brucellosis, tuberculosis and leptospirosis, among others. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 29 JEE Indicator P.4.1 Surveillance systems in place for priority zoonotic diseases/pathogens JEE Scores Score 3 Objective To further develop the comprehensive surveillance systems in place for priority zoonotic diseases/pathogens No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Finalize and approve zoonotic DG/DAPH, ∙ Finalized Strategic Plan for disease control strategy D/AH, zoonotic disease control √ D/WLH-DWC

02 Establish surveillance programs D/AH, ∙ Surveillance plans, monthly for important zoonoses - rabies, D/WLH-DWC, reports Surveillance data √ √ √ √ √ leptospirosis, brucellosis, TB etc. D/PHVS in the Vet. epidemiological bulletin

03 Upgrade laboratory facilities at DG/DAPH, ∙ Percentage of upgraded central and district level for disease D/AH, laboratories √ √ √ surveillance D/WLH-DWC, D/PHVS

04 Improve the implementing capacity Ministry of Rural Economy, ∙ Percentage of divisional √ √ √ √ √ for Veterinary Public Health (VPH) DAPH, level Veterinary Public at central, Provincial and divisional PDAPH health facilities with level minimum carder

05 Improve the capacity of animal Ministry of Rural Economy, ∙ Published protocols, √ √ √ √ √ quarantine at point of entry DAPH Number of trainings carried out per year, Availability of minimum required infrastructure at PoEs

30 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator P.4.2 Veterinary or Animal Health Workforce JEE Scores Score 3 PREVENT Objective To enhance the veterinary or animal health work force No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a VPH mechanism at Ministry of Rural Economy, ∙ VPH officers are in place central and peripheral (provincial & DG/DAPH, PDAPH with assigned duties √ √ √ √ √ divisional) level

02 Advertise existing vacancies and Ministry of Rural Economy, ∙ Number of vacancies filled √ √ √ √ √ recruitment DG/DAPH out of approved National Action Plan for Health Security of Sri Lanka: 2019 - 2023 31 JEE Indicator P.4.3 Mechanisms for responding to infectious zoonoses and potential zoonoses are established and functional JEE Scores Score 2 Objective To establish a functional mechanism to respond to infectious zoonoses and potential zoonoses No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Improve the epidemiology capacity DG/DAPH, D/AH ∙ Number of candidates of VIOs and field VSs complete Master courses √ √ √ √ √ and CPD modules

02 Improve the laboratory capacity for DG/DAPH, D/AH, D/VR ∙ Availability of veterinary animal disease diagnosis public health laboratory √ √ √ facilities at district and national level ( with minimum identified core tests)

03 Prepare and publish of SOPs D/AH, D/VR ∙ SOPs available at VICs and for laboratory methods and field VSOs √ disease investigation and response mechanisms

04 Improve the disease reporting DG/DAPH, DGHS ∙ Percentage of joint √ √ √ √ √ system based on a real time investigations conducted reporting mechanism for nationally within specified time identified zoonotic pathogens period

32 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 5. Food safety PREVENT State Parties should have surveillance and response capacity for food and water borne diseases risk or events. It requires to effective communication and collaboration among the sectors responsible for food safety, safe water and sanitation. Timely detection and effective response of potential food related events in collaboration with other sectors responsible for food safety should be achieve by the implementation of strategies under this technical area. There is one indicator under the food safety technical area and score achieved during JEE is as follows. JEE Indicator JEE Score P.5.1 Mechanisms are established and functioning for detecting and responding to food borne disease Score 3 and food contamination Recommendations for priority 1. Strengthen collaboration between Sri Lanka’s various agencies and ministries, aspiring to a “farm-to-plate” actions approach. 2. Carry out a risk profiling assessment and use the results to revise inter-agency responsibilities and the overall food safety strategy. 3. Upgrade capacities and guidelines, particularly laboratory capacity in areas such as on-site testing, and testing on chemical residues. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 33 JEE Indicator P.5.1 Mechanism for multisectoral collaboration are established to ensure rapid response to food safety emergencies and outbreaks of food borne diseases JEE Scores Score 3 Objective 1 To strengthen collaboration between ministries in the food supply chain from farm to plate. No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 1.1 Develop National Food safety Policy Food Control Administrative ∙ Policy and strategic plan and strategic plan Unit (FCAU) / Ministry of available √ √ Health, Ministry of Agriculture, Ministry of Fisheries, DAPH 1.2 Conduct coordination committee Ministry of Health ∙ Meeting minutes meeting quarterly for all √ √ √ √ stakeholders 1.3 Sharing of common action plan Ministry of Health, ∙ Relevant section of plans Ministry of Agriculture, available √ √ √ √ Ministry of Fisheries, DAPH 1.4 Establish food safety program FCAU /PDHS/ RDHS ∙ Number of functioning √ √ √ √ monitoring committee at National, committees Provincial, District and Divisional level Objective 2 To develop food safety risk profiling capacity No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 2.1 Capacity building of risk profiling Ministry of Health, ∙ Resource team available team Ministry of Agriculture, √ √ Ministry of fisheries and aquatic resources development, DAPH Ministry of Fisheries, DAPH

34 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 2.2 Develop a multisectoral Ministry of Health ∙ Plans available management plan, based on the √ √ √ PREVENT risk profile 2.3 Update regulations. based on Good Ministry of Health, ∙ Number of regulations Hygiene Practice (GHP) Ministry of Agriculture, gazetted √ √ √ √ √ Ministry of fisheries and aquatic resources development, DAPH Objective 3 To strengthen the food analysis capacity No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 3.1 Conduct gap analysis in food testing FCAU– Laboratories ∙ Conducted Gap analyzing √ √ 3.2 Expansion of laboratory testing E & OH & FS / Ministry of ∙ Expanded laboratory capacity to include heavy metals, Health, Government Analysts testing capacity √ √ √ √ pesticide residue , harmful algal / Water Board blooms (HAB) 3.3 Review food laboratory quarterly Food Control Administrative ∙ Number of reviews per Unit (FCAU)/ Ministry of year √ √ √ √ Health 3.4 Accreditation of food laboratories FCAU// Ministry of Health, ∙ Number of accredited food Sri Lanka Accreditation Board laboratories √ √ 3.5 Establishment of laboratory E & OH & FS / Ministry of √ √ √ √ quality management system and Health Laboratory information system National Action Plan for Health Security of Sri Lanka: 2019 - 2023 35 Objective 4 To enforce Good Hygiene Practice(GHP) in Food Business Operations (FBO) No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 4.1 Registration of food premises Ministry of Health ∙ Regulation available √ regulation adapted 4.2 Enforce food premises regulation Ministry of Health ∙ All FBO registered √ √ √ √ 4.3 Adapt good practices and DAPH ∙ Number of slaughter legislations on slaughter houses adhered good √ √ √ √ practice 4.4 Develop a training module and Ministry of Health ∙ Percentage of trained registration of all trained food workers √ √ √ handlers Objective 5 To establish Food Authority No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 5.1 Policy approval and logistic support Ministry of Health, ∙ Approved policy to establish National Food Authority Other stakeholders √ √ 5.2 Establish units for- risk profiling, Ministry of Health, ∙ Approved cadre legal and enforcement Other stakeholders √ √ 5.3 Training of staff in all ministries Ministry of Health, ∙ Number of training involving in food chain on GHP, Other stakeholders programs conducted √ √ √ √ Good Manufacturing Practice (GMP) and Hazard Analysis Critical Control Point (HACCP)

36 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Objective 6 To establish food safety surveillance system No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation PREVENT national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 6.1 Establish food safety surveillance Ministry of Health and other ∙ Food surveillance system √ √ √ √ system stakeholders in place 6.2 Establish common E -platform Ministry of Health ∙ E platform available √ √ √ √ 6.3 Establish a rapid response system Ministry of Health ∙ Rapid response system in √ √ √ place Objective 7 To conduct outbreak investigations No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 7.1 Multisectoral outbreak investigation Ministry of Health, ∙ Food event investigated √ √ √ √ of a food event Other ministries 7.2 Outbreak control Ministry of Health, ∙ Outbreak investigation and √ √ √ √ √ Other ministries control reports 7.3 Quarterly review meeting at Ministry of Health, ∙ Number of review √ √ √ √ national level Other ministries meetings conducted National Action Plan for Health Security of Sri Lanka: 2019 - 2023 37 Objective 8 To make consumer awareness No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 8.1 Develop a food safety Ministry of Health, ∙ Communication strategy √ √ √ √ communication strategy Other stakeholders available 8.2 Establish 24/7 reporting system Ministry of Health ∙ Number of inquiries from √ √ √ √ “Suwasariya” public 8.3 Conduct food safety weeks Ministry of Health, ∙ Food safety week report √ √ √ √ Ministry of Agriculture, Ministry of fisheries and aquatic resources development, DAPH Objective 9 To strengthen border control activities related to food items No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023 9.1 Strengthen border control activities Ministry of Health and other ∙ Communication strategy √ √ √ √ of all food items stakeholders available 9.2 Strengthen risk based surveillance Ministry of Health and other ∙ Risk based surveillance √ √ √ √ and testing facilities stakeholders and testing facilities in place 9.3 Establish an alert system Ministry of Health ∙ Alert system in place √ √ √ √

