One Health Strategic Plan 2019-2023

2019–2023 Federal Ministry of Health Federal Ministry of Agriculture and Rural Development Federal Ministry of Environment ONE HEALTH STRATEGIC PLAN FEDERAL REPUBLIC OF NIGERIA SUSTAINABI LIT Y ON E HEALTH HUMAN HEALTH ANIMAL HEALTH ENVIRONMENTAL HEALTH Design and Layout by Boboye Onduku/Blo’comms, 2019 One Health Strategic Plan 2019–2023 Copyright ©2019 Federal Ministry of Health, Federal Ministry of Agriculture and Rural Development and Federal Ministry of Environment This publication was produced by Federal Ministry of Health, Federal Ministry of Agriculture and Rural Development and Federal Ministry of Environment All rights reserved. FEDERAL REPUBLIC OF NIGERIA 2019–2023 ONE HEALTH STRATEGIC PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANII LIST OF ABBREVIATIONS IV FOREWORD VI ACKNOWLEDGMENTS VII EXECUTIVE SUMMARY IX 1. INTRODUCTION 1 1.1 Country Profile: Nigeria 1 1.1.1 Geography and Population 1 1.1.2 Economic Activities 1 1.1.3 Administrative Structure 1 1.1.4 Human and Animal Health Systems in Nigeria 3 1.1.5 Biodiversity and Wildlife Resources 5 2. ONE HEALTH SITUATION ANALYSIS 7 2.1 Zoonoses 7 2.1.1 Burden of Zoonoses in Africa 7 2.1.2 Burden of Zoonoses in Nigeria 7 2.1.3 Prioritisation of Zoonotic Diseases in Nigeria 8 2.2 Antimicrobial Resistance 8 2.3 Environmental Health 10 2.4 Surveillance 11 2.4.1 Surveillance for Zoonotic Diseases in Nigeria 11 2.5 AMR Surveillance 17 2.6 IHR 2005 Enactment and Implementation 19 2.7 Nigeria IHR Core Capacities Assessment 19 2.7.1 Key JEE Findings 19 2.7.2. Core Capacities Assessment Strengths 22 2.7.3 Areas that Need Improvement 24 2.7.4 Key Priority Actions Recommendations as it Relates to One Health 24 2.7.5 SWOT Analysis of One Health in Nigeria 25 CONTENTS FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANIII 3. ONE HEALTH IN NIGERIA 29 3.1 Nigeria Centre for Disease Control 29 3.2 Department of Veterinary and Pest Control, Federal Ministry of Agriculture and Rural Development 30 3.3 National One Health Coordinating Structure 32 3.1.1 National One Health Steering Committee 32 3.1.2 National One Health Technical Committee 33 3.1.3 National One Health Coordinating Unit (NOHCU) 34 4. ONE HEALTH STRATEGIC PLAN 36 4.1 Vision, Mission, Goals and Core Values of One Health 36 4.1.1 Vision 36 4.1.2 Mission 36 4.1.3 Goals 36 4.1.4 Core Values 36 4.1.5 Themes and Thematic Goals 37 4.1.6 Guiding Principles 37 5. FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA 38 6. ONE-YEAR IMPLEMENTATION PLAN 46 7. MONITORING & EVALUATION FRAMEWORK FOR THE ONE HEALTH STRATEGIC PLAN 54 REFERENCES 62 CONTRIBUTIONS 63 CONTENTS FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANIV AEFI Adverse Events Following Immunization AFENET African Field Epidemiology Network ARIS Animal Resource Information System AU-IBAR African Union Inter-African Bureau for Animal Resources BEP Bio-security Engagement Program BLIS Basic Laboratory Information System DVPCS Department of Veterinary and Pest Control Services ECOWAS Economic Community of West African States EID Emerging Infectious Disease EPR Epidemic Preparedness and Response FAO Food and Agriculture Organization FCT Federal Capital Territory FEC Federal Executive Council FMARD Federal Ministry of Agriculture and Rural Development FMoH Federal Ministry of Health GDP Gross Domestic Product GHSA Global Health Security Agenda GIS Global Implementation Solutions IDSR Integrated Disease Surveillance and Response IHR International Health Regulations IUCN International Union for the Conservation of Nature JEE Joint External Evaluation NADIS National Animal Disease Information and Surveillance NCDC Nigeria Centre for Disease Control NCH National Council on Health NFELTP Nigeria Field Epidemiology and Laboratory Training Program NUC National University Commission LIST OF ABBREVIATIONS FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANV OIE Office Internationale des Epizooties / World Organization for Animal Health PHEIC Public Health Emergency of International Concern POE Points of Entry PPP Purchasing Power Parity REDISSE Regional Disease Surveillance System Enhancement RRT Rapid Response Team SARS Severe Acute Respiratory Syndrome SMS Short Message Service SORMAS Surveillance Outbreak Response Management and Analysis System STI Sexually Transmitted Infection SWOT Strength Weakness Opportunities and Threats TADs Transboundary Animal Diseases UMB University of Maryland Baltimore WAHIS World Animal Health Information System WHO World Health Organization INTRODUCTION FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANVI One Health is an approach to designing and implementing programs, policies, legislations and research in which multiple sectors plan, communicate and work together to achieve better public health outcomes for the human, animal, and environment sectors. The world is confronted with a recurrent epidemics and other public health events that impact negatively on human health but whose origin may be traced to non human sources. Disease occurrence and spread is related to environmental factors, animal health, climate change and other human activities such as travel, urbanisation and globalisation. Diseases at the human-animal ecosystem interface (e.g. zoonotic diseases, water/food borne diseases, vector borne diseases) continue to pose threats to humans and animals with increasingly significant morbidity and mortality. Worse still, of the estimated 1400 diseases known to affect man, 60% are of animal (zoonotic) origin. Similarly, of the emerging infectious diseases reported globally, 75% are of zoonotic nature. In Nigeria, catastrophic effects of zoonotic diseases such as Ebola, Lassa fever, Dengue, rabies and yellow fever have been reported in the last 5 years. The increased burden of zoonotic diseases is a result of increasing human population growth and therefore increased need for food (need for farming and animal as sources of food), human encroachment on ecosystems that are high risk for diseases transmission, closer integration with animals /wildlife and rapid urbanisation. It is therefore imperative that we embrace the One Health approach to confront the ever-increasing disease burden affecting Africa in general and Nigeria in particular. Many microbes co-exist with animals and humans. Considering the impact of the human-animal-ecosystem interface on health, the need for a coordinated multi-sectoral approach to address the attendant health risks associated with such interface has been emphasized. A One Health approach is known to be important in most spheres of public health such as food safety, control of zoonoses, antimicrobial resistance, surveillance, outbreak response and human resource strengthening. In Nigeria, some strides have been made in implementing a One Health approach and these include the successful control of epidemic-prone diseases like H5N1 avian influenza, Ebola virus diseases, Monkey pox, Lassa fever and yellow fever. The Nigeria Field Epidemiology and Laboratory Training Program, a public health workforce development strategy, is also an important intervention aimed at promoting the One Health approach which continuously builds the capacity of medical doctors, veterinarians, laboratory scientists and environmental scientists especially in outbreak control and research. In line with the Global Health Security Agenda (GHSA), the Federal Government has FOREWORD FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANVII taken the initiative leveraging on the gains already made, by institutionalising One Health within the structures of relevant MDAs. It is envisioned that One Health-focused projects like the Regional Disease Surveillance System Enhancement (REDISSE) will make invaluable contribution to this process. For the timely prevention and control of zoonoses and other emergencies, the Federal Government recognises the need to join forces across sectors vis a vis sharing of epidemiological data including laboratory information or public health events. It is against this backdrop that that the NCDC, in collaboration with other Ministries, Departments and Agencies, has developed a 5-year strategic plan and a 1-year implementation plan for One Health in Nigeria (2019-2023). This plan was jointly developed with Department of Veterinary and Pest Control Services in the Federal Ministry of Agriculture and Rural Development, Federal Ministry of Health, Federal Ministry of Environment, Academia, development partners, the private sector as well as non-governmental organisations. The plan addresses some of the gaps identified in the Joint External Evaluation of the IHR core capacities. The plan reflects the shared commitment to enhance multi-sectoral collaborations in addressing human animal ecosystem public health challenges. If successfully implemented, the plan will institutionalise One Health, address zoonotic diseases, enhance food safety and security, improve livelihoods of many Nigerians and keep Nigeria heathier and safer. We call upon you all to support the implementation of the One Health strategy. HONOURABLE MINISTER OF HEALTH HONOURABLE MINISTER OF AGRICULTURE AND RURAL DEVELOPMENT HONOURABLE MINISTER OF ENVIRONMENT FOREWORD FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANVIII The Nigeria Centre for Disease Control wishes to thank all those who contributed to the successful completion of the five-year strategic plan for the implementation of One Health in Nigeria. We are grateful for the financial support from the Global Implementation Solutions and the invaluable support from our other partners who contributed to the development of this plan. These include the WHO, US Centres for Disease Control and Prevention, US Department of State, Nigeria Field Epidemiology and Laboratory Training Program, and African Field Epidemiology Network. We also appreciate individuals and organisations that provided expert opinion, essential inputs and valuable comments on the initial drafts that preceded the final document. These include experts from Ahmadu Bello University, Nigeria, University of Ibadan Nigeria and University of Jos, Nigeria. A full list of contributors to this plan is provided after the references. Chikwe Ihekweazu DR. CHIKWE IHEKWEAZU DIRECTOR GENERAL, NIGERIA CENTRE FOR DISEASE CONTROL (NCDC) ACKNOWLEDGMENTS FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANIX Nigeria, with a population of nearly 200 million and an annual estimated growth rate of 2.6% is faced with an increasing infectious and non-communicable disease burden. Among the infectious diseases are zoonotic diseases. Successful control of zoonotic diseases calls for a multi-sectoral approach to prevention and control. Multisectoral “One Health” approach is also required for other public health threats at the human animal- ecosystem interface. These include food safety and security, antimicrobial resistance and emerging and re-emerging infectious diseases with consequent spill over from animals to humans and vice versa. Therefore, a robust One Health approach is required in tackling these health issues. One Health is an approach to designing and implementing programs, policies, legislations and research in which multiple sectors plan, communicate and work together to achieve better public health outcomes for all the sectors. A jointly developed One Health strategic plan will allow human, animal (including wildlife), environment and other expertise to work collaboratively to prevent, detect and respond to emerging and re-emerging diseases from this interface. Nigeria conducted its Joint External Evaluation for International Health Regulations core capacities in June 2017 with strengths identified in the One Health space. These included successful control of zoonotic diseases such as H5N1 Avian influenza, Ebola, Yellow fever, Monkey pox and Lassa fever. A multidisciplinary surveillance and outbreak response capacity building program in the field epidemiology and laboratory training program has been implemented since 2008 and has trained close to 400 field epidemiologists in the human, animal and laboratory health sectors. Over 1000 public health officers have completed the ‘frontline’ FETP. In July2017, NCDC convened a multi-sectoral group of experts that prioritised zoonotic diseases in Nigeria using a pre defined international criterion for zoonosis prioritization. The prioritisation helps focus the limited resources on “the highest burden conditions”. The implementation of Regional Disease Surveillance System Enhancement (REDISSE) project being financed by the government through a credit facility from the World Bank and domiciled in NCDC is also being implemented through a One Health approach. A One Health approach was also used for an antimicrobial resistance (AMR) situational analysis and development of an AMR National Action Plan. Despite these progress in the One Health space, there still exists gaps in zoonotic disease surveillance and outbreak response. Additionally, a coordinated institutionalised long-term plan for One Health was identified as a gap that needed to be addressed in the JEE. NCDC therefore EXECUTIVE SUMMARY FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLANX convened its One Health stakeholders from MDAs in health, agriculture, environment, academia, development partners, private sector and non-governmental organisations to undertake a situation analysis and develop an implementation plan for One Health in Nigeria. The Nigeria One Health initiative with the coordination of NCDC has the vision of creating a nation of healthy people and animals living in a balanced ecosystem. The mission is to build a strategic, dynamic and functional platform that advances human, animal and environmental health through multidisciplinary and inter-sectoral collaboration. This would be achieved through creating partnerships, leadership and coordination, using a skilled workforce with an emphasis on research, innovation and development. The plan will be implemented through five thematic areas, namely - surveillance and response, training and research, governance and leadership, communication and resource mobilization. If successfully implemented the plans will lead to: • A sustainable and institutionalised One Health platform at all government levels • A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiative in Nigeria • Increased awareness of OH for all stakeholders • Enhanced Government and other stakeholders’ commitment and support for the OH platform • Effective prevention, detection and response to public health threats through the OH approach Additionally, implementation of the One Health strategy will lead to strengthening the IHR core-capacities, Office Internationale des Epizooties’ guidelines on PHEICs, and eventually lead to a safer, healthier Nigeria. The plan will also realise the goals of the National Action Plan for Health Security (NAPHS) which include National Action Plan on Antimicrobial Resistance amongst others in alignment with the NCDC Strategy and Implementation Plan: Idea to Reality, 2017-2021and existing plans for the Department of Veterinary and Pest Control, FMARD and Federal Ministry of Environment. EXECUTIVE SUMMARY FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN1 1.1 Country Profile: Nigeria 1.1.1 Geography and Population Nigeria is located in West Africa along the Atlantic Ocean’s Gulf of Guinea. The country’s land borders are with Republics of Benin to the west, Cameroon to the east, Chad to the northeast, and Niger to the north. It has a land area of 356,667 square miles (923,768km2) and a coastline area of 530miles. It is the most populous country in Africa with a population of about 196 million (2018) and a projected annual population growth rate of 2.6%. The country has two major seasons each year: dry season from October to March and the rainy season from April to September. Natural disasters with outstanding health emergencies are not frequent in Nigeria except for seasonal flooding and consequently, internally displacement of persons. Adverse effects of diseases are often exaggerated by low socioeconomic status, low level of education, less than optimal health care services, poor transportation and communication. 1.1.2 Economic Activities Nigeria is a culturally diverse middle-income, mixed economy and an emerging market, with expanding manufacturing, financial, service, communications, technology, and entertainment sectors. It is ranked as the 21st largest economy in the world in terms of nominal GDP, and the 20th largest in terms of purchasing power parity. It is the largest economy in Africa; its re-emergent manufacturing sector became the largest on the continent in 2013. As a regional power, the Nigerian economy represents about 55% of West Africa’s GDP (African Development Bank, 2013), and accounts for 64 percent of GDP based on purchasing power parity (PPP) valuation of the fifteen- member countries in the ECOWAS sub-region. It produces a large proportion of goods and services for the West African sub-region. 