Joint External Evaluation. of the. Mission report: 5 9 December 2016

Transcription

1 Joint External Evaluation of IHR Core Capacities of the REPUBLIC of côte d ivoire Mission report: 5 9 Deceber 2016

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3 Joint External Evaluation of IHR Core Capacities of the REPUBLIC of côte d ivoire Mission report: 5 9 Deceber 2016

4 WHO/WHE/CPI/ World Health Organization 2017 Soe rights reserved. This work is available under the Creative Coons Attribution-NonCoercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; Under the ters of this licence, you ay copy, redistribute and adapt the work for non-coercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not peritted. If you adapt the work, then you ust license your work under the sae or equivalent Creative Coons licence. If you create a translation of this work, you should add the following disclaier along with the suggested citation: This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition. Any ediation relating to disputes arising under the licence shall be conducted in accordance with the ediation rules of the World Intellectual Property Organization ( Suggested citation. Joint External Evaluation of IHR Core Capacities of the Republic of Côte d Ivoire. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at Sales, rights and licensing. To purchase WHO publications, see To subit requests for coercial use and queries on rights and licensing, see Third-party aterials. If you wish to reuse aterial fro this work that is attributed to a third party, such as tables, figures or iages, it is your responsibility to deterine whether perission is needed for that reuse and to obtain perission fro the copyright holder. The risk of clais resulting fro infringeent of any third-party-owned coponent in the work rests solely with the user. General disclaiers. The designations eployed and the presentation of the aterial in this publication do not iply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the deliitation of its frontiers or boundaries. Dotted and dashed lines on aps represent approxiate border lines for which there ay not yet be full agreeent. The ention of specific copanies or of certain anufacturers products does not iply that they are endorsed or recoended by WHO in preference to others of a siilar nature that are not entioned. Errors and oissions excepted, the naes of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the inforation contained in this publication. However, the published aterial is being distributed without warranty of any kind, either expressed or iplied. The responsibility for the interpretation and use of the aterial lies with the reader. In no event shall WHO be liable for daages arising fro its use. Design and layout by Jean-Claude Fattier Printed by the WHO Docuent Production Services, Geneva, Switzerland

5 ACKNOWLEDGEMENTS The WHO JEE Secretariat would like to acknowledge the following, whose support and coitent to the principles of the International Health Regulations (2005) have ensured a successful outcoe to this joint external evaluation ission: The Governent and host country experts of Côte d Ivoire for their support of, and work in, preparing and copleting the evaluation ission. The governents of France, Senegal and the United States of Aerica, for providing technical experts for the peer review process. The International Civil Aviation Organization (ICAO), The Food and Agriculture Organization of the United Nations (FAO), the United Nations Institute for Training and Research (UNITAR) and the World Organisation for Anial Health (OIE), for their contribution of experts and expertise. The governents of Gerany and Finland for their financial support to this ission. The following WHO entities: the WHO Country Offices in Côte d Ivoire, Gabon, Mauritania and Chad, the Regional Office for Africa, and the Departent for Country Health Eergency Preparedness & IHR at WHO headquarters. The Global Health Security Agenda for their collaboration and support.

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7 Contents Abbreviations vi Executive Suary: conclusions of the joint external evaluation Côte d Ivoire Scores PREVENT 6 National legislation, policy and financing IHR coordination, counication and advocacy Antiicrobial resistance Zoonotic diseases Food safety Biosafety and biosecurity Iunization DETECT 24 National laboratory syste Real-tie surveillance Reporting Workforce developent RESPOND 37 Preparedness Eergency response operations Linking public health and security authorities Medical countereasures and personnel deployent Risk counication OTHER IHR-RELATED HAZARDS AND POINTS OF ENTRY 51 Points of entry Cheical events Radiation Eergencies Appendix 1: Joint External Evaluation Background