38 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 6. Biosafety and Biosecurity PREVENT National biosafety and bio security system in place to ensure the safety from dangerous pathogens who are identified, held, secured and monitored in a minimal number of facilities according to best practices such as biological risk management training and educational outreach are conducted to promote a shared culture responsibility, reduce dual use risks, mitigate biological proliferation and deliberate use threats. There are two indicators under the biosafety and biosecurity technical area and score achieved during JEE are as follows. JEE Indicator JEE Score P.6.1 Whole-of-government biosafety and biosecurity system in place for human, animal and agricul- Score 2 ture facilities P.6.2 Biosafety and biosecurity training and practices Score 1 Recommendations for priority 1. Develop a comprehensive, multisectoral biosafety and biosecurity strategy and accompanying legislation. actions 2. Based on the strategy, develop an action plan for implementation at the national level for both the public and private sectors, : ² A biosafety and biosecurity training programme that includes professional awareness training; ² Measures to update the inventory dangerous pathogens and toxins 3. Update the laboratory licensing accreditation process to include biosafety and biosecurity requirements. 4. Identify how sustained funding can be ensured for biosafety and biosecurity programmes. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 39 JEE Indicator P.6.1 Whole-of-government biosafety and biosecurity system in place for human, animal and agriculture facilities JEE Scores Score 2 Objective To develop a comprehensive national biosafety and biosecurity system No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish line of authority and DDG (LS), DDG (ET&R), ∙ National Advisory relevant committees to develop a D/MRI, D/Lab Service,SLCM, Committee established national comprehensive biosafety DG / DAPH,D / VRI, ∙ Steering committees for and biosecurity system in SL. Department of Agriculture, Human Health, Animal Central Environmental sector and Plant sector Authority established

02 Develop national level records or DDG (LS), DDG (ET&R), ∙ Availability of institutional √ √ √ √ √ an inventory to monitor the number D/MRI, D/Lab Service,SLCM, inventories and type of dangerous pathogens DG / DAPH,D / VRI, ∙ Availability of tool to collect and toxins collected in the country. Department of Agriculture, data fisheries) sector according to OIE Central Environmental ∙ Availability of central data Authority base ∙ Availability of SOPs ∙ Availability of the national inventory

03 Develop comprehensive national DDG (LS), DDG (ET&R), MRI, ∙ Number of steering group √ √ √ √ √ biosafety and biosecurity frame D / Lab Service, SLCM, DG meetings held work and legislation / DAPH, D / VR, D / AH & D/ ∙ No. of workshops VRA, Ministry of Agriculture, conducted to collect Mo LS & RCD, MOA, MoMD information & E, MoE & NR, Central ∙ Number of different Environmental Authority sections of the legislation covered

04 Improve pathogen control DDG (LS), MRI,DDG (ET & R), ∙ Improved standards and √ √ √ √ measures, including standards D / Lab Service, DG / DAPH, systems in place for physical containment D / VR & D/AH, Department and operational handling and of Agriculture, Central containment failure reporting Environmental Authority systems.

40 National Action Plan for Health Security of Sri Lanka: 2019 - 2023

05 Implement laboratory licensing DDG (LS), MRI, DDG (ET&R), ∙ Number of training √ √ √ √ and accreditation process for state D / Lab Service, DG / DAPH & programmes conducted PREVENT sector laboratories. D / VR, DOA ∙ No. of activities performed for stepwise upgrades of laboratories in line with international standards ∙ Number of Laboratories accredited JEE Indicator P.6.2 Biosafety and biosecurity training and practices JEE Scores Score 2 Objective To conduct biological risk management training and educational outreach that includes professional awareness training; No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Complete a training needs DDG (LS), MRI, DDG (ET & Staff training schedules √ √ assessment. R), D / Lab Service, MoH, DG /DAPH, DOA, Mo LS & RCD, MOA, MoMD & E, MoE & NR,CEA

02 Develop A train-the-trainers DDG (LS), MRI, DDG (ET&R), Number of trainers in √ √ √ √ √ programme on biosafety based on D / Lab Service, MoH, DG / the country the results of the needs DAPH, DOA, Mo LS & RCD, MOA, MoMD & E, MoE & NR,CEA

03 Develop the national level DDG (LS), MRI, DDG (ET & Availability of a common √ √ √ √ √ comprehensive common training R), D / Lab Service, MoH, DG/ training curriculum curriculum needs. DAPH, DOA, Mo LS & RCD, MOA, MoMD & E, MoE & NR, CEA National Action Plan for Health Security of Sri Lanka: 2019 - 2023 41 7. Immunization A functioning national vaccine delivery system with nationwide reach, effective distribution, access for marginalized populations, adequate cold chain and ongoing quality control are essential to respond to the new disease threats. There are two indicators under immunization technical area and score they have achieved during JEE as follow. JEE Indicator JEE Score P.7.1.Vaccine coverage (1st Dose of measles contain vaccine) as part of national program Score 5 P.7.2 National vaccine access and delivery Score 5 Recommendations for priority 1. Introduce the Immunization Act, which will provide legal backing for the full implementation of the actions National Immunization Policy.

42 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator P.7.1.Vaccine coverage (1st Dose of measles contain vaccine) as part of national program JEE Scores Score 5 PREVENT Objective To maintain a well-qualified adequate number of public sector workforce No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Develop / revise a national level DDG (PHS) 1&2 DDG ∙ Number of norms √ √ norms for key public health workers (Planning) D / FHB, Chief developed for key PHC Epidemiologist workers

02 Identify the country needs of each DDG (PHS) 1 & 2 DDG ∙ Number of PHC workers √ √ key public health workers for next (Planning) DDG (ET & R),D/ categories -country need 5 years FHB, Chief Epidemiologist identified for next 5 years

03 Identify the training needs and gaps DDG (PHS) 1&2 DDG ∙ Number of PHC workers √ √ for next 5 years (Planning) DDG (ET & categories training need R), Heads of the training identified for next 5 years institutes

04 Address the identified training need DDG (PHS)1 & 2 DDG ∙ Number of PHC training √ √ √ √ gaps at institution level (Planning) DDG (ET & institutions with necessary R), Heads of the training facilities to train optimum institutes number of trainees National Action Plan for Health Security of Sri Lanka: 2019 - 2023 43 JEE Indicator P.7.2 National vaccine access and delivery JEE Scores Score 5 Objective To improve the national vaccine access and delivery No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Ensure the fair distribution of all DGHS, DDG (Planning), PD, ∙ Number of districts with √ √ √ √ categories of PHC staff depend on RDHS, MOOH fair distribution of all community demand categories of PHC staff bases on the community need

02 Ensure the rational, evidence based Epidemiology Unit ∙ Rational introduction of √ √ √ √ and timely introduction of new new vaccines vaccines to the EPI schedule

03 Ensure all immunization clinic Epidemiology Unit, ∙ Number of immunization √ √ √ √ centers have minimum required Directorate of Private Health clinics with minimum facilities to deliver effective, safe, sector, Private Health required facilities and quality immunization services Services Regulatory Council to the public.

44 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 8. National laboratory system Real time bio surveillance with a national laboratory system and provision of effective modern point of care was targeted by this technical area. There should be a national laboratory system with capable of safely and accurately detecting and characterizing pathogens causing epidemic diseases including both known and unknown. There are four indicators under the national laboratory system technical area and scores achieved during JEE are as follows. DETECT JEE Indicator JEE Score D.1.1 Laboratory testing for detection of priority diseases Score 4 D.1.2 Specimen referral and transport system Score 2 D.1.3 Effective modern point of care and laboratory based diagnostics Score 3 D.1.4 Laboratory Quality System Score 3 Recommendations for priority 1. Develop a national standard operating procedure for safe and efficient specimen transport to reference actions laboratories. 2. Develop a quality management system for laboratories, including national reference laboratories in the human and animal health sectors. 3. Increase the number of laboratories (human and veterinary) that participate in quality assurance programmes. 4. Strengthen multisectoral collaboration by sharing laboratory facilities and data, particularly between the human and animal health sectors. 5. Expand the number and scope of agreements with regional laboratories for specialized or advanced diagnostics (such as for emerging diseases). National Action Plan for Health Security of Sri Lanka: 2019 - 2023 45 JEE Indicator D.1.1 Laboratory testing for detection of priority diseases JEE Scores Score 4 Objective To conduct laboratory testing for detection of priority diseases No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Improve testing capacity in DDG (LS), DDG (ET & R), ∙ Testing capacity improved √ √ √ √ veterinary laboratories for IHR core D/LS,MRI,DAPH, Department for IHR core tests tests relevant to animal health. of Agriculture, Ministry of Fisheries & Aquatic Resources Development

02 Improve testing capacity in Department of Agriculture ∙ Testing laboratories are √ √ √ Plant Quarantine laboratories for upgraded and accredited in Phytosanitary tests relevant to Plant line with the international health/ In relation to Genetically standards Modified Organisms(GMO).