1.1.3 Administrative Structure Nigeria is a federal republic with three tiers of government: Federal (central), State and Local levels. It is divided into 6 geopolitical zones – North West, North East, North Central, South West, South East and South South – composed of 36 states and a federal capital territory. At the state level, the relevant Ministry of Local Government and Chieftaincy Affairs, or Bureau of Local Government Affairs, is responsible for the administration of state- level Acts governing local authorities. Local government 1.0 Introduction FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 1.0 INTRODUCTION 2 exists in a single tier across all states. There are 768 local government authorities (LGAs) and six FCT area councils ToTaling 774 authorities. The Head of State and Head of Government is the President, who is democratically elected by the people of Nigeria. The national assembly comprises an elected House of Representatives and an elected Senate. The Senate and House of Representatives have 109 and 360 members respectively providing legislative functions of the government. FCT EBONYI KEBBI NIGER BAYELSA BAUCHI OGUN SOKOTO NASARAWA BENUE ENUGU AN AM BR A IMO ABIA KOGI KWARA ZAMFARA KATSINA KANO JIGAWA KADUNA YOBE BORNO ADAMAWA TARABA GOMBE PLATEAU DELTA RIVERS AKWA IBOM CROSS RIVER OYO Map of Nigeria showing the 36 states and the Federal Capital Territory (FCT) Abuja and the six geopolitical zones OSUN EKITI EDO ONDO LAGOS NORTH EAST GEOPOLITICAL ZONES NORTH CENTRAL NORTH WEST SOUTH EAST SOUTH WEST SOUTH SOUTH FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 1.0 INTRODUCTION 3 1.1.4 Human and Animal Health Systems in Nigeria The Nigeria’s National Health Act (2014) and Animal Disease Control Act provides the legal framework for regulation, development and management of both National Health System and Animal Health sub-sectors setting standards in rendering the health services in the Nigerian federation. The acts are an embodiment of human and animal health emergency laws and provide rights and access to any public health emergency at the three tiers of the government. 1.1.4.1 Human Health Structure In 2015, FMoH estimated a ToTal of 34,176 health facilities in Nigeria of which 88.1% are primary health care facilities, 11.7% secondary and 0.2% tertiary. Of these, 33% are owned by the private sector, which provides 60% of health care in the country. While 60% of the public primary health care facilities are located in the northern zones of the country, they are mainly health posts and dispensaries that provide only basic curative services (NSDPH, 2018). Nigeria has started moving from the first to the second stage of epidemiological transition since some non-communicable diseases like cancers and hypertension have started appearing among the list of major causes of morbidity and mortality in the country. Since health is on the concurrent list, each of the three tiers of government has its roles and responsibilities regarding health issues. Integrated Disease Surveillance and Response (IDSR) is a strategy within the WHO-AFRO region which promotes rational use of resources by integrating and streamlining common surveillance activities. The core functions of surveillance and response in the IDSR are to detect (identify cases and events), notify (report cases/events/conditions to next level), process (analyse and interpret findings), establish (investigate and confirm cases/events/conditions) prepare for response, respond (institute control measures), inform (communicate and provide feedback), and finally assess (evaluate and improve the surveillance and response system). Health facilities e.g. dispensaries, health centres, clinics hospitals (both private and public) constitute the first level of surveillance reporting. However, the front-line health facility staff report to Disease Surveillance and Notification Officers (DSNOs) at the LGA level. The DSNOs in turn submit data to the state level, (the state epidemiologists and state DSNOs) who FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 1.0 INTRODUCTION 4 collate the aggregate data for the state and send data to the Surveillance Department of Nigeria Centre for Disease control (NCDC). The IDSR is therefore implemented at these levels: health facilities, LGA, State, and National. The laboratory is an integral component of surveillance, especially for the purpose of case confirmation through identification of causative organisms or pathogens, management and public response/interventions. The Nigeria Centre for Disease Control (NCDC) manages the National Reference Laboratory in Gaduwa, Abuja, and supports a network of public health laboratories across the country. 1.1.4.2 Animal Health Structure The organization of the veterinary services in Nigeria mirrors the administrative and political organization of the national (federalised) territory : (a) the federal level is in charge of the development of policies and implementation of protocols, monitoring and coordination of development programmes, national disease control, and development of relevant legislation, (b) the state veterinary services are in charge of disease control, provision of clinical services, livestock product quality control, meat inspection, agricultural extension services and development of regulations, and (c) local government veterinary services mainly participate as mobilization and extension agents in operational actions in close coordination with the State Area Veterinary Officers, livestock farmers, traditional institutions, law enforcement agents and other stakeholders to facilitate delivery of services, disease reporting, control of livestock diseases and pests. The Federal Department of Veterinary and Pest Control Services (FDVPCS) of the Federal Ministry of Agriculture and Rural Development (FMARD) is composed of five divisions and has field offices at state capitals for ease of collaboration with the state Director of Veterinary Service (DVS). At the federal level, the National Veterinary Research Institute (NVRI) is the reference laboratory for the diagnosis and investigation of livestock diseases that collaborates with international reference laboratories. NVRI is recognised as a Regional laboratory for West and Central African countries for avian influenza and trans-boundary animal diseases (TADs). FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 1.0 INTRODUCTION 5 It is also involved in the production and testing of vaccines for the control of animal diseases in the country and conducts research and training in relevant veterinary fields. Two other federal institutions are involved in veterinary services missions: (a) NAFDAC: National Agency for Food Drug Administration and Control and is in charge of registration and control of veterinary medicines and biological products and (b) NAQS: Nigeria Agricultural Quarantine Services in charge of the border control and quarantine service. Nigeria has nine accredited faculties of veterinary medicine (Abeokuta, Abuja, Ibadan, Maiduguri, Makurdi, Nsukka, Sokoto, Umudike and Zaria). Three colleges of animal health and production located in Ibadan, Kaduna, and Vom also provide training for the veterinary paraprofessionals. A private veterinary sector is in place, but there is currently no provision for the delegation or regulation, nor is there appropriate clarity about government responsibilities towards this private sector (animal health accreditation or sanitary mandate). Private veterinarians are mainly involved in the supply and distribution of veterinary drugs, vaccines, equipment and livestock feeds, and in the provision of routine clinical services, preventive care for livestock, and consultancy services. 1.1.5 Biodiversity and Wildlife Resources Nigeria occupies a unique geographic position in Africa and its highly varied climate and other geographic features endow the country with one of the richest in biodiversity on the continent. According to the 2006 National Biodiversity Strategy and Action Plan Nigeria possesses more than 5,000 recorded species of plants, 22,090 species of animals, including insects and 889 species of birds, and 1,489 species of microorganisms. Nigeria is known as a global hotspot for primate species, with a great diversity found especially in the Gulf of Guinea forests of Cross-River State and adjacent parts of Cameroon. Some important endemic birds and mammals include three monkey species, the white-throated monkey (Cercopithecus erythrogaster), Sclater’s guenon (Cercopithecus sclateri) and the Niger Delta red colobus (Procolobus pennantii epieni) and three birds, the Anambra waxbill (Estrilda poplipaia), the Ibadan malimbe, (Malimbus ibadanensis) and the Jos indigo-bird (Vidua maryae). FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 1.0 INTRODUCTION 6 The most endangered gorilla subspecies on earth, the Cross-River gorilla (Gorilla gorilla diehli) with an estimated population of less than 250 individuals is found only in a couple of protected areas of the Nigeria/ Cameroon border. The International Union for the Conservation of Nature (IUCN) Red List of Threatened Species (i.e. of globally threatened species) includes 148 animals and 146 plants that are found in Nigeria. Of these, 26 animals and 18 plants are classified as endangered and another three animals and 15 plants are critically endangered worldwide. In general, since the beginning of the last century, biological resources in Nigeria have been subjected to increasing pressures of habitat loss, over harvesting, pollution and the introduction and invasion by alien species. Consequently, their productive potential for present and future generations is threatened. Improvement in the quality of life for the people will require long-term economic growth which is itself dependent upon improved management and conservation of the natural resource base. Several obstacles to sustainable management of biodiversity include financial and human resource constraints, lack of awareness among the general public and decision makers, inadequate legal structures at the national level, and ineffective cooperation between countries in the sub-region. Sustainable management of biodiversity and wildlife in Nigeria requires a careful juxtaposition between the needs of a large and growing human population today and the long-term sustainability of the natural resources that people ultimately depend upon for the future. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN7 2.0 One Health Situation Analysis 2.1 Zoonoses 2.1.1 Burden of zoonoses in Africa Weak surveillance and paucity of scientific data makes it difficult to quantify the true burden of zoonotic diseases in most African countries. Research however identifies some countries in East and West Africa: Ethiopia, Tanzania, Nigeria, Togo and Mali as the nations that bear the greatest burden of neglected zoonoses not only in Africa but globally.Parts of Africa are also considered potential hotspots for zoonotic emergence because of high wildlife biodiversity, rapid human population growth, change in land use and recurrent outbreaks of emerging infectious diseases of zoonotic origin. Besides the public health burden, zoonotic outbreaks in Africa have serious impact on economies of affected countries due to production losses, implications on livestock trade and international travel. Outbreaks of Rift Valley fever in the horn of Africa, viral haemorrhagic fevers in West and East Africa and anthrax in Southern Africa are classic examples. 2.1.2 Burden of Zoonoses in Nigeria Nigeria is considered to have one of the highest burdens of endemic diseases globally and one of the four countries that contributes 44% of the world’s poorest livestock keepers. Diseases like anthrax, zoonotic tuberculosis and rabies are widespread among livestock keepers, but their neglected nature provides a false perception of low public health importance. Besides the burden of endemic diseases, the country has also experienced epidemics of zoonotic origin like Ebola Virus Disease, avian influenza and Lassa fever and is considered to have one of the highest risks of emerging infectious diseases of zoonotic origin based on a spatial model to describe the global spatial patterns of zoonotic emerging infectious disease. Despite the huge burden of endemic zoonosis and increased risks of emergence of novel zoonotic diseases, there is little awareness about zoonosis, even among health professionals in Nigeria. While there is no single intervention that can address all zoonoses, it is now increasingly recognized that the establishment of inter-sectoral collaborative mechanisms is the most efficient strategy to address existing and emerging zoonoses. However, the coordination mechanisms in place are more administrative in nature and not always effective in promoting diffusion of knowledge across sectors. In the aftermath of H5N1 outbreak of 2008, there has FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 8 been a felt need for a flexible space outside formal structures that promote technical dialogue between human, veterinary, and wild life health sectors and inform policy discussions in the formal sector. 2.1.3 Prioritisation of zoonotic diseases in Nigeria Zoonotic diseases represent critical threats not only to global health security but also to economies of developing countries. However, in the resource-poor settings of most developing countries like Nigeria, where HIV, malaria and respiratory illnesses are the main cause of mortality, inadequate resources are dedicated to the control of zoonotic diseases. There is therefore a need to ensure that the limited resources are channeled to address the most important problems to achieve the greatest outcomes in improving human and animal health. Effective mitigation of the impact of endemic and emerging zoonotic diseases of public health importance requires multi-sectoral collaboration and interdisciplinary partnerships. A multi-sectorial zoonotic disease prioritisation workshop was therefore conducted to develop a priority zoonotic disease list through collaborative decision-making process in July 2017. From this process, the top 10 priority zoonotic diseases in Nigeria agreed are: Table 1: Agreed list of priority zoonotic diseases in Nigeria (July 2017) 1. Rabies 2. Avian influenza 3. Ebola 4. Swine influenza 5. Anthrax 6. Tuberculosis 7. African Trypanosomiasis 8. Lassa fever 9. Escherichia coli O157 10. Brucellosis “Yellow fever, Monkey pox” After prioritisation of zoonotic disease in July 2017, Nigeria started recording cases of Monkey pox which became an emerging zoonotic public health events in the country and re-emergence of Yellow fever. 2.2 Antimicrobial Resistance Globally, the threat from antimicrobial resistance (AMR) has continued to grow and compromises effective treatment. The impact is particularly felt by vulnerable patients, who FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 9 bear the consequences of associated higher costs, worsened illness, greater disability and increased mortality. Though estimates show that the burden is largely borne by low-income countries like Nigeria, the magnitude of its impact on human health, food safety and international trade of food animal products remains unknown. The 68th World Health Assembly (WHA) in May 2015 adopted the Global Action Plan, in collaboration with the Food and Agricultural Organization (FAO) and the World Organisation for Animal Health (OIE) to control AMR. It also requested Member States through WHA Resolution 68.7, to participate in an integrated global programme for the control of antimicrobial resistance. The goal of the Global Action Plan is to, “ensure continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way and accessible to all who need them”. Using several criteria including all-cause mortality, healthcare and community burden, prevalence of resistance, 10-year trend of resistance, transmissibility, the WHO prioritised 10 pathogens for global surveillance. These pathogens are in three categories: critical, high and medium priority. The most critical group includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients using medical devices such as catheter. The high and medium bacteria such as Neisseria gonorrhoea and Salmonella are those that cause more common diseases and are becoming increasingly resistant to last-line antibiotics. The report of the Nigerian AMR situation analysis conducted in 2017 showed that, communicable diseases requiring antimicrobial therapy, accounted for 66% of ToTal morbidity in 2015. Several of the “priority bacteria” listed by WHO as posing the greatest threat to human health, are prevalent in healthcare settings in Nigeria. This is of grave concern as these bacteria which are resistant to multiple antibiotics, can spread resistance genes to other bacteria. In addition, susceptibility testing is rarely performed due to limited laboratory capacity. Nigeria constitutes a large market for pharmaceuticals (60% of the volume consumed in Economic Community of West African States (ECOWAS) sub-region). Furthermore, manufacturers and importers have vertical drug distribution channels for wholesalers, retailers and hospitals, with limited regulatory capacity. A Rational Drug Use survey conducted in 12 developing countries reported that, Nigeria had the highest number of medicines prescribed (3.8 drugs/ encounter) and third highest prescription of antibiotics. Regarding irrational medicine use behavior in the country, about 46.7% to 71.1% of FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 10 children aged five years and were given antibiotics without prescription, while only 68.3% of adults used antibiotics following a doctor’s prescription. Factors contributing to the irrational use of antibiotics include the lower education level of caregivers, health insurance status of patients, and prescribers’ characteristics such as longer years of practice and lack of specialization. Resistant bacteria are commonly recovered from livestock, food animals and their products as well as vegetables. The high levels of antibiotic residues in food animals and the low recovery of resistant organisms from wildlife, point to antimicrobial use in agricultural and veterinary practices as principal drivers of resistance. Resistant bacteria have also been recovered from presumed potable, soil, natural, wastewater sites and at aquaculture sites. This illustrates that antimicrobial resistance is highly prevalent in the country and a ‘One Health’ approach to resistance containment is Nigeria’s best option. 