8 Joint External Evaluation Abbreviations AMR antiicrobial resistance AET CAPSCA Collaborative Applied Epideiology Arrangeent Training for the (Cabodia s Prevention version and Manageent of FETP) of Public Health Events APSED in Asia Civil Pacific Aviation Strategy for Eerging Diseases AFRIMS CBRN cheical, Ared Forces biological, Research radioactive Institute and of Medical nuclear Sciences AMR CDC Centers Antiicrobial for Disease Resistance Control CaEWARN CIAPOL Ivorian Cabodia Antipollution early warning Agency surveillance syste CaLIS CIRAD French Cabodia Agricultural Laboratory Research Inforation and International Syste Cooperation Organization CBRN cmyp coprehensive Cobined Joint ulti-year Cheical, plan Biological, Radiological, and Nuclear CDC CRESAC Regional Departent Centre of Counicable for Educational, Diseases Environental Control, and Ministry Accreditation of Health Evaluations in Africa DHS ECTAD Eergency Departent Centre of Hospital for Transboundary Service Anial Disease EBS EOC eergency Event-based operations Surveillance centre EOC EPI Expanded Eergency Prograe Operations on Centre Iunization EQA FAO Food External and Agriculture Quality Assurance Organization of the United Nations EVD FETP field Ebola epideiology Virus Disease training prograe FAO NFP National Food and Focal Agricultural Point Organization of the United Nations GHSA Globally Health Haronized Security Syste Agenda IBS GHSA Global Indicator-based Health Security Surveillance Agenda IHR GOARN (2005) Global International Outbreak Health Alert Regulations and Response (2005) Network IPC IAEA International Infection Prevention Atoic Energy and Control Agency IMS IHR International Incident Manageent Health Regulations Syste JEE ILO International Joint External Labour Evaluation Organization OIE INFOSAN International World Organisation Food Safety for Anial Authorities Health Network MERS INSSP Integrated Middle East Nuclear respiratory Security syndroe Support Plan FETP ISO International odified Field Organization Epideiology for Training Standardization NAMRU JEE II joint Naval external Medical evaluation Research Unit II NFP LANADA Ivorian National National IHR Focal Agricultural Point Developent Laboratory PoE NFP national Points of IHR Entry focal point RRT OIE World Rapid Organisation Response Tea for Anial Health SNRA ORMICI Ivorian Strategic Anti-infective-resistant National Risk Assessent Microorganiss Observatory SOPs PVS perforance Standard Operation of veterinary Procedures services THIRA SOP standard Threat and operating Hazard procedure Identification and Risk Assessent TWG UNITAR United Technical Nations Working Institute Group for Training and Research USAID United States Agency for for International Developent USCDC USDA United States Departent Centers for of Disease Agriculture Control and Prevention WHO WAHO West World African Health Health Organization Organization WHO World Health Organization vi

9 Executive suary: Conclusions of the joint external evaluation Introduction The International Health Regulations (2005) (IHR (2005)) are a legally binding international instruent that have been in force since 15 June Their purpose and scope are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are coensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. of IHR Core Capacities of the Republic of Côte d Ivoire Since 2010, the IHR (2005) core capacity onitoring fraework has used a self-assessent questionnaire copleted by States Parties to report to the World Health Assebly on the status and developent of the iniu core public health capacities required by the IHR (2005). Progress has been ade, but countries in the Region do not yet have the necessary resources. In 2014, the IHR (2005) Review Coittee recoended that the Director-General consider a variety of approaches for the shorter- and longer-ter assessent and developent of IHR (2005) core capacities. WHO has developed a new IHR (2005) onitoring and evaluation fraework for core capacities that cobines qualitative and quantitative approaches to ake an objective assessent of countries true capacities. The new fraework focuses on increased accountability and transparency by requiring regular, detailed reporting on the status of application of the IHR (2005), thereby prooting dialogue, trust and accountability between States Parties. The four coponents of the new onitoring and evaluation fraework are: (i) annual reporting; (ii) joint external evaluations; (iii) after-action review; and (iv) siulation exercises. Joint external evaluations (JEEs) easure the ability of a State Party to the IHR (2005) to prevent, detect and rapidly respond to natural, accidental and deliberately engineered public health threats. A national ultisectoral action plan should be drawn up following the JEE ission to ensure that its recoendations are applied. Main findings All national stakeholders, representing a range of disciplines and sectors, participated actively in highlevel discussions. The presence of the Ivorian Director-General for Health and senior officials fro all key sectors testified to the national authorities full engageent in the process. Logistics were in place to allow the evaluation tea to visit all sites as planned. The tea itself was ultidisciplinary, coposed of ebers fro different international institutions and Meber States, with the necessary skills to support the ission. This report can therefore serve as a reference docuent for drawing up the country s IHR (2005) plan incorporating a One Health approach. Main strengths Côte d Ivoire has a nuber of legal texts that are helpful in ters of applying the provisions of the IHR (2005). A national IHR focal point (NFP) has also been identified within the National Institute of Public Health. The NFP carries out its activities in coordination with stakeholders fro other institutions and thus follows a ultisectoral and ultidisciplinary approach. The country has a public health eergency operations centre (EOC) that acts as a coordination centre, and has established a national epideic control coittee. The electronic notification syste is fully functional in all health districts and regions, eaning that notifiable diseases can be reported in real tie, in addition to facilitating the event-based surveillance systes already in place. 1