03 Establish coordination between DDG (LS), DDG (ET & R), ∙ Shared reports √ √ √ √ √ human and veterinary laboratories. D/LS, MRI, DAPH, Department of Agriculture, Ministry of Fisheries & Aquatic Resources Development

04 Expand the national system for DDG (LS), DDG (ET & R), ∙ Number of labs enrolled √ √ √ √ √ procurement and quality assurance D / LS, MRI, DAPH, of laboratories. Department of Agriculture, Ministry of Fisheries & Aquatic Resources Development

05 Expand the national system for Department of Agriculture ∙ Well established approval √ √ √ √ outsourcing testing activities for mechanism for regulatory quality assurance. activities

46 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator D.1.2 Specimen referral and transport system JEE Scores Score 2 Objective To establish an organized specimen referral and transport system No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national for implementation including Milestones level (Strategic actions) budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Improve the specimen DDG (LS), DDG (ET&R), D/LS, ∙ Number of centers provided √ √ √ √ √ transport system and MRI, Department of Agriculture, transport facilities. develop a systematic Ministry of Fisheries & Aquatic ∙ Number of centers provided national programme. Resources Development triple package system for specimen transport and +4c DETECT storage facilities

02 Establish regulations DDG(LS), DDG (ET & R), D/LS, ∙ Number of meetings to discuss √ √ √ √ √ for a specimen referral MRI, Department of Agriculture, about the regulations and network for each of the Ministry of Fisheries & Aquatic printing the regulations core tests. Resources Development

03 Establish systematic DDG (LS), DDG (ET & R), D/LS, ∙ Number of hospitals / specimen √ √ √ √ √ delivery system for MRI, Department of Agriculture, collecting centers provided reports from reference Ministry of Fisheries & Aquatic facilities for E reporting system, laboratories. Resources Development laboratory information system

04 Develop a specimen DDG (LS), DDG (ET & R), D / LS, ∙ Number of centers provided √ √ √ √ transport system for MRI, Department of Agriculture, transport facilities. veterinary laboratories Ministry of Fisheries & Aquatic ∙ Number of centers provided Resources Development triple package system for specimen transport and +4 c storage facilities

05 Develop a specimen Department of Agriculture ∙ Established facility for detention √ √ √ √ detention, storing and and storing transport system for Plant ∙ Established proper specimen Quarantine laboratories. transfer facilities (-20 coolers), protected packaging) National Action Plan for Health Security of Sri Lanka: 2019 - 2023 47 JEE Indicator D.1.3 Effective modern point of care and laboratory based diagnostics JEE Scores Score 3 Objective To strengthen the point of care facilities in primary health care institutions No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish improved tier-specific DDG (LS), DDG (ET & R), ∙ Established strategies √ √ √ √ √ testing strategies for rapid D/LS, MRI, Department diagnostics and other point-of care of Agriculture, Ministry tests. of Fisheries & Aquatic Resources Development, DAPH

02 Establish a plan for evaluating new DDG (LS), DDG (ET & R), ∙ Evaluated new point of √ √ √ √ √ point-of-care tests. D / LS, MRI, Department care tests of Agriculture, Ministry of Fisheries & Aquatic Resources Development, DAPH

03 Develop and establish a point-of- DDG (LS), DDG (ET & R), ∙ Established point-of- √ √ √ √ care testing capability at primary D / LS, MRI, Department care testing capability at care hospitals and veterinary of Agriculture, Ministry primary care hospitals and facilities. of Fisheries & Aquatic veterinary facilities Resources Development, DAPH

48 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator D.1.4 Laboratory Quality System JEE Scores Score 3 Objective To develop a laboratory quality system No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Develop monitoring of quality DDG (LS), DDG (ET & R), ∙ Developed quality √ √ √ √ √ indicators and develop international D / LS, MRI, Department indicators standards of measurements for the of Agriculture, Ministry quality indicators. of Fisheries & Aquatic DETECT Resources Development, DAPH

02 Establish a national external quality DDG (LS), DDG (ET & R), ∙ Number of Laboratory √ √ √ √ assurance programme for the D / LS, MRI, Department involve in national animal health sector. of Agriculture, Ministry external quality assurance of Fisheries & Aquatic programme Resources Development, DAPH

03 Ensure that accreditation DDG (LS), DDG (ET & R), ∙ Number of laboratories √ √ √ √ programmes include all laboratories. D / LS, MRI, Department enrolled for accreditation of Agriculture, Ministry programme of Fisheries & Aquatic Resources Development, DAPH National Action Plan for Health Security of Sri Lanka: 2019 - 2023 49 9 . Real time surveillance Strengthened foundational indicator and event based surveillance system that are able to detect events of significance for public health, animal health and health security, improved communication and collaboration across sectors and between sub national (local and intermediate) , national and international levels of authority regarding surveillance of events of public health significance. There are four indicators under the real time surveillance technical area and score they have achieved during JEE as follows. JEE Indicator JEE Score D.2.1 Indicator and event based surveillance systems Score 3 D.2.2 Interoperable, interconnected, electronic real-time reporting system Score 4 D.2.3 Integration and analysis of surveillance data Score 4 D.2.4 Syndromic surveillance systems Score 4 Recommendations for priority 1. Expand the web-based surveillance system so that it includes hospitals. actions 2. Increase capacity for incorporating laboratory data in the surveillance system by, for example, establishing a public health laboratory. 3. Formalize and implement structures for sharing data between the human and animal health sectors. 4. Develop formal structures, based on existing collaboration practices, for the joint analysis of surveillance data from the animal and human heath sectors at all levels.

50 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator D.2.1 Indicator and event based surveillance systems JEE Scores Score 3 Objective To establish indicator and event based surveillance system No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Introduction of web based Epidemiology Unit ∙ Number of health √ √ √ √ √ communicable disease notification care institutions with mechanism from health care functioning web bases institution to MOOH offices notification system

02 Establish a web based mechanism Epidemiology unit , Health ∙ Web base system is √ √ √ √ DETECT to monitor & evaluate the care institutions in place to monitor & completeness and timeliness of evaluate the completeness communicable disease notification & timeliness of at each level. communicable disease notification process.

03 Provision of in service training on Epidemiology unit , Health ∙ Number of health care √ √ √ √ communicable disease notification care institutions, Regional institutions where training for medical officers attached to Epidemiologist programme conducted in a both state and private health care given year institutions

04 Develop a efficient information Epidemiology unit , Health ∙ Number of institutions √ √ sharing mechanism between health care institutions with information sharing care institutions and laboratories mechanism National Action Plan for Health Security of Sri Lanka: 2019 - 2023 51 Objective To enhance influenza surveillance and response activities No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Strengthen the influenza sentinel DDG (PHS)1, Chief ∙ Percentage of sentinel √ √ √ √ √ site surveillance Epidemiologist, D / MRI, sites timely reporting NIC - MRI cases of influenza like illness out of planned

02 Expand the diagnostic facilities for DDG (PHS)1, Chief ∙ Completion of the task √ √ √ √ √ influenza at MRI and Regional labs Epidemiologist, D / MRI, NIC - MRI

03 Further strengthen the collaboration DDG (PHS)1, Chief ∙ Number of meetings √ √ √ √ √ between Human health and animal Epidemiologist, D / MRI, conducted health sector at each level (National, NIC - MRI, D / Animal Health district, and divisional) activities related to influenza control

04 Develop a business contingency DDG (PHS)1, Chief ∙ Developed business √ √ plan for selected key service Epidemiologist, D / MRI, contingency plan sectors in the event of influenza NIC - MRI pandemic preparedness

52 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator D.2.2 Interoperable, interconnected, electronic real-time reporting system JEE Scores Score 4 Objective To establish an interoperable, interconnected, electronic real time reporting system No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a formal mechanism Epidemiology Unit, DAPH ∙ Number of districts with √ √ to exchange relevant disease functioning mechanism surveillance information between to exchange surveillance human and animal health sector. information between animal and human sector DETECT JEE Indicator D.2.3 Integration and analysis of surveillance data JEE Scores Score 4 Objective To integrate and analysis of surveillance data No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a formal mechanism Epidemiology Unit, DAPH ∙ Number of districts with √ √ to exchange relevant disease functioning mechanism surveillance information between to exchange surveillance human and animal health sector. information between animal and human sector JEE Indicator D.2.4 Syndromic surveillance systems JEE Scores Score 4 Objective To develop a syndromic surveillance system No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conduct periodical national risk Epidemiology Unit, DAPH ∙ Conducted periodical risk √ √ assessment for communicable assessment exercises diseases in view of identification of current needs National Action Plan for Health Security of Sri Lanka: 2019 - 2023 53 10. Reporting Timely and accurate disease reporting according to WHO requirements and consistent coordination with FAO and OIE. National IHR focal points, OIE delegates and WAHIS National focal points will have access to a toolkit of best practices, model procedures, reporting templates and training materials to facilitate rapid notification of events that may constitute a PHEIC. There are two indicators under the reporting technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score D.3.1 System for efficient reporting to WHO, FAO and OIE Score 3 D.3.2 Reporting network and protocols in country Score 2 Recommendations for priority 1. Develop and establish protocols, processes, regulations and if necessary, legislation on reporting, for actions implementation within one year. 2. Develop a collaboration mechanism between the human and animal health sectors that is aligned with the IHR and World Organization for Animal Health standards.

54 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator D.3.1 System for efficient reporting to WHO, FAO and OIE JEE Scores Score 3 Objective To develop a system for efficient reporting to WHO, FAO and OIE No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conduct a need assessment to National IHR focal points, ∙ National needs of √ √ identify the real need of developing DAPH developing protocols, protocols, processes, regulations processes, regulations, and legislation regarding reporting and legislation regarding of IHR related issues reporting of IHR related issues identified DETECT

02 Develop necessary protocols, National IHR focal points, ∙ Availability of necessary √ √ processes, regulations, and DAPH protocols, processes, legislation regarding reporting of regulations and legislation IHR related issues regarding reporting of IHR related issues. JEE Indicator D.3.2 Reporting network and protocols in country JEE Scores Score 2 Objective To develop reporting network and protocols in country No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a formal mechanism Epidemiology Unit / ∙ Number of districts with √ √ to exchange relevant disease Ministry of Health, DAPH functioning mechanism surveillance information between to exchange surveillance human and animal health sector. information between animal and human sector National Action Plan for Health Security of Sri Lanka: 2019 - 2023 55 11. Workforce development State parties should have skilled and component health personnel for sustainable and functional public health surveillance and response at all levels of the health system and the effective implementation of the IHR (2005). A workforce including physicians, animal health or veterinarians, biostatisticians, laboratory scientists, farming/ livestock professionals with an optimal target of one trained field epidemiologist per 200,000 population, who can systematically cooperate to meet relevant IHR and PVS core competencies. There are three indicators under the workforce development technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score D.4.1 Human resources are available to implement IHR core capacity requirements Score 4 D.4.2 Applied epidemiology training program in place such as FETP Score 4 D.4.3 Workforce strategy Score 3 Recommendations for priority 1. Review the draft workforce strategy; giving consideration to the various sectors that need to be included, actions cadre revisions based on realistic cadre projections, measures to retain staff and career pathways for some categories of staff (veterinary staff and public health laboratory technicians, for example); and responding to the workforce-related recommendations of the World Organization for Animal Health’s PVS gap analysis. 2. Develop strategies for joint training programmes with other sectors to improve coordination and collaboration between the human and animal health sectors. 3. Expand the current public health and field epidemiology training programmes to include: refresher courses, an induction programme for field epidemiologists, regular in-service programmes and continuous professional development programmes for veterinary public health staff and a sustainable methodology and process to provide continuous and regular education for field epidemiology staff from both the human and animal health sectors.