2.3 Environmental Health This is the branch of public health concerned with all aspects of the natural and built environment affecting human health. On the other hand, environmental protection is concerned with protecting the natural environment for the benefit of human health and the ecosystem. Environment and the factors associated with it are other parts of the causes of many epidemic diseases both in the developed and developing nations. In Nigeria, environmental health problems arise from population pressure on housing, poor environmental sanitation, coupled with lack of safe water and basic housing facilities. Despite the deplorable state of environmental health (lack of safe water, bad housing condition, and so on), there is no reliable and timely means of surveillance or any monitoring system. Currently, environmental health surveillance has not commenced but there is a proposal to use a similar structure to the IDSR for environmental surveillance in Nigeria. It is proposed that environmental health officers (EHOs) stationed at the local government routinely collect environmental data; send to their state environmental officer (SHO) who compiles data for all the LGAs in the state before passing on the information to the national office Since 2010, major outbreaks of lead toxicity have been observed in northern Nigeria related to the processing of lead rich ore for the extraction of gold. Lead is a naturally occurring metal which though has beneficial uses, can be toxic. Exposure to lead is particularly harmful to children because their bodies are still developing, lead can cross FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 11 the placenta and be passed through breast milk while adults are most often exposed by work activities, consuming food or water contaminated by lead. In Nigeria’s Niger Delta region, the key environmental issues relate to the petroleum industry through oil spillage. Oil spillage has a major impact on the ecosystem into which it is released and may constitute ecocide. Immense tracts of the mangrove forests, which are especially susceptible to oil, have been destroyed. Spills in populated areas often spread out over a wide area, destroying crops and aquacultures through contamination of the groundwater and soils. The consumption of dissolved oxygen by bacteria feeding on the spilled hydrocarbons also contributes to the death of fish. In agricultural communities, often a year’s supply of food can be destroyed instantaneously. Due to the nature of oil operations in the Niger Delta, the environment is growing increasingly uninhabitable. People in the affected areas complain about health issues including breathing problems and skin lesions; many have lost basic human rights such as health, access to food, clean water, and an ability to work. In 2017, there were reports of chlorine gas poisoning in both Jos and Kano following gas explosions in both cities. Signs of acute chlorine gas poisoning are primarily respiratory including sneezing, nose irritation, burning sensation, and throat irritation. Chronic exposure may lead to pulmonary problems like acute wheezing attacks, chronic cough with phlegm, and asthma. Large populations of Nigerians live in poverty and do not have access to basic amenities such as food, safe water, sanitation and proper hygiene with resultant increased susceptibility to water-borne infections. Thus, there is an urgent need to invest more in environmental health and ensure every Nigerian has access to potable water, proper waste disposal mechanisms and proper environmental sanitation. This would go a long way in preventing spread of diseases. 2.4 Surveillance 2.4.1 Surveillance for Zoonotic disease 2.4.1.1 Human health The Nigeria Centre for Disease Control (NCDC) is the country’s national public health institute responsible for carrying out disease surveillance activities. This function includes surveillance of zoonotic diseases in human such as acute haemorrhagic fever syndrome, anthrax, Lassa fever, yellow fever, plague, and rabies using the national Integrated Disease Surveillance FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 12 and Response (IDSR) strategy. Event-based surveillance is also conducted at the national level to capture events using both automated and moderated search engines. Reporting of zoonotic diseases within the country’s surveillance system is conducted immediately (for epidemic- prone diseases), weekly or monthly, with set reporting timelines against which timeliness of reporting is measured. IDSR routine data on the 41 priority diseases is collected on a weekly and monthly basis and forwarded to LGAs using SMS or paper forms. The LGAs collate and forward to the state also by SMS and paper form for weekly reporting or via the new Surveillance Outbreak Response Management and Analysis System (SORMAS) database tool. The states enter the data using customised excel spreadsheet. NCDC has piloted and is rolling out an electronic based diseases surveillance and outbreak management SORMAS platform. This system will improve timeliness and quality of surveillance and effective management of disease outbreaks. Among the IDSR priority diseases, the following prioritised zoonotic diseases are included: 1. Epidemic prone diseases a. Ebola, Yellow fever, Dengue, Lassa fever, Avian influenza 2. Other major diseases, events or conditions of public health importance a. Human rabies, Tuberculosis, Leptospirosis, Human African Trypanosomiasis, Typhoid Fever, Human Influenza, Schistosomiasis 3. Diseases or events of international concern a. Human influenza due to a new subtype, any public health event of international or national concern such as infectious zoonotic diseases or food borne diseases e.g. anthrax, plague, human influenza due to new subtype Reference laboratories exist for all priority diseases at the federal government level and in academic institutions. Each laboratory deals with specific (not all) priority diseases such as the national influenza reference laboratory NCDC, Gaduwa and the three reference laboratories for Lassa fever at NCDC, Irrua and Lagos. Generally, the laboratory capacity and networks are weak and NCDC has a robust plan to strengthen public health laboratories in the country. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 13 Priority diseases, conditions and events for Integrated Disease Surveillance and Response (IDSR), 2018 Gaps still exist in linking surveillance and laboratory information on disease surveillance in the country. The public health workforce is enhanced by the participation of surveillance officers, State Epidemiologists, DSNOs and laboratorians in the frontline and advanced programs of the NFELTP. Since the training approach is multidisciplinary with a focus on One Health, medical doctors, veterinarians, laboratory scientists and environmental scientists are included in the various levels of epidemiology training. The training emphasises acquisition of necessary competencies in disease surveillance, investigation, analysis, evaluation, communication, management and critical appraisal / research. Trainees and graduates of the program have supported outbreak response to several zoonotic outbreaks including Lassa fever, monkey pox, rabies, yellow fever, dengue, Ebola virus disease among others. EPIDEMIC PRONE DISEASES DISEASES TARGETED FOR ERADICATION OR ELIMINATION OTHER MAJOR DISEASES, EVENTS OR CONDITIONS OF PUBLIC HEALTH IMPORTANCE 1. Cholera 1. Buruli ulcer 1. Acute viral hepatitis 2. Measles 2. Drancunculiasi (Guinea Worm) 2. Diabetes mellitus 3. Meningococcal meningitis 3. Leprosy 3. Diarrhoea with dehydration less than 5 years of age 4. Viral haemorrhagic fever Lassa Fever, Dengue) 4. Lymphatic filariasis 4. HIV/AIDs (new cases) 5. Yellow fever 5. Neonatal tetanus 5. Hypertension 6. Noma 6. Injuries (Road traffic accidents) 7. Onchocerciasis 7. Malaria 8. Poliomyelitis1 8. Malnutrtion in children under 5 years of age 1Disease specified by IHR (2005) for immediate notification 9. Maternal deaths 10. Mental Neurological & Substance Abuse (MNS) disorders (Epilepsy, Schizorpherinia, depression, etc.) 11. Human Rabies 12. Severe pneumonia in less than 5 years of age FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 14 2.4.1.2 Animal Health Zoonotic disease surveillance in animal is coordinated by the Department of Veterinary and Pest Control Services under the Federal Ministry of Agriculture and Rural Development (FMARD). Trans-boundary Animal Diseases (TADs) and potential zoonotic diseases such as avian influenza, rabies, brucellosis, bovine tuberculosis and anthrax in animals are reported regularly through the National Animal Disease Information and Surveillance (NADIS) system. The system needs significant strengthening. The animal disease reporting forms are designed on MS Excel for data entries and analysis periodically. Reports from surveillance points such as abattoirs, live bird and livestock markets, control posts, animal health facilities and wild life parks are captured and reported 13. STIs 14. Sickle Cell Disorder 15. Trachoma 16. Human African Trypanosomiasis 17. Tuberculosis 18. Schistosomiasis 19. SARI 20. Diarrhoea with blood 21. Whooping cough (Pertussis) 22. Diphtheria Diseases or events of international concern 23. Snake bites 1. Human influenza due to a new subtype1 24. Soil Transmitted Helminths 2. SARS1 25. Adverse Events Following Immunization (AEFI)* 3. Smallpox1 26. Asthma 4. Any public health event of international or national concern (infectious, zoonotic, food borne, chemical, radio nuclear, or due to unknown condition–Anthrax, Plague) 27. Typhoid Fever 1Disease specified by IHR (2005) for immediate notification *All serious AEFIs shall be reported immediately EPIDEMIC PRONE DISEASES DISEASES TARGETED FOR ERADICATION OR ELIMINATION OTHER MAJOR DISEASES, EVENTS OR CONDITIONS OF PUBLIC HEALTH IMPORTANCE FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 15 monthly, biannually and annually. Immediate notification is also conducted within 24 hours of confirmation of diseases or events that have high negative impact on public health and livestock production such avian influenza, rabies, anthrax etc. The country has adopted the Animal Resource Information System (ARIS) which was developed by the African Union Inter-African Bureau for Animal Resources (AU-IBAR) and being used by the surveillance officers for reporting animal diseases in all the states of the federation. The system is efficient and adaptable for country-specific real time surveillance activities. ARIS data is generated from veterinary facilities in hard copies and forwarded to the State Director of Veterinary Services (DVS). Epidemiology Officers collate and key into ARIS. Reports are validated by the Director of Veterinary Services before sending to AU-IBAR and OIE through the ARIS and World Animal Health Information System (WAHIS) platform respectively. Neither event-based nor syndromic surveillance is well established in the animal health sector. There is no routine sharing of surveillance information about zoonotic diseases between the Ministry of Health and the Ministry of Agriculture. The laboratory system in the National Veterinary Research Institute (NVRI) is integrated with the animal surveillance system but laboratory confirmation of outbreaks of zoonotic diseases is limited. Furthermore, laboratory information or specimens related to zoonotic diseases are not routinely shared between the NCDC and FMARD. The animal health sector in Nigeria is largely rudimentary since a majority of the ownership is solely in the hands of pastoralists who still practice an extensive animal management system with little or no veterinary care. Compounding this problem is limited government funding for the sector. Issues related to animal health are often on ad-hoc basis due to a lack of an organized structure leading to several unreported disease outbreaks. Resulting from this therefore, animals with diverse diseases are potentially imported into or exported out of the country due to porous borders and this is accentuated by limited implementation of existing regulatory policies and guidelines by relevant government agencies. Due to these situations, diverse populations and species of animals in the country are infected with several diseases leading to high morbidity and mortalities (sometimes resulting in reproductive and production losses) which FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 16 ultimately result in huge economic losses. Overall, failure in surveillance of animal health results in human health problems leading to challenges of food security and food safety as well as problems bordering on zoonotic disease spill-over to human populations. Disease suspicion: Private vet, Animal owner/ farmer, Wildlife/Park ranger, Community Leader, Animal health superintendent, etc. Surveillance agent Local Govt Veterinary Officer, State Area Veterinary Officer NADIS/Epidemiology Unit Zonal Coordination FDLPCS Field Office State Director of VS Disease Desk Officer Director–LPCS NADIS –Epidemiology Unit Relevant Division/project OIE, FAQ, AU-IBAR other stakeholdersWorld/Regional Reference laboratory Minister of Agriculture and Rural Development FMH, FMINO, FMST Police, Army, Customs Immigration NEMA, Other Donors Laboratory NVRI (VTH) SDT FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 17 2.5 AMR Surveillance The Honourable Minister of Health, on November 26, 2016, approved the establishment of Nigeria’s National AMR Coordinating Body at the Nigeria Centre for Disease Control (NCDC). A National AMR Technical Working Group (AMR-TWG) was created, comprising stakeholders from human health, animal health, food animal production and environment sectors. The AMR-TWG was tasked with conducting a situation analysis of AMR in Nigeria. Several gaps were identified from the situation analysis which include: 1. Poor public awareness and weak coordination of AMR awareness activities by government and partners such asvertical disease control programmes. 2. Poor One Health coordination of animal and human national disease surveillance systems. 3. Non-existence of a national AMR laboratory surveillance system and no dedicated funding for AMR control activities. 4. Non-existence of a national IPC coordinating bod and poor budgetary support for IPC activities in health facilities. 5. Lack of antimicrobial stewardship in both private and public sectors. 6. Studies on the health and economic impact of AMR inNigeria are non-existent with poor coordination of research on antibiotic use. Following the identification of these gaps, the AMR-TWG decided on a governance structure for Nigeria. This included the need for a Steering Committee that will support and guide for AMR control activities. The committee will include representatives of Ministries, Departments and Agencies (MDAs), regulatory bodies, the private sector, academia from human, animal, environmental health and food safety institutions and partners. AMR-TWG ONE-HEALTH AMR STEERING COMMITTEE AMR Secretariat Awareness AMR Surveillance AMR Research Antimicrobial Stewardship PC and Biosecurity FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 18 Increase Awareness • Increase awareness of AMR among Nigerians • Improve knowledge of AMR and related topics Build AMR surveillance • Strengthen institutional capacities for AMR detection • Build One Health laboratory infrastructure • Contribute to Global AMR surveillance Ensure rational antimicrobial use • Improve access to quality antimicrobial agents • Promote One Health antimicrobial stewardship • Strengthen regulatory agencies across all sectors Prevent infections • Strengthen IPC in healthcare facilities and communities • Promote food safety and biosecurity at farms • Improve environmental sanitation • Increase the use of vaccines in humans and animals Invest in research • Promote use of innovative investment channels • Incorporate One Health AMR research into training • Encourage development of antibiotic alternatives and new AMR diagnostics Strategic Interventions The focus areas were developed based on identified priority gaps. The strategic interventions used a ‘One Health’ approach, aimed at implementing proposed actions by strengthening and utilizing existing national systems and creating new structures where they do not exist. