How the IHR Monitoring and Evaluation Framework Strengthens Health Security

When a health emergency strikes, how do we know if countries are truly prepared to respond? This question became urgent during the COVID-19 pandemic, revealing gaps in global health security systems. The International Health Regulations Monitoring and Evaluation Framework provides a systematic approach to answer this critical question by assessing whether countries can prevent, detect, and respond to public health threats.

Understanding the four pillars of the MEF
States Parties Self-Assessment Annual Reporting
Joint External Evaluations
After Action Reviews
Simulation Exercises
Mandatory versus voluntary: Why the distinction matters
CDC’s critical support for global health security
Technical assistance and capacity building
Building sustainable workforce capacity
Strengthening monitoring systems
Moving from assessment to action

Understanding the four pillars of the MEF

The IHR Monitoring and Evaluation Framework consists of four distinct assessment processes that work together to evaluate national health security capacities. Each component serves a specific purpose in building a complete picture of a country’s preparedness.

States Parties Self-Assessment Annual Reporting

SPAR is the only mandatory component of the framework, requiring all 196 countries that signed the IHR to report their capacity status annually. Countries use standardized indicators to evaluate their own capabilities across key areas like surveillance systems, laboratory capacity, emergency response coordination, and points of entry management. The electronic SPAR platform simplified this process significantly, making it easier for countries to submit their assessments and allowing for better tracking of progress over time.

While SPAR data provides valuable year-to-year monitoring, the self-reported nature of these assessments can sometimes lead to inflated scores. Research comparing assessment tools found that average SPAR scores tend to be approximately 18% higher than external evaluation scores, highlighting the importance of complementary assessment methods.

Joint External Evaluations

The JEE brings independent experts from around the world to conduct peer-to-peer evaluations of a country’s health security systems. These voluntary assessments occur every four to five years and examine 19 technical areas spanning prevention, detection, and response capabilities. Unlike SPAR, the JEE process involves extensive consultations, technical discussions, and field visits that provide objective validation of a country’s reported capacities.

The external evaluation process creates transparency and builds mutual trust among nations. Countries request JEEs voluntarily and are encouraged to publish their findings publicly, which helps donors and technical partners identify where support is most needed. As of 2022, more than 115 countries have completed JEE assessments, with comprehensive coverage achieved across the African region.

After Action Reviews

AAR represents learning from real-world experience. Following a public health emergency or outbreak response, countries conduct systematic reviews to identify what worked well and what needs improvement. This qualitative process brings together responders, decision-makers, and key stakeholders to critically examine the entire response timeline.

The AAR process helps identify best practices, lessons learned, and gaps in emergency preparedness and response capacity. Unlike the forward-looking assessments of SPAR and JEE, AARs provide retrospective insights grounded in actual operational experience. Countries can conduct AARs through various formats including debriefs, working group discussions, key informant interviews, or mixed-method approaches depending on the scale and complexity of the event.

Simulation Exercises

SimEx allows countries to test their preparedness plans without waiting for a real emergency. These exercises range from discussion-based tabletop scenarios to full-scale operational drills involving multiple sectors and response agencies. Simulation exercises assess plans, procedures, and standard operating guidelines while revealing planning weaknesses and resource gaps before they become critical during actual emergencies.

The value of simulation exercises extends beyond identifying gaps. They clarify roles and responsibilities, improve coordination between agencies, and build confidence among emergency management teams. Regular exercises also familiarize staff with new equipment and procedures, making actual emergency responses smoother and more effective.

Mandatory versus voluntary: Why the distinction matters

The framework’s design balances accountability with country sovereignty through its mix of mandatory and voluntary components. All countries must complete SPAR annually under Article 54 of the IHR, ensuring baseline monitoring and mutual accountability for global health security. This mandatory reporting creates consistent data for tracking global and regional trends in health security capacity development.

The three voluntary components serve different but complementary purposes. Research shows that while SPAR provides consistent annual data, JEE assessments offer more detailed and objective evaluations that help countries identify specific technical gaps. The voluntary nature of JEE, AAR, and SimEx allows countries to request these assessments when they’re ready and able to act on the findings.

