WHO benchmarks

for strengthening
health emergency
capacities
WHO benchmarks
for strengthening
health emergency
capacities
 2

WHO benchmarks for strengthening health emergency capacities

This publication is the update of the document published in 2019 under the following title -“WHO benchmarks
for International Health Regulations (‎IHR)‎capacities”.

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WHO benchmarks for strengthening health emergency capacities

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Contents

Acronyms 5 Benchmarks: technical areas 24

1. Legal instruments 25

Acknowledgements 8 2. Financing 39

3. IHR coordination, national IHR focal point 46

functions and advocacy

Introduction 11
4. Antimicrobial resistance 58

What is the benchmark tool? 11

5. Zoonotic diseases 77

Purpose of the benchmark tool 12

6. Food safety 90

Who is the audience? 13

7. Immunization 100

Structure of the tool 13

8. Biosafety and biosecurity 112

When to use the benchmark tool? 13

9. National laboratory system 120

How to use the benchmark tool? 14

10. Surveillance 137

Benchmarks online portal 17

11. Human resources 152

Building systems using the benchmarks 17

12. Health emergency management 167

What is the tool about? 18

Health emergency management additional 192

What is the tool not about? 18 benchmarks

Updating process of the benchmark tool 18 13. Linking public health and security authorities 205

Content updates 19 14. Health services provision 210

15. Infection prevention and control 221

Continuous updating and improvement of the 23

tool
16. Risk communication, community engagement 234
& infodemic management

WHO benchmarks for strengthening health emergency capacities

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Risk communication, community engagement 251 Annex 1: Glossary 357

& infodemic management additional

benchmarks

Annex 2: Mapping of benchmarks to 364

17. Points of entry and border health 261
JEE/SPAR and HEPR

18. Chemical events 275

19. Radiation emergencies 281 Annex 3: Summary of changes from 385

WHO benchmarks for international
20. Public health and social measures 286 health regulations (IHR)
capacities (2019)
21. Additional benchmarks for health emergency 291

capacities beyond IHR

Annex 4: Declaration of interests from 397

WHO experts at the global consultative
meeting, March 13-15 2023

WHO benchmarks for strengthening health emergency capacities

 5

Acronyms

AAR After action review

AEFI Adverse event following immunization

AMC Antimicrobial consumption

AMR Antimicrobial resistance

AMS Antimicrobial stewardship

AMU Antimicrobial use

AST Antibiotic susceptibility testing

BTWC Biological and Toxin Weapons Convention

CBO Community based organization

CHV Community health volunteer

CHW Community health worker

CPE Continuing professional education

CSO Civil society organization

DRR Disaster risk reduction

EBS Event-based surveillance

EDRM Emergency and disaster risk management

EHS Essential health services

EMT Emergency medical team

EOC Emergency operations centre

EPHF Essential public health functions

EWAR Early warning alert and response

FAO Food and Agriculture Organization of the United Nations

FETP Field epidemiological training program

FETPV Field epidemiological training program for veterinarians

GLASS Global Antimicrobial Resistance Surveillance System

GOARN Global Outbreak Alert and Response Network

HCAI Health care acquired infection

HEPR Health emergency prevention, preparedness, response and resilience

HSP Hospital Safety Programme

WHO benchmarks for strengthening health emergency capacities

 6

IAEA International Atomic Energy Agency

IAR Intra-action review

IBS Indicator-based surveillance

IHR International Health Regulations

IHR MEF International Health Regulations Monitoring & Evaluation Framework

IM Incident management

IMS Incident management system

InFARM FAO Antimicrobial resistance monitoring

INFOSAN International Food Safety Authorities Network

INTERPOL International Criminal Police Organization

IPC Infection prevention and control

IPCAF Infection prevention and control assessment framework

IPCAT Infection prevention and control assessment tool

ISO International Organization for Standardization

IT Information technology

JEE Joint external evaluation

LIMS Laboratory information management system

M&E Monitoring and evaluation

MCV1 Measles-containing-vaccine first-dose

MDRO Multidrug resistant organism

MEF Monitoring and evaluation framework

MHPSS Mental health and psychosocial support

MoU Memorandum of understanding

NAP National action plan

NAPHS National action plan for health security

NCC National coordinating centre

NFP National focal point

NGO Nongovernmental organization

OPCW Organisation for the Prohibition of Chemical Weapons

PFM Public financing mechanism

PHC Primary health care

PHEIC Public health emergency of international concern

PHEOC Public health emergency operations centre

PHSM Public health and social measures

WHO benchmarks for strengthening health emergency capacities

 7

POCT Point of care testing

PoE Points of entry

PPE Personal protective equipment

PRET Preparedness and Resilience for Emerging Threats

PVS Performance of Veterinary Services

R&D Research and development

RCCE Risk communication and community engagement

RD&I Research, development and innovation

RRA Rapid risk assessment

RRT Rapid response team

SimEx Simulation exercises

SOP Standard operating procedure

SPAR IHR State Party self-assessment annual reporting tool

STAR Strategic tool for assessing risk

ToR Terms of reference

TrACSS Tripartite AMR Country Self-Assessment Survey

UHC Universal health coverage

VPD Vaccine-preventable disease

WAHIS WOAH-World Animal Health Information System

WASH Water, sanitation and hygiene

WASH FIT Water and sanitation for health facility improvement tool

WHA World Health Assembly

WHO World Health Organization

WOAH World Organisation for Animal Health (previously OIE)

WHO benchmarks for strengthening health emergency capacities

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Acknowledgements
The World Health Organization (WHO) would like to express its sincere gratitude to all those who contributed
to the development of the WHO Benchmarks for Strengthening Health Emergency Capacities. The WHO
Health Security Preparedness Department developed this tool to support States Parties, partners, academia
and WHO regional and country offices.

Thank you to our colleagues at WHO Headquarters who provided valuable input, review and expert
consultations: Mohamed Refaat Abdelfattah, Philip Abdelmalik, Onyema Ajuebor, Oluwatosin Akand, April
Baller, Benedetta Allegranzi, Farah Al-Shorbaji, Brett Archer, Anand Balachandran, Valentina Baltag, Sara
Barragan Montes, Helene Barroy, Uzma Bashir, Yolanda Bayugo, Isabel Bergeri, Silvia Bertagnolio, Eric Gerard
Bertherat, Supriya Bezbaruah, Kingsley Bieh, Lucy Boulanger, Nienke Bruinsma, James Campbell, Zhanat
Carr, Lisa Carter, Ofelia Cazaku, Denis Charles, Musse Chekol, Sean Cockerham, Sebastien Bruno Francois
Cognat, Giorgio Cometto, Frederik Anton Copper, Peter Cowley, Miranda Deeves, Stéphane De La Rocque
De Severac, Khassoum Diallo, Zlatina Dobreva, Jicui Dong, Erin Downey, Rachelle El Khoury, Sergey Eremin,
Siobhan Fitzpatrick, Melinda Frost, Lester Sam Geroy, Nina Gobat, Shoshanna Goldin, Fernando Gonzalez-
Martin, Brandon Gray, Michael Griffin, Christine Guillard, Fahmy Hanna, Sarah Hess, Vicky Houssiere, Kai-
Hsun Hsiao, Qudsia Huda, Verica Ivanoska, Nellie Kartoglu, Mika Kawano, Suzanne Kerba, Kazunobu Kojima,
Monika Kosinska, Ljubica Latinovic, Hannah Lewis, Jian Li, Glenn Lolong, Ramona Ludolph, Catherine
Makison Booth, Constance McDonough-Thaye, Yuki Minato, Andrew Mirelman, Ryoko Miyazaki-Krause, Paul
Molinaro, Madison Moon, Simone Moraes Raszl, Thomas Moran, Deusdedit Mubangizi, Arno Muller, Tapas
Nair, Tim Nguyen, Lesley Jayne Onyan, Ponnu Padiyara, Narayan Pal Shanthi, Sarah Paulin-Deschenaux,
Boris Pavlin, Devin Perkins, Emilie Peron, Carmen Pessoa da Silva, Camila Philbert Lajolo, Rogerio Paulo Pinto
De Sa Gaspar, Pravarscha Prakash, Ong-orn Prasarnphanich, Tina Purnat, Guillaume Queyras, Pryanka Relan,
Mauricio Reynaud, Kwang Rim, Clara Rodriguez Ribas, Paul Rogers, Diana Rojas Alvarez, Sohel Saikat, Flavio
Salio, Gina Samaan, Karl Schenkel, Lisa Scheuermann, Redda Seifeldin, Dubravka Selenic Minet, Rajesh
Shreedharan, Katja Siling, Hiiti Baran Sillo, Sudhvir Singh, Susan Sparkes, Romina Stelter, Lisa Stevens,
Sameera Suri, Ludy Prapancha Suryantoro, Rayoko Takahashi, Barnas Thamrin, Joao Toledo, Anthony
Twyman, Nosheen Usman, Nicole Valentine, Mark Van Ommeren, Liviu Vedrasco, Kai Von Harbou, Ninglan
Wang, Kathleen (Taylor) Warren, Niluka Wijekoon Kannangarage, Victoria Willet, Jun Xing, Yu Zang and Rica
Zinskey.

A special thank you to colleagues at WHO regional offices who provided valuable insight, review and expert
perspectives: Ali Abdullah, Jehan Al-Badri, Ali Ardalan, Gertrude Avortri, Tara Rose Aynsley, Celso Bambaren,
Deborah Barasa, Joyrine Biromumaiso, Philippe Borremans, Nilesh Buddha, Emma Callon, Alex Camacho,
Astrid Chojnacki, Jennifer Collins, Ana Paula Coutinho Rehse, Ibadat Dhillon, Senait Tekeste Fekadu, Mahgoub
Hamid, Peggy Hanna, Iman Heweidy, Genevieve Howse, Masaya Kato, Aminata Grace Kobie, Benjamin Kung,
Jan-Erik Larsen, Zhao Li, Allan Mpairwe, Miriam Nanzunia, Julienne Ngoundoung Anoko, Phuong Nam
Nguyen, Leonardo Palumbo, Ihor Perehinets, Jetri Regmi, Cristiana Salvi, Dalia Samhouri, Reuben Samuel,

WHO benchmarks for strengthening health emergency capacities

 9

Tanja Schmidt, Sandip Shinde, Aparna Singh Shah and Roland Wango. A special thank you to representatives
of WHO Member States who provided input: Jantsansengee Baigalmaa (Mongolia), Chuman Lal Das Kebrat
(Nepal), Muhammad Salman (Pakistan), Ratsamy Vongkhamsao (Lao People’s Democratic Republic).

A sincere thank you to our partners, including international organizations and academia for their time and the
particular inputs of: Mario Ignacio Alguerno (World Organization for Animal Health (WOAH)), Susan Amoaten
(United Kingdom Health Security Agency (UKHSA)), Hellen Amuguni (Tufts University), Cedric Aperce (Resolve
to Save Lives (RTSL)), Ombretta Baggio (International Federation of the Red Cross (IFRC)), Sulzhan Bali (World
Bank), Nicholas Brook (UKHSA), Sydney Morgan Brown (United States Centres for Disease Control (US-CDC)),
Gina Chen (UKHSA), Haydn Cole (UKHSA), Michael Coninx (US-CDC), Duncan Cox (UKHSA), Sheena De Silva
(The Caribbean Public Health Agency (CARPHA)), Raquel Duarte-Davidson (UKHSA), Gwendolen Eamer
(IFRC), Rania Elessawi (United Nations International Children’s Emergency Fund (UNICEF)), Sarah Emami
(RTSL), Tina Endericks (UKHSA), Annie-May Gibb (UKHSA), Rachel Goodermote (IFRC), Lydia Izon-Cooper
(UKHSA), Humberto Jaime (UNICEF), Mariam Kone (IFRC), Jennifer Lasley (WOAH), Christopher Lee (RTSL),
David Lowrance (The Global Fund), Rachel Amy MacLeod (IFRC), Silvia Magnoni (IFRC), Mike Mahar (US-
CDC), Amanda McClelland (RTSL), Maureen McKenna (IFRC), Virginia Murray (UKHSA), Rohini Pande (World
Bank), Julio Pinto (Food and Agriculture Organization of the United Nations), Monica Posada (IFRC), Maria
Consorcia Quizon (SafetyNet), Wbeimar Sanchez (IFRC), Maya Schaerer (IFRC), Muhammad Shafique (IFRC),
Jane Shallcross (UKHSA), Charles Turner (UKHSA), Madeline Tyre (Health Canada), Julie Wahl (RTSL) and
Peter Williams (CARPHA).

We would also like to extend gratitude to the members of the World Health Organization Strategic & Technical
Advisory Group on Infectious Hazards with Pandemic and Epidemic Potential as well as the members of the
World Health Organization Informal Technical Working Group for Health Security Preparedness Research,
Development and Innovation.

The tool was developed and finalized by the Evidence and Analytics for Health Security Unit, in particular
by Priyanga Ranasinghe, Rebecca Gribble, Luc Tsachoua Choupe, Marc Ho, Guna Nidhi Sharma, Lina Yu,
Barbara Burmen, Cynthia Bell, Luca Vernaccini, Lorcan Clarke, Robert Nguni, under the supervision of Nirmal
Kandel and the leadership of Stella Chungong, Scott Pendergast and Mike Ryan. The tool was edited by
Sanjana Ravi and administrative support was provided by Cecile Vella.

WHO benchmarks for strengthening health emergency capacities

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WHO benchmarks for strengthening health emergency capacities

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Introduction
What is the benchmark tool? emergency prevention, preparedness, response and
resilience2 (HEPR) capacities and the Preparedness
Benchmarking is a strategic process often used by
and Resilience for Emerging Threats (PRET)3
businesses and institutes to standardize performance
initiative. The benchmarks support implementation
in relation to the best practices of their sector. The
of IHR and HEPR capacities and are broad in nature
World Health Organization (WHO) and partners
to improve health security and integrate multisectoral
have developed a tool with a list of benchmarks and
actions at national and subnational levels, where
corresponding suggested actions that can be applied
appropriate. The benchmark actions are designed
to implement the International Health Regulations
to provide guidance for capacity development to
2005 (IHR) and strengthen health emergency
move up capacity levels as measured by the IHR
prevention, preparedness, response and resilience
MEF, including voluntary external evaluation such
capacities. The first edition of the benchmarks was
as the Joint External Evaluation (JEE) tool4 and the
published in 2019 to support countries in developing,
States Parties Self-assessment annual reporting
implementing and documenting progress of national
tool5 (SPAR). Other assessment tools including the
IHR or health security plans (e.g. national action
Performance of Veterinary Services (PVS) Pathway
plan for health security (NAPHS), national action
(from the World Organisation for Animal Health
plan for emerging infectious diseases, public health
(WOAH)), the Dynamic Preparedness Metric6 (DPM),
emergencies and health security1 and other country-
Universal Health and Preparedness Review (UHPR)
level plans for health emergencies). The tool has been
and readiness assessments can also measure
updated to incorporate lessons from COVID-19 and
improvements in capacity, with the ultimate goal to
other health emergencies, to align with the updated
sustain an optimal level of prevention, preparedness,
IHR monitoring & evaluation framework (IHR MEF)
response and resilience for health emergencies in
tools and the health systems for health security
the country.
framework, and to support strengthening health

1
World Health Organization. 2019. Documenting progress following the Joint External Evaluation (JEE) and implementation of
the national plan for emerging infectious diseases (EID), public health emergencies (PHE) and health security in Loa People’s
Democratic Republic Mission Report: 04-08 February 2019. https://cdn.who.int/media/docs/default-source/health-security-
preparedness/ehs/lao-pdr-mission-report.pdf?sfvrsn=4c81f642_5&download=true
2
World Health Organization. 2023. Strengthening the global architecture for health emergency prevention, preparedness, response
and resilience https://www.who.int/publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--
preparedness--response-and-resilience
3
World Health Organization. Preparedness and resilience for emerging threats (PRET). https://www.who.int/initiatives/preparedness-
and-resilience-for-emerging-threats
4
World Health Organization. 2022. International Health Regulations (2005) Joint External Evaluation Tool third edition. https://www.
who.int/publications/i/item/9789240051980
5
World Health Organization. 2021. International Health Regulations (2005): State Party Self-assessment annual reporting tool, second
edition. https://www.who.int/publications/i/item/9789240040120
6
World Health Organization. 2023. Dynamic Preparedness Metric. https://extranet.who.int/sph/dpm

WHO benchmarks for strengthening health emergency capacities

 12

Purpose of the benchmark tool MEF, DPM, UHPR and other assessment tools. The
benchmarks can help countries delineate relevant
This document guides States Parties, partners,
steps to take to improve capacity in each technical
donors, international and national organizations,
area and document progress. The benchmarks are
and other stakeholders on suggested actions
organized around five levels of capacity, from no
to improve IHR and HEPR capacities for health
capacity to sustainable capacity, mirroring the IHR
emergencies. States Parties and other entities
MEF structure. The suggested actions at each level
working to reduce the risk of global health threats
provide guidance to build the capacity needed to
can use the benchmarks and suggested actions in
move up levels, starting at a country’s current level
their national planning and investment processes to
and working up to reach level five.
address gaps, including those identified by the IHR

IHR MEF tools

The IHR MEF provides a framework and a process by which States Parties can monitor and evaluate
the implementation of IHR capacities in accordance with the IHR. It consists of multiple components:
mandatory annual reporting (SPAR) and voluntary external evaluations such as the JEE as well as
after action reviews (AAR), intra-action reviews (IAR) and simulation exercises (SimEx).