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 19 2.6 IHR 2005 Enactment and Implementation The International Health Regulations (IHR) is a set of regulations adopted by 194 WHO Member States to govern surveillance of public health emergencies of international concern. They were enacted in 2005 and came into force on 15 June 2007 and are legally binding for WHO Member States. In 2006, the Resolution AFR/RC56/R2 of the Regional Committee for Africa in Addis Ababa called for the implementation of the IHR (2005) in the context of the IDSR. IHR 2005 has an expanded scope to include all public health emergencies of International concern (including zoonoses). Successful implementation of IHR requires the fulfilment of 8 core capacities: legislation, policy and coordination, surveillance, preparedness, response, risk communications, laboratory and human resources. 2.7 Nigeria IHR Core capacities assessment The Joint External Evaluation (JEE) is an assessment of a country’s capacity to prevent, detect, and respond to public health threats as part of the International Health Regulations (IHR 2005) monitoring and evaluation framework. Nigeria JEE was conducted in June 2017. 2.7.1 Key JEE Findings Nigeria has made commendable progress in bio-surveillance for vertical diseases such as polio, TB, HIV/AIDS; response to PHEICs like Ebola, Lassa fever, meningitis, and cholera. Nigeria has several Points of Entry (PoEs) that are already involved in commendable routine (screening, have holding areas) and emergency actions. However, additional investments are required to attain higher IHR compliance which include finalisation of the legislative approval for the Nigeria Centre for Disease Control (NCDC) which has recently been achieved; strengthening laboratory capacity, especially specimen shipping, transportation and referral; formulating, costing, implementing, monitoring and evaluating all hazard national action plan for health security aligned with sector strategies; strengthening inter-sectoral collaboration for emergency response particularly between human and animal health, the environmental sectors and security agencies; scaling up, enhancing and sustaining the Integrated Disease Surveillance and Response (IDSR) nation wide at all levels (Federal State, LGA, health facilities), capitalising on the polio investments; and developing and implementing a comprehensive public health workforce strategy. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 20 TECHNICAL AREAS INDICATORS SCORE National legislation, policy and financing P.1.1 Legislation, laws, regulations, administrative requirements, policies or other government instruments in place are sufficient for implementation of IHR (2005) 1 P.1.2 The State can demonstrate that it has adjusted and aligned its domestic legislation, policies and administrative arrangements to enable compliance with IHR (2005) 1 IHR coordination, communication and advocacy P.2.1 A functional mechanism is established for the coordination and integration of relevant sectors in the implementation of IHR 2 Antimicrobial resistance P.3.1 Antimicrobial resistance detection 2 P.3.2 Surveillance of infections caused by antimicrobial-resistant pathogens 2 P.3.3 Health care-associated infection (HCAI) prevention and control programmes 2 P.3.4 Antimicrobial stewardship activities 2 Zoonotic diseases P.4.1 Surveillance systems in place for priority zoonotic diseases/ pathogens 2 P.4.2 Veterinary or animal health workforce 3 P.4.3 Mechanisms for responding to infectious and potential zoonotic diseases are established and functional 1 Food safety P.5.1 Mechanisms for multisectoral collaboration are established to ensure rapid response to food safety emergencies and outbreaks of foodborne diseases 2 Biosafety and biosecurity P.6.1 Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities 1 P.6.2 Biosafety and biosecurity training and practices 1 Immunization P.7.1 Vaccine coverage (measles) as part of national programme 3 P.7.2 National vaccine access and delivery 4 National laboratory system D.1.1 Laboratory testing for detection of priority diseases 3 D.1.2 Specimen referral and transport system 1 D.1.3 Effective modern point-of-care and laboratory-based diagnostics 2 D.1.4 Laboratory quality system 2 Joint External Evaluation of IHR Core Capacity in Nigeria, June 2017 The following observations were made on the country’s capacity to handle public health threats including Zoonotic Events (ZE): FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 21 TECHNICAL AREAS INDICATORS SCORE Joint External Evaluation of IHR Core Capacity in Nigeria, June 2017 Real-time surveillance D.2.1 Indicator- and event-based surveillance systems 3 D.2.2 Interoperable, interconnected, electronic real-time reporting system 2 D.2.3 Integration and analysis of surveillance data 3 D.2.4 Syndromic surveillance systems 3 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 3 D.4.2 FETP or other applied epidemiology training programme in place 4 D.4.3 Workforce strategy 2 Preparedness R.1.1 National multi-hazard public health emergency preparedness and response plan is developed and implemented 1 R.1.2 Priority public health risks and resources are mapped and utilised 1 Emergency response operations R.2.1 Capacity to activate emergency operations 2 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. 2 Linking public health and security authorities R.3.1 Public health and security authorities (e.g. law enforcement, border control, customs) are linked during a suspect or confirmed biological event 1 Medical counter measures and personnel deployment R.4.1 System in place for sending and receiving medical countermeasures during a public health emergency 1 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.) 1 R.5.2 Internal and partner communication and coordination 3 R.5.3 Public communication 2 R.5.4 Communication engagement with affected communities 3 R.5.5 Dynamic listening and ruMoUr management 3 Points of entry PoE.1 Routine capacities established at points of entry 1 PoE.2 Effective public health response at points of entry 1 FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 22 2.7.2. Core Capacities Assessment Strengths • Nigeria Integrated Disease Surveillance and Response (IDSR) in the Ministry of Health/NCDC is well established and routinely includes information of human cases of limited number of zoonotic diseases. • The National Animal Disease Information System (NADIS) is established in the Ministry of Agriculture and Rural Development. • Surveillance for avian influenza among poultry is established. • Surveillance and public health management of dog bites, including testing of dogs for rabies, is available. • Situational awareness reports were produced. These include quarterly newsletter by FMARD and Nigerian Agricultural Quarantine services and the Weekly Epidemiological Report by NCDC. • The NFELTP within NCDC/FMoH is well established and has trained many veterinarians in the FET advanced and frontline training programs • Public health training of veterinarians is also conducted by McArthur Foundation at the Ahmadu Bello University. • Veterinarians trained in public health, including graduates of NFELTP programs, are employed by the Ministry of Agriculture and Rural Development at the national and state levels. • Joint field investigations of outbreaks of zoonotic diseases, including Lassa fever and rabies, have been conducted, particularly by the NFELTP, and have included veterinarians. • A policy document and a response plan exist for avian influenza and rabies Chemical events CE.1 Mechanisms established and functioning for detecting and responding to chemical events or emergencies 1 CE.2 Enabling environment in place for management of chemical events 2 Radiation emergencies RE.1 Mechanisms established and functioning for detecting and responding to radiological and nuclear emergencies 3 RE.2 Enabling environment in place for management of radiation emergencies 3 TECHNICAL AREAS INDICATORS SCORE Joint External Evaluation of IHR Core Capacity in Nigeria, June 2017 FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 23 guidelines have been developed and are awaiting approval. • A National Action Plan on AMR, with a One Health approach, was developed, approved, and submitted to WHO in May 2017. • An AMR National Reference Laboratory, though interim, has been designated and nine sentinel laboratories for AMR surveillance among selected pathogens have been identified. • The National Action Plan on AMR includes surveillance for human infections caused by AMR pathogens. • Nigeria is enrolled in the WHO GLASS surveillance network for AMR. • A situation analysis which details the most common human pathogens, and prevalence of resistance patterns of these pathogens, has been conducted. • Passage of the National Policy for Food Safety and its Implementation Strategy in 2016. • Creation of the National Food Safety Management Committee (NFSMC) and the InterMinisterial Committee on Food Safety. • Outbreak investigations by NCDC are robust and timely, although a multisectoral response system for foodborne diseases and food safety emergencies is not established. • A laboratory inspection system including EQA is available but restricted to private laboratories. • NCDC plays an important role in the capacity enhancement of the laboratory testing for the priority diseases in the country. • The surveillance systems are able to detect public health threats. • The animal health sector conducts surveillance on select notifiable diseases. • Weekly surveillance epidemiological reports are produced at national level and disseminated in real time. • Existence of surveillance units in human (IDSR) and animal health (NADIS) sectors. • Existence of IHR NFP and OIE delegates in the FMoH and Ministry of Agriculture. The focal points are linked to learning package and best practices as provided by WHO, OIE and FAO. • The country has demonstrated ability to identify a potential PHEIC and file a report to WHO and similarly to the OIE for relevant zoonotic disease within 24 hours of confirmation and similarly to the OIE. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 24 2.7.3 Areas that Need Improvement • The highest priority zoonotic diseases for surveillance have not been formally identified through a One Health approach involving input from both the Ministry of Health and Ministry of Agriculture. • A robust surveillance system for the top priority zoonotic diseases in animals is lacking in the Ministry of Agriculture. • There is no routine forum or formal mechanism for sharing of results, surveillance data, reports or laboratory specimens between the Ministry of Agriculture and the Ministry of Health. • Given the large size of Nigeria, more veterinarians at central, state and district levels need to be trained in public health through the FETP advanced and Frontline programs. • To meet the goal of having a trained veterinarian at all LGA/district levels, field epidemiology training is particularly needed for veterinarians from district and state levels. • Policy documents and response plans for selected priority zoonotic diseases are needed. • Enhanced capacity for timely and coordinated inter-sectoral outbreak response and field investigations for priority zoonotic diseases is needed • Inter-sectorial collaboration on food safety and food-borne diseases is inadequate. Overall need for food safety capacity building in the public health, food safety and agriculture and animal health sectors at central, state and district levels. • Foodborne disease surveillance, monitoring of contaminants in the food chain, and outbreak/ emergency investigation and response capacities need strengthening. • Laboratory infrastructure, equipment and expertise for food safety is inadequate • Data on antimicrobial use, including prescription patterns, are lacking - for both humans and food animals. The enforcement of the need for a rational prescription for antimicrobial use in humans is lacking. There is no requirement that antimicrobials used in animals be available only by prescription and therefore antimicrobials are widely available, over the counter, for use in animals. 2.7.4 Key Priority Actions Recommendations as it Relates to One Health • Establishment of a One Health platform for intersectoral collaboration of outbreak responses that involve the human and animal sectors. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 25 • Adopt measure behaviors, policies and/or practices that minimize the transmission of zoonotic diseases from animals into human populations. • Enhance collaboration between Ministry of Health and Ministry of Agriculture at the national, state and local government levels. • Strengthen linkage between public health and animal health laboratories. • Enhance surveillance of zoonotic diseases by holding a meeting of appropriate stakeholders to identify the top priority zoonotic diseases to include in zoonotic disease surveillance system • Put in place a robust surveillance system for the highest priority zoonotic diseases in animals which is lacking in the Ministry of Agriculture. • There should be routine forum or formal mechanism for sharing of results, surveillance data, reports or laboratory specimens between the Ministry of Agriculture and the Ministry of Health. • Mechanisms for responding to infectious and potential zoonotic diseases established and functional. • Policy documents and response plans for selected priority zoonotic diseases are needed. • Enhance capacity for timely and coordinated intersectoral outbreak response and field investigations for priority zoonotic diseases is needed. • Develop integrated zoonotic disease surveillance system • Strengthen laboratory detection for priority zoonotic diseases/pathogens • Strengthen technical capacity for animal health workforce (Zoonotic disease control, communications, RDTs, etc) • Develop risk mapping for highest priority zoonotic diseases using One Health approach • Build technical capacity for zoonotic disease among Disease Surveillance and Notification Officers and Animal Surveillance Officers at LGA level Surveillance and laboratory • Availability of IDSR and NADIS platforms for disease surveillance reporting • Inadequate logistics for surveillance officers to carry out their duties (inadequate funding) • Poor inter-sectoral collaborations on surveillance activities Weak RRT at LGA levels THEMATIC AREAS STRENGTHS AND OPPORTUNITIES WEAKNESS AND THREATS 2.7.5 SWOT Analysis of One Health in Nigeria FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 26 Surveillance and laboratory • Availability of laboratories and equipment to handle some disease agents • Availability of trained laboratory personnel • Availability of rapid response teams from LGA to National levels • Availability of disease surveillance officers/agents • Availability of trained field epidemiologists and the NFELTP training. • Availability of interested partners supporting surveillance of priority diseases e.g. SORMAS, WHO, UMB, AFENET • Collaboration with partners on training of Lab staff and supply of consumables, external quality assurance • Research opportunities • Networking of Laboratories through tools like BLISS and ARIS used to connect the human and animal Labs and exchange of information Incoming REDISSE program • Inadequate funding for laboratory maintenance and stocking of consumables • Poor training of low-level surveillance officers • Inadequate surveillance tools • Inadequate tools for data management • Lack of human resources for equipment maintenance in the laboratories • Poor quality management system in the laboratories • Poor, late sample transportation system • Poor, late and incomplete reporting • Poor harmonisation of data (parallel programmes and reporting systems) • EPR committee meets only during outbreaks • Donor fatigue • Global economic recession • Insecurity and political instability in the country • Poor border control • Emerging and re-emerging zoonotic disease Training and research • Existing One Health problems (diseases, pathogens, AMR, environmental risk factors, biosafety, biosecurity