10 2Joint External Evaluation Reliable national laboratories are operational in key sectors at the central level and there are national reference centres for detecting and confiring cases of antiicrobial resistance. There is also good analytical capacity at the central level - at the Ivorian Antipollution Agency (CIAPOL) for quantifying cheical substances and at the National Public Health Laboratory for identifying biological speciens. The Ministry of the Environent has a laboratory for onitoring and detecting radiological waste in the environent, particularly that produced by State-owned copanies. Generally speaking, huan resources are supported by several universities and technical schools, and the Governent provides incentives to otivate the workforce. National and interediary sectoral plans exist to respond to different types of huan and anial health events. There is a national plan in place to organize relief during eergencies (the ORSEC Plan). It contains provisions for sending and receiving edical equipent and deploying health workers during a health crisis. The procedures of the New Public Health Pharacy contain a provision for stockpiling edical supplies in case of a public health eergency. An effective standard operating procedure for counication systes in health-crisis anageent was also developed by the EOC as part of its response to the Ebola disease outbreak. Félix-Houphouêt-Boigny International Airport in Abidjan has edical services, specialized equipent and qualified personnel in place, and there is a national plan for public health eergency preparedness and response specific to civil aviation. Côte d Ivoire receives support under the Global Health Security Agenda (GHSA) initiative, which has invested significantly in capacity-building for uch of the IHR (2005). Main challenges Existing legal instruents do not take the IHR (2005) entirely into account and should be revised to better integrate the necessary provisions. The lack of a foral coordination fraework liits the functioning of the NFP. Despite clear buy-in in the country, there is also no foral fraework for ipleenting a One Health approach. For exaple, there are a nuber of shortcoings with regard to foral procedures for sharing inforation between the NFP and the OIE focal point. In addition, there is insufficient collaboration between the epideiological and environental surveillance echaniss. The EOC has not taken all necessary steps to ipleent a ultisectoral platfor for coordination and inforation-sharing so that inforation can be passed to all key stakeholders. Veterinary capacities are lacking in certain key areas and counity-based surveillance is not robust enough. The involveent of hospitals and private health facilities in the surveillance of diseases that constitute a public health and security threat takes place only on an ad-hoc basis. The syste for transporting speciens vital to the propt confiration of an outbreak does not yet cover all sectors. There is no approved plan for ipleenting the World Health Assebly s recoendations on the surveillance of antiicrobial resistance. Biosafety and biosecurity capacities ust be extended to the other levels of the health pyraid using a ultisectoral approach, and the Ministry of Higher Education ust be included as a stakeholder in this technical area. Risk counication skills and their applications are quite liited. In all sectors there is a lack of policy docuents on career profiles, particularly for counity health workers. There are no foral echaniss for reaching agreeents with doestic and international anufacturers/ distributers to obtain edical equipent during public health eergencies. Robust public health eergency preparedness is essential, but the country has not yet developed a unified ulti-risk, ultisectoral national plan.

11 Félix-Houphouêt-Boigny International Airport has suitable edical services, but not the Autonoous Port of Abidjan. In general, the country does not have a national ultisectoral public health eergency plan at points of entry. As in ost countries in the region, preparedness for ajor public health incidents especially cheical or radiological events is still not optial. Next steps After five days of discussions with host country experts, the evaluation tea proposed the following steps for ipleenting all the priority actions identified in each technical area: of IHR Core Capacities of the Republic of Côte d Ivoire Côte d Ivoire should continue to search for opportunities to aterialize the coitents ade by West African States in the couniqué issued by the Ministerial Meeting of the West African Regional Conference on One Health. It is also iportant to take other related fraeworks such as the GHSA into consideration when accelerating the IHR ipleentation process. A national action plan that takes into account the findings of the JEE and other recent evaluations of key sectors should be finalized in To strengthen health security and ipleent the IHR (2005) core capacities, the country should continue to proote the ipleentation of the new IHR fraework (annual reporting, JEE, after-action review and siulation exercises). 3

12 4Joint External Evaluation Côte d Ivoire scores Capacities Indicators Score National legislation, policy and financing IHR coordination, counication and advocacy Antiicrobial resistance Zoonotic diseases Food safety Biosafety and biosecurity Iunization National laboratory syste Real-tie surveillance Reporting Workforce developent 1 FETP: Field epideiology training prograe P.1.1 Legislation, laws, regulations, adinistrative requireents, policies or other governent instruents in place are sufficient for ipleentation of IHR (2005) 2 P.1.2 The State can deonstrate that it has adjusted and aligned its doestic legislation, policies and adinistrative arrangeents to enable copliance with the IHR (2005) 2 P.2.1 A functional echanis is established for the coordination and integration of relevant sectors in the ipleentation of IHR (2005) 2 P.3.1 Antiicrobial resistance (AMR) detection 1 P.3.2 Surveillance of infections caused by AMR pathogens 1 P.3.3 Health care-associated infection (HCAI) prevention and control prograes 1 P.3.4 Antiicrobial stewardship activities 1 P.4.1 Surveillance systes are in place for priority zoonotic diseases/pathogens 3 P.4.2 Veterinary or anial health workforce 3 P.4.3 Mechaniss for responding to infection zoonoses and potential zoonoses are established and functional 2 P.5.1 Mechaniss are established and functioning for detecting and responding to foodborne disease and food containation 2 P.6.1 Whole-of-governent biosafety and biosecurity syste is in place for huan, anial and agriculture facilities 2 P.6.2 Biosafety and biosecurity training and practices 2 P.7.1 Vaccine coverage (easles) as part of the national prograe 3 P.7.2 National vaccine access and delivery 3 D.1.1 Laboratory testing for detection of priority diseases 4 D.1.2 Specien referral and transport syste 2 D.1.3 Effective, odern point-of-care and laboratory-based diagnostics 3 D.1.4 Laboratory quality syste 3 D.2.1 Indicator- and event-based surveillance systes 3 D.2.2 Interoperable, interconnected, electronic real-tie reporting syste 3 D.2.3 Analysis of surveillance data 3 D.2.3 Syndroic surveillance systes 3 D.3.1 Syste for efficient reporting to WHO, FAO and OIE 3 D.3.2 Reporting network and protocols in the country 2 D.4.1 Huan resources are available to ipleent IHR (2005) core capacity requireents 2 D.4.2 FETP or other applied epideiology training prograe is in place 3 D.4.3 Workforce strategy 2