This dual approach has proven effective. SPAR provides continuous monitoring between JEE cycles, which typically occur once every four to five years. Countries can demonstrate incremental progress through annual SPAR submissions while preparing for more comprehensive external evaluations. The voluntary tools also encourage ownership and commitment, as countries actively request these assessments rather than viewing them as imposed obligations.

However, the voluntary nature of JEE creates coverage gaps. Data shows uneven implementation across regions, with developing countries in Africa and Eastern Mediterranean showing higher JEE completion rates than wealthier regions like Europe and Western Pacific. This suggests that voluntary assessments may not always reach the countries that need them most urgently.

CDC’s critical support for global health security

The United States Centers for Disease Control and Prevention plays a substantial role in making the MEF operational across partner countries. CDC works to build and strengthen global health security preparedness so countries can quickly respond to public health crises, contributing directly to IHR compliance efforts worldwide.

Technical assistance and capacity building

CDC’s involvement extends far beyond financial support. The agency has provided assistance in over 60% of JEEs conducted worldwide, deploying technical experts to support assessment processes and helping countries interpret findings. Through more than 60 country and regional offices, CDC implements programs addressing hundreds of diseases and health threats.

Following JEE assessments, CDC helps countries translate recommendations into actionable National Action Plans for Health Security. This support includes facilitating communication and coordination among government sectors, helping prioritize activities based on available resources, and providing expertise throughout implementation and monitoring phases.

Building sustainable workforce capacity

Long-term capacity building forms a cornerstone of CDC’s MEF support. The agency established programs like the Field Epidemiology Training Program that have trained thousands of disease detectives worldwide. Through partnerships with organizations like TEPHINET, CDC connects over 80 Field Epidemiology Training Programs across more than 100 countries.

CDC also developed the Global Rapid Response Team following the West Africa Ebola epidemic. This dedicated cadre of trained responders provides surge capacity for international emergencies while helping countries build their own rapid response systems. These capacity-building activities directly support countries’ progress toward IHR compliance, particularly in workforce development and emergency operations.

Strengthening monitoring systems

CDC support has been critical in developing and implementing the JEE tool itself, working with WHO and partner countries to harmonize monitoring for both Global Health Security Agenda targets and IHR compliance. The agency’s decades of experience in disease surveillance and outbreak response informs practical improvements to assessment methodologies.

CDC’s global presence enables rapid collaboration when health threats emerge. Through trusted partnerships developed over years of technical cooperation, CDC staff are often the first call by host country governments when disease outbreaks start, demonstrating how MEF capacity building translates into effective emergency response.

Moving from assessment to action

The true value of the MEF lies not in generating scores but in driving concrete improvements in health security. Countries that actively engage with all four components create a comprehensive cycle of assessment, learning, and capacity development. Regular SPAR submissions track progress, periodic JEEs provide objective validation, AARs capture operational lessons, and SimEx exercises test preparedness plans before real emergencies strike.

Evidence suggests this framework works when properly implemented. Studies have shown that countries improving their IHR capacity scores experience measurable reductions in cross-border disease threat events. The COVID-19 pandemic demonstrated both the critical importance of these capacities and the ongoing gaps that need addressing through continued MEF implementation and international support.

What do you think? How can countries balance the resource demands of conducting these assessments with the need for continuous capacity building? What role should international partners play in ensuring that MEF assessments lead to sustained improvements rather than just periodic evaluations?

References

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Table of Contents

Understanding the four pillars of the MEF 🔗

States Parties Self-Assessment Annual Reporting 🔗

Joint External Evaluations 🔗

After Action Reviews 🔗

Simulation Exercises 🔗

Mandatory versus voluntary: Why the distinction matters 🔗

CDC’s critical support for global health security 🔗

Technical assistance and capacity building 🔗

Building sustainable workforce capacity 🔗

Strengthening monitoring systems 🔗

Moving from assessment to action 🔗