issues) Human Resource – Availability of trainers and trainees – Mobilise during emergencies – Universities – Research institutes and other tertiary institutions – NFELTP • Research expertise – Existing capacity – Laboratory network • Inadequate infrastructure • Poor funding • Poor enabling environment for research (lack of motivation, incentives) • High turn-over/brain drain • Poor collaboration among researchers/institutions/ • Poor collaboration between researchers and policy makers • Poor uptake of research findings • Brain drain/high staff turn-over • Professional quackery • Insecurity/internal-external conflict THEMATIC AREAS STRENGTHS AND OPPORTUNITIES WEAKNESS AND THREATS SWOT Analysis of One Health in Nigeria FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 27 THEMATIC AREAS STRENGTHS AND OPPORTUNITIES WEAKNESS AND THREATS • Partnership and technical support • (WHO, OIE, UNICEF, BEP, UNEP, FAO, etc.) • International professional exchanges • Available market for indigenous research ideas and products • Availability of research questions • More platforms for evidence based training • Previous, demonstrable success stories • Donor fatigue/lack of program ownership • Inter-professional rivalry/conflicts/ strife • Political instability/lack of government goodwill • Competing demands for limited resources Governance and leadership • Existence of human health, animal health and environmental health in the concurrent list of the government • Existence of three tiers of governance structure that involves the LGAs, State and Federal • Existence of legislation and policy on human health, animal health and environmental health • Establishment of NCDC that anchors One Health • Inauguration of One Health committee –AMR at the federal level • Nigeria is a signatory to GHSA • Acceptance of One Health concept by the academia • Introduction of monitoring system by the government to address corrupt practices • International and regional initiative on One Health concept • Strong linkages between health, agriculture and environment • Lack of continuity of government policies • Lack of institutionalisationof One Health platform at the three tiers of government • Legislative process is expensive and cumbersome • Corruption • Insecurity • Professional rivalry • Labour unrest • Loss of interest • Lack of sustainability plan • Imposition of leadership SWOT Analysis of One Health in Nigeria FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN 2.0 ONE HEALTH SITUATION ANALYSIS 28 THEMATIC AREAS STRENGTHS AND OPPORTUNITIES WEAKNESS AND THREATS Resource mobilisation and communication • Existence of natural resources e.g. oil • Presence of well-trained human resource • History of successful collaboration in healthcare delivery (Public-Private Partnership) • Vibrant private sector • Large population in country and a growing democracy • Large population in the Diaspora • REDISSE: regional disease surveillance system enhancement • Presence of multiple stakeholders/donors • Increasing incidence of emerging diseases/ trans boundary animal diseases with funding support • Consistent private sector involvement in healthcare • Potential for future partnerships with global institutions in education and research • Membership/ influence in ECOWAS/ AU • Increasing foreign direct Investment • Poor ownership by government • Duplication of roles/ functions by partners • Weak PPP in healthcare sector • Absence of budget lines/ poor funding • Mismanagement of resources • Brain drain • Poor micro economic policies • Inconsistency in government policies • Changing donor priorities • Political instability/ insurgency • Global economic recession • Corruption • Competition for funding from other developing countries • Poor international image SWOT Analysis of One Health in Nigeria FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN29 3.0 One Health in Nigeria One Health is a multidisciplinary approach that implements programs, policies and research intersectorally – working at the local, regional, and global levels – with the goal of achieving optimal health outcomes, recognising the interconnection between people, animals, plants, and their shared environment. Many One Health efforts have been implemented in Nigeria across disease surveillance, outbreak response and research. These include the response to H5N1 Avian influenza, Lassa fever, monkey pox, Ebola, rabies and the multi-disciplinary FETP training. Many of these efforts have partially involved the NCDC and DVPCS and therefore have not been institutionalised and sustained. In March 2018 with support from Global Implementation Solutions (GIS), NCDC and DVPCS jointly convened a One Health key stakeholders meeting in Nigeria. The stakeholders were drawn from government ministries, departments and agencies, development partners, academia, private sector and non-governmental organization. There was recognition that OH was the guiding principle for the new World Bank Regional Disease Surveillance Systems Enhancement (REDISSE), NAPHS and the National AMR Action Plan. These efforts needed to be expanded to an NCDC lead full-fledged One Health program. During the five-day meeting, the zoonosis disease priority list was reviewed and a situation analysis for OH implementation in Nigeria conducted. A 5-year strategic plan was developed with a one-year implementation plan. 3.1 Nigeria Centre for Disease Control The Nigeria Centre for Disease Control (NCDC) was established in the year 2011 in response to the challenges of public health emergencies and to enhance Nigeria’s preparedness and response to epidemics through prevention, detection, and control of communicable diseases. Its core mandate is to detect, investigate, prevent and control diseases of national and international public health importance. The mission for the NCDC next five years (2017-2021) is ‘to protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response activities, using a One Health approach, guided by research and led by a skilled workforce.’ The core functions of the NCDC include: • Prevent, detect, and control diseases of public health importance • Coordinate surveillance systems to collect, analyses and interpret data on diseases of public health importance • Support States in responding to small outbreaks and lead the response to large disease outbreaks FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN30 • Develop and maintain a network of reference and specialsed laboratories • Lead Nigeria’s engagement with the international community on diseases of public health relevance • Conduct, collate, synthesize and disseminate public health research to inform policy 3.2 Department of Veterinary and Pest control, Federal Ministry of Agriculture and Rural Development The Department of Veterinary and Pest Control Services (DVPCS) functions as the policy adviser to the Government on all animal health, safety and wholesomeness of food of animal origin for human consumption and pest control services. The Department draws its mandate from the Animal Diseases Control Act NO. 10 of 1988 and the World Organization for Animal Health (Office Internationale des Epizooties-OIE) standards, recommendations and guidelines for animal health and welfare. It is involved in the prevention, control and eradication of trans-boundary animal diseases and pests, control of vector and vector-borne diseases, zoo-sanitary certification services, provision of veterinary public health services, food safety services and zoonotic diseases control to guarantee healthy national herd, wholesomeness of foods of animal origin, international trade in livestock and livestock products and the general economic well-being of the populace. The foregoing is achieved through: • Building a strong herd-health that will guarantee increased productivity and output of all species of livestock in Nigeria; • Guaranteeing the provision of wholesome food of animal origin to meet local demands and for export • Ensuring optimum utilisation of the ecosystem for livestock production with minimal damage • Carrying out effective surveillance on animal diseases and develop early warning early raction system • Encouraging private sector participation in all aspects of animal health services including marketing • Certification of animal and animal products for trade (import/export) • Developing manpower and vocational skills for all stakeholders in the animal health sub-sector • Effective control and management of vectors of animal diseases and transboundary animal pests • Ensuring that animal health systems are founded on good governance enabled by 3.0 ONE HEALTH IN NIGERIA FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN31 the appropriate legislation and the necessary means to enforce it • Ensure and coordinate the registration of poultry and livestock farms in line with zoo sanitary requirements • Establishment of a network covering the whole country based on a tripod composed of official veterinarians, private veterinarians/para-veterinarians/community animal health workers and animal producers which ensure effective surveillance • Ensuring early detection of an outbreak to enable a rapid response to potentially serious health events • Facilitating the provision of bio-security and bio containment measures for infected farms to prevent pathogens from spreading and enabling them to be eliminated • Ensuring rapid and fair financial compensation measures for producers whose animals have had to be culled due to health reasons • Provision of vaccination for healthy animals whenever appropriate • Ensuring good initial training and continuing education for all professionals • Ensuring continuous applied research on control methods since pathogens are constantly adapting • Strengthening and expansion of Veterinary Public Health Services to cover Meat Inspection Services, Milk Hygiene, Public Health Education, Environmental Hygiene and Laboratory Services to ensure the consumption of quality and safe Animals and Animal commodities • Liaison with international and regional organisations (OIE, WTO, FAO, AU-IBAR, ECOWAS, Codex Alimentarius etc) on all matters relating to animals and animal health National One Health Steering Committee DG NCDCNational One Health Technical Committee Human Health Desk Officer Animal Health Desk Officer Environmental Health Desk Officer National One Health Coordinating Unit 3.0 ONE HEALTH IN NIGERIA Institutional/operational framework of National One Health Coordination Unit (NOHCU) FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN32 3.3 National One Health Coordinating Structure The proposed One Health Platform will have three structures namely: National One Health Steering Committee (NOHSC), National One Health Technical Committee (NOHTC) and National One Health Coordination Unit (NOHCU) that are involved in providing leadership oversight in the planning, implementation and monitoring of One Health related activities in the country. The Nigeria Centre for Disease Control (NCDC) will host the National One Health Coordination Unit (NOHCU) and coordinate the implementation. The unit will be coordinated by the global health security unit of the department of surveillance. The unit will be responsible in providing technical support to ensure OH approach to emergency preparedness and response. The DG NCDC will have oversight responsibilities of the operations of the Unit. 3.1.1 National One Health Steering Committee The National One Health Steering Committee(NOHSC) will be constituted to provide leadership at the highest level of government for an early resolution of One Health public health crisis in the country. The membership of the Committee comprises the following: • Minister of Federal Ministry of Health (Chair) • Minister of Federal Ministry of Agriculture and Rural Development (co-chair) • Minister of Federal Ministry of Environment • Minister of Federal Ministry of Finance • Minister of Federal Ministry of Information • DG of NCDC (Secretary) • The Director of Public Health (FMoH) • The Director of the Department of Veterinary and Pest Control Services, FMARD Terms of reference The Committee shall meet at least biannually and shall have the following functions: a. Provide overall oversight and supervision to the OH technical committee b. Review and approve proposed activities by the OH technical committees c. Provide high-level support for implementation of OH activities in the country d. Focus on policy issues related to the national One Health 3.0 ONE HEALTH IN NIGERIA FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN33 e. Provide leadership at the highest level of government for an early resolution of public health crisis in the country f. Provide technical assistance to neighboring countries as directed by Mr. President g Report back regularly to Mr. President and the FEC on the implementation of the integrated One Health Strategic Plan Meeting • The National One Health Steering Committee will hold meetings twice a year but may hold additional extraordinary meetings as necessary if convened by the Chairman/Co-Chairman • The quorum required is one third • Notice of meetings to be provided at least two weeks before the scheduled date 3.1.2 National One Health Technical Committee The National One Health Technical Committee (NOHTC) with representatives from the relevant ministries and agencies as well as development partners will be constituted to supervise the operation of NOHCU. The membership of the Committee comprises of the following: • DG NCDC (Chair) • Chief Veterinary Officer (Co-Chair) • Four (4) representatives from NCDC (Director of Surveillance; Director Prevention and Policy Coordination, Director, Emergency Preparedness and Response and Director of Laboratory) • One representatives from the Federal Ministry of Health • One representatives from the Federal Ministry of Agriculture and Rural Development • One representative from NVRI • One representatives from the Federal Ministry of Environment • One representative from NEMA • One representative from ONSA • One representative from NESREA • Representatives from the following partners: WHO, FAO, CDC, AFENET • A representative from the academia 3.0 ONE HEALTH IN NIGERIA FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN34 Terms of reference The Technical Committee will have the following functions: a. Support advocacy efforts to provide funds and other support for OH activities b. Collaborate with the communication committee for effective dissemination of information on the status of the outbreak and its management c. Ensure the successful implementation of the integrated plan by monitoring its implementation and reviewing the plan as may be necessary d. Establish liaison with development partners to coordinate national and international efforts to contain disease outbreaks e. Support multi-sectoral collaboration in management of public health emergencies f. Provide oversight and technical support to ensure OH approach to emergency preparedness and response g. Report back regularly to NOHSC on the implementation of the One Health activities h. Ensure inter-ministerial cooperation and coordination i. Ensure that Memorandum of Understanding (MoU) is signed for the operational framework of NOHCU among the implementing MDAs Meetings • The National One Health Technical Committee will hold meetings quarterly but may hold additional extraordinary meetings as necessary if convened by the Chairman/Co-Chairman • The quorum required is one third • Notice of meetings to be provided at least two weeks before the scheduled date 3.1.3 National One Health Coordinating Unit (NOHCU) The National One Health coordination unit will have a National One Health coordinator – a senior technical officer from NCDC with qualification in public health, or veterinary public health and other relevant disciplines in One Health. The unit will have animal health desk, human health desk and environmental health desk in the implementation of One Health related activities with the relevant technical working groups. In addition, the unit will liaise with other relevant sectors to provide technical support in the containment of disease outbreaks and to ensure 3.0 ONE HEALTH IN NIGERIA FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN35 effective inter-agency collaboration under the supervision of the DG NCDC. Membership of National One Health Coordination Unit comprise the following; • One Health Coordinator from NCDC assisted by • Desk officers in human health, veterinary public health, environment health and other disciplines related to One Health. Terms of Reference a. Provide secretariat support to the technical and steering committees b. Support the development of interoperable, multi-sectoral system capable of preventing, detecting and responding promptly to infectious disease outbreaks c. Enhance collaborations between animal, human and environment sectors for control of endemic zoonoses and outbreak response. d. Prepare annual work plans e. Coordinates regular stakeholders meeting to share information f. Develop quarterly and annual progress reports on OH activities g. Facilitate liaison between NCDC as the IHR/NFP and relevant MDAs h. Facilitate the utilisation of OH approach in outbreak response activities i. Review and prepare technical information and documentation j. Ensure replication and implementation of the same OH structures at state and local government levels 3.0 ONE HEALTH IN NIGERIA FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN36 4.0 One Health Strategic Plan 4.1 Vision, Mission, Goals and Core Values of One Health 4.1.1 Vision To be a nation of healthy people and healthy animals living in a balanced ecosystem 4.1.2 Mission To build a strategic, dynamic and functional platform that advances human, animal and environmental health through multidisciplinary and intersectoral collaboration 4.1.3. Goals • A sustainable and institutionalised One Health platform at all government levels • A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiative in Nigeria • Increased awareness on One Health for all stakeholders • Enhanced Government and other stakeholders’ commitment and support for OH platform • Effective prevention, detection and response to public health threats through the One Health approach 4.1.4 Core Values 1. Partnerships – Working together to advance human, animal and environmental health 2. Accountability – Acknowledging and accepting responsibility for One Health activities by all stakeholders 3. Integrity – Promotion of ethical values and standards in OH activities 4. Equity – Fair and just actions that promote good health and preserve natural resources for future generations 5. Coordination – Bringing together all stakeholders in OH to work harmoniously 6. Innovation- Adoption of new and improved approaches and processes for addressing OH issues 7. Sustainability – Ensure continuous availability of resources, capacities and processes for the OH approach. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN37 4.1.5 Themes and Thematic Goals The strategic plan is divided into the following thematic areas and goals: 1. Surveillance and Laboratory a. Thematic Goal: Effective prevention, detection and response to public health threats through the One Health approach 2. Training and Research a. Thematic Goal: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria 3. Governance and Leadership a. Thematic Goal: A sustainable and institutionalised One Health platform at all government levels 4. Communication a. Thematic Goal: Increased awareness on One Health for all stakeholders 5. Resource Mobilisation a. Thematic Goal: Enhanced Government and stakeholder commitment and support for the One Health platform 4.1.6 Guiding Principles The following principles will guide the implementation of this plan: 1. Prevention and control of public health events including zoonoses is a national public good and requires strong political and financial commitment at all levels of government 2. Sustainable utilisation of existing institutions and whenever possible drawing on lessons learned 3. Use of a multidisciplinary approach to realise technical, political, and regulatory frameworks to effectively manage public health events including zoonoses. 4. Recognition and respect for cultural diversity and human rights. 4.0 ONE HEALTH STRATEGIC PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN38 5.0 Five-Year Strategic Plan for One Health in Nigeria STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 1. To constitute standing coordination committee by 3rd Quarter of 2019 for the establishment of One Health platform Develop a draft of the structure to be validated by appropriate government officials 1. Define the structure for the committee Structure defined x 2. To develop an institutional framework on operation alisation of One Health in Nigeria by the 4th Quarter of 2019 Engage in country experts to perform situation analysis and facilitate community involvement and buy–in Compose a legal and technical team to develop concept note and MoU Engage stakeholders to attend meeting 1. Perform situation analysis of OH in Nigeria 2. Develop a concept note on operationalisation of OH 3. Adopt and implement a set of inter-agency Memorandum of Understanding (MoU) to define areas for collaboration and coordination on One Health activities in the 1st Quarter of 2020. 4. Conduct consultative meetings of stakeholders quarterly Situation analysis performed Concept note developed MoU signed Consultative meetings held x x x x x 3. Institutionalise One Health concept among line Ministries in 36 States and the FCT Engage the states through the National Councils (NCARD, NCH and NCE) to replicate One Health at states and LGA levels 1. Develop a joint Council memo on One Health 2. Presentation of the memo at the National Councils (NCARD, NCH and NCE) 3. Presentation of the approved memo to the Council of States Council memo developed Memo presented Memo presented to Council of States x x x x x 4. To develop an advocacy and sensitisation plan for the key stakeholders by 2nd Quarter of 2020 Create awareness among political class for buy-in 1. Decide on target groups and identify focal points within the groups (stakeholders) 2. Develop and test the advocacy messages 3. Engage relevant groups and associations Target groups /focal person identified Advocacy message developed Relevant groups and associations engaged x x x GOAL 1: Sustainable and institutionalised One Health platform at all government levels FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN39 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 1. To have a 5-year OH research agenda for Nigeria by the 1st Quarter of 2019 using the Nigeria prioritised zoonotic disease list Engage relevant OH stakeholders (institutions, researchers and subject matter expert) to develop OH research agenda 1. Draft list of relevant OH stakeholders to be involved/ engaged in the process establishment 2. Develop agenda and templates to be used for the development of the OH research agenda 3. Organise a 3-day residential retreat for the relevant stakeholders to draft the research agenda 4. Share the e-draft research agenda with a wider stakeholder forum (local and international) for review and comments/ inputs 5. Conduct a half-day launch of the research agenda 6. Two-day TWG meeting to prepare for the launch and subsequently revise agenda 7. Set up OH research fund and board that will support and manage OH grants List drafted Agenda and template developed 3-day residential retreat conducted E-draft agenda shared Research agenda launched Two-day technical meeting held Research fund and board established x x x x x x x 2. To promote incorporation of OH into the curriculum of medical, veterinary and environmental health and life science disciplines in NUC by 4th Quarter of 2019 Engage relevant stakeholders to develop and advocate for OH curriculum inclusion 1. Development of pre service curriculum 2. Advocacy visits to NUC 3. Advocacy visits to regulatory bodies (MDCN, VCN, EHORCON, MLSCN) 4. Conduct a three-day workshop on curriculum review targeting relevant OH stakeholders Pre-service curriculum developed Visit documented Visit documented Three-day curriculum review workshop conducted x x x x x x GOAL 2: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN40 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA GOAL 2: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 3. To develop and implement by 4th Quarter of 2020, a One Health modular in-service training for all levels of personnel within medical, veterinary and environmental health sectors at Federal, State and LGA Use existing resources in the universities and relevant institutions to enhance the capacity of OH 1. Liaise with relevant stakeholders (e.g. NFELTP and associated universities) to identify suitable resource persons to establish the training program 2. Conduct one-week retreat to develop curriculum and training materials for the modular training 3. Engage experts to collate and review drafts of training modules and methodology 4. Pilot training for 20 participants among relevant OH stakeholders 5. Train 200 participants per year with the developed module 6. Develop sensitisation plan to be used at the meeting with policy makers Number of meetings held with stakeholders Retreat conducted Training modules reviewed Training for 20 participants conducted Training for 200 participants conducted Sensitisation plan developed x x x x x x x 4. To establish a platform to enhance harmonious collaboration between researchers and policy makers for effective dissemination and uptake of research findings by the 4th Quarter of 2019 Engage OH researchers and policy makers to foster collaboration on research harmonization 1. Convene a two-day meeting of researchers and policy makers in different relevant institutions sensitise them on OH research agenda and facilitate agreement on an annual meeting for researchers and policy makers Two-day meeting held x FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN41 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 1. Improve public perception and awareness in zoonotic diseases and the One Health approach Planning and instituting communication and advocacy strategies for OH Utilisation of the different social media at all levels to sensitise on One Health Utilise contact person at community level Communication advocacy Plan 1. Put in place communication and advocacy strategies in place and conduct conferences, workshops, seminars at national, state and local government level • Set up a media fellowship to showcase the human face of One Health • Develop a dissemination plan on how to spread and create awareness • Design the materials (fliers, handbills, posters, social media etc.) to spread the One Health awareness • Write and disseminate press releases on One Health 2. Plan and carry out town hall meetings with community stakeholders 3. Design, develop, test, produce and distribute IEC materials in English, local languages, Pidgin English and on One Health 4. Develop and disseminate standardised messages on One Health via multimedia platforms e.g. Facebook, Whatsapp etc. 5. Engage policy makers, legislators, traditional leaders, community members in dialogue on One Health 6. Engagement of professional bodies/organisations in disseminating information on One Health e.g. CSOs, faith-based groups 7. Identify and engage a brand champion to represent OH at all levels 8. Develop a schedule for regular dissemination of radio jingles, TV adverts, SMS messages, short plays, role plays on One Health Advocacy strategy Document preparation for communication and its dissemination via conferences, workshops, seminars Media fellowship Number of media documentaries produced Developed plans available Number of print media documentaries disseminated Number of press releases Number of approved press releases Number of locations where releases have been made Number of media houses that aired the messages Number of town hallmeetings conducted Number of IEC materials distributed Number of standard messages developed and number disseminated Availability of standard messages in various platforms Number of meetings held with policy makers, legislators etc Number of bodies engaged/ associations/organisations Brand champions identified Number of developed schedules x x x x x x x x x x x x x x x x x x x x x x x GOAL 3: Increased awareness of One Health for all stakeholders FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN42 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 2. Build capacity for sustainable communication activity at all tiers of government and among other stakeholders Integrate OH communication activities at all levels of government Conducting ToT for effective succession OH training Communication/ training plan Conduct capacity Building capacity at the institutions among lecturers/ instructors for One Health 1. Identify health related programmes on media platforms for use in information dissemination 2. The classes and categories of ToTs for use 3. Build capacity of media personnel for One Health reporting 4. Build capacity of technical officers for One Health communication packaging 5. Minimum number of lecturers/instructors at institutions trained Number of health-related programmes identified Documentation and outcome of ToT on OH Number of media personnel trained/ sensitised Number of technical officers trained Number of lecturers/instructors trained on, inventory of the institutions and lecturers instructors with OH expertise x x x x x x x x x 3. To develop and standardise a com munication plan bring together a group of multi-sec torial technical/ communication experts to develop and standardise a One Health vocab ulary and message plan within the first three months Use existing dat bases and professional groups Workshop agenda, using the prioritised zoonotic diseases list and list of known and potential funding Identified list of key stakeholders and partners Journals, quarterly reports 1. Identify key stakeholders and experts to develop key One Health messages 2. Conduct 5-day workshop to adapt One Health key messages 3. Produce and disseminate printed copies of key messages for all stakeholders Number of stakeholder identified Workshop held for 5 days Number of messages printed x x x x x GOAL 3: Increased awareness of One Health for all stakeholders FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN43 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 1. To design and implement (operationalise) a framework for coordinating Donor/ private sector contributions 2. Identify and create linkages among partners on One Health resource Community needs assessment, use of community informants 1. Develop a One Health profile/brochure that details successes and priority focus areas 2. Conduct a stakeholder analysis to review and Identify available/potential donors and private sector organisations 3. Conduct a mapping of animal, environmental and human health infrastructure, and resources Brochure produced Stakeholder analysis conducted Mapping conducted x x x x x x x x x 3. To increase stakeholder participation and ownership in management of resources for One Health Engage stakeholders and establish guidelines for OH resource managment Organise a system to ensure availability of OH resource 1. Conduct quarterly meetings of stakeholders 2. Institute rapid coordinated and functional 3. Multidisciplinary OH teams with their TOR 4. Provide monthly feedback on OH activities to all stakeholders 5. Harmonise OH activities in workplans of governments and partner organisations 6. Set up PPP office Quarterly meetings conducted Functional team with their TOR Number of monthly feedback conducted Workplans harmonise x x x x x x x x x x x 4. Mobilise greater goverment commitment in sustained annual budgetary provision for One Health and increase donor funding to support One Health activities Advocacy and lobbying for One Health funding 1. Conduct advocacy for the creation of a government budget allocation for OH 2. Conduct advocacy for increased donor funding to support One Health activities Advocacy meetings briefs and progress reports. Advocacy meeting briefs and progress reports. x x GOAL 4: Enhanced Government and other stakeholders’ commitment and support for OH platform FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN44 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 1. To have in place integrated surveillance system for human, animal diseases and environmental hazards To weave the existing systems into an integrated platform and bridge gaps where they exist. 