13 Preparedness Eergency response operations Linking public health and security authorities Medical countereasures and personnel deployent Risk counication Points of entry Cheical events Radiation eergencies R.1.1 Multi-hazard national public health eergency preparedness and response plan is developed and ipleented 2 R.1.2 Priority public health risks and resources are apped and utilized 1 R.2.1 Capacity to activate eergency operations 2 R.2.2 Eergency operations centre operating procedures and plans 2 R.2.3 Eergency operations prograe 3 R.2.4 Case anageent procedures are ipleented for IHR (2005) relevant hazards 2 R.3.1 Public health and security authorities, (e.g. law enforceent, border control, custos) are linked during a suspected or confired biological event 2 R.4.1 Syste is in place for sending and receiving edical countereasures during a public health eergency 2 R.4.2 Syste is in place for sending and receiving health personnel during a public health eergency 1 R.5.1 Risk counication systes (such as plans, echaniss) 1 R.5.2 Internal and partner counication and coordination 3 R.5.3 Public counication 2 R.5.4 Counication engageent with affected counities 2 R.5.5 Dynaic listening and ruour anageent 2 PoE.1 Routine capacities are established at points of entry 2 PoE.2 Effective public health response at points of entry 1 CE.1 Mechaniss are established and functioning for detecting and responding to cheical events or eergencies 2 CE.2 Enabling environent is in place for anageent of cheical events 2 RE.1 Mechaniss are established and functioning for detecting and responding to radiological and nuclear eergencies 1 RE.2 Enabling environent is in place for anageent of radiation eergencies 2 of IHR Core Capacities of the Republic of Côte d Ivoire PREVENT 5

14 PREVENT 6Joint External Evaluation PREVENT National legislation, policy and financing Introduction The IHR (2005) provide obligations and rights for States Parties. In soe States Parties, ipleentation of the IHR (2005) ay require new or odified legislation. Even if new or revised legislation ay not be specifically required, States Parties ay still choose to revise soe regulations or other instruents in order to facilitate IHR ipleentation and aintenance in a ore effective, efficient and beneficial anner. Ipleenting legislation could serve to institutionalize and strengthen the role of IHR (2005) and operations within the State Party. It can also facilitate coordination aong the different entities involved in their ipleentation. (See detailed guidance on IHR (2005) ipleentation in national legislation at legislation/en/index.htl.) Policies that provide for national facilities, detail the country s responsibilities and deterine the distribution of sufficient funding are also of the highest iportance. Target States Parties should have an adequate legal fraework to support and enable the ipleentation of all of their obligations and rights to coply with and ipleent the IHR (2005). In soe States Parties, ipleentation of the IHR (2005) ay require new or odified legislation. Even where new or revised legislation ay not be specifically required under the State Party s legal syste, States ay still choose to revise soe legislation, regulations or other instruents in order to facilitate their ipleentation and aintenance in a ore efficient, effective or beneficial anner. States Parties should ensure provision of adequate funding for IHR ipleentation through the national budget or another echanis. Côte d Ivoire level of capabilities Côte d Ivoire has a series of legal instruents aied at ipleenting the provisions of the IHR (2005). Aong the are: Decree No of 9 October 1991 creating the Ivorian Antipollution Agency (CIAPOL); Decree No of 9 October 1991 creating the National Institute of Public Health, which is in charge of epideiological surveillance; Decree No of 3 Septeber 2014 establishing the organizational fraework for the prevention and control of Ebola virus disease; and Order No. 435-MSP/ CAB of 31 Deceber 2007 aending Order No. 415/CAB/MEMSP of 28 Noveber 2005 creating the national epideic control coittee and establishing its organization, reit and functioning. However, these instruents do not take the IHR (2005) entirely into account and should be revised to better integrate the necessary provisions. In ters of institutions, an NFP has been identified within the National Institute of Public Health. The NFP carries out its activities in coordination with stakeholders within other bodies, but this is hapered by the lack of a foral coordination fraework. There is also a national health developent plan in place that includes health onitoring and epideiological surveillance for the period There is as yet no foral fraework for ipleenting a One Health approach, although there is clear buyin in the country. A draft text in this regard has been developed and is awaiting approval. For the oent,