HEPR
The HEPR framework encompasses proposals and ongoing efforts related to governance, financing
and systems based on the lessons learned from the COVID-19 pandemic and other emergencies and
more than 300 recommendations from various independent reviews. HEPR explores core capacities
across five interconnected health emergency subsystems referred to as the “five Cs” that sit at the
intersection of health security, primary health care and health promotion: collaborative surveillance,
community protection, safe and scalable care, access to medical countermeasures and emergency
coordination. The five interlinked systems encompass and complement all core capacities required
by the IHR (2005), and require a multi-sectoral, One Health and whole-of-government approach.

WHO benchmarks for strengthening health emergency capacities

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Who is the audience?

For the propose of this document the following
The main audiences for this benchmark document
definitions are used:
are:

Benchmark
z States Parties to the IHR, to suggest
Denotes a standard or point of reference for
activities for IHR and HEPR implementation
the capacity. Setting benchmarks facilitates
and any other strategic plans relevant to
the development of plans to increase capacity
ensure prevention, preparedness, readiness
levels (limited, developed, demonstrated and
and resilience for health emergencies.
sustainable) and the adoption of best practices
z Health agencies, civil society and
with a target of reaching sustainable capacity
specialized organizations at local,
for each benchmark.
subnational, national, regional and global
levels, to identify priorities for strengthening
capacity and support the implementation Action
of strategic plans. Denotes a set of activities in each capacity
z Researchers and academics for level of the benchmark. These actions define
the development and conduction of the steps that may be taken to progress up
implementation and operational studies to levels for the given benchmark.
generate scientific evidence for innovative
solutions to address health emergency
capacity gaps and to promote training and Structure of the tool
education programs.
The tool covers all IHR capacities and all HEPR
z Development partners, non-governmental
capabilities/capacities. This includes the 15 IHR
organizations (NGOs) and other donors,
capacities covered in SPAR (2021), the 19 technical
who can use the benchmarks to guide
areas in the JEE (2022), and the HEPR five Cs. The
funding and technical support for country
actions provided in the tool reflect an amalgam
assistance and ensure alignment with
of attributes of both JEE, SPAR indicators and
evolving needs, and to provide objective
HEPR capacities, with technical areas arranged to
milestones to help guide and determine the
reflect the IHR MEF. The tool contains a total of 80
effectiveness of assistance.
benchmarks, 62 strengthening both IHR and HEPR
z All national sectors and stakeholders who
capacities with an additional 18 focusing on HEPR
are involved in activities to strengthen health
capacities beyond IHR.
emergency prevention, preparedness,
response and resilience.
z WHO country and regional offices, to be When to use the benchmark tool?
able to prioritize assistance.
The tool should be used during a country’s planning
z Other stakeholders with interest in national
process (such as national health plans, strategies
and global improvements in health security.
and policies (NHPSP), NAPHS, hazard-focused plans,
diseases specific plans, etc.) when a multisectoral
and multidisciplinary planning team is identifying
and prioritizing activities, when strengthening health

WHO benchmarks for strengthening health emergency capacities

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systems for health security capacities at local,

Using the benchmark tool for country planning subnational, national or global levels, and when
processes strengthening HEPR architecture.

NAPHS/HEPR
Benchmarks complement the NAPHS or HEPR How to use the benchmark tool?
planning process by looking at the current
The benchmarks tool can be utilized through this
level of capacity (based on IHR MEF and other
document and through the Benchmarks online
assessments) within the country and providing
portal7. Both versions of the tool present the same
suggested actions to adapt according to
set of benchmarks and actions. The benchmarks tool
capacity level and country context. These can
facilitates State Party planning through the process
then be used to update or develop plans.
of:
NHPSPs
After performing a situational/gap analysis, Review current
the benchmarks provide suggested actions situational analysis for
STEP

01
which can be adapted to the country’s current priority actions within
capacities and expected targets. These can the selected technical
then be used to update or develop NHPSPs. area

PRET
The PRET initiative recognizes that the same
Review the benchmarks
systems, capacities, knowledge and tools
tool and determine which
can be leveraged and applied for groups of STEP

02
capacity level a country
pathogens based on their mode of transmission
would like to achieve
(e.g. respiratory, vectorborne, foodborne). The
benchmarks online portal provides key actions
for respiratory pathogens (which include
influenza viruses and coronaviruses), which
based on a country’s hazard, vulnerability and
Identify the actions that
capacity, can be used to update or develop a STEP the country needs to
hazard-focused plan.

Disease specific plans

03 establish to achieve the
selected level
The benchmarks online portal provides
suggested actions for specific diseases (e.g.
cholera, Ebola and respiratory pathogens (such Develop a list of activities
as influenza, Middle East respiratory syndrome the country needs to put STEP
(MERS), coronavirus disease (COVID-19))),
which based on a country’s hazards,
in place to achieve each
selected action. 04
vulnerabilities and capacities, can be used to
update or develop disease specific plans.

7
World Health Organization. Strengthening health emergency capacities. https://ihrbenchmark.who.int/

WHO benchmarks for strengthening health emergency capacities

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Each benchmark presents actions across five levels, Please see the table below for an explanation of each
ranging from no capacity to sustainable capacity, benchmark level and example actions within each
as in line with the IHR MEF levels of evaluation. level of capacity.

CAPACITY LEVEL Suggested actions to achieve the capacity level and strengthen prepar-
edness
These suggested standardized actions define the steps which can be taken to
move from one capacity level to the next, depending on country context and
requirements
For example, actions listed in level 3 (developed capacity) are suggested actions
to help achieve level 3 (developed capacity).

01
The country has no core capacity related to the area. Such as no risk assessment,
plan, nor human or financial resources assigned to the area. Or capacities are in
NO CAPACITY development with activities conducted ad hoc.

02
Actions to achieve this level:
Core capacities at level 2 are in the development stage, with implementation
LIMITED started. While some elements of the capacity area may be in place, others are at
CAPACITY the commencement stage. Example actions across technical areas at this level
include:
z Conduct stakeholder mapping and form a national multisectoral committee/
working group to perform subsequent actions
z Conduct analysis, including a review of existing plans and policies relevant to
the area, to identify gaps and needs
z Map existing resources and required needs for implementation in the area

03
Actions to achieve this level:
Core capacities at level 3 are in place at the national level but are not sustainable.
DEVELOPED Example actions across technical areas at this level include:
CAPACITY
z Develop and implement procedures, processes and plans at national level to
support capacity implementation for the area
z Develop and conduct training of relevant staff at the national level
z Establish systems relevant to the area, such as standards, data and
information sharing, deployment mechanisms and networks

WHO benchmarks for strengthening health emergency capacities

 16

04
Actions to achieve this level:
Core capacities at level 4 are in place at the national and subnational level and
DEMONSTRATED are somewhat sustainable through being supported by funding and inclusion in
CAPACITY national plans. Example actions across technical areas at this level include:
z Conduct SimEx/AAR/IAR or other M&E actions (if not already performed at
earlier levels)
z Expansion and adaptation of national-level plans, training actions and
systems to the subnational level
z Securing funding

05
Actions to achieve this level:
Core capacities at level 5 are fully functional and sustainable, reaching the highest
level of achievement of core capacity implementation. Example actions across
SUSTAINABLE
technical areas at this level include:
CAPACITY
z Regular, ongoing improvement of systems and functions based on updates
and integration of results from SimEx/AAR/IAR and other M&E actions
z Achieve long-term sustainability of systems and capacities, including full
funding
z Contributions to capacity development through peer-to-peer learning and
sharing of best practices at subnational, national and international levels

In this tool, actions are presented within each level with a multisectoral approach. Each level contains actions
for IHR implementation and health sector as well as actions which require engagement from other sectors.
This is visually represented in the example table below. The second row in each level lists actions that require
engagement from other sectors alongside additional actions. This listing does not prioritize actions, it serves
as a reference list to support a multisectoral approach.

Capacity level Benchmark actions

01
The country has no core capacity related to the area. Such as no risk assessment,
plan, nor human or financial resources assigned to the area. Or capacities are in
NO CAPACITY development with activities conducted ad hoc.

02
IHR Implementation and Health Sector
z Action 1
LIMITED z Action 2
CAPACITY
z Action 3

Other Sector Engagement

Participation and contribution of other sectors to actions: 1, 2
z Action 4

WHO benchmarks for strengthening health emergency capacities

 17

However, for two benchmarks8 the two rows are Benchmarks online portal
reversed with the top row of each level containing
Countries are able to quickly develop draft national
actions for IHR implementation, animal health and
plans through the Benchmarks online portal9. These
agricultural sectors while the lower row contains
plans are based on the automated input of benchmark
actions which require engagement from human
actions according to available current JEE scores/
health and other sectors.
SPAR scores and the score in which the country
would like to aim to progress towards. The online tool
How to apply the benchmarks takes users through a step-by-step process, is fully
The benchmarks tool provides a list of suggested interactive, and countries can manually adapt the
actions which can then be used at the country-level target levels and actions as needed for the country
to inform the health emergency planning process. context.
This includes determining the activities required to
achieve each suggested action based on country The Benchmarks online portal contains a reference
context. All actions and activities are aimed at library to support application of the benchmarks.
meeting a priority recommendation from previous The library contains downloadable documents (best
assessments or to advance to a higher level in practices, guidelines, tools, training packages) which
capacity implementation, focusing on progressing provide guidance for implementing benchmark
to sustainable capacity (level 5) in the future. For actions by technical area. The library is a living portal
example, an action may be to develop guidelines that is continually being updated and which users
and standard operating procedures (SOPs) relevant can contact through the webpage directly to request
to the technical area; activities which contribute to certain guidance or to share additional references to
this may include forming a working group to develop be included.
such guidelines and SOPs, identifying a focal point
for drafting documents, finalizing the guidelines Building systems using the
and SOPs, developing and implementing training benchmarks
packages to increase awareness and facilitate roll
The collective and coordinated actions described in
out.
the benchmarks contribute to the country’s health
systems for health security. These benchmark actions
While benchmark actions are primarily used to
support the strengthening of health system capacity
support the planning process for IHR and HEPR
for health emergency prevention, preparedness,
implementation, they may additionally be used
response and resilience. These benchmark actions
to help develop priority recommendations during
serve five purposes in strengthening the system:
evaluations and reviews (such as a JEE) or to help
track incremental progress made from one capacity
z Allow for a definition of desirable attributes
level to the next.
– what actions are required for prevention,

8
Benchmark 4.5 in AMR (Optimize use of antimicrobial medicines in animal health and agriculture) and benchmark 5.3 in Zoonotic
diseases (Safe practices in animal breeding and animal product systems limit the risk of zoonotic diseases).
9
World Health Organization. Strengthening health emergency capacities. https://ihrbenchmark.who.int/

WHO benchmarks for strengthening health emergency capacities

 18

preparedness, response and resilience at prevention, preparedness, response and

each level of the benchmark. resilience at local, subnational, national
z Provide a way of defining health emergency and global levels.
priorities for countries, development z Offering recommendations informed by
partners and WHO. technical experts.
z Provide a useful way of clarifying z A starting point for development of
essential actions that require a more evidence-based strategic plans/programs
integrated response and recognize the for health emergency prevention,
interdependence of each action of the preparedness, response and resilience.
benchmarks.
z Suggest actions that require the support of
What is the tool not about?
multiple sectors.
z Support the optimal implementation of z A list of mandatory activities.
activities based on whole-of-society, z Completely applicable to every context.
whole-of-government and multilevel z An exhaustive list of actions/
approaches to strengthen overall IHR recommendations.
and HEPR capacities at national and z Comparing country capacity levels.
subnational levels.

Updating process of the benchmark

What is the tool about? tool
z A list of benchmarks that are required Updating the benchmarks tool took place between
to sustain capacities to support IHR August 2020 and September 2023, through
implementation, effective prevention, multiple rounds of expert consultation from States
preparedness, response and resilience, Parties, WHO regional and country offices, WHO
and overall management of health headquarters, partner agencies and technical
emergencies. experts with experience using the first edition of the
z A list of suggested actions that can increase benchmarks. The process followed four phases:
capacities for IHR implementation and

WHO benchmarks for strengthening health emergency capacities

 19

PHASE PHASE PHASE PHASE

01 02 03 04
z August 2020 to z March 2022 to z March 2023 to z May 2023 to
February 2022 March 2023 May 2023 September 2023
z Wide online z Ongoing extensive z In person global z Development
consultation consultation consultation of additional
across all levels of across WHO and meeting to finalize benchmarks for
WHO and partners partners draft. HEPR technical
z Map and z Update draft to z Incorporate areas
incorporate align with updated suggestions from
lessons learned IHR MEF, HSforHS, the global meeting
from COVID-19 HEPR z Finalization of
z Further document with all
Incorporate relevant technical
recommendations focal points
from COVID19
and other
recent health
emergencies,
novel initiatives
and new
health security
frameworks
z Added new
benchmarks
and updated all
actions

Content updates health security frameworks, IHR capacities

as per the third edition of the JEE (2022) and
z All benchmarks and all actions were
the second edition of the SPAR (2021), and
updated to incorporate lessons learned
HEPR. While the majority of benchmarks
from recent health emergencies.
strengthen both IHR and HEPR capacities,
z New benchmarks were added to this
additional benchmarks that focus on HEPR
edition, based upon alignment with current
capacities beyond IHR were added.

WHO benchmarks for strengthening health emergency capacities

 20

Technical area New benchmark

Alignment with JEE/SPAR

Legal instruments 1.2 Gender equity and equality principles are applied throughout IHR
capacities

IHR coordination, 3.3 Strategic planning for IHR, preparedness or health security are in
national IHR focal point place and supported by functional advocacy mechanisms for IHR
functions and advocacy implementation

Antimicrobial 4.3 Effective mechanisms are in place to prevent multidrug resistant

resistance organisms (MDRO)
4.5 Optimize use of antimicrobial medicines in animal health and
agriculture

Zoonotic diseases 5.3 Safe practices in animal breeding and animal product systems
limit the risk of zoonotic diseases

Immunization 7.3 An effective mechanism for mass vaccination for epidemics of

vaccine preventable disease (VPD) is in place

Surveillance 10.2 Well functioning event verification and investigation systems are
in place

Human resources 11.4 Multisectoral workforce surge strategy for health emergencies is
well established and functional

Health emergency 12A.1 Effective risk profiling, readiness assessment and rapid risk
management assessment (RRA) processes are in place and strongly linked
to health emergency and disaster management plans and
structures
12A.6 Research, development and innovation (RD&I) capacity for
emergency management is in place

Health services 14.2 Mechanism for continuity of essential health services (EHS)
provision during a health emergency is well established
14.3 Mechanism is in place to ensure effective utilization of health
services before, during and after health emergencies at all levels
of health service delivery

Infection prevention 15.1 National and health facility level infection prevention and control
and control (IPC) programmes are in place
15.2 A functional healthcare acquired infection (HCAI) surveillance
system is in place for public health decision-making
15.3 Provide a safe environment in all healthcare facilities

WHO benchmarks for strengthening health emergency capacities

 21

Risk communication, 16B.1 Community engagement is integrated and prioritized within the
community management of health emergencies and unusual events
engagement and
infodemic management

Points of entry and 17.3 An effective multisectoral mechanism for risk-based approach to
border health international travel related measures is in place

New technical areas

Public health and social 20.1 Leadership and governance dedicated to public health and social
measures measures (PHSM) is in place in relevant sectors, at all levels and
between levels

Additional benchmarks

Health emergency 12B.1 All hazard health emergency and disaster risk management
management (EDRM) are mainstreamed across IHR capacities
12B.2 Safe and resilient hospitals and health facilities are in place to
rapidly respond to emergencies

Risk communication, 16B.2 Inclusive community centred governance and management of

community health emergencies is in place
engagement and 16B.3 Capacity-building mechanisms for multisectoral community
infodemic management health workforce and community engagement in the
management of health emergencies and resilience building are
well established
16C.1 An infodemic management system for health emergencies and
unusual events is in place

Alignment with HEPR (additional benchmarks for health emergency capacities beyond IHR)

Collaborative H1.1 A resilient monitoring system is established and fully functional

surveillance to routinely monitor the key metrics of health service availability,
capacity, access and usage

H1.2 Genomic surveillance systems are in place and functional

H1.3 Integrated, interoperable and standardized data systems and

data sharing platforms are established and functional

H1.4 Integrated networks are created and functional to support

surveillance information sharing and collaboration

WHO benchmarks for strengthening health emergency capacities

 22

Community protection H2.1 Integrated vector control management systems are in place

H2.2 Community-driven water, sanitation and hygiene (WASH)

interventions are in place and effective

H2.3 Social welfare and protection systems are expanded and health
emergency specific mechanisms are implemented

H2.4 Resilient food production and distribution systems are functional

to ensure food security during health emergencies

H2.5 The protection of livelihoods, business continuity and continuity

of education and learning systems is in place and functional
during health emergencies

H2.6 Strategic scaling of community health services and mental

health and psychosocial support (MHPSS) are in place for health
emergencies

Access to H4.1 Standardized platforms for conducting equitable and scalable

countermeasures clinical trials are created and functional

H4.2 Regulatory and legal frameworks are developed and functional

for timely trials, product review and approval

H4.3 Adaptable manufacturing platforms are established and

functional, and supported by prenegotiated agreements

H4.4 Manufacturing capabilities are enhanced through ever-ready

capabilities for rapid mobilization of medical countermeasure
production during health emergencies

H4.5 National regulatory frameworks for manufacturing platforms are

developed and implemented for health emergencies

H4.6 Coordinated demand aggregation systems are established and

operational

H4.7 Equitable and transparent needs-based allocation frameworks

are in place for medical countermeasures during health
emergencies

Emergency H5.1 Operational support and logistics platforms are established and
coordination functional for health emergencies

z Actions for foundational health system elements and other sector contributions were added for
each benchmark.

