National Action Plan for Health Security: Accelerating IHR Core Capacities

Global health emergencies don’t respect borders. When a disease outbreak occurs in one country, it can rapidly spread to others through travel and trade. This reality has pushed nations to strengthen their health security systems. The National Action Plan for Health Security (NAPHS) emerged as a critical tool for countries to build resilient health systems capable of preventing, detecting, and responding to public health threats effectively.

Understanding the One Health approach for all hazards 🔗

The NAPHS is built on a foundation that recognizes health threats don’t come from just one source. NAPHS is a country-owned, multi-year planning process that accelerates the implementation of International Health Regulations (IHR) core capacities through a comprehensive One Health strategy.

The One Health approach acknowledges that human health, animal health, and environmental health are deeply interconnected. When countries develop their health security plans, they must consider disease threats that can jump from animals to humans, environmental factors that enable disease spread, and chemical or radiological hazards that can affect entire populations. This integrated perspective ensures no potential threat falls through the cracks.

What makes NAPHS particularly effective is its whole-of-government approach. Rather than placing the entire burden on health ministries alone, NAPHS brings together multiple government sectors. Ministries of health collaborate with agriculture departments, environmental agencies, defense sectors, finance ministries, and transportation authorities. This cross-sector coordination ensures that when a health emergency strikes, all relevant government entities can respond in a unified manner.

The planning process captures national priorities for health security using a risk management approach. Countries identify their most pressing threats based on local context, historical disease patterns, and potential emerging risks. The plan brings sectors together, identifies partners from international organizations and donor agencies, and allocates both domestic and external resources for health security capacity development.

How Joint External Evaluations guide national planning 🔗

Before countries can develop an effective NAPHS, they need to know where they stand. This is where the Joint External Evaluation (JEE) becomes essential. The JEE is a voluntary, collaborative process where countries invite international experts to assess their health security capacities across 19 technical areas.

The JEE process begins with a country conducting a thorough self-assessment. National experts from health, animal health, environmental health, and security sectors evaluate their own systems honestly. This self-assessment is then validated by independent external experts during a peer-to-peer evaluation that includes site visits to facilities. The external team brings fresh perspectives and benchmarks the country’s capacities against global standards.

These 19 technical areas cover the full spectrum of health security. They include national legislation and financing, coordination across sectors, antimicrobial resistance, zoonotic diseases, food safety, biosafety and biosecurity, immunization, surveillance systems, laboratory capacity, workforce development, preparedness planning, emergency response operations, risk communication, points of entry management, chemical and radiation events, and more.

Each technical area receives a score from 1 to 5, where 1 indicates no capacity and 5 represents sustainable capacity. The JEE findings guide the prioritization of gaps that countries must address. When Tanzania completed its JEE, for example, none of the 19 technical areas had achieved sustainable capacity, with most scoring at limited or developed capacity levels. This baseline assessment provided clear direction for their NAPHS development.

The JEE delivers more than just scores. It produces detailed priority actions for each technical area. These priority actions become the foundation for NAPHS development. Countries can identify which gaps pose the greatest risks, which improvements will have the most immediate impact, and where international partners can provide the most valuable support.

Translating assessment into action 🔗

The transition from JEE results to NAPHS implementation requires careful planning. Countries use resource mapping tools to identify existing funding sources and gaps. They determine which activities can be funded through domestic budgets and where external donor support is needed. This financial planning ensures the NAPHS remains realistic and implementable rather than just an aspirational document.

Countries also establish governance structures to oversee NAPHS implementation. Multi-sectoral oversight committees typically include representatives from all relevant government agencies, technical experts, and partner organizations. These committees meet regularly to review progress, adjust priorities based on changing circumstances, and ensure accountability for achieving targets.

CDC’s technical support throughout the NAPHS journey 🔗

Developing and implementing a comprehensive NAPHS is complex work that requires specialized expertise. The U.S. Centers for Disease Control and Prevention (CDC) provides crucial technical support to countries throughout this process, helping translate international standards into actionable national strategies.