56 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator D.4.1 Human resources are available to implement IHR core capacity requirements JEE Scores Score 4 Objective To formalize coordination related to workforce development between the human and animal sectors, despite collaborate between the two sectors during outbreaks. No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Promotion of training and research ETR Unit / Ministry of Health, ∙ Number of workshops √ activities focus on animal and DAPH conducted per year. human health within the IHR scope. Number of participants to each workshop. DETECT

02 Fulfill the requirement of HR for IHR Ministry of Health ∙ Number of health √ activities staff trained per year. Identified training needs.

03 Capacity building of the laboratory Ministry of Health ∙ Number of training √ staff and other categories of MRI modules developed per year. ∙ Number of Local training programs conducted per year. ∙ Number of International training programs conducted per year.

04 Capacity building of the laboratory Ministry of Health ∙ Number of training √ staff and other categories of VRI modules developed per year. ∙ Number of Local training programs conducted per year. ∙ Number of International training programs conducted per year. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 57 JEE Indicator D.4.2 Applied epidemiology training program in place such as FETP JEE Scores Score 4 Objective To streamline field epidemiology training. No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Preparing training modules for the ETR Unit + DAPH ∙ Number of IHR training √ identified Public Health Staff related modules completed in to IHR and Field Epidemiology (RE, each year. MOOH, PHID, SPHI, Tutor PHI, PHI, ∙ Number of training SPHM, PHM, PHNS, PHNO, PHFO, modules introduces to the Entomologists, Veterinary Surgeon) existing programs.

02 Provision of technical guidance for Ministry of Health ∙ Number of programs √ coordination of training programs conducted under technical related to IHR guidance.

03 Formulation and launching of online Ministry of Health ∙ Number of e-learning √ e-learning mechanism programs conducted per year ∙ Number of participants to each e-learning programme.

04 Identification of the training needs Ministry of Health ∙ Conduct annual √ of Human health sectors stakeholder meetings.

05 Identification of the training needs DAPH ∙ Conduct annual √ of Animal sectors stakeholder meetings.

06 Capacity building and training of Ministry of Health ∙ Number of training √ field staff in human health sectors programs conducted per year. ∙ Number of participants to each training programme.

58 National Action Plan for Health Security of Sri Lanka: 2019 - 2023

07 Capacity building and Training of DAPH ∙ Number of training √ field staff in Animal sectors programs conducted per year. ∙ Number of participants to each training programme.

08 Training of MOOHs (Medical officer Ministry of Health ∙ Number of MOOHs and √ of Health) and AMOOHs (Assistant AMOOHs participated to Medical officer of Health) the program.

09 Field epidemiology training as apart Board of study Community ∙ Number of Post Graduate √ of Post Graduate MSc and MD in Medicine trainees recruited per year. Community Medicine

10 Field epidemiology training Program PGIS ∙ Number of PG trainees √ DETECT for Veterinary Surgeons recruited per year. JEE Indicator D.4.3 Workforce strategy JEE Scores Score 3 Objective To implement the workforce strategy in both the human and animal health sectors No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Prepare workforce development Ministry of Health ∙ Number of activities in the √ strategic plan for IHR in Health strategic plan suggested sector. by the Ministry of Health. Availability of strategic plan

02 Prepare workforce development DAPH ∙ Number of activities in the √ strategic plan for IHR in Animal strategic plan suggested sector. by the DAPH ∙ Availability of strategic plan National Action Plan for Health Security of Sri Lanka: 2019 - 2023 59 12. Preparedness Preparedness includes the development and maintenance of national, intermediate and local or primary response level public health emergency response plans for relevant biological, chemical, radiological and nuclear hazards. There are two indicators under the preparedness technical area and score achieved during JEE are follows. ARE YOU PREPARED? JEE Indicator JEE Score R.1.1 Multi-hazard national public health emergency preparedness and response plan is developed and Score 1 implemented R.1.2 Priority public health risks and resources are mapped and utilized Score 1 Recommendations for priority 1. Identify and map the country’s main risks. actions 2. Develop and disseminate the national emergency preparedness and response plan among responsible stakeholders, considering a multi-hazard approach in compliance with the IHR.

60 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator R.1.1 Multi-hazard national public health emergency preparedness and response plan is developed and implemented JEE Scores Score 1 Objective To conduct multi-hazard risk mapping at district and national level. R.1.1.1 No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national for implementation including Milestones (Monitoring and level (Strategic actions) budget line holder Evaluation) 2019 2020 2021 2022 2023

01 Conduct district (26) National level: DPRD, Epidemiology ∙ Number of district √ √ √ √ √ level multi-hazard risk Unit, D - E&OH, DMC, Met risk assessments assessments. Department, NBRO, CEA, conducted Number of Ministry of Industries District risk assessment reports level:RDHS, District Secretary with the available support of Assistant Director Disaster ∙ Number of risk Management, District Met Offices, assessment maps District NBRO Offices, District level available. officers of CEA

02 Develop and update DPRD, Epidemiology Unit, D- E&OH, ∙ Five national multihazard √ √ √ √ √ national level multi-hazard DMC, Met Department, NBRO, RDHS risk assessment risk map. workshops conducted. ∙ Five updated national multihazard risk RESPOND assessment reports available. ∙ Five updated multi hazard risk maps available. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 61 Objective To develop and disseminate joint national preparedness and response plan R.1.1.2 No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conduct two national consultative National level: DPRD, ∙ Number of consultations √ √ √ workshops for the development Epidemiology Unit, FHB, conducted and one national meeting for the MSD, HEB, D- MS, D- E&OH, dissemination of joint national DMC, RDHS, Armed Forces ∙ Availability of the plan; emergency preparedness and usefulness of the plan response plan. demonstrated during real disasters or simulation exercises JEE Indicator R.1.2 Priority public health risks and resources are mapped and utilized JEE Scores Score 1 Objective To advocate for development sharing and use with the involvement of multiple stakeholders R. 1.2.1 No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Established a formal mechanism Epidemiology Unit, DAPH ∙ Number of districts with √ √ to exchange relevant disease functioning mechanism surveillance information between to exchange surveillance human and animal health sector. information between animal and human sector

62 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Objective To train 12 key personnel from the DPRD, Epidemiology Unit, Quarantine Unit, D-E&OH and DMC and RDHS on multihazards risk R.1.2.2 assessment at a center of excellence on performing risk assessments. No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Train 12 key personnel from DPRD, DMC ∙ Two advocacy seminars √ √ the DPRD, Epidemiology Unit, conducted Quarantine Unit, D-E&OH and ∙ Stakeholder cooperation DMC and RDHS on multi-hazards for risk mapping enhanced risk assessment at a center of excellence.

02 Train 12 key personnel from Center of Excellence; ∙ Number of officials √ the DPRD, Epidemiology Unit, Ministry of Health; WHO trained in multihazard risk Quarantine Unit, D-E&OH and assessment DMC and RDHS on multi-hazards ∙ Trained persons lead risk risk assessment at a center of assessments conducted at excellence. district and national level RESPOND National Action Plan for Health Security of Sri Lanka: 2019 - 2023 63 13. Emergency response operations Countries will have a public health emergency operation centre (EOC) functioning according to minimum common standards: maintaining trained, functioning, multi-sectoral rapid response terms and real time bio surveillance Risk laboratory networks and information systems: and trained EOC staff capable of activating a coordinated emergency Management response within 120 minutes of the identification of a public health emergency. There are four indicators under the national laboratory system technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score R.2.1 Capacity to Activate Emergency Operations Score 1 R.2.2 Emergency Operations Centre Operating Procedures and Plan Score 2 R.2.3 Emergency Operations Program Score 3 R.2.4 Case management procedures are implemented for IHR relevant hazards Score 4 Recommendations for priority 1. Develop a national PHEOC handbook, following WHO guidelines, that expands upon existing response actions documentation and includes: ∙ Procedures for daily ‘watch mode’ operations, to include triage of information from surveillance, laboratory, and other information sources, as well as keeping public health leaders informed of emerging public health situations in a timely manner; ∙ Criteria and authorities for declaration of a public health emergency; ∙ Procedures for activation and deactivation of the national PHEOC; ∙ A concept of operations for the national PHEOC within the national disaster management system, and; ∙ Procedures for post-response (and post-exercise) review and corrective action planning. 2. Develop an integrated national public health emergency training and exercise programme that includes: ∙ A competency-based master curriculum of public health emergency management trainings for both national and sub-national emergency operations centre staff, building upon existing training programmes, and addressing both position-specific functions as well as training on national public health policies, plans, and procedures. ∙ A multi-year series of progressive discussion and operations-based exercises that address national risk-based priority public health threats. 3. Expand the cadre of trained personnel on roster as both core and surge staff for national and sub-national PHEOCs.

64 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator R.2.1 Capacity to Activate Emergency Operations JEE Scores Score 1 Objective To develop PHEOC guidelines and to train key staff on their use during emergencies and disasters. No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conduct a national level meeting DPRD, Epidemiology Unit, ∙ Consultation held √ for key stakeholders to obtain their D-Quarantine, D-E & OH, ∙ Recommendations inputs towards the development of DMC Document available for the the PHEOC handbook. PHEOC handbook.

