By Iyemah David
The second Joint External Evaluation (JEE), a review of Nigeria’s International Health Regulations (IHR) capacities to prevent, detect and respond to public health threats, has been concluded and a new average JEE score of 54 per cent for Nigeria reached.
Dr Henk Jan Ormel, Senior Advisor, World Health Organisation (WHO), Global JEE Secretariat, at the end of the evaluation on Friday in Abuja, said that the score was not sustainable.
The Joint External Evaluation (JEE) is a voluntary, collaborative, multi-sectoral process to assess country capacities to prevent, detect and rapidly respond to public health risks whether they are occurring naturally or due to deliberate or accidental events.
In 2017, Nigeria had the first JEE of its IHR capacities and scored 39 per cent. These regulations are global standards of countries’ preparedness to tackle public health threats.
This was coordinated by the Nigeria Centre for Disease Control (NCDC) as the IHR National Focal Point, with close involvement of Ministries, Departments and Agencies (MDAs) whose functions are related to national health security.
Ormel said that the country needed to work hard to get to the yellow colour mark as the orange colour was not sustainable for a country like Nigeria.
He provided a summary of their findings from the assessment of Nigeria’s International Health Regulation core capacities and gave feedback from their visits to selected sites in the country.
He said that the field visits were an extremely important part of the JEE for the country.
According to Ormel, “We could see that the shreds of evidence that were presented here at the evaluation were actually in existence.”
He said that there was the need for coordination among; MDAs – specifically Health, Agriculture and Environment sectors, National/Federal/State/local communities, Public-and private sectors and the National and International levels.
He said that another area to focus on was also the implementation of prioritised strategic actions.
At the end of this rigorous and in-depth evaluation process, he presented the external evaluator’s feedback and priority actions for the scorecards of each technical area under the PREVENT (P), DETECT (D), RESPOND (R) and its International Health Regulations (IHR) related hazards and points of entry border health core capabilities.
He said that priority actions include developing a framework for monitoring and accountability for IHR and National Action Plan for Health Security (NAPHS) implementation across ministries, departments and agencies at national and sub-national levels.
He said that NAPHS should operationalise the health emergency financing mechanism of the Basic Health Care Provision Fund (BHCPF) at subnational levels.
He said that the National Emergency Operation Centre (EOC) has responded to over 23 events over the last years and this has granted opportunities to learn from bottlenecks and low-hanging fruits.
According to him, Priority actions include increasing the number of events to which the Public Health Emergency Operations Centre (PHEOC) responds, integrating inter and after-action reviews as a routine part of the response, and leading research with an applied practical research agenda.
Speaking on the legal instrument, Dr Sarah Emami, Legal Instruments team lead of the WHO JEE mission, said that the legal instruments underpin all 19 technical areas and the work that has been done in the country was impressive.
Emami said that priority actions going forward were to conduct subnational legal assessments of health laws, develop and revise necessary legal instruments for IHR implementation, and have a dedicated budget for conducting these activities, among many others.
She said that the country has a dedicated and committed workforce. However, there was a comparatively large population the limited workforce caters for.
“The development of mechanisms for better recruitment and retention of skilled professionals including career paths for epidemiologists and other emergency responders, is needed,” she said.
Dr Kazi Noore Alam, WHO JEE mission team, said that IHR cooperation, national IHR focal point functions and advocacy were extensively discussed.
Alam said that in addition to in-country capacity, priority actions include conducting a summative evaluation of the current NAPHS, developing a new 5-year NAPHS for the country, and conducting subnational health security assessment exercises.
He said that health service provision was a new area in the JEE 3.0 tool with three indicators.
“The priority areas to focus on are the development of a government accountability and coordination framework with periodic 5-year review for maintaining essential health services during emergencies and develop a monitoring, evaluation, accountability and learning framework for implementing post-event improvement plans,” he said.
Dr Makamure Tendai, co-lead Technical Areas, WHO, JEE mission team, said that documented priority actions for antimicrobial resistance were to finalise and implement the National antimicrobial resistance Action Plan 2.0.
Tendai said there was a need for the country to develop an advocacy plan for the domestic dedicated budget and develop an integrated antimicrobial resistance surveillance system with priority pathogens.
She said that the country has made significant progress in terms of infection prevention and control (IPC).
“Priority action to drive the IPC programmes to all healthcare facilities in the 36 states of the Federation and the FCT is to finalise and validate the updated healthcare-associated infections (HAI), plan and incorporate secondary health facilities into the National HAI surveillance network.
“The country also needs to develop national standards for a safe environment in healthcare facilities,” she said.
Dr Richard Garfield, WHO JEE mission team, said that there was a less institutional development and organisational capacity in this area in zoonotic in the country.
Garfield said that there was a need for strengthened integrated and interoperable One Health surveillance and analysis platform at the national and state level.
He said that there was a need for the country to review outbreaks to develop and disseminate improved outbreak identification and reporting materials and above all implement animal identification practices.
Speaking of Food security, he said that the country needs to develop self-study training materials with well-defined steps to investigate possible food-borne illnesses.
“There is also a need to integrate food-borne illness into the Integrated Disease Surveillance and Response (IDSR) database.
“The country also needs to work with health communications to develop food-borne and food-safety materials,” he said.
He said that the country needs to improve data management to mobilise vaccination efforts better and develop working relations with primary and secondary medical facilities to identify missed populations for priority vaccines.
According to him, there is a need for the country to aggressively develop and disseminate communication materials to combat vaccine misinformation.