WHO benchmarks for strengthening health emergency capacities

 23

Continuous updating and from users around the world who want to share their
implementation experience. Following versions of
improvement of the tool
the benchmarks tool will be updated based on these
The development of the benchmarks tool follows a contributions, keeping up to date with the IHR MEF
process of continuous improvement. We will continue framework, ongoing lessons learned from health
to receive comments and suggestions on the tool emergencies, IHR and HEPR implementation.

WHO benchmarks for strengthening health emergency capacities

 24

technical areas
Benchmarks:

WHO benchmarks for strengthening health emergency capacities

 01
Legal instruments
Legal instruments:
Adequate legal instruments for States Parties to support and enable the implementation of all their obligations and rights created by the International Health
Regulations (2005) (IHR). The development of new or modified legal instruments in some States Parties for the implementation of the Regulations. Where
new or revised legal instruments may not be specifically required under a State Party’s legal system, the State may revise some laws, regulations or other
legal instruments in order to facilitate their implementation in a more efficient, effective or beneficial manner.

IMPACT:
Legal instruments are in place in all relevant sectors to support IHR implementation including core capacity development and maintenance.

MONITORING AND EVALUATION:

Current legal instruments including constitutions, laws, arrêtés, decrees, regulations, administrative requirements or other government instruments
are proven to adequately support IHR implementation across relevant sectors.

GENDER:
All persons irrespective of their gender identity (men, women and gender diverse people), should have equal and equitable access to service delivery during

WHO benchmarks for strengthening health emergency capacities

health emergencies, support and protection to effectively conduct their work as part of the workforce responding to health emergencies, and protection from
marginalization and stigmatization during health emergencies, among others. This needs to be supported by adequate systems that incorporate a gender-
responsive approach, including through the identification of relevant data that can inform gender-specific vulnerabilities, risks and coping capacities. This
data can in turn inform the design of appropriate strategies to increase resilience throughout health emergency preparedness, response and recovery cycles.
The integration of gender analysis within systematic assessments conducted across relevant sectors can help identify key opportunities and challenges that
strengthen health emergency preparedness, response, recovery and IHR implementation10. The identified priority gender gaps11 should be addressed with
25

sustainable strategies and integrated through multisectoral action across all IHR capacities.
 IMPACT:
Gender informs the design of health emergency preparedness, response and recovery legal instruments, frameworks and strategies, resulting in
equal and equitable access to health services, information and protection mechanisms for health security. Moreover, the integration of gender-
responsive approaches into health emergency preparedness, response and recovery will help achieve gender parity and gender equality in the
workplace, balance representation in leadership and decision-making roles (particularly increasing representation of women), and help ensure
decent working conditions for all.

MONITORING AND EVALUATION:

Gender equity and equality is integrated in relevant sectors involved in IHR implementation and in response to all health threats and emergencies.

WHO benchmarks for strengthening health emergency capacities

10
Gender mainstreaming for health managers: a practical approach provides a number of tools that can be used to conduct gender assessments across sectors. These assessments provide
valuable information about the variations in risk, exposure and vulnerability of population groups based on their access to and control of resources, such as information, health services and
other areas relevant to health security. This information, in turn, should inform the design and implementation of IHR capacity strengthening strategies, to ensure they are adequately tailored
to reduce risks, vulnerability and exposure across population groups. Note: An updated version of the manual will become available in 2023.
11
High priority gender gaps refer to sex and gender gaps that are assessed to (i) inhibit implementation effectiveness, (ii) potentially affect a large proportion of the population of the
disadvantaged sex and (iii) act as a constraint to effective and full preparedness and response that the entire population can access. Based on the gender analysis conducted, each country
will determine which elements of gender inequalities are high priority, with consideration given to the differences in sociocultural contexts and gender norms between countries.
26
 BENCHMARK 1.1: Legal instruments are in place across relevant sectors to support and enable International Health Regulations (2005) (IHR)
implementation and compliance
OBJECTIVE: To document and review legal instruments to identify gaps across relevant sectors and develop new or revise legal instruments as necessary
to support and facilitate IHR implementation and compliance in a more efficient, effective or beneficial manner

CAPACITY LEVEL BENCHMARK ACTIONS

z The country has not conducted legal mapping12 (identification, review, collection and documentation of relevant legal

01 instruments13) for IHR implementation.

NO CAPACITY

Mechanism for legal mapping

02 z Establish a national multisectoral coordination working group (with drafted terms of reference (ToRs)) for legal
LIMITED preparedness to convene key stakeholders to coordinate the identification, review, collection and documentation of legal
CAPACITY instruments for IHR implementation across relevant sectors.
z Identify experts from relevant sectors (outside of public health) who should be part of the national multisectoral
coordination working group for aligning efforts to review identified gaps for IHR implementation in the health sector.
z Identify human resource capacity to complete the legal mapping process, including development of mechanisms to
enhance legal literacy across relevant sectors on strengthening legal preparedness.
z Identify, review and collect available legal instruments across sectors relevant to health emergency prevention,
preparedness and response that enable effective implementation and compliance with IHR requirements.
z Develop an implementation plan and timeline for conducting legal mapping and legal analysis at the national and

WHO benchmarks for strengthening health emergency capacities

subnational levels, where applicable.
z Conduct legal mapping of identified legal instruments for IHR implementation at national and subnational levels.

12
Legal mapping helps to survey (and compare) the relevant legal instruments existing within a larger context in order to understand the country’s legal frameworks for the prevention,
preparedness, and response of public health emergencies. Such mapping provides a look at legal instruments across jurisdictions and/or review of legal instruments within a jurisdiction to
understand how public health risks are addressed. Legal mapping involves the review and documentation of the existence of legal authorities, what those authorities do or provide, and what
they do not provide. Legal mapping is an objective activity. The process does not intend to evaluate the effectiveness of legal instruments, nor analyze its gaps.
27

13
Legal instruments are measures enacted and implemented by national or subnational levels of government that are legally binding and enforceable. The types of legal instruments vary
depending on the country’s legal system (e.g. constitutions, laws, arrêtés, decrees, regulations, administrative requirements and applicable international agreements).
 Advocacy
z Develop advocacy materials and packages to raise awareness on the process and resources needed to conduct a legal
mapping and legal analysis at the national and subnational levels, where applicable.
z Identify legislative/policy champion(s) who can advocate for the role and necessity of conducting legal mapping and legal
analysis at the national and subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

Mechanism for conducting and completing a legal analysis and developing and/or revising necessary legal
03 instruments in the health sector
DEVELOPED z Establish a unit or function within the health sector to serve as a liaison across relevant sectors, ensure legal mapping
CAPACITY documentation is kept up to date and to align activities across relevant sectors.
z Conduct legal analysis14 (legal mapping and legal assessment) and develop or revise the necessary legal instruments for
IHR implementation at the national and subnational levels.
z Complete a functional review using legal mapping results to identify, understand, assess and analyse gaps within the
country’s legal instruments for IHR implementation across the health sector at the national and subnational levels, where
applicable.
z Complete a multisectoral review of identified gaps for IHR implementation across the health sector and develop or revise
legal instruments in the health sector at the national and subnational levels, where applicable.
Advocacy
z Use and update strategies and materials (e.g. communication strategies with targeted messaging based on stakeholder) to

WHO benchmarks for strengthening health emergency capacities

advocate for needed changes to legal instruments to support enhanced IHR compliance in the health sector at the national
and intermediate levels, where applicable.
z Increase awareness of changes required to ensure that legal instruments support enhanced IHR compliance through
legislative/policy champions.
z Develop training curricula for health and relevant sector experts about legal instruments for health emergency prevention,
preparedness and response.
28

14
Legal analysis is a process consisting of legal mapping, legal assessment and legal surveillance.
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Involve all national legislative and regulatory bodies, as well as law enforcement bodies (e.g. parliament, senate,
interministerial committees, police, national security agencies, etc.) in regular preparatory meetings about proposals for
revision of IHR related legal instruments.
z Involve relevant professional organizations (e.g. medical associations, law associations) and civil society organizations
(CSOs) in discussions around revising legal instruments.

Mechanisms for conducting and completing a legal analysis and developing and/or revising necessary legal
04 instruments in all sectors
DEMONSTRATED z Conduct a legal analysis across relevant sectors and government levels (to complement the health sector’s legal analysis)
CAPACITY to identify, understand, assess and analyse gaps within the country’s legal instruments for IHR implementation.
z Analyse any conflict of law in legal instruments for IHR implementation across relevant sectors.
z Convene a national multisectoral coordination working group for legal preparedness to align efforts to review identified
gaps in legal instruments for IHR implementation across sectors and develop or revise legal instruments at the national
and subnational levels, where applicable.
z Routinely organize and conduct simulation exercises, after action reviews, intra-action reviews (SimEx/AAR/IAR)
(as relevant) to monitor and evaluate the implementation and effectiveness of legal instruments relating to IHR
implementation.
z Develop or revise legal instruments as necessary based on identified gaps for IHR implementation across all sectors and
all levels of governance.

WHO benchmarks for strengthening health emergency capacities

Advocacy
z Develop and adjust advocacy strategies and materials to support development and revisions of necessary legal
instruments across all sectors and all levels of governance.
z Maintain a routine training curricula for health and relevant sector experts about legal instruments for health emergency
prevention, preparedness and response at national and subnational levels.
29
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Monitor and control compliance with relevant legal instruments in relevant sectors and adjust when required.
z Identify clear roles and legal responsibilities for IHR implementation across relevant sectors (i.e. human health, animal
health, environment, military, education, social protection, etc.).

Mechanisms for conducting and completing legal surveillance

05 z Provide mechanisms for continuous monitoring and evaluation (M&E) of current legal instruments and tracking changes
SUSTAINABLE over time (legal surveillance15) for implementation of IHR.
CAPACITY
z Amend or revise relevant legal instruments, based on lessons learned from M&E, continuous data collection and SimEx/
AAR/IAR.
Advocacy
z Participate in international initiatives to support country and organization effort to build capacity in legal preparedness16 in
line with the IHR.
z Engage the country in peer-to-peer learning programmes at the subnational, national and international levels.
z Maintain and improve the availability and accessibility of the country’s legal instruments (through a publicly available
database) in order to promote global information sharing to achieve a common and collective understanding of legal
preparedness.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

z Assess country governance structure and context to ensure that the country has a governance environment that enables
effective IHR implementation with solid and reliable institutions and sound domestic policies that fully respect the dignity,
human rights and fundamental freedoms of persons.
z Document, widely disseminate and apply relevant existing and updated legal instruments and administrative requirements
appropriately by relevant sectors.
15
Legal surveillance refers to the process of tracking changes to legal instruments over time.
16
Legal preparedness can be defined as the capacity to understand, map, develop, refine and utilize legal instruments and related authorities that enable implementation of public health
30

activities.
 BENCHMARK 1.2: Gender equity and equality principles are applied throughout IHR capacities
OBJECTIVE: To integrate gender equity and equality within all IHR capacity areas to ensure gender-based health inequities and inequalities are not
exacerbated by health emergency prevention, preparedness, response or recovery interventions

CAPACITY LEVEL BENCHMARK ACTIONS

z No analysis available on health-related gender inequities and inequalities in the context of health emergencies, to inform

01 health emergency prevention and preparedness strategies.

NO CAPACITY z No efforts made to specifically promote gender equity and equality and respect for human rights commitments advance
health equity within any IHR capacities.
z No coordination mechanisms exist to oversee the gender responsiveness of health emergency preparedness and response
interventions.
z There is a dearth of gender-responsive interventions within operational plans for the strengthening of IHR core capacities
or the operationalization of health emergency preparedness and response plans.

z Integrate gender analysis into specific IHR capacity assessments in relevant sectors to identify and prioritize gender gaps,

02 and integrate indicators to measure effects of gender norms, roles and relations on an individual’s differential vulnerability
LIMITED to health emergencies, including treatment received, immediate and long-term effects, and differences between persons
CAPACITY with different gender identities.
z Compile key sources of information (e.g. academic-, scientific-, government-led or other) to identify key sociocultural,
economic and other factors influencing gender gaps in access to and use of health information, services, care and
treatment for essential health services in the country17.
z Promote collection, analysis, dissemination and use of data disaggregated by sex and age at minimum, and by pregnancy

WHO benchmarks for strengthening health emergency capacities

status, across all IHR capacities.
z Identify government entities tasked with overseeing, developing and implementing gender equity and equality policies, and
engage to establish formal or informal coordination mechanisms for application of these policies within the health sector,
with special reference in health emergencies (e.g. the ministry/secretary of women’s affairs, child protection authorities,
social welfare and sociology departments, or others).
z Appoint an official focal point responsible for cross-sectoral engagement for gender equity and equality and health
31

emergencies and identify gender focal points in relevant sectors such as education, social welfare and employment.
17
Resource: Out-of-Pocket Expenditure: The Need for a Gender Analysis
 z Conduct a stakeholder analysis to identify relevant actors that could support integration of gender-responsive actions
across IHR capacity areas, and identify linkages between programmes dedicated to the advancement of gender equity and
equality (including education, social and economic sectors) and the development of IHR core capacities.
z Develop training curricula to raise awareness and understanding of gender and human rights issues within health security.
z Assess whether decision making mechanisms for IHR core capacities incorporate equitable representation of diverse
stakeholders, including balanced gender representation.
z Establish a robust national communications strategy to promote gender-specific needs and considerations during health
emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9
z Institutionalize national policy frameworks promoting the advancement of non-discrimination and gender equity and
equality.

z Conduct novel research jointly with relevant stakeholders (including government and nongovernment actors) to assess

03 gender-based health inequities and inequalities; how these may be exacerbated by potential health emergencies and how
DEVELOPED they negatively affect the country’s (and individuals’) capacity to prepare, respond and recover from health emergencies.
CAPACITY This could also include holding consultations with communities living in vulnerable situations to identify priority gender
needs and potential implementation mechanisms, to inform development of IHR sector-specific action plans18.
z Identify and prioritize gender gaps in both service delivery and service access based on gender analysis data collected
through IHR capacity assessments, compilation of key sources of information and novel research, to be addressed with
short-, medium- and long-term interventions.

