As international trade grows by the day, travel and migration have increased and this is likely to raise the chance of microbes and pathogens to grow. This threatens people’s health. It is reported that 60% of human pathogens are of animal origin and 75% of emerging animal diseases can be transmitted to humans. In Africa, over 100 public health emergencies occur annually. Out of these 82 (78%) are infectious, 18 (17%) disasters, and four (4%) of chemical origin.
These figures indicate that the continent is at risk of health emergencies and re-emerging pathogens are of particular concern. Updating medical procedures and health documents is critical in finding better solutions to the challenges in the health sector. This means dealing with health securities which are defined as the required proactive and reactive activities to minimize vulnerabilities to acute public health events that endanger the collective health of national populations.
As part of its preventative plans, the Ministry of Health (MoH) has recently been updating several documents. On Tuesday, 27th of March, it officially launched the National Health Security Action Plan (NAPHS):2017-2021 developed in partnership with different sectors. The NAPHS document aims to prevent, detect any epidemic infectious disease early and respond rapidly at its sources, before it grows and becomes a national or international threat. In May 2016, the World Health Assembly (WHA) requested the World Health Organization (WHO) to develop a global implementation plan to promote the delivery of the International Health Regulations (2005). Health Ministers of the 196 member states then restated this in August 2016 at the meeting of the regional committee of WHO AFR who endorsed the Regional Strategy for Health Security and Emergencies: 2016-2020. Today, the development of NAPHS became a reality with the interaction between concerned line ministries both during the planning and implementation phases. It was a consultative exercise, based on the results of the situation analysis as well as the results of an agreed set of recommendations and activities under the Joint External Evaluation (JEE) of 19 technical areas.
The Regional Strategy for Health Security and Emergencies- 2016-2020-urges all member states to develop National Action Plans for Health Security by 2018. Meanwhile, the 2005 IHR was introduced in Eritrea in 2009 and assessed in 2016 by an internal self-assessment team. In October 2016, this was followed by JEE, with a support of experts from WHO, the Africa Communicable Disease Control (CDC) as well as experts from other member states and partner organizations. The JEE assessment of 19 Packages were conducted with respect to 48 indicators and the respective results showed that eight indicators (16.7%) had sustainable capacity, thirty indicators (62.5%) had limited or developed capacity and ten indictors (20.8%) had no capacity. The indicators are meant to measure the progress made towards achieving the national health security. Following the JEE, the MOH, in collaboration with other relevant sectors, identified key recommendations within the 19 technical areas. These key recommendations were the basis for the formulation of the major NAPHS’s activities and their costs. The key recommendations for each technical area are preventing, detecting and responding to outbreaks by every means and strengthening the points of entry and identifying other possible hazards.
In April 2017, Eritrean Ministries were supported to develop and work out cost of a comprehensive NAPHS: 2017-2021 tied up to the Health Sector Strategic Development Plan II(NHSSDP II), anchored to national and international priorities such as Global Agenda of the Sustainable Development Goals (SDGs). The implementation plan includes the list of all activities that stakeholders should perform in the national health security implementation over the next five years, supporting its objectives. The document has also costs of the whole plan and figured out the implementation framework at different levels. The action plan is costed through the newly adapted hybrid software between that of “One Health” and WHO Costing Tool.
On the launching ceremony of the NAPHS document, Minister of Health, Ms. Amina Nurhussien, said that Eritrea has been alert to pandemic and prone diseases which are serious to public health security by establishing Integrated Disease Surveillance and Response System (IDSR) and by forming committees for leadership, preparing management guidelines to ensure the availability and accessibility of medicine and medical supplies, personal protection, equipment and other logistics. Dr. Josephine Namboze, WHO representative in Eirtrea, said that strengthening preparedness for prevention, detection, and response protects essential health services, contributes to health systems resilience, avoids fragmentation of health systems and leads to improved national, regional and global health security. Dr. Josephine further said that strengthening the resilience of communities and health systems in countries will facilitate a faster achievement of Universal Health Coverage (UHC, 2030), which is critical and the foundation for public health emergency risk management.
In launching the document, it was said that stakeholders should use the “One Health” Approach to respond jointly to health threats. This approach designs and implements programs, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes. More importantly, the approach is indispensable in combating Antimicrobial Resistance (AMR). “One Health” approach is particularly relevant to the control of zoonotic diseases, environmental breakdown, climatic changes, and food safety/security. The Ministry of Land, Water and Environment promotes the approach by integrating all relevant sectors to attain human, and animal health management success and ecosystem restoration.
According to the communicable diseases control division of MoH, the five year NAPHS country strategy’s goal is to reduce morbidity, mortality, disability and socio-economic disruptions due to public health threats and to contribute to the Sustainable Development Goal 3 (SDG – 3).
The NAPHS objectives are outlined into five. Basically, to prevent or reduce the likelihood of outbreaks occurring from all public health hazards and events as defined by IHR (2005) by 2021. Secondly, to promptly detect and report all threats (outbreaks and all hazards) within 72 hours, to save lives and ensure proper control measures by 2021. Thirdly, to establish and implement a functional coordination mechanism in the six zones for effective multi-sectorial response to all public health events by 2021. Fourthly, to establish and maintain the core capacities at the four designated points of entry for routine and timely detection and prompt effective response of any potential hazards by 2021.
And, lastly, to develop and sustain optimum capacity in the six zones to prevent, detect and manage chemical events and radiation emergencies by 2021.
Public Health Security and Emergencies has always been given priority by the MoH. The Ministry is devoted to strengthening health and community systems from national to community level. Eritrea has been very successful in meeting the health related MDGs. Surveillance of the communicable diseases that have been given priority is a major function of the IDSR Unit. Priority diseases targeted to be eliminated by IDSR include Neonatal Tetanus, Acute Flaccid paralysis polio, Dracunculiasis, Measles); Epidemic – prone (Cholera, Shigellosis, Plague, Viral Haemorrhagic Fevers (VHFs), Yellow Fever, Meningitis) and also on diseases of Public health Importance (Diarrhoea in < 5 years , Pneumonia in < 5 years , HIV/AIDS, Malaria, Sexually Transmitted Infections, Tuberculosis, Rabies, Infectious Hepatitis, Schistosomiasis). In addition, reports and rumors of unusual public health events have been investigated and necessary actions taken as required.
This comprehensive endeavor takes into account the prevention of health threats countries had faced in the past and makes sure no more sad experiences that devastated communities, health systems and the economies of countries are repeated. Minister Amina, in her closing remarks, underlined that by implementing this national strategy, Eritrea and its people are prepared for, protected from, and resilient enough to absorb shocks that may arise due to epidemics or disasters from emergency of public health events of international concern. The National Health Security Action Plan launching workshop gave assurance that the five year action document will be monitored and evaluated throughout its life.