15 however, stakeholders are in contact and work together within the fraework of an inforal coordination platfor. Recoendations for priority actions Re-evaluate legislation related to the IHR (2005). Ipleent recoendations based on that evaluation. Produce copleentary instruents (laws, degrees and regulations) for ipleenting the IHR (2005). of IHR Core Capacities of the Republic of Côte d Ivoire Proote wider knowledge of the IHR (2005) aong decision-akers, stakeholders and the public. Provide regular training and outreach to focal points in the bodies that ipleent the IHR (2005). Produce and distribute regulations that forally institutionalize a One Health approach. Develop a unified funding plan for actions related to the IHR (2005). Indicators and scores P.1.1 Legislation, laws, regulations, adinistrative requireents, policies or other governent instruents in place are sufficient for ipleentation of IHR (2005) - Score 2 PREVENT Legislation, laws, regulations, adinistrative requireents, policies and other governent instruents related to ipleenting the IHR (2005) were reviewed. Regulatory texts exist that organize epideiological surveillance. Procedural guidance, anuals and directives exist for each level of the health pyraid. A cooperation protocol with Burkina Faso is in place. Intersectoral coordination is carried out. Local epideic onitoring and control coittees are in place. Annual siulation exercises are carried out at Félix-Houphouêt-Boigny International Airport in Abidjan. Legal fraework for epideiological surveillance. Coordination between various surveillance networks. Effective application of existing legal instruents. Clarification of stakeholders roles and responsibilities within the intersectoral collaboration fraework. P.1.2 The State can deonstrate that it has adjusted and aligned its doestic legislation, policies and adinistrative arrangeents to enable copliance with the IHR (2005) - Score 2 Legislation, regulations, adinistrative requireents and other governent instruents related to ipleenting the IHR (2005) were reviewed and necessary adaptations were identified. Necessary adaptations to the legal fraework have been identified. Plan for strengthening surveillance capacities is available. 7

16 PREVENT 8Joint External Evaluation Partners and donors are fully coitted to funding IHR-related activities. There is political will to strengthen surveillance and response for epideics and other public health incidents. Forecasting and allocation of resources for IHR-related activities. Funding in the national budget eararked for IHR-related activities outside of eergency situations. Sufficient, predictable obilization of resources for ipleenting the plan outside of ties of crisis.

17 IHR coordination, counication and advocacy Introduction The effective ipleentation of the IHR (2005) requires ultisectoral/ultidisciplinary approaches through national partnerships for effective alert and response systes. Coordination of nationwide resources, including the designation of an IHR NFP, which is a national centre for IHR counications, is a key requisite for IHR ipleentation. of IHR Core Capacities of the Republic of Côte d Ivoire Target The NFP should be accessible at all ties to counicate with the WHO IHR Regional Contact Points and with all relevant sectors and other stakeholders in the country. States Parties should provide WHO with contact details of NFPs, continuously update and annually confir the. Côte d Ivoire level of capabilities PREVENT Côte d Ivoire established an EOC in February 2016 that acts as a coordination centre. The country also has a national epideic control coittee and a national coittee for Ebola virus disease control. The NFP s counication activities are carried out in coordination with stakeholders within other institutions. However, the following liiting factors reain: There is no unified ultidisciplinary, ultisectoral inforation-sharing echanis for counication and coordination. There is no action plan for ultidisciplinary, ultisectoral inforation-sharing echaniss. There is no inforation-sharing platfor. Challenges to functioning of NFP (24-hour accessibility) in ters of: counications qualified huan resources. However, the country has other capacities that facilitate counication, coordination and advocacy aong all stakeholders: intersectoral coordination echanis that functions on an ad-hoc basis; sharing of reports with other the institutions involved; standard operating procedures (SOPs) and guidelines for coordination between the NFP and other sectors involved; organization of coordination eetings. The NFP is tasked with enhancing coordination and counication between inistries. It is a ultisectoral coordination, counication and IHR advocacy echanis that operates within the context of the national epideic control coittee, which includes stakeholders with the necessary copetencies (representatives fro the Ministry of the Environent, the Ministry of the Interior and the Ministry of Water and Forests, etc., who participate as needed). Unfortunately, the coittee is active only in crises (e.g. outbreaks of avian influenza or Ebola virus disease). 9