WHO benchmarks for strengthening health emergency capacities

z Develop and implement an advocacy package based on gender gap analysis to support integration of gender-responsive
actions into relevant IHR legislation and sector-specific action plans, with dissemination to relevant decision-makers and
policy-makers19.
z Promote intersectional analysis of sex and age disaggregated data, including income, place of living, language, ethnicity,
gender diverse people and other variables to identify most vulnerable communities.
18
Resource: Gendered Health Analysis: COVID-19 in the Americas
19
Resource: Advancing health through attention to gender, equity and human rights: stories from the Western Pacific Region
32
 z Coordinate with relevant government sectors working on human rights-based approaches and gender equality skills
to conduct trainings and seminars to raise awareness and build an intersectoral team of experts with skills to integrate
gender within IHR core capacity development20.
z Identify a unit or team with established ToRs to be the focal point from the health ministry to oversee progress towards
integration of gender-responsive approaches into health service access and delivery.
z Jointly work with relevant sectors to integrate gender analysis findings into planning and development of IHR capacities
and corresponding action plans21,22.
z Develop a standalone, multisectoral gender equality strategy for health emergency preparedness, response and recovery,
linked to IHR capacities and to broader national gender policies and frameworks.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 7, 8
z Integrate gender-responsive approaches, informed by a gender analysis, into national policies to ensure equal and
equitable access to services, including for all genders, in education, health, employment and living conditions23.
z Integrate health security into the national gender policy objectives to ensure gender dimensions of health emergency
preparedness, response and recovery are addressed.
z Integrate health emergency scenarios into capacity-building efforts led by relevant sectors such as the ministry of social/
family/women’s affairs, to raise awareness of the continued relevance of gender in the context of health emergencies.

z Systematically conduct gender analysis of health information systems data, on health seeking behaviour, service access,

04 service provision and other data related to health emergency response and recovery in relevant surveillance systems24.
DEMONSTRATED

WHO benchmarks for strengthening health emergency capacities

CAPACITY
21
This could include, but not be limited to, the design and implementation of systems to advance equal access to employment opportunities and decision making for all individuals including all
genders; the establishment of policies to formalize and improve conditions of care workers that address the needs and opportunities of all genders; the review of surveillance data systems
to ensure data collection, analysis and reporting integrates a gender-lens; and the integration of human rights-based approaches, inclusive of gender responsive interventions, across health
sector strategies.
22
Resources: Taking sex and gender into account in emerging infectious diseases programme: an analytical framework, Gender mainstreaming for health managers: a practical approach,
Human rights and gender equality in health sector strategies: how to assess policy coherence, A tool for strengthening gender-sensitive national HIV and Sexual and Reproductive Health
(SRH) monitoring and evaluation systems, Human resources for health: a gender analysis, Delivered by women led by men: a gender and equity analysis of the global health and social
workforce.
33

23
Resource: Guide for analysis and monitoring of gender equity in health policies
24
Resources: Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19, Health and Service Availability Monitoring System (HeRAMS), The
Gender Handbook for Humanitarian Action, Guidelines for Integrating Gender-Based Violence Interventions in Humanitarian Action – Reducing risk, promoting resilience and aiding recovery,
Minimum Initial Service Package (MISP) Resource.
 z Promote discussions, public engagements and seminars on gender equity and equality in health emergencies as an
essential thematic area and disseminate findings of systematic data collection systems to ensure continuous engagement
and positioning of the relevance of gender equity and equality for IHR.
z Establish a functional multisectoral coordination mechanism of gender focal points and experts tasked with
periodically reviewing progress on the integration of gender into IHR capacity development, identifying gaps and issuing
recommendations to inform future planning.
z Appoint a gender advisor within health sector M&E teams responsible for monitoring data collected for gender-responsive
interventions and initiatives and reporting on IHR, including integration of gender equity and equality principles in health
emergencies as a pillar to assess in SimEx/AAR/IAR (as relevant).
z Identify and implement evidence-based, sector-specific interventions for the integration of gender-responsive approaches
for health security25.
z Integrate specific objectives related to gender inequities and inequalities in health into national health sector policies and
strategies, including in health emergency contexts, with budgeted activities and a monitoring framework that reflects
gender-responsive indicators.
z Integrate training modules focused on gender analysis in health and gender-responsive programming skills into national
health systems trainings.
z Include gender equity and equality with special reference to health emergency prevention, preparedness and response
as a major thematic area in multisectoral research symposia, orations, conferences and other academic and/or scientific
venues that focus on health systems.
z Incorporate gender analysis and interventions for gender equity and equality into curricula and research agendas for
undergraduate and postgraduate research in relevant subject streams (e.g. sociology, disaster management, public health,
epidemiology, etc.).

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8, 9
25
This could include (but not be limited to): Updating sector-specific action plans based on monitoring feedback and analysis of gender intervention data; integration of sexual and reproductive
health services, as well as prevention and response to gender-based violence, into national and local health emergency response plans; development of legal frameworks that advance
gender equity in recruitment, retention and promotion of staff, to address gender imbalance in representation particularly within senior positions at local and national levels; and develop risk
communication and community engagement tools that are gender responsive.
34
 z Collect, analyse and use on a periodic basis, indicators, statistical approaches and monitoring tools (including qualitative

05 and mixed methods approaches) to understand and address gender inequality in health emergencies, including at
SUSTAINABLE subnational levels26.
CAPACITY z Identify and integrate M&E indicators to track progress towards gender-responsive health security within relevant
strategies, including through the establishment and maintenance of data platforms to identify gender gaps in health
service access and delivery during health emergencies.
z Document best practices and lessons learned related to addressing gender inequalities in health emergencies and
disseminate widely across IHR capacities, relevant sectors and external partners to encourage peer-to-peer learning and
knowledge-sharing across countries.
z Develop and sustain mechanisms to monitor, detect and address unequal gender distribution in key decision-making roles
across the health system.
z Outline specific objectives within the national IHR capacity development strategies that seek to increase the ratio of
reached populations in vulnerable situations – disaggregated by sex and age – during preparedness, response and
recovery interventions.
z Establish clear funding streams to support gender integration across IHR capacity areas and ensure that specialized
gender functions and specialists are in place and adequately resourced.
z Establish an accountability framework that is aligned with the national gender policy, against which staff, systems,
structures and activities are audited.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Focus all relevant national policies on addressing gender inequity and inequality, and make reference to interlinkages with

WHO benchmarks for strengthening health emergency capacities

health emergencies and the implementation of IHR capacities.
z Develop mechanisms to monitor, evaluate and report gender inequities and inequalities across relevant sectors.
z Develop an action plan to operationalize the national gender policy, including health security objectives.

26
Resource: Pan American Health Organization. 2019. A framework for indicators for monitoring gender equality and health in the Americas.
35
 Tools:
z International Health Regulations (2005). Third edition. Geneva: World Health Organization; 2016
(https://www.who.int/publications/i/item/9789241580496).
z Supporting national implementation of International Health Regulations [website]. Geneva: World Health Organization; 2023 (https://www.who.int/
activities/supporting-national-implementation-of-international-health-regulations).
z World Health Organization Strategy (2022-2026) for the National Action Plan for Health Security. Geneva: World Health Organization; 2022 (https://
www.who.int/publications/i/item/9789240061545).
z Health systems strengthening glossary. Geneva: World Health Organization (https://cdn.who.int/media/docs/default-source/documents/health-
systems-strengthening-glossary.pdf).
z Terrestrial Animal Health Code. Paris: World Organisation for Animal Health; 2022 (https://www.woah.org/en/what-we-do/standards/codes-and-
manuals/terrestrial-code-online-access/?id=169&L=1&htmfile=chapitre_vet_legislation.htm).
z PVS Pathway [website]. Paris: World Organisation for Animal Health; 2023 (https://www.woah.org/en/what-we-offer/improving-veterinary-services/
pvs-pathway/#ui-id-2).
z International health regulations (2005): state party self-assessment annual reporting tool, 2nd ed. Geneva: World Health Organization; 2021 (https://
www.who.int/publications/i/item/9789240040120).
z Addressing sex and gender in epidemic-prone infectious diseases. Geneva: World Health Organization; 2007 (https://apps.who.int/iris/
handle/10665/43644).
z Pande RP, Mollard IMP, Lnu NKH. Gender in Preparedness and Response Toolkit (GENPAR). Washington DC: World Bank Group; 2022 (https://www.
genderandcovid-19.org/resources/gender-in-preparedness-and-response-toolkit-genpar/).
z Gender mainstreaming for health managers: a practical approach. Facilitator’s Guide. Geneva: World Health Organization; 2011 (https://www.who.int/

WHO benchmarks for strengthening health emergency capacities

publications/i/item/9789241501057).
z George A. Human resources for health: a gender analysis. India: World Health Organization; 2007 (https://www.who.int/publications/m/item/human-
resources-for-health-a-gender-analysis).
z Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. Geneva: World Health Organization; 2019
(https://apps.who.int/iris/handle/10665/311322).
z Building healthy and equitably workplace for women and men: a resource for employers and worker representatives. Geneva: World Health
36

Organization; 2011 (https://apps.who.int/iris/handle/10665/77350).

 z Human rights and gender equality in health sector strategies: how to assess policy coherence. Geneva: World Health Organization, Office of the
High Commissioner for Human Rights and the Swedish International Development Cooperation Agency; 2011 (https://www.who.int/publications/i/
item/9789241564083).
z Incorporating intersectional gender analysis into research on infectious diseases of poverty: a toolkit for health researchers. Geneva: World Health
Organization and TDR for research on diseases of poverty; 2020 (https://www.who.int/publications/i/item/9789240008458).
z Health Resources and Services Availability Monitoring System (HeRAMS) [website]. Geneva: World Health Organization; 2023 (https://www.who.int/
initiatives/herams).
z Taking sex and gender into account in emerging infectious disease programme: an analytical framework. Manila: WHO Regional Office for Western
Pacific; 2011 (https://www.who.int/publications/i/item/9789290615323).
z Advancing health through attention to gender, equity and human rights: stories from the Western Pacific Region. Manila: WHO Regional Office for
Western Pacific; 2017 (https://www.who.int/publications/i/item/9789290618300).
z Gendered Health Analysis: COVID-19 in the Americas. Washington DC: Pan American Health Organization; 2021 (https://iris.paho.org/
handle/10665.2/55432).
z Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19, 4 June 2020. Washington DC: Pan
American Health Organization; 2020 (https://iris.paho.org/handle/10665.2/52247).
z Out-of-pocket expenditure: the need for a gender analysis. Washington DC: Pan American Health Organization; 2021 (https://iris.paho.org/
handle/10665.2/54670).
z A framework for indicators for monitoring gender equality and health in the Americas. Washington DC: Pan American Health Organization; 2019
(https://iris.paho.org/handle/10665.2/51786).
z Unpaid health care work: a gender equality perspective. Washington DC: Pam American Health Organization; 2012 (https://iris.paho.org/

WHO benchmarks for strengthening health emergency capacities

handle/10665.2/54847).
z Guide for analysis and monitoring of gender equity in health policies Washington DC: Pan American Health Organization; 2008 (https://iris.paho.org/
handle/10665.2/49286).
z UNAIDS and World Health Organization. A tool for strengthening gender-sensitive national HIV and Sexual and Reproductive Health (SRH) monitoring
and evaluation systems. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241515788).
37
 z UN Women. Guideline: The Gender Handbook for Humanitarian Action. February 2018 IASC Reference Group on Gender and Humanitarian Action. New
York: Inter-Agency Standing Committee; 2017
(https://www.gihahandbook.org/).
z Guidelines for integrating gender-based violence interventions in humanitarian action: reducing risk, promoting resilience and aiding recovery. New
York: Inter-Agency Standing Committee: 2015
(https://interagencystandingcommittee.org/working-group/iasc-guidelines-integrating-gender-based-violence-interventions-humanitarian-
action-2015).
z Minimum Initial Service Package (MISP) Resources [database]. New York: Inter-Agency Working Group on Reproductive Health in Crisis; 2023 (https://
iawg.net/resources/minimum-initial-service-package-misp-resources).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

38
 02
Financing
States Parties should have adequate funding for IHR implementation through the national budget and other mechanisms. The country should have financial
resources that can be easily accessible and disbursed for the routine implementation of IHR capacities, preparedness and response to health emergencies,
in order to ensure a timely and adequate response.

IMPACT:
Financial resources are available and agile public financial management systems are in place to enable IHR implementation, including core
capacity development and maintenance, as well as for the health emergency response.

MONITORING AND EVALUATION:

Adequate financial resources are available to enable effective IHR implementation and response to all health emergencies.

WHO benchmarks for strengthening health emergency capacities

39
 BENCHMARK 2.1: Financing27 is available and disbursed for the implementation of IHR capacities
OBJECTIVE: To ensure financing is available for the implementation of IHR capacities

CAPACITY LEVEL BENCHMARK ACTIONS

z No specific budget line or budgetary allocation28 available to finance the implementation of IHR capacities, or financing is

01 handled through extrabudgetary means or off budget external resources29.

NO CAPACITY

z Identify and convene key stakeholders to review financing for implementation of IHR capacities from both domestic and/or

02 external sources.
LIMITED z Establish a national coordination mechanism (with drafted ToRs) to coordinate prioritized IHR related funds and
CAPACITY corresponding alignment of budget lines allocated to implementation of IHR in relevant sectors at the national level.
z Identify different types of budgetary resources available for implementation of IHR capacities (including for capital and
recurrent sources of expenditure) and provide recommendations to prioritize IHR implementation actions to match the
available funds.
z Collate and review cost estimates for the implementation of national action plans relevant to IHR capacities that align with
a costed operational national action plan for health security (NAPHS). If a costed operational NAPHS is not available, then
develop one with costing experts and focal points of each technical area, as needed.

Participation and contribution of other sectors to actions:

1, 2, 3, 4
z Identify and convene key stakeholders who face financial risks linked to health emergencies.

WHO benchmarks for strengthening health emergency capacities

z Conduct resource mapping and associated financing advocacy analysis/strategy for the implementation of IHR capacities

03 to determine what activities are being funded, what are the sources of funding (domestic and/or external), and where are
DEVELOPED the funding gaps across sectors at the national level.
CAPACITY
27
Financing refers to funds and resources identified, allocated, distributed and executed with regard to activities and interventions. It does not consider costing or identifying how many
resources or funds are necessary for the implementation of activities or interventions.
40

28
A budget line exists, and a budget is allocated (the budget line is funded).
29
Accounts held by government bodies, but not included in the government budget.
 z Analyse current domestic and external financing for IHR capacities and compare resources available to resource needs to
understand funding gaps and opportunities.
z Prioritize, as needed, activities in the national action plan (e.g. NAPHS) and/or operational plans based on estimated costs,
expected impacts and available resources and funding.
z Routinely update cost and impact evidence, as well as resource mapping evidence, to allow for reprioritization and
reallocation of IHR-related budgets.
z Develop and institute flexible mechanisms for funds disbursement to match evolving needs and allow reallocations as
needs change.
z Develop a methodology/framework for monitoring relevant multisectoral IHR related expenditures.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

z Source sufficient30 budget at national and subnational levels for the implementation of all IHR capacities in relevant

04 ministries or sectors.
DEMONSTRATED z Routinely track IHR budget allocation, disbursement, spending and accounting embedded within routine expenditure
CAPACITY monitoring systems to assure funding is disbursed and spent effectively by relevant ministries at national and subnational
levels.
z Implement and review the use of available financing and its effectiveness in achieving IHR implementation benchmark
actions.
z Conduct a political (i.e. political cycle and budget process) and legal (i.e. legislative and administrative pathways)
landscape analysis and impact assessment to build the case for increased investment in the implementation of IHR

WHO benchmarks for strengthening health emergency capacities

capacities.
z Accelerate program-based or output oriented budgeting reforms to provide more flexibility and accountability in resource
allocation and management.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
30
41

This refers to access to funds by relevant ministries or government bodies for the implementation of all IHR capacities. Sufficiency is measured, where possible, by comparing budget
allocation amounts to resource needs identified in national plans related to IHR and/or health security.
 z Engage a national coordination group in annual operational planning for the implementation of IHR capacities, prepare

05 annual budget requests and advocate for funding levels for relevant ministries or sectors.
SUSTAINABLE z Document and disseminate information on the timely distribution and effective use of funds to strengthen health security
CAPACITY capacities at the national and subnational levels in relevant ministries or sectors.
z Develop open access platforms embedded within routine expenditure monitoring and accountability systems to assure
transparency and accountability of IHR related budgets.
z Engage relevant sectors regarding multisectoral program-based budgeting for IHR implementation.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

WHO benchmarks for strengthening health emergency capacities

42
 BENCHMARK 2.2: Financing available for timely response to health emergencies31
OBJECTIVE: To put in place financing mechanisms to ensure that funds are available and flexible for timely response to health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z No mechanism of financing exists to respond to health emergencies.

01 z Funds are allocated and distributed in an ad hoc manner from different sources during health emergencies.
NO CAPACITY

z Define potential sources of and mechanisms to access general, earmarked or contingency funding to support timely

02 response to health emergencies.

LIMITED z Establish regulations that allow the government to activate emergency funding to respond to health emergencies.
CAPACITY z Define protocols for activating emergency funding to respond to health emergencies, including levels of funding and
deployment modalities.
z Conduct a stakeholder analysis to identify domestic and external partners who can support rapid mobilization of funds
during health emergencies.
z Identify flexible funding sources and map key decision-makers and processes for reallocation of funds during a health
emergency.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

z Identify and convene key stakeholders to conduct a legal and regulatory review to understand the various legal

WHO benchmarks for strengthening health emergency capacities

03 mechanisms to access sources of domestic funding in the case of a health emergency.
DEVELOPED z Establish or make certain any emergency funds that can be accessed for health emergencies and are able to, at bare
CAPACITY minimum, support national level urgent responses, and when required a national authority which can coordinate the receipt
and distribution of funds to local and subnational levels.
z Develop links between domestic and international mechanisms for joint financing of timely response to health
emergencies and procurement of key resources, such as personal protective equipment (PPE), medicines and vaccines.
43

31
Defined by the country through a set of triggers that declare a situation as a public health emergency.
 z Develop or revise mechanisms and structures to receive and rapidly disburse funds during health emergencies.
z Analyse current health system capacity for routine service continuity during a health emergency and devise a plan to
address financial constraints for routine service delivery during a health emergency.
z Review and make recommendations to ensure the functionality of emergency public financing mechanisms (PFM),
particularly the mobilization of funds when needed at the national and subnational levels for relevant sectors.
z Develop and share training packages to raise awareness and train relevant stakeholders on PFM to enable timely response
to health emergencies.
z Disseminate, build capacity and ensure awareness of exceptions to routine PFM rules for health emergency funding.
If external funding is being used for health emergencies, external funding accounting and procurement rules are well
understood.
z Demonstrate and document that sources of funding have been identified and could be mobilized in advance of a health
emergency.
z Develop mechanisms and guidelines to adapt routine provider payment mechanisms, such as diagnosis related groups,
outcomes-based payment, or capitated payments, in a health emergency.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10
z Engage relevant stakeholders, such as civil service commission or national audit authority, to investigate exemptions that
could be applicable whenever health emergency funding is released.

z Demonstrate that relevant ministries and levels of government have capacity to access and utilize the PFM for early
detection, notification, response and recovery operations.