02 Develop and print PHEOC DPRD, Epidemiology Unit, ∙ Printable version of the √ √ guidebook as per the WHO D-Quarantine, D-E & OH, PHEOC handbook guidelines. DMC ∙ Printed copies of the handbook.

03 Development of an integrated DPRD, Epidemiology Unit, ∙ Availability of training √ √ √ √ √ national public health emergency D-Quarantine, D-E & OH, curriculum; training curriculum. DMC

04 Conducting national level PHEOC DPRD, Epidemiology Unit, ∙ Number of training √ √ training programs for national D-Quarantine, D-E & OH, programs conducted RESPOND level officers involved in disaster DMC ∙ Level of contribution for response Public Health Emergency management from the trained staff.

05 Training of sub-national level staff DPRD, Epidemiology Unit, ∙ Number of training √ √ √ √ on PHEOC based in the national D-Quarantine, D-E & OH, programs conducted public health emergency training DMC ∙ Level of contribution for curriculum. Public Health Emergency management from the trained staff. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 65 JEE Indicator R.2.2 Emergency Operations Centre Operating Procedures and Plan JEE Scores Score 2 Objective To improve emergency operation center operating procedures and the plan No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Clarification of the role of the DGHS DPRD, DGHS ∙ DGHS is aware of his role √ during disasters during disaster response.

02 Advanced content of emergency DPRD, Epidemiology Unit, ∙ Availability of advanced √ operations procedure developed. D-Quarantine, D-E & OH, content DMC ∙ Stakeholders aware of the advanced content ∙ Advanced content used for effective disaster response.

66 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator R.2.3 Emergency Operations Program JEE Scores Score 3 Objective To establish an emergency operation program No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national for implementation Milestones level (Strategic actions) including budget line (Monitoring and Evaluation) holder 2019 2020 2021 2022 2023

01 Conduct annual PHEOC DPRD, Epidemiology Unit, ∙ Simulation exercise conducted √ √ √ √ √ simulation (one) exercise D-Quarantine, D-E & H, ∙ Number of reviews conducted based irrespective of response to DMC on the simulation exercises real disasters. ∙ Corrective action initiated based on the simulation exercises ∙ Amendments done to the PHEOC handbook and the training from the simulations.

02 Development of PHEOC DPRD, Epidemiology Unit, ∙ Availability of PHEOC activation criteria √ activation criteria and D-Quarantine, D-E & H, and protocol protocol. DMC ∙ All relevant stakeholders aware of the above criteria and protocol RESPOND ∙ Above criteria and protocol used during the disaster and emergency response.

03 Document lessons learnt DPRD, Epidemiology Unit, ∙ Number of reviews conducted √ √ √ √ √ report after each disaster D-Quarantine, D-E & OH, ∙ Number of lessons learnt Publications and disseminate above DMC, respective RDHS based on the reviews learning. where the disaster occurs. ∙ Number of corrective actions done based on the lessons learnt ∙ Improvements achieved in disaster response based from the lessons learnt. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 67 JEE Indicator R.2.4 Case management procedures are implemented for IHR relevant hazards JEE Scores Score 4 Objective To improve the implementation of case management procedures for IHR related activities. No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national for implementation Milestones level (Strategic actions) including budget line (Monitoring and Evaluation) holder 2019 2020 2021 2022 2023

01 Plan and systematic Eidemiology Unit, ∙ Number of training programs √ √ √ √ √ dissemination of D-Quarantine, conducted management and transport College of Microbiologists ∙ Number of staff trained of potentially infectious ∙ Use of knowledge and skills during patients. management and transport of potentially infectious patients.

02 Refresher training on the Eidemiology Unit, ∙ Number of training programs √ √ √ √ √ use of case management D-Quarantine, conducted guidelines during College of Microbiologists ∙ Number of staff trained outbreaks. ∙ Use of knowledge and skills on case management guidelines during outbreaks.

68 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 14. Linking public health and security authorities In the event of a biological event of suspected or confirmed deliberate origin, a country will be able to conduct a rapid, multisectoral response, including the capacity to link public health and low enforcement and to provide and/or request effective and timely international assistance, including to investigate alleged use events. Development and implementation of a memorandum of understanding (MOU) or other similar framework outlining roles, responsibilities and best practices for sharing relevant information between and among appropriate human and animal health, law enforcement and defence personnel and validation of the MOU through periodic exercises and simulations. There is one indicator under the linking public health and security authorities technical area and score achieved during JEE is as follows. JEE Indicator JEE Score R.3.1 Multi-hazard national public health emergency preparedness and response plan is developed and Score 4 implemented Recommendations for priority 1. Expand mechanisms for information sharing and joint operations between the security and health sectors. actions 2. Perform regular joint exercises between the health, security and other sectors RESPOND National Action Plan for Health Security of Sri Lanka: 2019 - 2023 69 JEE Indicator R.3.1 Multi-hazard national public health emergency preparedness and response plan is developed and implemented JEE Scores Score 4 Objective To promote intersectoral collaboration between public health and security authorities. No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national for implementation Milestones level (Strategic actions) including budget line (Monitoring and Evaluation) holder 2019 2020 2021 2022 2023

01 Development of standard DPRD/Ministry of Health ∙ Number of consultations completed. √ operating procedures for and other stakeholders ∙ Availability of standard operating collaboration between procedures. different stakeholders for ∙ Enhanced collaboration between health sector response stakeholders.

02 Conduct multistakeholder DPRD/Ministry of Health ∙ Number of simulation exercises √ √ √ √ √ simulation exercises and other stakeholders conducted Level of participation of annually. stakeholders ∙ Use of multistakeholder collaboration based during actual disaster response.

70 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 15. Medical countermeasures and personnel deployment A national framework for transferring (sending and receiving) medical countermeasures and public health and medical personnel among international patterns during public health emergencies. There are two indicators under the medical countermeasures and personnel deployment technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score R.4.1 System is in place for sending and receiving medical countermeasures during a public health Score 2 emergency R.4.2 System is in place for sending and receiving health personnel during a public health emergency Score 1 Recommendations for priority 1. Revise and formalize policy guidelines for receiving or sending medical countermeasures during an emergency. RESPOND actions 2. Draft a national plan and associated guidelines for deploying national and receiving international personnel during emergencies, including capacity building for these personnel in collaboration with healthand non-health stakeholders such as the Ministries of Defence, Disaster Management, Finance and Foreign Affairs. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 71 JEE Indicator R.4.1 System is in place for sending and receiving medical countermeasures during a public health emergency JEE Scores Score 2 Objective To introduce the legal provisions for the supply and distribution of medical countermeasures during emergencies. R. 1.1.1 No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Development and adoption Ministry of Disaster ∙ Percentage of completion of national inter-ministerial Management, Ministry of of inter-ministerial standard standard operation procedures on Finance , Ministry of Foreign operation procedures International Relief Assistance Affairs , Ministry of Health, on International Relief Food Commissioners Assistance Department, Sri Lanka

02 Development of national guidelines Sri Lanka Customs ∙ Percentage of completion √ √ for sending and receiving of medical of National Guidelines countermeasures during a public health emergency.

03 Develop and adopt standard Medical Supplies Division ∙ Percentage of completion √ √ protocols to be followed by the (MSD), DPRD/Ministry of of standard protocols to MSD and State Pharmaceuticals Health be followed by the MSD Corporation (SPC) as the National and SPC Procuring Agency for the emergency procurement of medical countermeasures, regionally and internationally.

04 MSD to undertake a risk MSD ∙ Number of units/stores √ √ √ √ assessment for its national and which risk assessment regional durg stores for internal completed disasters that could affect them and external disasters for which they would have to respond to.

72 National Action Plan for Health Security of Sri Lanka: 2019 - 2023

05 MSD to update current disaster MSD ∙ Percentage of completion √ √ preparedness and response plan. of updated disaster preparedness response plan

06 MSD to develop standard operating MSD ∙ Percentage of completion √ √ procedure for the distribution of of standard operating medical countermeasure during procedure for the emergencies. distribution of medical countermeasures during emergencies

07 MSD to develop Emergency MSD ∙ Percentage of completion √ √ Storage plan. of Emergency Storage plan

08 MSD to enhance the emergency MSD ∙ Number of institutions/ √ √ storage capacity,. RMSD with enhanced emergency storage capacity

09 Training of the staff of MSD on MSD ∙ Number of staff members √ √ √ √ Disaster Management (local and trained foreign training) RESPOND

10 Assess the emergency MSD ∙ Number of desktop √ √ √ √ preparedness and response simulation exercises capacity through annual desktop simulation exercise. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 73 JEE Indicator R.4.2 System is in place for sending and receiving health personnel during a public health emergency JEE Scores Score 1 Objective To advocate and plan for systematic the deployment and receiving of emergency medical teams. No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conduct advocacy campaign for DPRD, other stakeholders. ∙ Advocacy done for √ √ √ √ health and non-health stakeholders health and non-health on management of emergency stakeholders. medical teams in disasters.

02 Incorporate sections on systematic DPRD ∙ Sections incorporated on √ √ deployment and receiving of systematic deployment emergency medical teams to and receiving of existing national general and health emergency medical sector disaster preparedness and teams to existing national response plans. general and health sector disaster preparedness and response plans.

03 Incorporate sections on systematic DPRD ∙ Sections incorporated on √ √ deployment and receiving of systematic deployment emergency medical teams to and receiving of existing SOPs. emergency medical teams to existing SOPs.

04 Train health staff on emergency DPRD ∙ Health staff trained on √ √ √ √ medical teams coordination. emergency medical teams coordination.

05 Assemble of necessary equipment Ministry of Health ∙ Necessary equipment and √ and supplies for the deployment of supplies available for the a national emergency medical team. deployment of a national emergency medical team.

06 Registration of Sri Lanka National Ministry of Health, WHO ∙ Sri Lanka National Emergency Medical Team with Emergency Medical Team WHO. registered with WHO.