18 Joint External Evaluation There is currently no ultisectoral coordination echanis for responding to non-critical events. Most of these situations are handled on a sectoral basis, with the appropriate inistry being responsible for activities falling within its reit. SOPs are currently being approved and will soon be available for disseination. A presidential decree on the One Health approach is currently being drafted to support the work of the NFP. It is of particular iportance that stakeholders agree upon a ultisectoral coordination fraework and the assignent of tasks in the interest of technical collaboration. Legal advisers fro different inistries should eet to discuss the presidential decree and develop a coordination and counication echanis. Recoendations for priority actions Develop a national One Health plan. PREVENT Fuse the various supra-inisterial coordination echaniss into a single fraework at the presidential level that coordinates all actions related to the One Health approach, thus strengthening its ultisectoral aspect. Strengthen the capacities of counication teas and the teas that anage the EOC. Evaluate the effectiveness of the NFP and ipleent the resulting recoendations. Indicators and scores P.2.1 A functional echanis is established for the coordination and integration of relevant sectors in the ipleentation of IHR (2005) - Score 2 Mechanis for interinisterial coordination is in place. National SOPs, or their equivalent, are in the process of being approved and will allow for coordination between the NFP and other the sectors involved. National and departental epideic control coittees are in place. Interinisterial order on avian influenza control has been issued. Decree on Ebola virus disease control has been issued. A public health EOC is in place. Drafting of SOPs is in progress. Epideic control coittee holds coordination eetings during health crises. Shared reporting on ipleentation of the IHR (2005). An inforation-sharing platfor should be put in place so that inforation is accessible to all, by: establishing a coordination and counication echanis that is ultisectoral and ultidisciplinary; developing a ultisectoral, ultidisciplinary action plan on coordination and counication echaniss. 10

19 Antiicrobial resistance Introduction Bacteria and other icrobial species evolve in response to their environent and inevitably develop echaniss to resist being killed by antiicrobial agents. For any decades, the proble was anageable as the growth of resistance was slow and the pharaceutical industry continued to create new antibiotics. of IHR Core Capacities of the Republic of Côte d Ivoire Over the past decade, however, this proble has becoe a crisis. The evolution of antiicrobial resistance (AMR) is occurring at an alaring rate and is outpacing the developent of new countereasures capable of thwarting infections in huans. This situation threatens patient care, econoic growth, public health, agriculture, econoic security, and national security. Target Support work coordinated by FAO, OIE and WHO to develop an integrated global package of activities to cobat antiicrobial resistance, spanning huan, anial, agricultural, food and environental aspects (i.e. a One Health approach). Each country has: (i) its own national coprehensive plan to cobat antiicrobial resistance; (ii) strengthened surveillance and laboratory capacity at the national and international levels following international standards developed as per the fraework of the Global Action Plan and taking into account existing laws; and (iii) iproved conservation of existing treatents and collaboration to support the sustainable developent of new antibiotics, alternative treatents, preventive easures and rapid point-of-care diagnostics, including systes to preserve new antibiotics. PREVENT Côte d Ivoire level of capabilities Although Côte d Ivoire has been working to detect AMR in the laboratory for 23 years, the country does not have an approved national plan. Several national reference centres, which contribute to detecting and confiring cases of AMR, have nonetheless been created since The centres alert the Ministry of Health and Public Hygiene and the Ministry of Higher Education when such cases arise. Work is regularly carried out on the topic, particularly acadeic studies, but there is no national organization that supports it. The President s Eergency Plan for AIDS Relief project has strengthened the capacities of six regional laboratories in Yaoussoukro, Korhogo, Abengourou, Daloa, San Pedro and Man bringing the country s total nuber of national reference centres to 20 (Order No. 393/MSHP/MESRS of 21 June 2006). Other resources in Côte d Ivoire: Huan health: 4 teaching hospitals, 84 general hospitals, 17 regional hospitals and 1964 first-contact health facilities (source: RASS 2015). Aong these facilities, there are a total of 27 AMR laboratories. Anial health and environent: 19 public and 24 private veterinary clinics (source: 2015 DSV annual reports), the National Agricultural Developent Laboratory (LANADA) and the Ivorian Antipollution Agency (CIAPOL). Recoendations for priority actions Develop a national institutional fraework for the prevention and control of infections and AMR and establish set roles and responsibilities at all levels of the health pyraid in huan and anial edicine. 11

20 Joint External Evaluation Develop a strategic action plan, based on WHO technical recoendations, that is adapted to the reality on the ground and accopanied by a budgeted operational plan. Strengthen the capacity of all facilities with an iportant role to play under the new One Health policy. Increase advocacy and awareness-raising about AMR in the anial, agricultural, food and environental sectors. Ipleent the national plan for AMR surveillance capacity-building. Indicators and scores P.3.1 Antiicrobial resistance detection - Score 1 No national plan has been approved for detecting and reporting priority antiicrobial-resistant pathogens. PREVENT Although this capacity is non-existent, the country nonetheless has the potential to cobat AMR through: (i) a national laboratory for antiicrobial-resistant pathogens (the Pasteur Institute of Côte d Ivoire); (ii) 44 laboratories (for huan and anial health, both public and private) able to detect and report antiicrobialresistant pathogens; and (iii) verified laboratory ethods and quality control carried out by external quality assurance. This potential reains geographically liited to a few facilities at the top of the health pyraid. A broader network of laboratories needs to be developed, and their capacities strengthened, so that they can be involved in the global AMR surveillance syste for huan and anial health. WHO has proposed a odel that all countries can use and adapt. There is also soe disparity between the huan and anial sectors, in the sense that the latter is not as involved in cobatting AMR. National AMR guidelines available. National surveys of resistance to tuberculosis edication. 27 public and private laboratories identified. Anti-infective-resistant icroorganiss observatory (ORMICI) established in External quality control at 6 regional laboratories. National AMR surveillance guidelines provided to laboratories. Best practices developed for veterinary and environental sectors. More laboratories identified in all 3 sectors. External quality control of ore laboratories. Accreditation and certification process in place. Training for laboratory workers to detect AMR in huan and anial health care and agriculture. Creation of technical guidance for the veterinary and environental sectors. Manageent of input stocks. Manageent of data and outputs (bio-collection, archiving and waste). Standardized AMR detection and surveillance techniques in laboratories in all three sectors. Participation in the global surveillance syste put in place by WHO. 12