2. Update the situational analysis 3. Stakeholders meeting to harmonise the different surveillance systems to fit into the One Health platform 4. Convene stakeholders meeting to adopt and validate report of the in country subject matters experts Situational analysis updated Stakeholder meeting held Stakeholders meetings held Minutes of meetings, validated report x x x x x x x x 2. To strengthen laboratory capacity to diagnose priority zoonotic diseases and public health issues in human and animal and environmental threats in 40% of the states Situation analysis of human, animal and environmental labs Enhancement and zoonotic diseases specific integration of lab diagnostics capacity informed by situation analysis 1. Mapping of public health laboratories in the country • Conduct needs assessment of public health laboratories in the country • Validate report of the needs assessment • Enhance the laboratory physical infrastructure, equipment, reagents and consumables, quality management systems to sustain an integrated national laboratory network (develop sub activities) • Train laboratory staff to detect in a safe, secure and timely manner priority zoonotic diseases threats Mapping conducted Needs assessment conducted Validation conducted Proportion of labs with improved infrastructure Number of laboratory staff trained Training report, list of participants x x x x x x x x x x x GOAL 5: Effective prevention, detection and response to public health threats through the One Health approach FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN45 5.0 FIVE-YEAR STRATEGIC PLAN FOR ONE HEALTH IN NIGERIA STRATEGIC OBJECTIVE STRATEGY ACTIVITIES MONITORING INDICATORS YR 1 YR 2-3 YR 4-5 3. Ensure an effective multi sectoral EPR committee and RRT in the States and LGAs in all States and FCT Identify and train animal health and environmental health teams into multi sectoral EPR committees at all levels 1. Identify and incorporate all relevant stakeholders into multi-sectoral EPR committee and RRT at all levels 2. Map out potential hazard area 3. Identification and maintenance of available resources including medical counter-measure and stockpiling at all levels of government (sub activity for RRT) 4. Prepositioning of emergency supplies (drugs, PPE, medical consumables) for public health emergency response 5. Integrate animal and environmental emergencies into public health emergency operation centre at all levels of government Surveillance stakeholders identified Surveillance stakeholders incorporated into multisectoral EPR Mapping done Identification process conducted Availability of emergency supplies in strategic locations Integrated EOC at all levels of government x x x x x x x x x x x x x x 4. To increase reporting of disease from healthcare facilities including private health facilities to 80% within 2 years of implementation of the One Health platform Increase number of reporting portals/outlets sites, tools, logistics 1. Conduct assessment of reporting in the human, animal and environmental surveillance system 2. Strengthen and improve consistency, completeness and timeliness in reporting from the local and State levels 3. Develop a framework for multi sectoral coordination in reporting and communication that will enable information sharing 4. Integrate human, animal and environmental sector data into a central data base Assessment conducted Improved reporting attributes at all levels Framework for multisectorial coordination developed Integrated database available x x x x x x x x GOAL 5: Effective prevention, detection and response to public health threats through the One Health approach FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN46 6.0 One-Year Implementation Plan STRATEGIC OBJECTIVE STRATEGY ACTIVITIES 1. To constitute standing\ coordination committee by quarter of 2019 for the establishment of One Health platform Develop a draft of the structure to be validated by appropriate government officials 1. Define the structure for the committee 2. To promote incorporation of OH into the curriculum of medical, veterinary and environmental health and life science disciplines at NUC. To develop an institutional framework on operationalisation of One Health in Nigeria by the 4th quarter of 2019. 1. Perform situation analysis of OH in Nigeria 2. Develop a concept note on operationalisation of OH 3. Conduct consultative meetings of stakeholders quarterly 4. Adopt the framework 5. Adopt and implement a set of inter-agency Memorandum of Understanding to define areas for collaboration and coordination on One Health activities in the 1st quarter of 2019. SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY 1. Development of inclusion criteria for selection of members of the committee Structure defined Copy of document defining the structure x NCDC 2. Define TOR for the committee TOR developed x NCDC 3. Inaugurate the committee Committee inaugurated x NCDC GOAL 1: Sustainable and institutionalised One Health platform at all government levels GOAL 1: Sustainable and institutionalised One Health platform at all government levels 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN47 STRATEGIC OBJECTIVE STRATEGY ACTIVITIES 1. Provide a framework for collaborative research between human, animal and environmental health sectors on priority zoonotic diseases in Nigeria Promote collaborative research between experts in human, animal and environmental health 1. Develop structure for research work 2. Adopt a framework to enhance coordination of research activities 3. Provide links for funding and collaboration 4. Develop thematic areas for research on One Health SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY 1. Procure the services of a Team of Consultants Situation analysis performed Report of situation analysis x 2. Review and validate the drawn-up concept note Concept note developed Copy of concept note NCDC 3. Plan consultative meeting. Communicate to stakeholders. Hold meetings Four consultative meetings held Minutes of the consultative meetings NCDC 4. Review of the framework by the TWG Framework adopted Copy of framework guidelines 5. Presentation for adoption to the higher Management level 6. Adopt an existing MoU into a template 7. Compose a legal team to review an agreed template for the proposed MoU 8. Draft the MoU 9. Signing of MoU by FMoH, FMARD and FMEnv MoU signed Copy of signed MoU x The three line Ministries GOAL 1: Sustainable and institutionalised One Health platform at all government levels GOAL 2: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN48 STRATEGIC OBJECTIVE STRATEGY ACTIVITIES 2. To Identify novel animal reservoirs for priority zoonotic diseases in Nigeria Provision of guidelines/protocol on coordinated research within and among institutions. 1. Formation of One Health research groups within and among institutions 2. Identify gaps 3. Identify areas of collaboration for One Health research 4. Identify available institutions for research purposes 5. Plan pet project to enhance to enhance strategic objective 3. To identify and describe animal human-environment interphase for priority zoonotic diseases in Nigeria Promote the development of tools and resources to improve the scope, scale and sensitivity of zoonotic disease surveillance in Nigeria. 1. Formation of One Health structure across all level 4. Mapping of animal reservoirs of priority zoonotic pathogens in Nigeria Serological testing of animal species for zoonotic diseases in Nigeria. 1. Identify laboratories to be used for testing Develop research proposals exploring animal-human environment interphases for priority zoonotic diseases in Nigeria e.g Brucellosis, Anthrax 1. Collate available data on available animal reservoirs in Nigeria GOAL 2: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria GOAL 2: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY 1. Conduct surveys to obtain baseline data based on One Health for priority zoonotic diseases in Nigeria A standardised One Health research contigency plan/strategy. Increased knowledge and capacity to tackle the zoonotic priority diseases that affect Nigeria. A A NCDC (OHTWG) 2. Promote participation in One Health conferences 3. Develop a One Health journal to boost research activities 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN49 GOAL 2: A strategic, integrated, safe and secure research agenda and sustained capacity for implementation of OH initiatives in Nigeria SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY 1. Review guidelines/ protocol to suit identified gaps Delay in the adoption of the draft national One Health Strategic Plan. Guidelines/ protocols on coordinated research on zoonotic diseases Improved understanding of the risk factors for the animal to human transmission of zoonotic diseases. A A A NCDC (OHTWG) 1. Carry out One Health research at interphasal level Sharing of Research findings with relevant stakeholders Established research collaborations among the academia, governmental and non-governmental agencies. A A A 2. Describe the role of each level of interphase 1. Conduct seroprevalence of priority zoonotic disease in Nigeria Publications of findings in scientific journals. X X X 1. To identify ecological nicheof animal reservoirs for different priority zoonotic disease Presentation in scientific conferences. X X X GOAL 3: Increased awareness of One Health for all stakeholders STRATEGIC OBJECTIVE STRATEGY ACTIVITIES 1. Improve public perception and awareness in zoonotic diseases and the One Health approach Utilisation of the communication plan 1. Identify a communication focal person 2. Design, develop, test, produce and distribute IEC materials in English, local languages, Pidgin English and on One Health 3. Design, develop, test, produce and distribute IEC materials in English, local languages, Pidgin English and on One Health 4. Develop and disseminate standardised messages on One Health via multimedia platforms e.g. Facebook, Whatsapp etc. 5. Engage policy makers, legislators, traditional leaders, community members in dialogue on One Health 6. Engagement of professional bodies organisations in disseminating information on One Health e.g. CSOs, faith-based groups 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN50 GOAL 3: Increased awareness of One Health for all stakeholders SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY 1. Write a TOR A communication focal person identified TOR and letter of appointment x NCDC (Secretariat of OHTWG) Publish online x Recruit x Appointment x 2. Identify thematic areas Number of press releases Number of approved press releases x Develop content Number of locations. where releases have been made. Number of media houses that aired the messages x Obtain approval and release Transcript of press releases x 3. Identify and invite media Number of IEC materials in English and Local languages distributed Copies of IEC materials available in English and local languages Identify target audience Develop technical content Identify language experts Translate content into other languages Identify channels for dissemination Testing of IEC materials 4. Identify thematic areas Copies of standard messages developed Number of standard messages disseminated x Develop technical content x Identify language experts x Translate content into other languages Availability of standard messages in various platforms x Identify channels for dissemination x Testing of IEC materials x 5. Identify relevant stakeholders Number of meetings held with policy makers, legislators, etc. Minutes and attendance listAdvocacy to stakeholders x Share information and IEC on One Health x Identify and discuss community involvement and need for community mobilisers x 6. Identify relevant stakeholders Number of bodies engaged/ associations organisations Minutes of engagement meeting with associations, bodies, organisations Advocacy to stakeholders Share information on One Health Identify and discuss organisational roles in One Health 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN51 GOAL 3: Increased awareness of One Health for all stakeholders GOAL 3: Increased awareness of One Health for all stakeholders STRATEGIC OBJECTIVE STRATEGY ACTIVITIES 2. Build capacity for sustainable communication activity at all tiers of government and among other stakeholders Integrate One Health communication activities at all levels of government 1. Identify health related programmes on media platforms for use in information dissemination 2. Build capacity of media personnel for One Health reporting 3. Build capacity of technical officers for One Health communication packaging 3. To develop and standardise a communication plan bring together a group of multi-sectorial technical/ communication experts to develop and standardise a One Health vocabulary and message plan within the first three months Stakeholder engagement 1. Identify key stakeholders and experts to develop key OH messages 2. Conduct five-day workshop to adapt One Health key messages SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY Number of health related programmes identified Relevant audio and visual materials X 1. Identify the participants/ key media personnell Number of media personnel trained and sensitised Training reports, list of participants, pictures X 2. Conduct a capacity needs assessment X 3. Conduct 2-day training of participants X 4. Identify technical officers Number of technical officers trained Training reports, list of participants, pictures X 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN52 GOAL 3: Increased awareness of One Health for all stakeholders SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY Number of stakeholders identified List of stakeholders X Workshop held for 5 days Workshop report X 1. Testing of the messages will be a sub-activity in the OP Number of messages tested Copy of tested message X 2. Produce and disseminate printed copies of key messages for all stakeholders Number of messages printed Report of message test, pictures and list of stakeholders who participated Copies of printed messages available Printed copy of brochure X STRATEGIC OBJECTIVE STRATEGY ACTIVITIES 1. To design and implement (operationalise) a framework for coordinating donor/ private sector contributions IIdentify and create linkages among partners on OH resource 1. Develop a One Health Profile/brochure that details successes and priority focus areas 2. Conduct a stakeholder analysis to review and Identify available potential donors and private sector organisations 3. Conduct a mapping of animal, environmental and human health infrastructure, and resources 2. To increase stakeholder participation and ownership in management of resources for OH Engage stakeholders and establish guidelines for OH resource management 1. Conduct quarterly meetings of stakeholders 2. Ensure monthly feedback on OH activities to all stakeholders 3. Harmonise OH activities in workplans of governments and partner organisations 3. Mobilise greater Government commitment in sustained annual budgetary provision for OH and increase donor funding to support One Health activities Advocacy and lobbying for OH funding 1. Conduct quarterly meetings of stakeholders 2. Ensure monthly feedback on OH activities to all stakeholders 3. Harmonise OH activities in workplans of governments and partner organisations 4. Conduct advocacy for increased donor funding to support One Health activities GOAL 4: Enhanced government and other stakeholders’ commitment and support for OH platform 6.0 ONE-YEAR IMPLEMENTATION PLAN FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN53 GOAL 4: Enhanced government and other stakeholders’ commitment and support for OH platform SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY 1. Identify priority focus areas and successe x 2. Design a brochure Brochure produced Printed copy of brochure x 3. Identify communication technical resource persons x 4. Conduct a 3-day workshop to develop One Health brochure/ advocacy briefs x 5. Conduct a one-day meeting Stakeholder analysis conducted Number of private organisations, donors identified, analysis report x 6. Identify target communities Mapping conducted Report of resource mapping x 7. Advocacy visits to community gatekeepers x 8. Participatory community needs assessment to map resources x 1. Quarterly meetings conducted Minutes of quarterly meetings x 2. Number of monthly feedback conducted Feedback report x 3. Workplans harmonised Copies of harmonised workplans x 1. Advocacy meetings conducted Advocacy reports 2. Advocacy meetings conducted Advocacy reports x Report of message test, pictures and list of stakeholders who participated x FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN54 7.0 Monitoring & Evaluation Framework for the One Health Strategic Plan The implementation plan for the One Health (OH) strategic plan has activities, indicators, means of verification, time frame, and responsible party. The monitoring and evaluation plan will be based on the existing fields in the workplan. The plan will be evaluated twice a year (by the end of the 2nd and 4th quarters of the calendar year). The evaluation will be based on the yearly workplan. All activities will be adjudged to be either completed, ongoing, pending, or planned Completed This refer to activities that have been completed based on the indicators and means of verification as at the time the evaluation is being carried out. Ongoing Ongoing activities are those that have commenced, but their timelines have passed or is extended based on a compelling need to do so. Pending This refer to activities that have not commenced even though their timelines have elapsed. Planned These are activities whose timelines has not been reached and thus there is no basis for starting them. Reporting The report of the evaluation will be based on the goals of the plan. For each goal, the proportion of activities under each goal that are classified as completed, ongoing, pending, or planned will be documented. Responsible persons will be interviewed to document why activities were pending or ongoing (for those whose timelines elapsed). This will enable identification of challenges and bottlenecks to implementation of the plan. The midyear evaluation will be conducted by the NOHCU at the end of the second quarter, while the end of year evaluation will be conducted by an independent consultant at the end of the year. FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN55 