CDC’s support begins even before NAPHS development. The agency has provided assistance in over 60% of JEEs conducted worldwide, helping countries prepare for evaluations and ensuring the assessment process captures accurate information about their capacities.

Facilitating communication and coordination 🔗

One of CDC’s primary roles involves facilitating communication between different stakeholders. Health security planning requires dialogue between government sectors that may not typically work together. CDC helps establish communication channels and coordination mechanisms that enable agriculture specialists to collaborate with health officials, environmental experts to share data with laboratory scientists, and finance planners to understand public health priorities.

This communication support extends to international partnerships as well. CDC connects countries with donor agencies, technical organizations, and other nations facing similar challenges. These connections enable knowledge sharing, peer learning, and coordinated resource mobilization that strengthens the NAPHS beyond what any single country could achieve alone.

Supporting prioritization and resource planning 🔗

CDC provides technical expertise in prioritizing NAPHS activities. Not every gap identified in a JEE can be addressed simultaneously. Countries must decide which capacity improvements will have the greatest impact on health security and which can be phased in over time. CDC helps countries analyze their risk profiles, evaluate the cost-effectiveness of different interventions, and sequence activities logically so that foundational capacities are built before more advanced systems.

Resource mapping represents another critical area where CDC provides guidance. Countries need to understand what funding and technical resources are already available, what gaps exist, and how to mobilize additional support. CDC assists with analyzing domestic budget allocations for health security, identifying potential donor partners, and developing compelling funding proposals that attract international investment.

Monitoring implementation and sustaining progress 🔗

CDC works with countries to establish robust monitoring and evaluation frameworks for NAPHS implementation. Countries need systems to track progress toward capacity development targets, identify implementation bottlenecks, and make evidence-based adjustments to their plans. CDC helps design these systems and build country capacity to use monitoring data for continuous improvement.

The agency also supports operational planning that breaks multi-year strategic NAPHS into annual operational plans with specific, measurable activities. This approach makes large-scale capacity building more manageable and allows countries to demonstrate progress incrementally. Sierra Leone successfully used this approach with CDC support, doubling the number of high-scoring JEE technical areas between assessments despite facing the challenges of the COVID-19 pandemic.

CDC provides ongoing technical assistance across four essential areas that underpin effective NAPHS implementation: strengthening laboratory systems for disease detection, developing the public health workforce with necessary skills, enhancing surveillance systems to identify threats early, and improving emergency management and response capabilities. This sustained engagement helps countries build sustainable capacity rather than temporary improvements that fade when external support ends.

From planning to preparedness 🔗

The NAPHS represents more than a planning document. It serves as a roadmap for countries to systematically strengthen their health security capacities over multiple years. By using the One Health approach and whole-of-government strategy, countries ensure comprehensive coverage of all potential health threats. The JEE provides objective assessment and clear priorities for action. CDC and other partners provide technical expertise and support that makes implementation achievable even for countries with limited resources.

Countries that have successfully implemented their NAPHS demonstrate measurably improved capacity to detect and respond to health emergencies. They build trust with neighboring nations and international partners through transparent reporting and coordinated action. Most importantly, they protect their populations more effectively against the diverse health threats that characterize our interconnected world.

What do you think? How can countries balance the need for comprehensive health security planning with the reality of limited resources? What role should international organizations play in supporting NAPHS implementation while respecting national sovereignty and priorities?

References

1. https://www.who.int/emergencies/operations/international-health-regulations-monitoring-evaluation-framework/national-action-plan-for-health-security
2. https://www.who.int/publications/i/item/9789240104983
3. https://www.who.int/emergencies/operations/international-health-regulations-monitoring-evaluation-framework/joint-external-evaluations
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873533/
5. https://www.cdc.gov/global-health/topics-programs/ihr.html
6. https://www.cdc.gov/global-health-protection/php/stories-from-the-field/cdc-helps-countries-close-gaps-in-global-health-security-through-operational-planning.html