21 P.3.2 Surveillance of infections caused by antiicrobial-resistant pathogens - Score 1 No national plan has been approved for the surveillance of infections caused by antiicrobial-resistant pathogens. The sae strengthening actions are needed. Collaborative partnerships between laboratories and clinics ust be put in place at the operational level for the surveillance of infections in both huan and veterinary edicine. A network of 16 public and 11 private laboratories has been identified. of IHR Core Capacities of the Republic of Côte d Ivoire Anti-infective-resistant icroorganiss observatory (ORMICI) is in place. Greater nuber of laboratories nationwide in the areas of public health, veterinary edicine and the environent have been identified and strengthened. Infections caused by pathogens are reported for AMR surveillance. ORMICI has been ade an official institution. Collection of antiicrobial-resistant pathogens. PREVENT Transport of antiicrobial-resistant pathogens. Collection of AMR data. Overview of infections caused by antiicrobial-resistant pathogens (reporting of infections caused by antiicrobial-resistant pathogens, providing inforation about antiicrobial-resistant pathogens to the authorities, health workers, NGOs and the public). Mapping of infections caused by antiicrobial-resistant pathogens. Creation of a database of infections caused by antiicrobial-resistant pathogens. Effective operational collaboration between clinics and laboratories in detecting infections caused by ulti-resistant icrobes. P.3.3 Health-care-associated infection prevention and control prograes - Score 1 No national plan has been approved for health-care-associated infection prevention and control prograes. A nationwide prograe, set within a well-defined institutionalized fraework, ust be put in place and roles and responsibilities ust be designated at the national, interediate and operational levels. National docuentation approved (toolbox, hospital hygiene docuentation and national guidelines on the surveillance and prevention of health-care-associated infections). Organizational structure for infection prevention and control (3 health-care-associated infection control coittees, at Cocody, Yopougon and Treichville University Hospitals). Policy on the prevention and control of health-care-associated infections is being drafted. Training in health-care-associated infection prevention and control provided to 60 people: 30 staff at Cocody University Hospital and 30 staff at Treichville University Hospital. Key docuents exist (see above), to be circulated nationally. 13

22 Joint External Evaluation National training plan developed. More health-care-associated infection control coittees established. Policy docuents and guidelines approved and disseinated nationally. Investigation into national prevalence of health-care-associated infections. Health-care-associated infection control capacities for health facilities to be strengthened. Organizational and adinistrative easures to be put in place at the national, interediate and operational levels to reduce health-care-associated infections nationwide. Monitoring and evaluation. P.3.4 Antiicrobial stewardship activities - Score 1 PREVENT No national plan has been approved for antiicrobial stewardship activities. A national antiicrobial stewardship plan needs to be drafted and ipleented based on the tool proposed by WHO, which countries can use and adapt as needed. National survey on cotrioxazole has been carried out. National survey on antiicrobial use is in developent. AMR surveillance carried out by the ORMICI. National prograe of regular surveys into the use of antiicrobials in all three sectors is in place. Consensus conferences are held on treatent regiens. ORMICI coordinates AMR stewardship activities. National action plan to be put in place using the WHO tool. Awareness-raising aong health professionals and the population regarding the judicious use of antiicrobials in all three sectors. Workforce developent in support of prograes prooting the proper use of antibiotics. 14