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITIES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 1: Sustain able and institu tionalised One Health platform at all govern ment levels 1. To constitute standing coordination committee by 3rd Quarter of 2019 for the establish ment of One Health platform. Develop a draft of the struc ture to be validated by appropriate government officials 1. Define the structure for the commit tee Development of inclusion crite ria for selection of members of the committee Structure defined Copy of docu ment defining the structure x NCDC Define TOR for the committee TOR devel oped x NCDC Inaugurate the committee Committee inaugurated x NCDC 2. To promote incorpora tion of OH into the curriculum of medical, veterinary and envi ronmental health and life science disciplines at NUC To develop an institu tional frame work on operation alisation of One Health in Nigeria by the 4th Quarter of 2019. Perform situation analysis of OH in Nigeria Procure the services of a Team of Consultants Situation analysis performed Report of situation analysis X Develop a concept note on operation alisation of OH Review and validate the drawn-up concept note Concept note developed Copy of concept note x NCDC Conduct consultative meetings of stakeholders quarterly Plan consulta tive meeting. Communicate to stakeholders. Hold meetings Four consul tative meet ings held Minutes of the consultative meetings x NCDC Adopt the framework Review of the framework by the TWG Framework adopted Copy of Framework Guidelines x OHTWG Adopt and implement a set of inter-agency Memorandum of Under standing to define areas for collabo ration and coordination on One Health activities in the 3rd Quar ter of 2019. Presentation for adoption to the higher manage ment level MoU signed Copy of signed MoU x The three line minis tries Adopt an exist ing MoU into a template x Compose a legal team to x Review an agreed tem plate for the proposed MoU x Draft the MoU x Signing of MoU by FMoH, FMARD and FMEnv x FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN56 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 2: A strategic, integrated, safe and secure joint zoonotic research agenda and sustained capacity for imple mentation of OH initiatives in Nigeria 1. Provide a framework for col laborative research between human, animal and environ mental health sectors on priority zoonotic diseases in Nigeria 1.Promote col laborative research between experts in human, ani mal and en vironmental health 1. Develop structure for research work 2. Adopt a framework to enhance coordination of research activities 3. Provide links for funding and collabo ration 4. Develop thematic areas for research on One Health 1. Conduct surveys to obtain base line data based on One Health for priority zoo notic diseases in Nigeria 2. Promote participation in One Health conferences 3. Develop a One Health journal to boost re search activities · A stan dardised One Health research contigency plan/strat egy. · Increased knowledge and capacity to tackle the zoonotic pri ority diseases that affect Nigeria. A A NCDC (OHTWG) 2 .To Iden tify novel animal reservoirs for priority zoonotic diseases in Nigeria 1. Provision of guide lines or protocol on coordinated research within and among institutions. 1. Formation of One Health research groups within and among institutions 2. Identify gaps 3. Identify areas of collabora tion for One Health rese arch 4. Identify available institutions for research purposes 5. Plan pet project to enhance to enhance strategic objective 1. Review guidelines/ protocol to suit identified gaps Delay in the adoption of the draft national One Health Strategic Plan. · Guidelines/ Protocols on coor dinated re search on zoonotic diseases. · Improved understand ing of the risk factors for the animal to human transmission of zoonotic diseases. A A A 3 To iden tify and describe animal-hu man-en vironment interphase for priority zoonotic diseases in Nigeria. 1.Promote the develop ment of tools and resources to improve the scope, scale and sensitivity of zoonotic disease surveillance in Nigeria. 1. Formation of One Health structure across all levels 1. Carry out One Health research at interphasal level 2. Describe the role of each level of interph ase · Sharing of Research findings with relevant stakehold ers · Established research col laborations among the academia, governmental and non-gov ernmental agencies. A A A GOAL 2: A strategic, integrated, safe and secure joint zoonotic research agenda and sustained capacity for implementation of OH initiatives in Nigeria FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN57 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 2: A strategic, integrated, safe and secure joint zoonotic research agenda and sustained capacity for imple mentation of OH initiatives in Nigeria 4. Mapping of animal reservoirs of priority zoonotic pathogens in Nigeria. 2. Serological testing of animal species for zoonotic diseases in Nigeria. 1. Identify laboratories to be used for testing 2. Collate avail able data on available ani mal reservoirs in Nigeria Conduct seroprevalence of priority zoo notic disease in Nigeria · Publica tions of findings in scientific journals. X X X 3. Develop research proposals exploring animal-hu man-en vironment interphases for priority zoonotic diseases in Nigeria e.g Brucellosis, Anthrax To identify ecological nicheof animal reservoirs for different pri ority zoonotic disease · Presen tation in scientific confer ences. X X X FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN58 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITIES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 3: Increased awareness on One Health for all stakeholders 1. Improve public per ception and awareness in zoonotic diseases and the One Health approach Utilisation of the commu nication plan Identify a communi cation focal person Write a TOR Publish online Recruit Appointment A communica tion focal per son identified TOR and letter of appointment x NCDC (Secretariat of OHTWG)) x x x Write and disseminate press releases on One Health Identify themat ic areas Number of press releases Number of approved press releases x NCDC (Sec retariat of OHTWG)) Number of lo cations where releases have been made Number of media houses that aired the messages x Develop content Transcript of press releases x Obtain approval and release x Identify and invite media x Design, Develop, test, produce and distribute IEC materials in English, local languages, Pidgin English and on One Health Identify target audience Number of IEC materials in English and Local languag es distributed Copies of IEC materials available in English and local languages x NCDC (Sec retariat of OHTWG))Develop techni cal content x Identify lan guage experts x Translate con tent into other languages x Identify channels for dissemination x Testing of IEC materials x Develop and disseminate standardised messages on One Health via multime dia platforms e.g. Facebook, Whatsapp etc. Identify themat ic areas Copies of stan dard messages developed Number of standard messages disseminated x NCDC (Sec retariat of OHTWG)) Develop techni cal content x Identify lan guage experts x Translate con tent into other languages x Identify channels for dissemination x Testing of IEC materials x FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN59 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITIES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 3: Increased awareness on One Health for all stakeholders 1. Improve public per ception and awareness in zoonotic diseases and the One Health approach Utilisation of the com munication plan Engage policy makers, legisla tors, traditional leaders, commu nity members in dialogue on One Health Identify rele vant stakehold ers Number of meetings held with policy makes, legislators etc Minutes and attendance list x NCDC (Secretariat of OHTWG)) Advocacy to stakeholders x Share infor mation One Health/ IEC x Identify and discuss commu nity involve ment and need for community mobilisers Number of community Mobilised x Engagement of professional bodies/or ganisations in disseminating information on One Health e.g. CSOs, faith based groups Identify rele vant stakehold ers Number of bodies engaged/ associations/ organisations Minutes of engagement meeting with associations, bodies, or ganisations x Advocacy to stakeholders x Share informa tion One Health and IEC x Identify and discuss organ isational roles in One Health x 2. Build capacity for sustainable commu nication activity at all tiers of government and among other stakehold ers Integrate OH com munication activities at all levels of govern ment Identify health related programmes on media plat forms for use in information dissemination Number of health-re lated programmes identified Relevant au dio and visual materials x NCDC (Secretariat of OHTWG)) Build capacity of media personnel for One Health reporting Identify the participants and key media personnel Number of media personnel trained and sensitised Training reports, list of participants, pictures x Conduct a capacity needs assessment x Conduct 2-day training of participants x Build capacity of technical officers for One Health communication packaging Identify techni cal officers Number of technical offi cers trained Training reports, list of participants, pictures x Conduct a 3-day work shop x FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN60 FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN60 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITIES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 3: Increased awareness on One Health for all stakeholders 3. To devel op and standardise a commu nication plan bring together a group of multi-sec torial technical/ communica tion experts to develop and stan dardise a One Health vocabulary and mes sage plan within the first three months Stakeholder engage ment Identify key stakeholders and experts to develop key OH messages Number of stakeholders identified List of stake holders x NCDC (Secretariat of OHTWG)) Conduct 5-day workshop to adapt One Health key messages Workshop held for 5-day Workshop report x Testing of the messages will be a sub-activi ty in the OP Number of messages tested Copy of tested message x Produce and disseminate printed copies of key mes sages for all stakeholders Number of messages printed and disseminated x Report of message test, pictures and list of stake holders who participated x Number of messages printed Copies of printed messages available x FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN61 FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN61 STRATEGIC GOAL STRATEGIC OBJECTIVES STRATEGY ACTIVITIES SUB-ACTIVITIES MONITORING INDICATORS VERIFICATION Q1 Q2 Q3 Q4 RESPONSIBLE AUTHORITY GOAL 4: Enhanced government and other stakeholders’ commitment and support for OH platform 1. To design and implement (operationalise) a framework for coordinating Do nor/ private sector contributions Identify and create link ages among partners on OH resource Develop a One Health Profile/ brochure that details successes and priority focus areas Identify priority focus areas and successes Brochure produced Printed Copy of brochure X NCDC (Secretariat of OHTWG)) Design a bro chure X Identify commu nication/tech nical resource persons X Conduct a 3-day workshop to develop One Health bro chure/ advocacy briefs X Conduct a stake holder analysis to review and Identify available/poten tial donors and private sector organisations Conduct a one day meeting Stakeholder analysis conducted Number of private organi sations, donors identified, analysis report X Conduct a mapping of animal, envi ronmental and human health infrastructure, and resources Identify target communities Mapping conducted Report of resource mapping X The three line ministries Advocacy visits to community gatekeepers Advocacy reports Advocacy reports X Participatory community needs assess ment to map resources Need assessment conducted Community resources mapping X 2. To increase stakeholder participation and ownership in management of resources for OH Engage stakeholders and establish guidelines for OH resource management Conduct quar terly meetings of stakeholders Quarterly meet ings conducted Minutes of quarterly meetings X NCDC (Secretariat of OHTWG)) Ensure monthly feedback on OH activities to all stakeholders Number of monthly feed back conducted Feedback report X Harmonise OH activities in workplans of governments and partner organisations Workplans harmonised Copies of harmonised workplans X 3. Mobilise greater Government commitment in sustained annual budgetary provi sion for OH and increase donor funding to sup port One Health activities Advocacy and lobbying for OH funding Conduct advocacy for the creation of a government budget alloca tion for OH Advocacy meet ings conducted Advocacy reports The three line Ministries Conduct advoca cy for increased donor funding to support One Health activities Advocacy meet ings conducted Advocacy reports X report of message test, pictures and list of stake holders who participated X FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN62 FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN62 1. FETP: Field Epidemiology Training Programme conference publications 2. Grace D, Mutua F, Ochungo P, Kruska R, Jones K, Brierley L, Lapar ML, Said M, Herrero M, Pham-Duc P, Elich Tao N, Akuku I, Ogutu F, 2012. Mapping of poverty and likely zoonoses hotspots. 3. Molyneux D, Hallaj Z, Keusch GT, McManus DP, Ngowi H, Cleaveland S, Ramos Jimenez P, Gotuzzo E, Kar K, Sanchez A, Garba A, Carabin H, Bassili A, Chaignat CL, Meslin F-X, Abushama HM, Willingham AL, Kioy D, 2011. Zoonoses and Marginalised infectious diseases of poverty: Where do we stand? Parasites & Vectors 106. 4. Van Doorn HR, 2014. Emerging infectious diseases. Medicine 42: 60-63. 5. Jones K, G Patel N, Levy M, Storeygard A, Balk D, L Gittleman J, Daszak P, 2008. Global Trends in Emerging Infectious Diseases. 6. Althaus CL, Low N, Musa EO, Shuaib F, Gsteiger S, 2015. Ebola virus disease 7. Outbreak in Nigeria: Transmission dynamics and rapid control. Epidemics 11: 80-84. Ducatez MF, Olinger CM, Owoade AA, De Landtsheer S, Ammerlaan W, Niesters 8. HGM, Osterhaus ADME, Fouchier RAM, Muller CP, 2006. Multiple introductions of H5N1 in Nigeria. Nature 442: 37. 9. Roberts L, 2018. Nigeria hit by unprecedented Lassa fever outbreak. Science 359 10. Toph Allen, Kiss A. Murray, Carlos Zambana- Torrelio, 2017: Global hotspots and correlates of emerging zoonotic diseases. NAture Science/541467-8 REFERENCES FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN63 FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN63 NAME DESIGNATION/ORGANISATION 1. Chikwe Ihekweazu DG, NCDC COORDINATION 2. Olubunmi Ojo Director Surveillance, NCDC 3. Oyeladun Okunromade AD Surveillance, NCDC 4. Patrick Nguku Regional Coordinator, AFENET 5. Kaitlin Sandhaus CEO, Global Implementation Solutions, GIS CONTRIBUTIONS 6. Elsie Ilori DD Surveillance, NCDC 7. Joshua Obasanya Director P&PC, NCDC 8. John Oladejo Director HEPR, NCDC 9. Emmanuel Agogo DD, P& PC, NCDC 10. Adesola Yinka-Ogunleye Epidemiologist, NCDC 11. Abiodun Egwenu Epidemiologist, NCDC 12. Eze Ugochukwu Lagos University Teaching Hospital 13. Damilola Kolade D. NCDC 14. Dada Augustine AFENET 15. Ajani Oyetunji AFENET 16. Mahmood Dalhat AFENET 17. Muhammad S.Balogun Resident Advisor, AFENET 18. Ndadilnasiya Endie Waziri National Coordinator, NSTOP/AFENET 19. Charles Akato Field Coordinator, AFENET 20. Aboyowa Edukugho Field Coordinator, AFENET 21. Junaid Kabir Prof, ABU Zaria 22. Oyeronke Oyebanji Technical Assistant, NCDC 23. Tony Johanuw Head of AI Lab, NVRI 24. Asabe Dzikwi-Emenna HOD Vet Public Health, UNIJOS 25. Mathew Muturi Global Implementation Solutions, GIS 26. Daniel Duvall Program Director, US-CDC CONTRIBUTIONS FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN64 S/NO NAME DESIGNATION/ORGANISATION 27. Kamaldeen Khadeejah State Epidemiologist, Kwara SMoH 28. Aishatu Abubakar Sadiq State Epidemiologist, Kaduna SMoH 29. Denleye Abiodun A. Lagos State University 30. Tayo Babatobi University of Ibadan 31. Tura Galgalo GIS 32. Simeon Cadmus University of Ibadan 33. Sunday Omilabu University of Lagos 34. Grace Kia, S.N ABU Zaria 35. Jarlath U. Umoh Awka Ibom State University (AKSU) 36. E.C Okolocha ABU Zaria 37. Lami H. Lombin UNIJOS 38. Abdulrazaq Habib Bayero University, Kano 39. Adebola Olayinka WHO/NCDC 40. Ope Adejoro NCDC/Tony Blair Institute 41. James Balami I. DD PH, FMoH 42. Alabi Olaniran CVO, FMARD 43. Ntadoru Godu CCE, FMoH 44. Dooshima Kwange CVO, FMARD/VPCS 45. Eric Cook SNL Sandia 46. Columba Teru Vakuru DD FMARD/VPCS 47. Godson Ana University of Ibadan 48. Enem Simon University of Abuja 49. Ify Nwadiuto State Epidemiologist, Rivers SMoH 50. Rita AD, FMEnv CONTRIBUTIONSCONTRIBUTIONS FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN65 NOTES FEDERAL REPUBLIC OF NIGERIA ONE HEALTH STRATEGIC PLAN66 NOTES