WHO benchmarks for strengthening health emergency capacities

04
DEMONSTRATED z Develop standard operating procedures (SOPs) to support actors not usually involved with public sector services (e.g.
CAPACITY nongovernmental organizations (NGOs) and the private sector) to access emergency funds when needed.
z Develop SOPs or memorandum of understanding (MoUs) that fast track procurement and service agreements (within
existing PFM guidelines or approved by finance ministry) that can be activated during emergencies to expedite response.
z Review, with the finance ministry, effectiveness of the emergency financing mechanism following any response to health
emergencies and make recommendations to finance ministry to adjust procedures to ensure speed, transparency and
44

accountability of all funds.

 z Develop guidance on engaging additional resources called upon as regular or complementary human resources for health
to work on addressing the health emergency, including funding to support the efforts of unwaged volunteers.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

z Establish a link and/or MoU with other regional or global emergency contingency funds, through which a national authority

05 can coordinate and distribute funds.

SUSTAINABLE z Establish a mechanism for multisectoral review of functionality and adequacy of health emergency financing whenever the
CAPACITY financing is accessed.

Participation and contribution of other sectors to actions:

1, 2

Tools:
z Delivering global health security through sustainable financing. Geneva: World Health Organization; 2018 (https://www.who.int/publications/i/item/
WHO-WHE-CPI-2018.38).
z Funding for emergencies [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/funding).

z Health systems strengthening glossary. Geneva: World Health Organization (https://cdn.who.int/media/docs/default-source/documents/health-

systems-strengthening-glossary.pdf).
z Out-of-pocket expenditure: the need for a gender analysis. Washington DC: Pan American Health Organization; 2021 (https://iris.paho.org/
handle/10665.2/54670).

WHO benchmarks for strengthening health emergency capacities

45
 03
IHR coordination, national IHR focal point functions and advocacy
States Parties should have multisectoral multidisciplinary approaches through national partnerships that allow efficient alert and response systems for
effective implementation of the IHR. The coordination of nationwide resources allows for the sustainable functioning of a National IHR Focal Point – a
national centre for IHR communications which is a key obligation of the IHR – that is accessible at all times. States Parties provide WHO with contact
details of National IHR Focal Points, continuously update and annually confirm them. Timely and accurate reporting of notifiable diseases, including the
reporting of any events of potential public health significance according to WHO requirements and consistent relay of information to the Food and Agriculture
Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH). Planning and capacity development are undertaken and
supported through advocacy measures to ensure high-level support for implementation of IHR.

IMPACT:
A mechanism for multisectoral multidisciplinary coordination, communication and partnerships to detect, assess and respond to any public health
event or risk is in place. A National IHR Focal Point is accessible at all times to communicate with the WHO IHR Regional Contact Points and with
all relevant sectors and other stakeholders in the country. The National IHR Focal Points, the WOAH Delegate and WOAH-World Animal Health
Information System (WAHIS) National Focal Point (NFP) will have access to a toolkit of best practices, model procedures, reporting templates and
training materials to facilitate rapid (within 24 hours) notification of events that may constitute a potential public health emergency of international
concern (PHEIC) to WHO and listed diseases to WOAH, as well as be able to respond rapidly (within 24-48 hours) to communications from these
organizations. High-level support for implementation of IHR is present within the country.

WHO benchmarks for strengthening health emergency capacities

MONITORING AND EVALUATION:
(1) A functional multisectoral multidisciplinary mechanism for the coordination and integration of relevant sectors in the implementation of IHR to
respond to any public health events. (2) A system to report potential public health events of international concern to WHO and to meet the needs of
other official reporting systems, such as WAHIS. (3) Planning and ongoing capacity development efforts with established and effective advocacy
mechanisms for implementation of IHR. (4) Mechanisms are regularly tested through exercises with subsequent improvement of arrangements
46

and procedures.
 BENCHMARK 3.1: The IHR national focal point (NFP) is fully functional
OBJECTIVE: To establish a fully functional IHR NFP

CAPACITY LEVEL BENCHMARK ACTIONS

z IHR NFP does not exist, or consists of one individual, lacks legal authority, capacity and resources to effectively carry out

01 functions.
NO CAPACITY z ToRs describing the mandate, structure, roles and responsibilities of NFP are not in place or are under development.

z Designate or establish an office or centre to serve as the IHR NFP in line with Article 4 of the IHR.

02 z Develop ToRs outlining the roles and responsibilities of the IHR NFP in fulfilling relevant obligations of the IHR.
LIMITED z Maintain and regularly update a contact directory including all members of NFP and capacitate NFP to be available 24
CAPACITY hours a day, seven days a week (24/7) in line with Article 4 of the IHR and share with the World Health Organization (WHO)
and relevant partners.
z Develop and test SOPs for communicating and coordinating with WHO, including triggers and processes for notification,
verification and reporting in line with Annex 2 of the IHR.
z Develop and test SOPs for communication among relevant sectors, including thresholds for reporting, response,
coordination and communication mechanisms during health emergencies.
z Develop and implement an IHR NFP training package for NFP unit staff.
z Provide annual reporting to the World Health Assembly on IHR capacity development, in line with IHR obligations.
z Develop processes to complete and submit the States Parties Self-Assessment Annual Report (SPAR) Tool in line with
Article 54 of the IHR.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8
z Designate focal points in relevant sectors to work closely and regularly communicate with IHR NFP.
z Raise awareness about SOPs for communication in relevant sectors to share information on urgent events, including those
which meet thresholds for reporting and response by IHR NFP.
47
 z Develop policy to designate or establish the IHR NFP, with legal authority to conduct activities in accordance with IHR

03 requirements.
DEVELOPED z Establish IHR NFP and share ToRs describing the roles and responsibilities of the IHR NFR at all levels (i.e. senior and
CAPACITY technical) within the ministry where the IHR NFP is located.
z Implement SOPs on communication and coordination between NFPs and WHO including triggers and processes for
notification, verification and reporting based on relevant articles of the IHR, and review performance regularly.
z Implement SOPs for communicating between NFP and relevant sectors (e.g. those responsible for surveillance and
reporting, points of entry, public health services, clinics and hospitals and other government).
z Develop and test SOPs for communication and coordination between the NFP and nongovernmental agencies, including
media and civil society communication channels (e.g. website updates or newsletters), to apprise relevant sectors, media
and civil society on developments related to IHR implementation.
z Regularly test the processes of the IHR NFP for health emergency management, coordination, multisectoral collaboration
and communication through actual experience and/or scenarios for different types of health emergencies32.
z Regularly assess staffing and funding needs to maintain a functional IHR NFP and allocate sufficient funds for IHR NFP to
perform the basic functions required by the IHR for reporting and response to health emergencies.
z Conduct IHR NFP-led orientation events for relevant stakeholders and sectors.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Update regularly the IHR NFP list of focal points in relevant sectors.

z Raise and maintain awareness about the functions of the IHR NFP among senior leadership and technical levels across

WHO benchmarks for strengthening health emergency capacities

04 relevant government sectors through briefing and dissemination of materials.
DEMONSTRATED z Increase IHR awareness among communities, partners and the media by organizing information and education campaigns
CAPACITY and consider adding IHR NFP awareness and training to postgraduate curricula for public health and other relevant
educational disciplines.
z Conduct SimEx/AAR/IAR (as relevant) to monitor and evaluate the functionality of IHR NFP at national and levels, and
apply lessons learned to prioritize actions within relevant national action plans.
48

32
Such as disease outbreaks, mass gatherings, intentional biological incidents, chemical events, radiological emergencies.
 z Develop guidance on engaging additional resources called upon as regular or complementary human resources for health
to work on addressing the health emergency, including funding to support the efforts of unwaged volunteers.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

z Dedicate sustained resources (i.e. financial, human and technical) that are accessible and available for IHR NFP activities.

05 z Facilitate continuous quality improvement of IHR NFP functionality by leading national multidisciplinary risk assessment
SUSTAINABLE processes in line with Annex 2 of the IHR.
CAPACITY z Regularly monitor cross-sectoral surveillance mechanisms and evaluate the response to health emergencies at national
and subnational levels.
z Identify, document and address key bottlenecks and gaps in IHR NFP functionalities based on M&E results.
z Document and share lessons learned and best practices related to IHR NFP.
z Facilitate and engage country in peer-to-peer learning programmes at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

WHO benchmarks for strengthening health emergency capacities

49
 BENCHMARK 3.2: Multisectoral IHR coordination mechanism effectively supports the implementation of prevention, detection and response activities
OBJECTIVE: To establish a multisectoral IHR coordination mechanism to support the implementation of prevention, detection and response activities

CAPACITY LEVEL BENCHMARK ACTIONS

z No multisectoral coordination mechanism exists.

01
NO CAPACITY

z Define the scope of a multisectoral coordination committee and conduct a stakeholder analysis to identify key entities that

02 should be involved in a multisectoral coordination mechanism for IHR.

LIMITED z Establish a multisectoral coordination committee that meets regularly to discuss and promote IHR issues and establish,
CAPACITY activate and maintain the mechanism.
z Draft ToRs that specify how the multisectoral coordination committee and operations of the multisectoral coordination
mechanism reinforce priorities of the IHR NFP.
z Develop a work plan that specifies priority functions and activities of the multisectoral coordination mechanism to develop
a protocol, ToRs and identify resources needed for the mechanism (including among private organizations and NGOs).
z Conduct an IHR performance of veterinary services (PVS) National Bridging Workshop, document findings and incorporate
into multisectoral coordination mechanism to address zoonoses.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Designate focal points in relevant sectors to participate in the multisectoral coordination committee.

WHO benchmarks for strengthening health emergency capacities

z Participate in the IHR-PVS National Bridging Workshop by veterinary services and other relevant sectors.
z Conduct a World Organisation for Animal Health (WOAH) PVS evaluation, document findings and incorporate into
multisectoral coordination mechanism to address zoonoses and other existing or new events at the human-animal
interface.
50
 z Conduct regular meetings of the multisectoral coordination mechanism to advance its mandate and trigger action,

03 ensuring that outcomes of these meetings are promoted among external and internal stakeholders across sectors at the
DEVELOPED national level.
CAPACITY z Sensitize stakeholders from national level ministries, agencies, departments and partners to the purpose, role and priorities
of the multisectoral coordination mechanism and committee.
z Mobilize the multisectoral coordination mechanism at national level by enacting formal MoUs or other formal and legal
documents with multisectoral stakeholders whose engagement in IHR implementation is necessary.
z Develop and test a system to assess how the multisectoral coordination mechanism is working to address zoonotic
diseases, food safety and other existing or new health events at the human-animal interface at national and subnational
levels.
z Host trainings for experts from relevant sectors on the IHR aimed at promoting multisectoral coordination in IHR
implementation.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Institutionalize One Health coordination mechanisms (One Health platform/committee).

z Conduct regular meetings of the multisectoral coordination mechanism to advance its mandate and trigger actions,

04 ensuring that outcomes of meetings are promoted among external and internal stakeholders across sectors at the national
DEMONSTRATED and subnational levels.
CAPACITY z Mobilize the multisectoral coordination mechanism at subnational level by enacting formal MoUs or other formal and legal
documents with intermediate multisectoral stakeholders whose engagement in IHR implementation is necessary.

WHO benchmarks for strengthening health emergency capacities

z Routinely monitor and evaluate the functionality of the multisectoral coordination mechanism at both the national and
subnational levels through systematic approaches, such as routine data collection and SimEx/AAR/IAR (as relevant).
z Document and disseminate evidence on how effective the multisectoral coordination mechanism is working to manage
cross-sectoral public health issues (foodborne diseases, zoonotic diseases, etc.).
z Develop a system to assess how multisectoral coordination mechanism is working to address chemical safety among
stakeholders from relevant sectors at national and subnational level.
51
 z Develop a budget for sustained operation of multisectoral coordination mechanism and advocate for its full adoption. .

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

z Allocate funding for sustained operation of the multisectoral coordination mechanism.

05 z Routinely revise or update existing strategies, guidelines and SOPs for the multisectoral coordination mechanism based on
SUSTAINABLE lessons learned from M&E.
CAPACITY z Develop a system to assess how the multisectoral coordination mechanism is working to address radiation emergencies
among stakeholders from relevant sectors and safety authorities at national and subnational level.
z Document and share best practices for multisectoral coordination mechanism, and engage country in peer-to-peer
learning programmes at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

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52
 BENCHMARK 3.3: Strategic planning for IHR, preparedness or health security are in place and supported by functional advocacy mechanisms for IHR
implementation
OBJECTIVE: To develop, implement and monitor a national action plan for IHR, preparedness or health security and ensure functional advocacy
mechanisms for high level support of health emergency preparedness and IHR implementation

CAPACITY LEVEL BENCHMARK ACTIONS

Strategic planning
01 z There is no national action plan for IHR, preparedness or health security.
NO CAPACITY Advocacy for IHR implementation
z Planning and capacity development for IHR implementation is not supported by advocacy mechanisms or activities are
conducted on an ad hoc basis.

Strategic planning
02 z Identify gaps in health emergency preparedness and IHR implementation by synthesizing results from recent IHR
LIMITED monitoring and evaluation framework (MEF) approaches, assessments and implementation data from existing plans.
CAPACITY
z Convene technical area leads to prioritize actions based on synthesized results and recommendations and establish a
multisectoral working group to develop national action plan for IHR, preparedness or health security.
z Compile priority actions into a draft national action plan for implementation, cost the plan and map financial and technical
gaps as well as available resources to support implementation.
Advocacy for IHR implementation
z Conduct stakeholder analysis and mapping to identify actors (ranging from technical area implementers to high

WHO benchmarks for strengthening health emergency capacities

level decision-makers) from the public and private sectors who are relevant to improving national capacity for IHR
implementation.
z Conduct a situational analysis to understand current awareness and contribution to health emergency preparedness and
IHR implementation from key policy influencers and national level decision-makers to identify the degree of priority given at
the governance level of the country to health security.
z Analyse government policy, priority guidelines of the national government and annual budget allocations in relation to health
53

emergency preparedness and IHR implementation.

 z Identify advocacy objectives based on evidence analysis to achieve policy changes and develop an advocacy strategy
for gaining whole-of-government and whole-of-society commitments to health emergency preparedness and IHR
implementation.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

Strategic planning
03 z Engage the multisectoral working group to finalize a national action plan for IHR, preparedness or health security, involving
DEVELOPED relevant sectors across the government.
CAPACITY
z Identify offices and individuals in the government who can promote and/or provide avenues for promotion of national action
plans (such as NAPHS) and IHR implementation.
z Engage high level decision-makers to obtain formal endorsement and adoption of the national action plans (such as
NAPHS).
z Disseminate national action plans (such as NAPHS) to all departments, ministries, agencies and partners responsible for
implementation.
z Confirm availability and accessibility of the national action plans (such as NAPHS) for stakeholders as well as any guidelines
and SOPs needed for IHR implementation.
Advocacy for IHR implementation
z Develop and disseminate advocacy messages and materials for raising awareness across government and at all levels on
the national action plans (such as NAPHS) and importance of IHR implementation to the country (e.g. by introducing IHR
implementation and health emergency preparedness as an economic case).

WHO benchmarks for strengthening health emergency capacities

z Identify and utilize effective advocacy channels, mechanisms, people or groups who can lead disseminating advocacy
messages and materials, including media, at national level.
z Develop training materials to improve advocacy capacity for IHR implementation among key stakeholders in relevant
sectors and advocacy groups at national level.
54
 z Prepare and disseminated to national level decision-makers, including situational updates and advocacy messages
pertaining to health security concerns, health emergency preparedness and IHR implementation before parliamentary
engagements.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9
z Support dissemination of advocacy messages, through effective advocacy channels of the relevant sector, to the highest-
level authorities, decision-makers and relevant ministers to improve compliance with multisectoral action for IHR
implementation.
z Dedicate time in the national governance body (such as parliament) to discuss health emergency preparedness, health
security and IHR implementation.
z Participate in relevant advisory committees/steering committees of relevant sectors and ministries.
z Apply a whole-of-government and whole-of-society approach (including private sector) to identify stakeholders who can
contribute to the promotion of IHR implementation.

Strategic planning
04 z Develop a plan for routine monitoring and accountability for implementation of the national action plans (such as NAPHS).
DEMONSTRATED z Develop processes to incorporate SPAR, Joint External Evaluation (JEE), SimEx/AAR/IAR results (as relevant),
CAPACITY
recommendations and gaps national action plans (such as NAPHS).
z Define the processes for routine implementation tracking to ensure accountability among stakeholders and includes the key
elements of data-driven decision-making: collection, collation, analysis and dissemination of data.
z Organize regular SimEx/AAR/IAR (as relevant) as part of the IHR MEF programme for assessing the potential functionality of

WHO benchmarks for strengthening health emergency capacities

IHR capacities to prevent, detect and respond to health emergencies. Ensure that outcomes and key findings are shared with
all relevant stakeholders and that plans are updated accordingly, based on outcomes and recommendations.
Advocacy for IHR implementation
z Conduct a situational analysis to identify gaps in IHR implementation at subnational and local levels that require influence
from political authorities and decision-makers.
z Expand and adapt national advocacy strategies to subnational and local levels to disseminate key messages and materials
55

and activate political will for health emergency preparedness and IHR implementation.
 z Conduct training on advocacy for IHR implementation and health emergency preparedness for key stakeholders in relevant
sectors at the subnational level. Develop a budget for sustained operation of multisectoral coordination mechanism and
advocate for its full adoption. .