74 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 16. Risk communication States parties should have risk communication capacity which is multi level and multi faced, real time exchange of information, advice and opinion between experts and officials or people who face a threat or hazard to their survival, health, economic or social wellbeing so that they can take informed decisions to mitigate the effects of the threat or hazard and take protective and preventive action. There are five indicators under the risk communication technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score R.5.1 Risk Communication Systems (plans, mechanisms, etc.) Score 2 R.5.2 Internal and Partner Communication and Coordination Score 5 R.5.3 Public Communication Score 3 R.5.4 Communication Engagement with Affected Communities Score 4 R.5.5 Dynamic Listening and Rumour Management Score 5 1. ·Develop a consolidated risk communications plan that brings together existing policies, protocols and procedures. Recommendations for priority actions 2. ·Increase monitoring and outreach through social media (which could include the establishment of government social media accounts). 3. ·Develop a sector-wide training programme that includes regular seminars and refresher courses for risk RESPOND communications and standard trainings for staff, including surge capacity staff. 4. ·Review the feasibility of developing a formal network for risk communications that includes stakeholders, partners and surge capacity staff from all sectors. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 75 JEE Indicator R.5.1 Risk Communication Systems (plans, mechanisms, etc.) JEE Scores Score 2 Objective To establish a risk communication system for the country No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Include risk communication Health Promotion Bureau ∙ Risk communication √ √ √ √ activities as a main agenda item (HPB) activities are included in with the ‘National Committee on the National Committee on Health Communication’ chaired by Health communication the DGHS established under the Health Promotion Policy

02 Development of a consolidated HPB ∙ Consolidated national risk √ √ National risk communication plan communication plan is developed

03 Identification and appointing a Director /HPB will be the focal ∙ Risk communication focal √ risk communication focal point at point for risk communication point is established Ministry of Health

04 Training of Health officials and staff HPB ∙ Number of health officials, √ √ √ √ √ on risk communication other staff and non health staff trained on risk communication

05 Conducting Media conferences / HPB ∙ Number of media √ √ √ √ √ briefings to educate the public / to conferences conducted in prepare for an emergency a year ∙ Number of media persons attended ∙ Number of articles published on subject

76 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator R.5.2 Internal and Partner Communication and Coordination JEE Scores Score 5 Objective To improve the communication between stakeholders on risk management No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establishing a monthly risk HPB, Epidemiology unit, ∙ Risk reporting system is √ reporting system from the RDHS Disaster Preparedness and established level response unit, quarantine unit

02 Development and distribution HPB ∙ IEC materials are √ √ √ √ of Information, education, developed and distributed communication materials (IEC) such as leaflets, posters, wallcharts, booklets to educate the health/non health staff and public RESPOND National Action Plan for Health Security of Sri Lanka: 2019 - 2023 77 JEE Indicator R.5.3 Public Communication JEE Scores Score 3 Objective To improve the public communication at a risk situation No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Use of social media for risk HPB, Disaster Preparedness ∙ The social media network √ communication and feedback and response Unit, is developed Epidemiology unit, Quarantine unit of Ministry of Health

02 Development of a dialogue HPB, Disaster Preparedness ∙ Twenty-four hour hotline is √ √ √ √ between risk communicators and and response unit, developed. general public Epidemiology unit RDHS ∙ Number of educational programmes conducted by the Medical Officer of Health (MOOH) proportionate to the number of disasters

03 Training of media persons on HPB ∙ Number of media persons √ √ √ √ reporting a disaster or impending trained annually risk

78 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator R.5.4 Communication Engagement with Affected Communities JEE Scores Score 4 Objective To improve the communication between health officials and affected communities at a disaster situation No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establishment of a system to HPB ∙ Percentage of returns √ communicate with affected received by the HPB communities in a disaster situation

02 Capacity building of the staff included under 5.1 JEE Indicator R.5.5 Dynamic Listening and Rumour Management JEE Scores Score 5 RESPOND Objective To improve the understanding of the concerns of the affected communities by the health staff at a disaster situation No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Increase the publicity of the HPB ∙ Number of calls received √ √ √ √ ‘Suwaseriya’ 24 hour hotline among for ‘Suwaseriya’ within a the public month

02 Liaise with the other stakeholders HPB ∙ Official link is established √ for quick communication

03 Appointing a media spokesman HPB ∙ Availability of media √ √ √ at RDHS level and trained them spokesmen in districts especially on media briefing National Action Plan for Health Security of Sri Lanka: 2019 - 2023 79 17. Points of Entry (PoE) States parties should designate and maintain the core capacities at the international airports and ports which implement specific public health measures required to manage a variety of public health risks. There are two indicators under Points of Entry (PoE) technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score PoE.1 Routine capacities are established at PoE Score 3 PoE.1 Effective Public Health Response at Points of Entry Score 4 Recommendations for priority 1. Enhance facilities, in terms of spaces and equipment, at points of entry for the inspection, isolation andtreatment actions of passengers who are suspected to be ill. 2. Develop a regular capacity building programme for health officials on how to carry out conveyance inspection and quarantine procedures. 3. Develop a health information system for points of entry that includes real-time surveillance for both human and animal health. 4. Establish an integrated vector surveillance mechanism for all medically important vectors at all designated points of entry. 5. Conduct regular simulation exercises on public health contingency plans at points of entry and publish the assessment reports.

80 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator PoE.1 Routine capacities are established at PoE JEE Scores Score 3 Objective 1.1 To develop the facilities for assessment, care and isolation of ill passengers at BIA and Colombo Port No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Purchase of equipment for BIA and Director / Quarantine ∙ Equipment purchased √ √ Colombo port

02 Develop a quarantine bay for ill Director / Quarantine, SLPA ∙ Completion of the task √ passengers / Colombo Port

03 Develop an isolation room with Director / Quarantine, SLPA, ∙ Completion of the task √ √ √ facilities for assessment and care at AASL BIA / Colombo Port

04 Train the staff on SOPs Director / Quarantine ∙ Completion of the task √ √ √ √

05 Transport facilities for staff at PoE & Director / Quarantine ∙ Completion of the task √ √ Quarantine Unit

06 Improve quarantine / isolation Director / NIID and ∙ Completion of the task √ √ √ facilities at NIID (IDH) Director /Quarantine RESPOND Objective 1.2 To establish an integrated vector surveillance and control mechanism for medically important vectors No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Conduct an integrated vector Director / Quarantine, ∙ Number of programs √ √ √ √ √ surveillance and control mechanism D/ AMC, D/AFC relevant stake conducted for quarter out for mosquitoes (process has been holder of planned established with time frame, technical support to be seek)

02 Overseas / local training of staff on Director / Quarantine ∙ Number of staff trained √ √ vector surveillance for medically important vectors National Action Plan for Health Security of Sri Lanka: 2019 - 2023 81

03 Purchase equipment for the vector Director / Quarantine ∙ Completion of the task √ √ √ surveillance (e.g. during ship sanitation certification need to detect rat urine etc.)

04 Establish an integrated vector Director / Quarantine / DG ∙ Number of surveillance √ √ √ √ surveillance and control mechanism / APH conducted out of identified for other vectors (eg. rats) all surveillance Objective 1.3 To build capacity for ship sanitation certification, cruise ship inspection and air craft inspection No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Purchase equipment needed Director / Quarantine ∙ Completion of the task √ √ √ for ship sanitation certification, cruise ship inspection and air craft inspection

02 Overseas / local training of staff Director / Quarantine ∙ Number of staff trained out √ √ √ √ on Quarantine procedures / Ship of planned sanitation certification and cruise and ship inspection / aircraft inspection Objective 1.4 To develop an online information management system at Quarantine Unit, Assistant Port Health office and Public Health officers at Points of Entry and publish reports No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Purchase equipment needed for Director / Quarantine ∙ Completion of the task √ √ information management system

02 Develop a Quarantine Health Director / Quarantine ∙ Completion of the task √ √ Record Management and Surveillance System (QHRMS) and payment for service provision

82 National Action Plan for Health Security of Sri Lanka: 2019 - 2023

03 Online Server space for QHRMS Director / Quarantine ∙ Completion of the task (VPS)

04 Maintenance of Quarantine Director / Quarantine ∙ Completion of the task Website

05 Train staff (overseas and local) on Director / Quarantine ∙ Number of staff trained out √ √ online information management of planned system

06 Publish Annual Report of Director / Quarantine ∙ Published annual report √ √ √ √ Quarantine unit JEE Indicator PoE.2 Effective Public Health Response at Points of Entry JEE Scores Score 4 Objective 2.1 To update and publish contingency plans following regular exercises and after real events and purchase medical equipment and other auxiliary equipment are required for proper No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Update and publish Contingency Director / Quarantine ∙ Completion of the task √ √ √ Plans

02 Simulation exercises at PoEs with Director / Quarantine /NIID, ∙ Simulation exercise to √ √ √ √ √ involvement of other stakeholders AASL, CAASL, SLPA, DMC, be done in once a year and annually published reports DPRD, Ministry of Defense either in port or airport and and other respective units published reports annually OTHER IHR AND PoE

03 Purchase medical and other Director / Quarantine ∙ Completion of the task √ √ auxiliary equipment required for proper examination National Action Plan for Health Security of Sri Lanka: 2019 - 2023 83 18. Chemical events State parties should have surveillance and response capacity for chemical risk or events. Timely detection of effective response of potential chemical risks and /or events in collaboration with other sectors responsible for chemical safety, industries, transportation and safe disposal. There are two indicators under the chemical event technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score CE.1 Mechanisms are established and functioning for detecting and responding to chemical events or Score 2 emergencies CE.2 Enabling environment is in place for management of chemical events Score 2 Recommendations for priority 1. Create a national, multisectoral coordinating body to: actions ∙ Establish an integrated chemical surveillance system that builds upon existing monitoring activities; ∙ Strengthen laboratory capacities for chemical detection and identification; ∙ Establish standards for environmental and occupational health monitoring across sectors; ∙ Implement standards for classification and labeling of chemicals, and; ∙ Facilitate the sharing, data basing, and integration of chemical-relevant data from the surveillance, laboratory, environmental and occupational health monitoring activities from all sectors. 2. Develop guidelines or standard operating procedures for chemical surveillance and risk assessment ofchemical events. 3. Develop a national-level chemical event response plan based on a national risk assessment of chemica threats, expanding on existing documentation of roles and responsibilities, inventories of chemical sites, and case management guidelines.