23 Zoonotic diseases Introduction Zoonotic diseases are counicable diseases and icrobes spreading between anials and huans. These diseases are caused by bacteria, viruses, parasites, and fungi that are carried by anials and insect or inaniate vectors ay be needed to transfer the icrobe. Approxiately 75% of recently eerging infectious diseases affecting huans are of anial origin; approxiately 60% of all huan pathogens are zoonotic. of IHR Core Capacities of the Republic of Côte d Ivoire Target Adopted easured behaviours, policies and/or practices that iniize the transission of zoonotic diseases fro anials into huan populations. Côte d Ivoire level of capabilities PREVENT Côte d Ivoire has bodies responsible for zoonotic disease surveillance (the Ministry of Anial Resources and Fisheries, the Ministry of Water and Forests and the Ministry of Health and Public Hygiene), each of which carries out surveillance activities independently. However, when epideics occur, an interinisterial coittee is established to develop and ipleent an integrated epideic control plan. Côte d Ivoire has a list of zoonotic diseases under surveillance (anthrax, salonella, rabies, highly pathogenic avian influenza, bovine/huan tuberculosis, Ebola fever disease, brucellosis, echinococcosis, cysticercosis and Rift Valley fever). There is also a sall core group of trained professionals and copetent laboratories working in both huan and anial health. The country does not have an official One Health policy, but initiatives are under way to establish an integrated zoonotic disease control echanis. Recoendations for priority actions Establish a unified and integrated national plan for preventing and controlling priority zoonotic diseases. Establish foral ties for inforation-sharing that link technical partners (the three inistries listed above) with public health and veterinary laboratories. Increase country-wide coverage in ters of the anial health workforce, including private veterinarians. Indicators and scores P.4.1 Surveillance systes are in place for priority zoonotic diseases/pathogens - Score 3 Surveillance systes are in place for 1-4 zoonotic diseases/pathogens posing the greatest national public health threat. Surveillance syste for anial diseases (including zoonotic diseases) since 2001, for huan health and wildlife. Successful anageent of an avian influenza (A(H5N1)) epideic in 2006; 2016 epideic is under control. At the tie of writing, proactive prevention efforts have kept the country free of Ebola virus disease. 15

24 Joint External Evaluation Integration of anial, huan and wildlife surveillance systes. Use of the risk-analysis tool. Systeatic inforation-sharing between the anial, huan and wildlife sectors. Zoonotic disease prevention and control plan to be ipleented. Material, technical and financial capacity-building for stakeholders. P.4.2 Veterinary or anial health workforce - Score 3 Côte d Ivoire has an anial health workforce as part of its national public health-care syste but in less than half of lower-level systes within the country. PREVENT Public and private veterinarians and technical support staff (engineers, assistants and instructors). Joint field epideiology training prograe (FETP, 2016) for physicians and veterinarians. Insufficient workforce at the central and departental levels. Few veterinarians trained in field epideiology. Qualified workforce is too sall to cover the entire country. P.4.3 Mechaniss for responding to infectious and potential zoonotic diseases are established and functional - Score 2 A zoonotic disease response policy/strategy/national plan is in place. Prevention and control plans are in place for rabies, anthrax, highly pathogenic avian influenza and Ebola virus disease. National coittees and zoonotic disease control plans are in place in case of an epideic of highly pathogenic avian influenza or Ebola virus disease. Insufficient coordination (no joint issions) between structures involved in response operations. No effective echanis for rapid inforation-sharing between sectors and counication with the population. Response ties are soeties slow (seven days on average, including laboratory confiration). Intersectoral collaboration is weak. 16

25 Food safety Introduction Foodborne and waterborne diarrhoeal diseases are the priary cause of orbidity and ortality, particularly in less developed countries. The rapid globalization of food production and trade has increased the potential likelihood of international incidents involving containated food. The identification of the source of an outbreak and its containent is critical for control. Risk anageent capacity with regard to control throughout the food chain continuu ust be developed. If epideiological analysis identifies food as the source of an event, based on a risk assessent, suitable risk anageent options that ensure the prevention of huan cases (or further cases) need to be put in place. of IHR Core Capacities of the Republic of Côte d Ivoire Target States Parties should have surveillance and response capacity for foodborne and waterborne diseases risk or events. This requires effective counication and collaboration aong the sectors responsible for food safety and safe water and sanitation. PREVENT Côte d Ivoire level of capabilities Côte d Ivoire has national food safety standards and is part of the International Food Safety Authorities Network (INFOSAN) and Codex Alientarius. But there is insufficient coordination (no joint issions) between the various bodies involved in anaging crises, and response activities are not evaluated after they have been carried out. The following stakeholders play specific roles: The Ministry of Health and Public Hygiene ipleents nutrition policies. The Ministry of Agriculture ipleents inspection policies for agricultural production. The Ministry of Anial Resources and Fisheries Office of Veterinary Services ipleents inspection policies for anial or anial-origin foodstuffs. The Ministry of the Environent ipleents inspection policies for bodies of water and species used for agriculture. Recoendations for priority actions Speed up finalization and approval of the ultisectoral food safety anageent syste. Strengthen the echanis for inforation-sharing during foodborne illness outbreaks. Make funding available for joint issions and strengthen technical, logistical and financial capacities. Indicators and scores P.5.1 Mechaniss are established and functioning for detecting and responding to foodborne disease and food containation - Score 2 National standards are in place. Mebership in INFOSAN, Codex Alientarius and the OIE Aquatic Anial Health Code and Terrestrial Anial Health Code. 17