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Provide support, by relevant sectors, at subnational level for advocacy mechanism for health emergency preparedness and
IHR implementation through sector-specific advocacy channels to improve compliance for IHR implementation.

Strategic planning
05 z Review implementation progress for the national and subnational (if applicable) action plans on a quarterly basis to identify
SUSTAINABLE key implementation successes, gaps and recommendations for addressing gaps.
CAPACITY
z Regularly (i.e. quarterly) update all relevant stakeholders, ranging from implementers to high level decision-makers, on key
implementation progress, barriers and recommendations for improvement.
z Facilitate annual reviews of national action plans (such as NAPHS) to ensure that it is updated, costed and resourced each
year, based on implementation data and recommendations drawn from other capacity assessments.
z Develop policies to support the development and implementation of national action plans for IHR implementation,
preparedness and/or health security.
z Document and share best practices, challenges and lessons learned related to national action plans (such as NAPHS)
development, implementation and advocacy across relevant sectors and with other countries through bilateral and
international engagements, including capacity-building programmes.
Advocacy for IHR implementation

WHO benchmarks for strengthening health emergency capacities

z Collaborate with advocacy experts to influence policy-makers and decision-makers at all levels to ensure that health
emergency preparedness and IHR implementation remain a priority in the political agenda, with whole-of-government and
whole-of-society approaches.
z Advocacy strategies and mechanisms are reviewed and updated regularly.
z Routinely assess and annually update and allocate resources for advocacy strategies at the national and subnational levels.

Participation and contribution of other sectors to actions:

56

1, 2, 3, 4, 5, 6, 7, 8
 Tools:
z National IHR focal points [website]. Geneva: World Health Organization; 2023 (https://www.who.int/teams/ihr/national-focal-points)
Includes links to National IHR Focal Point Guide
z WHO guidance for the use of Annex 2 of the International Health Regulations (2005). Geneva: World Health Organization; 2010 (https://www.who.int/
publications/m/item/who-guidance-for-the-use-of-annex-2-of-the-international-health-regulations-(2005)).
z IHR-PVS National Bridging Workshops [database]. Geneva: World Health Organization; 2023 (https://extranet.who.int/sph/ihr-pvs-bridging-workshop).

z Bridging capacities between animal and human health sectors [website]. Geneva: World Health Organization; 2023 (https://www.who.int/activities/
bridging-human-and-animal-health-sectors)
z Members [website]. Paris: World Organisation for Animal Health; 2023 (https://www.woah.org/en/who-we-are/members/).

z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

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 04
Antimicrobial resistance
A functional system is in place for the national response to prevent and combat antimicrobial resistance (AMR) with a One Health approach, including:
z Multisectoral work spanning human, animal, agriculture, food safety and environmental aspects, which comprises of developing and implementing a
national action plan to combat AMR consistent with the Global action plan on antimicrobial microbial resistance.
z Surveillance capacity for AMR and antimicrobial consumption at the national level in accordance with internationally agreed systems such as the
WHO Global antimicrobial resistance surveillance system (GLASS), the WOAH Global database on use of antimicrobial agents in animals, and the FAO
Antimicrobial resistance monitoring (InFARM) system and IT platform.
z Prevention of AMR emergence and transmission in healthcare facilities, food production and the community, through infection prevention and control
(IPC) measures.
z Ensuring appropriate use of antimicrobials, including assuring quality of available medicines, conservation of existing treatments and access to
appropriate antimicrobials when needed, while reducing inappropriate use.
z Increasing awareness and engaging the community in activities related to combating AMR in humans and animals, with focus on outreach approach
for farmers and rural communities.

The JEE tool reviews the country’s self-assessed response to the annual global monitoring survey on AMR (Tracking AMR Country Self-assessment Survey
(TrACSS)).

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58
 IMPACT:
Decisive and comprehensive action to prevent the emergence and reduce the spread of AMR. Countries will, in line with the Global action plan on
AMR, increase awareness of AMR risks and how to respond to them, such as:

z Strengthening surveillance and laboratory capacity;

z Enhancing IPC measures in relevant sectors;

z Ensuring uninterrupted access to essential antimicrobials of assured quality;

z Regulating and promoting the appropriate use of antimicrobials in human medicine, animal health, agriculture, food production and other
fields as appropriate; and
z Supporting initiatives to foster the development and appropriate use of new antimicrobial agents, vaccines and diagnostic tools.

MONITORING AND EVALUATION:

(1) A multisectoral national action plan to combat AMR has been produced and made public. (2) Implementation of the AMR national action plan
and sector-specific plans, with monitoring and yearly reporting on progress (including reporting to the international level) in place.

WHO benchmarks for strengthening health emergency capacities

59
 BENCHMARK 4.1: Effective multisectoral coordination for antimicrobial resistance (AMR)
OBJECTIVE: To develop and implement a multisectoral national action plan on AMR

CAPACITY LEVEL BENCHMARK ACTIONS

z No national action plan for AMR and no formal multisectoral governance or coordination mechanism on AMR.

01
NO CAPACITY

z Establish a national AMR focal point to serve as a coordinating office for AMR within the health ministry or other relevant

02 ministry.
LIMITED z Identify key stakeholders and AMR leads across relevant ministries and sectors to establish a national multisectoral AMR
CAPACITY coordination committee.
z Initiate joint development of a national multisectoral AMR action plan (AMR NAP) based on situational analysis, to identify
major risks for occurrence and transmission and include a review of relevant existing regulations and policies.
z Identify programmes and priority activities to be included in the AMR NAP, aligned with the AMR Global Action Plan and for
development or scale up.
z Involve AMR experts in the development of national health policies, strategies and plans (NHPSPs) to strengthen health
system capacities to manage and integrate AMR activities.
z Advocate for political commitment to call for and support active participation of all relevant ministries in the national
multisectoral AMR coordination committee.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6
z Identification of AMR focal points within and by relevant sectors.
60
 z Develop ToRs for a multisectoral coordination committee, with defined lines of accountability, funding for committee

03 activities and regular meetings (at least four per year) to review AMR NAP implementation.
DEVELOPED z Complete the development of the multisectoral AMR NAP with prioritized activities to address AMR in line with the AMR
CAPACITY Global Action Plan33.
z Submit the AMR NAP for official endorsement through relevant governance mechanisms (e.g. office of the head of state,
cabinets, and health and agriculture ministries).
z Enhance internal health sector coordination between stakeholders for AMR, universal health coverage (UHC), primary
health care (PHC) and health emergencies.
z Train staff from relevant ministries and sectors on leadership skills for effective multisectoral collaboration and
coordination needed to develop, implement and monitor joint plans and activities..

Participation and contribution of other sectors to actions:

1, 2, 3, 5
z Assess existing capacities for awareness, training, surveillance, infection prevention and control (IPC), and stewardship of
antibiotic use in and by relevant sectors.
z Assess existing data and information systems for collecting recommended indicators in national sector-specific plans.
z Active contribution from civil society partners, academic and research institutions, and other relevant professional
organizations in the development and implementation of the national AMR NAP.

z Solicit the national government’s official endorsement of AMR NAP.

04 z Identify priority actions (based on risk and feasibility) from the AMR NAP, develop a costed implementation plan with
DEMONSTRATED engagement of responsible agencies with established timelines, and begin implementation of actions.

WHO benchmarks for strengthening health emergency capacities

CAPACITY z Identify and map required financial resources to implement and monitor prioritized activities in the multisectoral AMR NAP.
z Develop and implement the multisectoral AMR NAP M&E framework.
z Review AMR NAP implementation progress through regular meetings of the national AMR coordination committee, and
provide reports aligned with the annual tracking AMR country self-assessment survey (TrACSS).
z Develop capacities to collect, analyse and report on recommended indicators of the national action plan M&E framework
and relevant Sustainable Development Goals indicators.
61

33
WHO Global action plan on antimicrobial resistance.
 z Train staff in relevant sectors to support implementation of the AMR NAP.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Build sector-specific capacities to collect, analyse and report on M&E indicators monitored by the AMR coordination
committee.

z Incorporate prioritized AMR activities into national plans and budgets of relevant programmes and agencies, and allocate

05 adequate funding.
SUSTAINABLE z Regularly evaluate implementation of AMR NAP through M&E, involving relevant sectors and the multisectoral AMR
CAPACITY coordination committee, to jointly update plans and submit data on progress to regional and global levels accordingly.
z Dedicate senior level leadership for the AMR multisector coordination committee and empower it to hold partnering
sectors accountable for the delivery of clearly specified actions and targets.
z Embed specific AMR relevant interventions in national strategies and associated budgets for health systems strengthening
(e.g. PHC and UHC), as well as national pandemic preparedness plans, response strategies and budgets.
z Document and disseminate lessons learned from efforts for effective multisectoral coordination on AMR and the AMR NAP
implementation, including addressing inequities associated with gender, disability and social inclusion.
z Develop capacity to monitor and address social and economic inequities with regards to AMR interventions in relevant
sectors.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

WHO benchmarks for strengthening health emergency capacities

z Embed and promote AMR interventions in relevant, sector-specific national strategies and budgets and include in national
and international development financing proposals.
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 BENCHMARK 4.2: A surveillance system for AMR is in place
OBJECTIVE: To develop national AMR surveillance systems across sectors (human health, animal health and agriculture) for surveillance of pathogens of
concern and to facilitate data sharing and joint analysis for action

CAPACITY LEVEL BENCHMARK ACTIONS

z No or limited capacity for generating, collating and reporting data (e.g. antibiotic susceptibility testing (AST) and

01 accompanying clinical and epidemiological data).

NO CAPACITY

z Designate a national coordinating centre to oversee the development and functioning of the national AMR surveillance

02 system with epidemiological, information technology (IT) and data management capacities, with a designated a focal
LIMITED point for the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and other international AMR
CAPACITY surveillance networks the country collaborates with.
z Define national AMR surveillance objectives in accordance with AMR national action plan objectives and cost planned
activities.
z Complete an assessment of existing laboratory capacities for identifying and performing AST for common bacteria, fungal
pathogens and Mycobacterium tuberculosis.
z Designate a national reference laboratory to support AMR surveillance based on an assessment of existing microbiology
laboratory capacities in the country.
z Designate, based on the assessment of microbiology lab capacities, laboratories to support the national AMR surveillance
and secure laboratory reagents to detect and report on at least some priority AMR pathogens.
z Develop and initiate training programmes for diagnostic stewardship, data collection and reporting on AMR at national and

WHO benchmarks for strengthening health emergency capacities

subnational levels.
z Define laboratory standards and capacity requirements for laboratories to participate in the national AMR surveillance,
including identifying and performing AST for targeted pathogens.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
63

z Identify all laboratories that can contribute to an integrated AMR surveillance system using a One Health approach,
including food monitoring, animal health, environmental and other sectors.
 z Designate national focal points for the International Food and Agriculture Organization of the United Nations’ (FAO)
Antimicrobial Resistance Monitoring System (InFARM) covering AMR surveillance domains in food and agriculture.
z Designate national reference laboratories for AMR surveillance based on assessments of existing microbiology capacity.

z Establish an external quality assessment programme for the national reference laboratory and ensure that it can conduct

03 confirmatory or additional testing.

DEVELOPED z Provide adequate equipment, procurement, maintenance and supplies for laboratories supporting AMR surveillance and
CAPACITY notification of AMR events.
z Develop a national surveillance protocol including surveillance targets, laboratory standards, priority specimens, pathogens
and drug– bug combinations, sampling strategy, defined datasets, metrics, data production, analysis and reporting, quality
management and M&E.
z Identify functional AMR surveillance sites in the health sector and in foods production chains to ensure national or
subnational representativeness.
z Initiate AMR surveillance at pilot or representative regional and referral hospitals.
z Train sufficient staff to collect, analyse and report AMR data.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 6
z Define sectoral AMR surveillance objectives and develop a sectoral AMR surveillance strategy aligned with national AMR
surveillance.
z Define standards and capacity requirements for laboratories to participate in sectoral AMR surveillance.
z Develop steps to strengthen laboratory capacities for identifying and performing AST for targeted pathogens.

WHO benchmarks for strengthening health emergency capacities

z Establish a national AMR surveillance system including SOPs, protocols and databases for surveillance data, a system for

04 reporting to ministries of health and agriculture, and a mechanism to analyse data and report back to facilities and WHO.
DEMONSTRATED z Establish an external quality assessment programme for all laboratories generating data for AMR surveillance, to evaluate
CAPACITY and provide feedback on capacities to identify and perform AST for targeted pathogens.
z Expand AMR testing and surveillance to include other clinical sites and/or other components of the country’s health
64

system (e.g. private sector).

 z Collect population-based denominators, such as those recommended by GLASS.
z Perform AMR data analyses and disseminate regular reports from the AMR surveillance national coordinating centre.
z Establish mechanisms for AMR surveillance, data sharing and joint review across sectors.
z Establish capacities to perform and analyse molecular tests for AMR, at least within the national reference laboratory.
z Conduct SimEx/AAR/IAR (as relevant) to test the functionality of AMR surveillance systems.

Participation and contribution of other sectors to actions:

1, 2, 5, 6, 7, 8
z Develop strong animal, plant health and agricultural practices for AMR surveillance by implementing standards defined by
WOAH and FAO, including the Codex Alimentarius.
z Regularly evaluate laboratory capacities to identify and perform AST for targeted pathogens.

z Enhance monitoring of antibiotic resistance patterns.

05 z Disseminate reports indicating the proportion of AMR pathogens among specimens or isolates, results from participation
SUSTAINABLE in international external quality assessment rounds of the national reference laboratory, and incidence of infections caused
CAPACITY by AMR pathogens at sentinel sites (community- and hospital-acquired).
z Use surveillance data to implement policy changes, develop new legislation or update existing legislation, improving
facilities and adapting prevention and control strategies.
z Revise and update AMR surveillance strategies, guidelines, operational plans and SOPs based on lessons learned (from
M&E) and ensure follow up of the implementation of M&E recommendations.
z Regularly share AMR surveillance data across sectors, analyse relevant AMR data for policy-making and contribute to

WHO benchmarks for strengthening health emergency capacities

international surveillance information sharing and risk assessments for AMR.
z Define and allocate a multiyear budget for AMR surveillance.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Update sector-specific plans and integrated mechanisms based on feedback from AMR surveillance data analysis and
results from M&E of the national surveillance system.
65

z Designate international (e.g. FAO/WHO/WOAH) reference laboratories to support relevant sectors conducting regional and
global AMR surveillance based on assessments of technical capacities and global collaboration.
 BENCHMARK 4.3: Effective mechanisms are in place to prevent multidrug resistant organisms (MDRO)
OBJECTIVE: To strengthen mechanisms for preventing MDRO

CAPACITY LEVEL BENCHMARK ACTIONS

z Priority MDRO pathogens (phenotypes and genotypes) have not been identified by national authorities, and MDRO

01 pathogens are not detected.

NO CAPACITY

z Perform a situational analysis and document current efforts on MDRO prevention in the country.

02 z Map key stakeholders for MDRO prevention with a One Health approach and involvement from the AMR coordination
LIMITED committee and IPC programme.
CAPACITY z Mandate the IPC programme to develop an action plan and lead activities to prevent MDRO in close collaboration and
consultation with the AMR coordination committee, the AMR national reference laboratory and other relevant stakeholders.
z Integrate MDRO prevention into the country’s overall IPC strategy and programme, ensuring alignment with WHO minimum
requirements for IPC with involvement of all relevant stakeholders, and design measures to prevent MDRO in both health
facilities and community settings.
z Identify, in consultation with the AMR coordination committee, priority AMR types that are associated with common
infections and create a list of priority MDRO.
z Develop training materials on MDRO prevention including the roles and responsibilities of clinicians, laboratory technicians
and other relevant professionals, and integrate into existing IPC and AMR training packages.
z Develop surveillance and laboratory capacities to identify groups at risk for MDRO.

WHO benchmarks for strengthening health emergency capacities

z Officially circulate the standard definition of MDRO to all health facilities to align prevention activities accordingly.

03 z Improve awareness of priority MDRO at all health facilities (including both public and private sector facilities and
DEVELOPED laboratories) and in community settings, and provide training on MDRO prevention for relevant officials at national level.
CAPACITY z Implement a strategy and action plan to prevent MDRO at national level (embedded in the overall IPC strategy) and
develop, endorse and disseminate a standard protocol for containing MDRO outbreaks..
66
 z Collaborate with AMR and IPC programmes to apply available evidence to guide MDRO prevention activities and
understand effective prevention methods that extend beyond the AMR domain.
z Improve health facility capacities to characterize AMR pathogens causing human infections, systematically report to the
national level and identify reference laboratories to provide confirmatory testing for exceptional phenotypes.

z Implement national strategy and action plan on MDRO prevention at all levels.