84 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator CE.1 Mechanisms are established and functioning for detecting and responding to chemical events or emergencies JEE Scores Score 2 Objective 1.1 To establish sentinel surveillance system to detect hazardous chemical exposures in relation to chemical accidents No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Development of a programme for Disaster Management ∙ Formation of steering √ √ √ √ surveillance of chemical accidents centre / Central Environment committee Authority / Ministry of Health ∙ Guidelines and manuals / Sri Lanka police / Poison developed Center of National Hospital ∙ Number of simulation / National Authority for exercises Chemical Weapons (Joint ∙ Number of Chemical mechanism) Accidents Prevention and Preparedness (CAPP) reported by industries ∙ Number of chemical accidents reported Objective 1.2 To strengthen risk analysis and mitigation in responding to chemical events No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish risk analysis process in Central Environment Authority ∙ Number of risk assessors √ √ √ √ response to chemical events / Ministry of Health / National identified Authority for Chemical ∙ Number of training Weapons Convention programmes conducted (NACWC) OTHER IHR AND PoE National Action Plan for Health Security of Sri Lanka: 2019 - 2023 85 Objective 1.3 To establish an apex body for overall management of chemicals No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish an apex body for overall Ministry of Environment (lead ∙ Number of stakeholder √ √ √ √ management of chemicals role), Other stakeholders- meeting Central Environment Authority ∙ Report in place / Ministry of Health / Industrial ∙ Action plan in place technology Institute (ITI) / ∙ Progress made at the end Government analyst / WHO / of each year UN agencies / Universities Objective 1.4 To develop analytical facilities to monitor environmental and health effects of chemical events No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a well-equipped labs for Ministry of Environment, ∙ Number of stakeholder √ √ √ √ environmental and health effects Central Environment meetings Authority, Ministry of Health, ∙ Action plan in place Industrial technology Institute, ∙ Funding secured Government Analyst’s ∙ Physical and financial Department, WHO, UN progress of infrastructure agencies, Universities development Objective 1.5 To develop capacities in chemical event response and detection No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Formation of rapid deployment Disaster Management ∙ Number of stakeholder √ √ √ √ team at district level to take centre, Central Environment meetings immediate measures during a Authority, Ministry of ∙ Action plan in place chemical accident Environment, Ministry of ∙ Physical and financial Health, Sri Lanka police progress of infrastructure NACWC, Ministry of Defence development

86 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator CE.2 Enabling environment is in place for management of chemical events JEE Scores Score 2 Objective 2.1 To streamline land use planning for siting of chemical industries and disposal facilities No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation including Milestones (Strategic actions) budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Prepare policy guideline Ministry of Environment, Central ∙ Prepared policy guideline on siting and installation of Environment Authority, Urban chemical based industries Development Authority, Ministry of including life cycle Local government / Land use policy management of chemicals planning Department, Ministry of Health, NACWC

01 Incorporate existing land use Ministry of Environment, Central ∙ Number of stakeholder √ √ policy and plan with the siting Environment Authority, Urban meetings of chemical industries and Development Authority, Ministry of chemical disaster prone / risk Local government / Land use policy areas planning Department, Ministry of Health, NACWC Objective 2.2 To share information and monitoring and evaluation of chemical hazards and chemical events for future planning of response No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation including Milestones (Strategic actions) budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Establish a platform to share Ministry of Environment, Central ∙ Number of stakeholder √ √ √ √ information Environment Authority, Ministry of meeting Health,Ministry of Labour, Ministry ∙ Number of reports in place OTHER IHR AND PoE of Industry and Commerce, Board ∙ Database in place of Investment, NACWC, Local ∙ Annual reports Authority, Government Analyst’s Department National Action Plan for Health Security of Sri Lanka: 2019 - 2023 87

02 Establish a M&E system Ministry of Environment, Central ∙ Report in place √ Environment Authority, Ministry of ∙ M & E Committee Health,

03 Establish information clearing Sri Lanka Customs, Department of ∙ Action plan in place house Import and Export Control,Board of ∙ Number of sessions Investment, NACWC ∙ Updating Aggregate National Data Enlisting Factories and Industries Objective 2.3 To establish post-incident and Long-term Considerations No. Summary of planned Responsible authority(s) Output indicators / Year of implementation activities at national level for implementation including Milestones (Strategic actions) budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Provide multi-agency Ministry of Environment, Central ∙ Number of stakeholder √ √ √ √ debriefings for all responders Environment Authority, Ministry meeting of Health, Ministry of Labour, Ministry of Industry and Commerce, Board of Investment, NACWC, LA, Government Analyst’s Department

02 Provide psychological Ministry of Health, Ministry of ∙ Report in place counseling for victim and Defence responders

03 Enhance capability through Ministry of Environment, Central ∙ Number of sessions Investigative Science and Environment Authority, Ministry of Technology Health,Ministry of Labour, Ministry of Industry and Commerce, Board of Investment, NACWC, Local Authority, Government Analyst’s Department, Ministry of Defence

04 Initiate legislative and Ministry of Environment, Central ∙ Formation of a steering administrative measures Environment Authority, Ministry of committee Health,Ministry of Labour, Ministry of Industry and Commerce, Board of Investment, NACWC, Local Authority, Government Analyst’s Department, Ministry of Defence

88 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 19. Radiation emergencies States parties should have surveillance and response capacity for radio nuclear hazards/events/emergencies. This requires effective communication and collaboration among the sectors responsible for radio nuclear management. Timely detection and effective response of potential radio-nuclear hazards/events/emergencies in collaboration with other sectors responsible for radio nuclear management. There are two indicators under the radiation emergencies technical area and scores achieved during JEE are as follows. JEE Indicator JEE Score RE.1 Mechanisms are established and functioning for detecting and responding to radiological and Score 1 nuclear emergencies RE.2 Enabling environment is in place for management of radiation emergencies Score 3 Recommendations for priority 1. Develop risk assessment guidelines for radiation emergencies. actions 2. Finalize and gain approval for radiation emergency documents that are currently in draft form. 3. Incorporate the draft radiation Emergency Management Plan, the radiation detection guidelines and the radiation monitoring mechanism for radiation emergencies that may constitute a public health event of international concern into existing plans. 4. Develop an information sharing system for radiation-relevant information among all sectors. OTHER IHR AND PoE 5. Create an integrated multisectoral radiation emergency training and exercise programme. National Action Plan for Health Security of Sri Lanka: 2019 - 2023 89 JEE Indicator RE.1 Mechanisms are established and functioning for detecting and responding to radiological and nuclear emergencies JEE Scores Score 1 Objective To establish a functioning mechanism for detecting and responding to radiological and nuclear emergencies No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Allocate radiation surveillance and SLAERC ∙ Number of detection √ √ √ √ √ monitoring responsibilities in the systems draft Emergency Management Plan (EMP) for responsible stakeholders

02 Allocation of roles and SLAERC / DMC ∙ Number of stakeholder √ responsibilities to stakeholders in meetings draft Emergency Management plan

03 Radiation detection strategy has SLAERC ∙ Number of emergencies √ √ √ √ √ been established by the draft EMP detected and radiation hazard assessment has been carried out it will continue according to the plan

04 Development of SOP for SLAERC ∙ Availability of SOP √ √ management of radiation emergencies

05 Systematic Information exchange SLAERC,Disaster ∙ Shared reports √ √ √ √ √ between SLAERC, IAEA and MoH preparedness unit, Ministry of during radiation emergency Health

06 Establishment of health facilities Disaster Preparedness unit, ∙ Number of hospitals √ √ √ √ √ with capacity to manage patients of Ministry of Health established radiation emergency ∙ Number of doctors trained

90 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 JEE Indicator RE.2 Enabling environment is in place for management of radiation emergencies JEE Scores Score 3 Objective To enable the environment for management of radiation emergencies No. Summary of planned activities at Responsible authority(s) Output indicators / Year of implementation national level (Strategic actions) for implementation Milestones including budget line holder (Monitoring and Evaluation) 2019 2020 2021 2022 2023

01 Finalization of National Plan SLAERC ∙ Finalized national plan √

02 Arrangement of National exercise SLAERC / other stakeholders ∙ Number of exercises √ √ √ √ conducted ∙ Number of responders trained

03 Participation of International Atomic SLAERC / stakeholders ∙ Number of participants √ √ √ Energy Agency convex exercises attended for exercises and host the international exercise OTHER IHR AND PoE National Action Plan for Health Security of Sri Lanka: 2019 - 2023 91 5. REFERENCES Central Bank of Sri Lanka, 2018. Annual Report 2017. Colombo: Central Bank of Sri Lanka. Available from: https://www.cbsl.gov.lk/sites/default/files /cbslweb_ documents/publications/annual_report/2017/en/1_Preliminary.pdf [Accessed 15 July 2018]. Department of Census and Statistics, 2016. Press Release, Calculating the Life Expectancy for Sri Lankan Population Life Tables 2011-2013. Colombo: Department of Census and Statistics. Ministry of Health, 2015. Annual Health Bulletin 2013. Colombo: Ministry of Health, Nutrition and Indigenous Medicine. Ministry of Health, Nutrition and Indigenous Medicine, 2018. Annual Health Statistics of Sri Lanka-2016. Colombo: Ministry of Health, Nutrition and Indigenous Medicine. Parliament of the Democratic Socialist Republic of Sri Lanka, 2005. Sri Lanka Disaster Management Act, No. 13 of 2005. Colombo: The Department of Government Printing, pp.279-297. World Health Organization, 2016. Joint External Evaluation Tool. Geneva: World Health Organization. World Health Organization, 2017. Joint External Evaluation of IHR Core Capacities Democratic Socialist Republic of Sri Lanka, Mission report 19-23 June 2017. Geneva: World Health Organization, pp.1-62. Available from: https://extranet.who.int/sph/sites/default/files/jeeta/WHO-WHE-CPI-REP-2017.33-eng.pdf (Accessed 3 March 2018). World Health Organization, 2018. Strategic Partnership for IHR and Health Security (SPH) | Building Stronger Health Systems for Sustainable Health Security. Available from: https://extranet.who.int/sph/country-planning (Accessed: 15 February 2018).