04 z Conduct training on MDRO prevention for all relevant health workers at all levels.
DEMONSTRATED z Design a mechanism for timely detection, reporting, risk assessment and monitoring of novel, re-emerging and priority
CAPACITY MDRO in the country, and strengthen capacities for the national focal point to track and provide support for MDRO
incidents.
z Establish and use indicators and monitoring systems to regularly assess implementation of the MDRO prevention strategy,
action plan and MDRO risk assessment activities at national and facility levels.
z Conduct MDRO related research studies to generate local evidence to inform strategies, protocols and action.
z Improve IPC strategy implementation in both public and private health facilities to prevent and control MDRO infections in
alignment with WHO core components for effective IPC programmes.
z Implement systematic monitoring and reporting of AMR infections by the national body responsible, including a framework
for early reporting of any unusual antimicrobial susceptibility profile to WHO’s Global Antimicrobial Resistance and Use
Surveillance System - Emerging Antimicrobial Resistance Reporting (GLASS-EAR) framework.

z Conduct regular M&E for detection, timely notification of priority and novel MDRO within facilities and at the national level.

WHO benchmarks for strengthening health emergency capacities

05 z Enforce adherence to IPC protocols and interventions in all hospitals to prevent and respond to priority MDRO pathogens in
SUSTAINABLE a timely manner.
CAPACITY z Assess compliance with protocols and put in place mechanisms to strengthen implementation accordingly.
z Define indicators and patient populations based on local epidemiology, risk assessment and resource availability to
perform surveillance cultures including asymptomatic colonization with MDRO.
z Communicate pertinent MDRO data to local referral networks to inform prevention and containment efforts at health facilities.
67
 BENCHMARK 4.4: Optimize use of antimicrobial medicines in human health
OBJECTIVE: To ensure appropriate use of all antimicrobials in humans

CAPACITY LEVEL BENCHMARK ACTIONS

z No or weak policy and regulations on appropriate use, availability and quality of antimicrobials for human health.

01
NO CAPACITY

z Establish and endorse, by the national AMR coordination committee, a national working group (with ToRs) of experts from

02 relevant authorities and designate a national focal point for surveillance and optimal use of antimicrobials.
LIMITED z Assess the national medicines strategy including regulatory framework, selection on the essential medicines list, supply
CAPACITY chain management, stewardship, rational use plans and strategies, and activities focusing on antimicrobial medicines.
z Assess existing mechanisms for monitoring antimicrobial consumption34 (AMC), define objectives according to aims and
targets of the AMR NAP, and identify relevant actors and sources of data.
z Develop methods to collect relevant AMC data including piloting of methods.
z Develop a draft national antimicrobial stewardship (AMS) plan or strategy and national legislation that regulates use,
access and quality of antimicrobials.
z Identify AMS training and educational needs of health workforce, both in preservice and in-service education and training.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Involvement from public and private sector stakeholders in the activities of the dedicated national working group.

WHO benchmarks for strengthening health emergency capacities

z Share relevant plans/strategies, training & educational resources and assessment tools for AMS between sectors.
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34
Antimicrobial consumption: The term consumption refers to estimates that are derived from aggregated data sources (mainly import and domestic manufacturing, sales or reimbursement
data) and serves as proxy for actual use of antibiotics.
 z Establish a national AMC surveillance system to monitor and report national AMC data based on the Access, Watch,

03 Reserve (AWaRe) classification.

DEVELOPED z Adopt the AWaRe classification for antibiotics into the national essential medicines list.
CAPACITY z Develop protocols and tools for monitoring antimicrobial use35 (AMU) in hospitals to inform AMS.
z Develop or review the national regulatory framework for appropriate access to and use of quality assured antimicrobials in
humans, ensuring that economic incentives are accounted for in medicines reimbursement lists.
z Enact legislation and regulations on import, marketing authorization, production, selection, prescribing and sale of
antimicrobials.
z Develop or update and disseminate national AMS plan and clinical treatment guidelines that consider the essential
medicines list and apply the AWaRe classification for antibiotics.
z Implement AMS programmes and practices in designated health facilities, including training, monitoring, communication
and identification of required budget.
z Establish systems to ensure AMS elements are included in pre-service and in-service training curricula for health
professionals.
z Conduct periodic knowledge, attitude and practice surveys of health professionals to better understand drivers of
prescribing and dispensing behaviours.
z Develop materials for sensitizing experts in both public and private health sectors and raise community awareness of
appropriate antimicrobial medicine use.

Participation and contribution of other sectors to actions:

1, 4, 5, 8, 9

WHO benchmarks for strengthening health emergency capacities

z Participate in AMS training programmes implemented in relevant sectors.
z Share methods and tools for monitoring AMC for standardization and comparability across the human, animal, agricultural
and environmental health sectors.

35
69

Antimicrobial use: Data on antibiotic use refers to estimates derived from individual patient level data, and may be accompanied by information on patient characteristics and indication of
treatment.
 z Monitor and regularly report on AMC disaggregated by health sector and level when possible.

04 z Perform ad hoc surveys on antimicrobial use in hospitals as part of AMS programmes.

DEMONSTRATED z Set national targets for improvement, including the target of AWaRe Access group of antibiotics consisting of ³ 60% of total
CAPACITY antibiotic consumption and reported globally.
z Consistently update regulatory and legal frameworks for appropriate use and access to affordable quality assured
antimicrobials including: enforcement of prescription only antibiotics, regulation of promotional tactics for antimicrobials
by pharmaceutical companies, draft/review of the national medicine prescription and access policy for optimizing use by
detecting and correcting issues leading to shortages.
z Expand AMS activities to all health facilities, monitor and evaluate stewardship programmes including the analysis of AMR,
consumption and usage data, and provide recommendations for strengthening AMS programmes.
z Train a sufficient number of health workers, including public health professionals and community health workers at
the national and health facility level (including all types of health facilities), on AMS and AMR, as well as AMC and AMU
surveillance.
z Develop a list of behavioural change targets to ensure responsible and appropriate AMU in health facilities and the
community, and design strategies to facilitate behaviour change.
z Develop a system to monitor antibiotic quality and identify substandard and/or falsified medicines.

Participation and contribution of other sectors to actions:

3, 4, 7, 8
z Participate in education campaigns for raising community awareness on the appropriate use of antimicrobial medicines.
z Produce regular reports on AMC in animal, agricultural and environmental sectors, ensure data sharing is in place across

WHO benchmarks for strengthening health emergency capacities

sectors, and share publicly.
z Implement regulatory and legal frameworks to ensure that critically important antimicrobials (highest priority and high
priority) are used in a prudent manner.
70
 z Continue to monitor AMS activities and ensure AMS is a part of all relevant national policies and standards, including

05 curriculum standards for healthcare professionals, accreditation standards for health facilities and national health policies,
SUSTAINABLE strategies and plans.
CAPACITY z Maintain the national regulatory framework for appropriate use of affordable, quality assured antimicrobials, including
monitoring of prescription only sales of key antibiotics.
z Evaluate routine surveillance for AMC with annual data collection at national and facility levels.
z Perform regular surveys on AMU in hospitals and ad hoc surveys on AMU in primary healthcare/community facilities, and
report results to all relevant stakeholders.
z Monitor and report if national targets for AMC are met and adjust interventions accordingly.
z Conduct monitoring, documentation and reporting on antibiotic quality (e.g. substandard and falsified medicines).
z Capture data on illegal AMC (e.g. street markets, trafficking, internet sales).
z Participate in international initiatives to support capacity-building for optimizing AMU globally and share country
experiences in the human health sector relevant international forums and platforms.

Participation and contribution of other sectors to actions:

1, 2, 3, 5, 6, 7
z Document and disseminate the results and lessons learned from efforts to minimize AMR events by relevant sectors (e.g.
livestock, agriculture, food safety, etc.).
z Document permeability of AMU between sectors (e.g. human medicines given to animals).

WHO benchmarks for strengthening health emergency capacities

71
 BENCHMARK 4.5: Optimize use of antimicrobial medicines in animal health and agriculture
OBJECTIVE: To ensure responsible and prudent use of all antimicrobials in animal food production, animal health and agriculture systems
Please note: for this benchmark, the actions are led by the country’s animal health and agriculture sectors, and actions of all other sectors,
including the human health sector, fall under other sectoral engagement.

CAPACITY LEVEL BENCHMARK ACTIONS

IHR, Animal Health and Agriculture Sector
02 Human Health and Other Sector Engagement
LIMITED CAPACITY

CAPACITY LEVEL BENCHMARK ACTIONS

z No or weak policy and regulations on responsible and prudent use, availability and quality of antimicrobials in the animal

01 health sector and/or agriculture.

NO CAPACITY

z Involve public and private stakeholders from animal health and/or agriculture sector in activities of the dedicated national

02 technical working group under the multisectoral AMR coordination committee.

LIMITED z Map and review existing legislation, regulations and policies for the management of antimicrobial medicines in relevant
CAPACITY sectors (livestock, agriculture, food safety, etc.), particularly for nonveterinary medical purposes and use of medically
important antimicrobials in food-producing animals.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of human health and other sectors to actions:
1, 2
z Share the most recent WHO list of medically important antimicrobials for human medicine with the animal health and
agriculture sectors.
72
 z Develop regulations on prescription only sales of antimicrobials for use in animals and for food production, limiting non-

03 prescription use of medically important antimicrobials.

DEVELOPED z Develop capacity for enforcement of regulations.
CAPACITY z Develop training package on AMU in animal health and agriculture to promote responsible and prudent use at national,
subnational and facility levels.
z Establish a training and certification mechanism for veterinarians prescribing antimicrobials for both terrestrial and aquatic
animals.

Participation and contribution of human health and other sectors to actions:

1, 2

z Develop and disseminate information, education and communications materials to key stakeholders on AMR and misuse

04 or abuse of antimicrobials across the animal health sector and/or agriculture sectors.
DEMONSTRATED z Develop and enforce a full national regulatory framework for responsible and prudent use of affordable, quality assured
CAPACITY antimicrobials in animals and agriculture.
z Recommend and implement the phasing out the use of antimicrobials for animal growth promotion.
z Monitor the sale and use of substandard and/or falsified antimicrobials, and develop corresponding enforcement
mechanisms.

Participation and contribution of human health and other sectors to actions:

2, 4
z Collaboration between sectors on the development and dissemination of joint evidence-based information, education and

WHO benchmarks for strengthening health emergency capacities

communication materials on AMR and misuse or abuse of antimicrobials.

z Participate in international initiatives to build capacities for optimizing AMU globally.

05 z Document and disseminate the results and lessons learned from efforts to minimize AMR events in relevant sectors (e.g.
SUSTAINABLE livestock, agriculture, food safety, etc.)
CAPACITY z Develop and promote best practices for reducing AMU in the animal and plant farming and agriculture sectors.
z Conduct monitoring, documentation and reporting on antibiotic quality (e.g. substandard and falsified medicines).
73
 z Conduct and collaborate operational research on the impact of responsible and prudent AMU in relevant sectors (i.e.
animal health, human health, food security, agriculture and the environment).

Participation and contribution of human health and other sectors to actions:

1, 5
z Support the inclusion of relevant information and lessons learned in any annual reports developed by the national AMR
coordination committee.

Tools:
z The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. Geneva: World Health Organization; 2012 (https://apps.
who.int/iris/handle/10665/75828).
z Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in
health care facilities. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/259462).
z Implementation manual to prevent and control the spread of carbapenem-resistant organisms at the national and health care facility level. Geneva:
World Health Organization; 2019 (https://www.who.int/publications/i/item/WHO-UHC-SDS-2019-6).
z Handle antibiotics with care in surgery [infographic]. Geneva: World Health Organization (https://www.who.int/images/default-source/ihs/ipc/
infographic_ssi_tb.jpg?sfvrsn=7eee0a5_5).
z The role of infection prevention and control in preventing antibiotics resistance in health care [infographic]. World Health Organization (https://cdn.who.
int/media/docs/default-source/documents/infection-prevention-control09320f4b-309f-4999-8e23-23541eeb60a6.pdf?sfvrsn=1ea132d5_1).
z Antimicrobial Resistance: A manual for developing national action plans. Version 1. Geneva: Food and Agriculture Organization of the United Nations,

WHO benchmarks for strengthening health emergency capacities

World Organisation for Animal Health and World Health Organization; 2016 (https://www.who.int/publications/i/item/antimicrobial-resistance-a-
manual-for-developing-national-action-plans).
z National antimicrobial resistance surveillance systems and participation in the Global Antimicrobial Resistance Surveillance System (GLASS): core
components checklist and questionnaire. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/handle/10665/251552).
z Diagnostic stewardship, A guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016 (https://
www.who.int/publications/i/item/WHO-DGO-AMR-2016.3).
74

z Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Geneva: World
Health Organization; 2016 (https://www.who.int/publications/i/item/9789241549929).
 z Interim Practical Manual: supporting national implementation of the WHO Guidelines on Core Competencies of Infection Prevention and Control
Programmes. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/WHO-HIS-SDS-2017-8).
z WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human health sector. Geneva: World Health
Organization; 2022 (https://www.who.int/publications/i/item/9789240041981).
z Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS) [database]. Food and Agriculture
Organization of the United Nations, UN Environment Programme, World Health Organization and World Organisation for Animal Health (www.
amrcountryprogress.org).
z Monitoring and evaluation of the global action plan on antimicrobial resistance. Framework and recommended indicators. Geneva: Food and
Agriculture Organization of the United Nations, World Organisation of Animal Health and World Health Organization; 2019 (https://www.who.int/
publications/i/item/monitoring-and-evaluation-of-the-global-action-plan-on-antimicrobial-resistance).
z World Organisation for Animal Health. ANIMUSE Global Database on antimicrobial agents intended for use in animals [website]. Paris: World
Organisation for Animal Health; 2023 (https://amu.woah.org/amu-system-portal).
z OIE Standards, Guidelines and Resolutions on Antimicrobial Resistance and the use of antimicrobial agents. Paris: World Organisation for Animal
Health; 2020 (https://www.woah.org/app/uploads/2021/03/book-amr-ang-fnl-lr.pdf).
z OIE List of Antimicrobial Agents of Veterinary Importance. Paris: World Organisation for Animal Health; 2021 (https://www.woah.org/app/
uploads/2021/06/a-oie-list-antimicrobials-june2021.pdf).
z Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241509763).

z U.S. National action plan for combating antibiotic-resistant bacteria [website]. Atlanta: Centers for Disease Control and Prevention; 2021 (https://www.
cdc.gov/drugresistance/us-activities/national-action-plan.html#:~:text=The%20U.S.%20National%20Action%20Plan,the%20health%20of%20all%20
Americans).

WHO benchmarks for strengthening health emergency capacities

z Executive summary: The selection and use of essential medicines 2021: report of the 23rd WHO Expert Committee on the selection and use of essential
medicines. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.01).
z National systems to support drinking-water, sanitation and hygiene: global status report 2019. UN-Water global analysis and assessment of sanitation
and drinking-water (GLASS) 2019 report. Geneva: World Health Organization; 2019 (https://www.unwater.org/publications/un-water-glaas-2019-
national-systems-support-drinking-water-sanitation-and-hygiene).
z WHO guidelines on use of medically important antimicrobials in food-producing animals. Geneva: World Health Organization; 2017 (https://www.who.
75

int/publications/i/item/9789241550130).
 z Integrated surveillance of antimicrobial resistance in foodborne bacteria: application of a one health approach: guidance from the WHO Advisory
Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR). Geneva: World Health Organization; 2017 (https://apps.who.int/iris/
handle/10665/255747).
z Critically important antimicrobials for human medicine: 6th revision 2018. Geneva: World Health Organization; 2019 (https://www.who.int/
publications/i/item/9789241515528).
z GLASS Emerging antimicrobial resistance reporting framework (GLASS-EAR). Geneva: World Health Organization; 2018 (https://www.who.int/
publications/i/item/9789241514590).
z GLASS guidance for national reference laboratories. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/
item/9789240010581).
z Global Antimicrobial Resistance Surveillance System (GLASS) Molecular methods for antimicrobial resistance (AMR) diagnostics to enhance the
global antimicrobial resistance surveillance system. Geneva: World Health Organization; 2019 (https://www.who.int/publications/i/item/WHO-WSI-
AMR-2019.1).
z Global Antimicrobial Resistance and Use Surveillance System (GLASS) [website]. Geneva: World Health Organization; 2023 (https://www.who.int/
initiatives/glass).
z The International FAO Antimicrobial Resistance Monitoring (InFARM) System (under development) [website]. Rome: Food and Agriculture Organization
of the United Nations; 2023 (https://www.fao.org/antimicrobial-resistance/resources/database/infarm/en/).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

WHO benchmarks for strengthening health emergency capacities

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
76
 05
Zoonotic diseases
Functional multisectoral, multidisciplinary mechanisms, policies, systems and practices are in place to minimize the transmission and spread of zoonotic
diseases between animals and humans.

IMPACT:
Functional animal, environment and public health systems work individually and collaboratively through documented mechanisms and operational
frameworks using a multisectoral One Health approach, and based on international standards, guidance and best practices to limit the risk of spill
over and minimize transmission of endemic, emerging or re-emerging zoonotic diseases to human populations.