92 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 6. ANNEXURES

Annex 1 Responsible authorities for preparation of five year action plan to ensure health security of Sri Lanka No Section Main Stakeholder Other stakeholders/Ministries/ Departments/Unit 1 National Legislation, Policy and Deputy Director General- Public DDG-Planning/MoH Financing Health Services -1/ MoH Quarantine Unit/ MoH Epidemiology Unit/ MoH Director/ International Health/ MoH Legal Unit/ MoH Legal Units of other Ministries Department of Legal Draftsmen 2 IHR Coordination, Director /Quarantine Unit/ MoH Chief Epidemiologist/ MoH Communication and Quarantine Unit Advocacy Disaster Preparedness and Response Division WHO 3 Points of Entry (PoE) Director/Quarantine Unit/ MoH Epidemiology Unit/ MoH Quarantine Unit Ministry of Foreign Affairs Department of Immigration and Emigration Harbour Master/Sri Lanka Ports Authority Airport Aviation Sri Lanka Ceylon Association of Shipping Agents 4 Antimicrobial resistance Deputy Director General- Laboratory DDG-ET & R/MoH Services/ MoH Director/Lab Services/ MoH Medical Research Institute/ MoH Department of Animal Production and Health (DAPH) Ministry of Fisheries and Aquatic Resources Development 5 Biosafety and Biosecurity Deputy Director General - Laboratory DDG-ET & R/MoH Services/ MoH DDG-MSD/MoH Medical Research Institute/ MoH Director/Lab Services/ MoH DAPH Director (Bio-Diversity) Ministry of Mahaweli Development and Environment National Action Plan for Health Security of Sri Lanka: 2019 - 2023 93 6 National Laboratory System Deputy Director General - Laboratory DDG-ET & R/MoH Services/ MoH DDG-MSD/MoH Director/Lab Services/ MoH Director/MSD Medical Research Institute/ MoH DAPH Department of Agriculture Ministry of Fisheries and Aquatic Resources Development 7 Zoonotic Disease Director General/ Department DAPH of Animal Production and Health Ministry of Fisheries and Aquatic Resources Development (DAPH) 8 Food Safety Deputy Director General / Directorate/E & OH/MoH Environment & Occupational Health/ Epidemiology Unit/ MoH MoH DAPH Department of Agriculture Ministry of Fisheries and Aquatic Resources Development 9 Chemical Events Chemical & Hazardous Waste Central Environment Authority Management Unit / Central Directorate/ E & OH/MoH Environment Authority Directorate/NCD/MoH Deputy Director General / Head/National Poison Centre/ NHSL Environment & Occupational Health/ Director (Pollution Control & Chemical Management)/ Ministry of MoH Mahaweli Development & Environment Director (Hazardous Waste & Chemical Management) Ministry of Mahaweli Development & Environment Ministry of Defence 10 Immunizations Chief Epidemiologist/ Epidemiology Unit/ MoH Epidemiology Unit/ MoH DAPH 11 Real Time Surveillance Chief Epidemiologist/ Epidemiology Unit/ MoH Epidemiology Unit/ MoH DAPH 12 Reporting Chief Epidemiologist/ Epidemiology Unit/ MoH Epidemiology Unit/ MoH DAPH 94 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 13 Workforce Development Deputy Director General / Education Directorate/ET &R/MoH Training & Research Unit/ MoH Epidemiology Unit/ MoH DAPH 14 Preparedness National Coordinator/ Disaster Disaster Preparedness and Response Division / MoH Preparedness and Response Ministry of Disaster Management Division DAPH / MoH 15 Emergency response National Coordinator/ Disaster Disaster Preparedness and Response Division operation Preparedness and Response / MoH Division Ministry of Foreign Affairs / MoH Department of Immigration and Emigration Ministry of Disaster Management 16 Linking Public Health and Security National Coordinator/ Disaster Disaster Preparedness and Response Divison / MoH Authorities Preparedness and Response Ministry of Defence Division / MoH Ministry of Disaster Management 17 Medical Counter measures and Deputy Director General / Medical Medical Supplies Division/ MoH Personnel Deployment Supplies Division/ MoH Disaster Preparedness and Response Division / MoH Director/ Medical Supplies Division/ Ministry of Disaster Management MoH Medical Supplies Division/ MoH Ministry of Foreign Affairs 18 Risk Communication Director/ Health Promotion Bureau/ Directorate/ Health Promotion Bureau/ MoH MoH Epidemiology Unit/ MoH Quarantine Unit/MoH, Disaster Preparedness and Response Division / MoH Ministry of Disaster Management 19 Radiation Emergencies Director General/ Sri Lanka Atomic Sri Lanka Atomic Energy Regulatory Council Energy Regulatory Council Sri Lanka Atomic Energy Regulatory Board Ministry of Defence Epidemiology Unit/ MoH Quarantine Unit/MoH, Disaster Preparedness and Response Division / MoH Ministry of Disaster Management Ministry of Defence National Action Plan for Health Security of Sri Lanka: 2019 - 2023 95

Annex 2 Joint external evaluation scores for each technical area Technical areas Indicators Score National legislation, policy P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government 4 and financing instruments in place are sufficient for implementation of IHR (2005) P.1.2 The State can demonstrate that it has adjusted and aligned its domestic legislation, policies and 3 administrative arrangements to enable compliance with IHR (2005) IHR coordination, communication P.2.1 A functional mechanism is established for the coordination and integration of relevant sectors in the 2 and advocacy implementation of IHR Antimicrobial resistance P.3.1 Antimicrobial resistance detection 3 P.3.2 Surveillance of infections caused by antimicrobial-resistant pathogens 3 P.3.3 Health care-associated infection (HCAI) prevention and control programmes 3 P.3.4 Antimicrobial stewardship activities 3 Zoonotic diseases P.4.1 Surveillance systems in place for priority zoonotic diseases/pathogens 3 P.4.2 Veterinary or animal health workforce 3 P.4.3 Mechanisms for responding to infectious and potential zoonotic diseases are established and 2 functional Food safety P.5.1 Mechanisms for multisectoral collaboration are established to ensure rapid response to food safety 3 emergencies and outbreaks of foodborne diseases Biosafety and biosecurity P.6.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture 2 facilities P.6.2 Biosafety and biosecurity training and practices 1 Immunization P.7.1 Vaccine coverage (measles) as part of national programme 5 P.7.2 National vaccine access and delivery 5 National laboratory system D.1.1 Laboratory testing for detection of priority diseases 4 D.1.2 Specimen referral and transport system 2 D.1.3 Effective modern point-of-care and laboratory-based diagnostics 3 D.1.4 Laboratory quality system 3 Real-time surveillance D.2.1 Indicator- and event-based surveillance systems 3 D.2.2 Interoperable, interconnected, electronic real-time reporting system 4 D.2.3 Integration and analysis of surveillance data 4 D.2.4 Syndromic surveillance systems 4 96 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 Technical areas Indicators Score Reporting D.3.1 System for efficient reporting to FAO, OIE and WHO 3 D.3.2 Reporting network and protocols in country 2 Workforce development D.4.1 Human resources available to implement IHR core capacity requirements 4 D.4.2 FETP or other applied epidemiology training programme in place 4 D.4.3 Workforce strategy 3 Preparedness R.1.1 National multi-hazard public health emergency preparedness and response plan is developed and 1 implemented R.1.2 Priority public health risks and resources are mapped and utilized 1 Emergency response operations R.2.1 Capacity to activate emergency operations 1 R.2.2 EOC operating procedures and plans 2 R.2.3 Emergency operations programme 3 R.2.4 Case management procedures implemented for IHR relevant hazards. 4 Linking public health and security R.3.1 Public health and security authorities (e.g. law enforcement, border control, customs) are linked 4 authorities during a suspect or confirmed biological event Medical countermeasures and R.4.1 System in place for sending and receiving medical countermeasures during a public health 2 personnel deployment emergency R.4.2 System in place for sending and receiving health personnel during a public health emergency 1 Risk communication R.5.1 Risk communication systems (plans, mechanisms, etc.) 2 R.5.2 Internal and partner communication and coordination 5 R.5.3 Public communication 3 R.5.4 Communication engagement with affected communities 4 Points of entry PoE.1 Routine capacities established at points of entry 3 PoE.2 Effective public health response at points of entry 4 Chemical events CE.1 Mechanisms established and functioning for detecting and responding to chemical events or 2 emergencies CE.2 Enabling environment in place for management of chemical events 2 Radiation emergencies CE.2 Enabling environment in place for management of chemical events 2 RE.1 Mechanisms established and functioning for detecting and responding to radiological and nuclear 1 emergencies RE.2 Enabling environment in place for management of radiation emergencies 3 National Action Plan for Health Security of Sri Lanka: 2019 - 2023 97 98 National Action Plan for Health Security of Sri Lanka: 2019 - 2023