MONITORING AND EVALUATION:

(1) Agreement between the animal and public health sectors on a prioritized list of zoonotic diseases and pathogens of greatest national public
health concern. (2) Existence of functional capacities in animal health, public health and other relevant sectors with collaboration, coordination and
communication between sectors for preparedness, detection, assessment, early warning and response to zoonotic diseases. (3) Improvement of
sanitary animal production practices to reduce the risk of zoonotic disease transmission to human populations.

WHO benchmarks for strengthening health emergency capacities

77
 BENCHMARK 5.1: A multisectoral surveillance system is in place for priority zoonotic diseases/pathogens
OBJECTIVE: To strengthen multisectoral surveillance systems for priority zoonotic diseases/pathogens

CAPACITY LEVEL BENCHMARK ACTIONS

z No jointly agreed upon list of priority diseases to conduct coordinated multisectoral surveillance efforts.

01 z No organized coordinated surveillance system in place to connect animal and public health systems.
NO CAPACITY

z Identify key stakeholders and focal points from animal health (domestic animals and wildlife), human health, environmental

02 health and other key sectors, and formalize a coordination mechanism (e.g. a multisectoral national surveillance team).
LIMITED z Review and assess surveillance capacities for zoonotic diseases, as well as existing coordination or data sharing
CAPACITY mechanisms between relevant sectors.
z Conduct an IHR-PVS national bridging workshop to improve collaboration between the human and animal health sectors
for zoonotic disease surveillance.
z Conduct a joint process to define and prioritize zoonotic diseases of greatest national public health concern One Health
approach involving all relevant stakeholders and develop operational plans and training packages for the management of
priority diseases.
z Involve zoonotic disease experts in the development of NHPSPs to define the country’s vision, policy and strategies to
strengthen zoonotic disease management before, during and after health emergencies.
z Identify relevant medicines and medical products for preventing and treating priority zoonotic diseases that have a
potential to cause an outbreak, and develop novel and innovative solutions.

WHO benchmarks for strengthening health emergency capacities

z Identify a zoonotic disease focal point at the health ministry and collaborate with animal health departments and veterinary
services to conduct joint action.
z Utilize the Tripartite Zoonosis Guide operational tools (OT), especially for joint risk assessment, assessment of surveillance
capacity and coordination mechanisms.

Participation and contribution from other sectors in actions:

1, 2, 3, 4, 5, 6, 7, 8
78

z Identify a focal point or unit in animal health, veterinary services, wildlife and environmental sectors to collaborate with
health ministry for joint action. .
 z Perform a WOAH PVS evaluation (or other relevant tool of the PVS pathway), or review PVS evaluation findings and
implementation status if one was conducted in the past two to three years.
z Develop a list of priority animal diseases (zoonotic and non-zoonotic animal diseases) in the animal health sector.
z Establish basic disease surveillance mechanisms for priority animal diseases and early warning mechanisms in the
veterinary sector, and disseminate outputs to relevant health authorities.

z Develop and implement an operational plan to guide prevention and detection of priority zoonotic diseases of greatest

03 national public health concern, and allocate associated resources at the national level.
DEVELOPED z Establish mechanisms and procedures to exchange surveillance information on zoonotic diseases among relevant sectors
CAPACITY (and other decision-makers, as needed), ideally through interoperable electronic systems and/or platforms.
z Train responsible staff at the national level on surveillance and management of priority zoonotic diseases.
z Conduct a joint risk assessment to identify high risk areas to develop risk-based surveillance where/when appropriate,
and to inform risk management and communication for an effective coordinated preparedness and response to zoonotic
diseases.
z Develop laboratory capacities within relevant sectors (human, animals incl. wildlife) to enable zoonotic disease detection
and diagnosis.
z Develop and include modules on zoonotic disease management using a One Health approach in midlevel training
programmes and public health education.
z Incorporate a module on zoonotic diseases and interactions at the human-animal-environment interface to undergraduate
and postgraduate courses in relevant educational curricula, including for medical administrators.

Participation and contribution from other sectors in actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6, 7
z Establish a mechanism for operational surveillance of priority animal diseases (including zoonotic diseases) across the
country.
z Plan and prioritize capacity-building activities on coordinated surveillance system for priority zoonotic diseases/pathogens,
using results from the WOAH PVS evaluation (or relevant tool of the PVS pathway) and the IHR-PVS national bridging
workshops.
79

z Identify and map high risk settings for zoonotic diseases with the potential to cause an epidemic.
 z Implement operational plans for preventing and detecting priority zoonotic diseases of greatest national public health

04 concern and allocate associated resources at the subnational level.

DEMONSTRATED z Establish a surveillance mechanism for zoonotic diseases which includes specific components focusing on high risk areas
CAPACITY and/or populations, sentinel surveillance, hotspot mapping and monitoring of drivers or other relevant risk factors.
z Establish continuing education and training programmes on zoonotic disease surveillance and management for staff
across relevant sectors at subnational level.
z Regularly test surveillance system capacities with all relevant sectors to detect zoonotic events and the immediate
containment/control and management of zoonotic diseases either by SimEx/AAR/IAR (as relevant).
z Collect and analyse relevant health data to manage zoonotic diseases across the country.
z Share surveillance data on zoonotic diseases with the animal health sector on a routine basis.

Participation and contribution from other sectors in actions:

1, 2, 3, 4, 5
z Implement capacity-building activities for coordinated surveillance systems on priority zoonotic diseases/pathogens
using the results of the WOAH PVS evaluation (or relevant tool of the PVS pathway) and of the IHR-PVS national bridging
workshops.
z Share animal health surveillance data on zoonotic diseases with human health sector on a routine basis and that joint risk
assessments are conducted during zoonotic events.

z Revise and update the strategies, guidelines, operational plan and SOPs for coordinated surveillance of zoonotic diseases/

05 pathogens based on lessons learned from SimEx/AAR/IAR (as relevant).

SUSTAINABLE z Establish a follow up mechanism to implement recommendations from M&E activities.

WHO benchmarks for strengthening health emergency capacities

CAPACITY z Allocate sustainable resources for coordinated surveillance and management of all priority zoonotic diseases across
relevant sectors.
z Expand coordinated surveillance to all priority zoonotic diseases/pathogens, at all levels (national and subnational levels),
including environmental media (i.e. water bodies, feeding sites) and establish system for reporting anomalous events such
as unexpected mortality in key species of concern.
80
 z Share country experience in coordinated surveillance of priority zoonotic diseases and engage the country in peer-to-peer
learning programmes at the subnational level (i.e. between regions) or international level..

Participation and contribution from other sectors in actions:

1, 2, 3, 4, 5
z Revise and update strategies, guidelines, operational plans and SOPs for coordinated surveillance of zoonotic diseases/
pathogens based on lessons learned.

WHO benchmarks for strengthening health emergency capacities

81
 BENCHMARK 5.2: A functional mechanism to respond to priority zoonotic diseases is in place
OBJECTIVE: To strengthen mechanism for responding to priority zoonotic diseases

CAPACITY LEVEL BENCHMARK ACTIONS

z No coordination between the animal health, public health and environment sectors is organized for zoonotic diseases.

01
NO CAPACITY

z Designate a focal point (with ToRs) from relevant sectors (animal (domestic animals and wildlife), human and

02 environmental health, etc.) for coordinated response to priority zoonotic diseases.

LIMITED z Clarify, document and formalize (with MoUs and/or ToRs) the roles and responsibilities of each sector when responding to
CAPACITY a zoonotic disease outbreak.
z Review and assess existing policies, strategies, plans and/or mechanisms enabling multisectoral coordination for
responding to priority zoonotic events, and ensure awareness of all relevant stakeholders.
z Develop guidelines and/or SOPs for coordinated investigation and response during zoonotic disease events.
z Map operational centres and experts available to respond to priority zoonotic disease events at the national and
subnational levels.
z Develop and disseminate training packages on zoonotic event guidelines and SOPs.
z Develop a mechanism to rapidly alert relevant actors at the national and subnational levels, including communities during a
priority zoonotic event.

Participation and contribution from other sectors in actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6, 7
z Conduct a WOAH PVS evaluation (or other PVS pathway assessments) to identify gaps and capacity-building activities in
the veterinary service sector for responding to priority zoonotic events. If a WOAH PVS evaluation was conducted within
the past two to three years, review the results and their implementation status.
82
 z Conduct an IHR-PVS national bridging workshop to improve collaboration between animal and human health sectors
during response to zoonotic disease outbreaks.
z Establish emergency response mechanisms for the management of priority animal disease outbreaks (zoonotic and
animal diseases), as well as for animal culling, cleaning and disinfection, carcass disposal, etc.

z Develop a multisectoral One Health operational plan with provision of resources in relevant sectors for coordinated

03 responses to outbreak of the main priority zoonotic diseases.

DEVELOPED z Develop a training programme for staff from the human, animal (domestic animals and wildlife) and environmental health
CAPACITY sectors, including training on guidelines, SOPs and operational plans, at the national and subnational levels.
z Establish a mechanism for rapidly alerting relevant sectors in case of priority zoonotic outbreak events to reduce the time
to initiate a coordinated outbreak response.
z Include access to laboratory capacity to identify pathogens of any priority zoonoses within response plans.
z Include modules on coordinated response to zoonotic diseases (including awareness on differences of perspectives and
practices) in relevant medical curricula.
z Promote graduated training of personnel in the field of epidemiology of zoonotic diseases, such as a field epidemiology
training program.

Participation and contribution from other sectors in actions:

1, 2, 3, 4, 5, 6
z Organize in-country discussions based on the results of the WOAH PVS evaluation (or other PVS pathway assessments)
and the IHR-PVS national bridging workshops to plan and prioritize capacity-building activities.
z Support veterinary services’ investments and budget as indicated in WOAH PVS assessment reports.

WHO benchmarks for strengthening health emergency capacities

z Disseminate and expand the One Health operational plan to relevant sectors to respond to all priority zoonotic diseases

04 across subnational levels.

DEMONSTRATED z Regularly analyse and produce reports on the timeliness of information exchange and activation of response mechanisms
CAPACITY between sectors.
z Regularly monitor and evaluate the efficiency of the multisectoral coordination mechanism for response through SimEx/
AAR/IAR (as relevant) conducted at national and subnational levels.
83
 z Graduate trained personnel from human and animal health in the field of epidemiology and demonstrate shared experience
in responding to zoonotic disease epidemics.

Participation and contribution from other sectors in actions:

1, 2, 3, 4
z Use the results of the WOAH PVS evaluation (or other PVS pathway assessments) and the IHR-PVS national bridging
workshops to implement capacity-building activities for functional mechanisms to respond to priority zoonotic diseases.

z Review and update the operational plan or mechanism based on the results of M&E and ensure follow up in

05 implementation of recommendations.
SUSTAINABLE z Document and disseminate the results and lessons learned from efforts to minimize zoonotic disease transmission from
CAPACITY animals to humans.
z Share country experiences in zoonotic disease response and management and engage the country in peer-to-peer
learning programmes at the subnational, national and international levels.

Participation and contribution from other sectors in actions:

1, 2, 3
z Review and update the operational plan or mechanism in the animal and environmental health sectors, based on the
results of SimEx/AAR/IAR.

WHO benchmarks for strengthening health emergency capacities

84
 BENCHMARK 5.3: Safe practices in animal breeding and animal product systems limit the risk of zoonotic diseases
OBJECTIVE: To promote good sanitary practices in animal breeding and the production of animal products, to limit the risk of zoonotic disease
transmission
Please note: for this benchmark, the actions are led by the country’s animal health sector, and actions of other sectors, including the human
health sector, fall under other sectoral engagement.

CAPACITY LEVEL BENCHMARK ACTIONS

IHR, Animal Health and Agriculture Sector
02 Human Health and Other Sector Engagement
LIMITED CAPACITY

CAPACITY LEVEL BENCHMARK ACTIONS

z No systematic efforts to improve good sanitary practices in the breeding of terrestrial and aquatic animals and in the

01 production of animal products36 are actively promoted or are minimal.

NO CAPACITY

z Identify key stakeholders involved in the various value chains associated with a potential risk of zoonotic disease

02 transmission through animal breeding, trade and/or production of animal products in relevant sectors.
LIMITED z Establish a technical working group mandated to assess and map potential zoonotic disease transmission risks along
CAPACITY various value chains, with representatives from relevant sectors, including animal health and production, wildlife, human
health, agriculture, legislation, food and drug authority, police, animal welfare, etc.

WHO benchmarks for strengthening health emergency capacities

z Review, compile and publicize sanitary standards, country laws and regulations for animal production practices, including
breeding, animal product processes and trade, and animal welfare in compliance with WOAH international standards.
z Assess the level of awareness on sanitary practices among stakeholders and professionals involved in animal breeding
and production of animal products for limiting risk of zoonotic diseases, including knowledge of laws and/or policies
regulating activities (including those related to animal welfare).
36
This refers to all sorts of products from breeder animals.
85
 z Identify and document gaps/common issues in compliance and adherence to sanitary practices in animal breeding to
reduce the risk of exposure to zoonotic pathogens during selling, slaughtering, culling or other practices potentially at risk.
z Explore if zoonotic disease risk assessments include the entire value chain from animal breeding practices to animal
product, including export and import of livestock, animal feeders, animals, animal products, etc.
z Prioritize actions to promote sanitary standards in animal breeding and production practices under the leadership of
veterinary services and in collaboration with private sector stakeholders involved in the various value chains, as well as
with human health services, environment authorities, food and drug authorities, legislature, police and relevant sectors.

Participation and contribution from human health other sectors in actions:

1, 2, 3, 4, 5, 6

z Develop and implement management plans to reduce the risk of zoonotic diseases associated with animal breeding and

03 production of animal products.

DEVELOPED z Develop a mechanism to promote sanitary practices along the various value chains (from animal breeding to the final
CAPACITY animal product) that highlights potential sanitary risks and possible measures to reduce them.
z Develop a database of trained professionals from relevant sectors (e.g. food and agriculture, animal health, environment,
human health, etc.) capable to assess the risk of zoonotic diseases associated with animal breeding and the production of
animal products.
z Develop and update laws and regulations as needed, to ensure compliance with sanitary standards for animal production
and importation and exportation of animals and animal products as recommended by WOAH.
z Develop and disseminate a training package for professionals and the public on sanitary animal production practices,
including reducing the risk of exposure to zoonotic pathogens during selling, slaughtering, culling or other practices.

WHO benchmarks for strengthening health emergency capacities

z Regularly conduct national level training of trainers sessions for facilitated dissemination of good practices to reduce the
risk of zoonotic diseases associated with animal breeding and animal product processing practices.
z Identify and assess the risks associated with animal production practices, and identify communities or professionals who
are exposed to identified risks.

Participation and contribution from human health and other sectors in actions:
1, 2, 3, 4, 5, 6, 7
86
 z Establish continuous and functional processes to identify risks of zoonotic disease transmission associated with animal

04 breeding and animal products processing, with multisectoral involvement.

DEMONSTRATED z Assess adherence to sanitary standards along value chains identified with possible risks of transmission of zoonotic
CAPACITY diseases.
z Regularly conduct initial or refresher training at national and subnational levels to increase potentially exposed workers’
awareness of zoonotic disease risks associated with animal breeding and animal product processing practices.
z Improve awareness among the public on the importance of implementing sanitary standards along the various value
chains, from animal breeding sites to animal product, in order to prevent zoonotic disease transmission from animals to
humans.

Participation and contribution from human health and other sectors in actions:
1, 2, 3, 4

z Sustained collaboration and linkages across relevant sectors for promoting and implementing safe animal production

05 practices in animal breeding and animal products value chains.

SUSTAINABLE z Conduct periodic inspection, assessment and monitoring of practices in animal breeding and the production of animal
CAPACITY products in main animal production value chains, and routinely verify compliance with national guidance.
z Conduct a joint review, regularly with relevant sectors, to assess the functionality of mechanisms for safe animal
production practices and document best practices and lessons learned.
z Update legislation, regulations and guidelines based on lessons learned from joint reviews of safe animal production
practices and the risk of zoonotic disease transmission.
z Share country experiences in promoting and implementing safe animal production practices to reduce zoonotic disease

WHO benchmarks for strengthening health emergency capacities

transmission and engage the country in peer-to-peer learning programmes at the subnational, national and international
levels.

Participation and contribution from human health and other sectors in actions:
1, 2, 3, 4, 5
87
 Tools:
z Strengthening the IHR through a One Health approach. Geneva: World Health Organization; 2023 (https://www.who.int/activities/strengthening-global-
health-security-at-the-human-animal-interface/strengthening-the-IHR-through-a-one-health-approach).
z World Health Organization & World Organisation for Animal Health. Handbook for the assessment of capacities at the human–animal interface, 2nd
edition. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254552).
z Operational framework for good governance at the human-animal interface. World Health Organization and World Organisation for Animal Health; 2014
(https://www.who.int/publications/i/item/who-oie-operational-framework-for-good-governance-at-the-human-animal-interface).
z Berthe FCJ, Bouley T, Karesh WB, Legall IC, Machalaba CC, Plante CA, et al. One Health: Operational framework for strengthening human, animal,
and environmental public health systems at their interface. Washington DC: World Bank Group; 2018 (http://documents.worldbank.org/curated/
en/961101524657708673/One-health-operational-framework-for-strengthening-human-animal-and-environmental-public-health-systems-at-their-
interface).
z Joint Food and Agriculture Organization of the United Nations-World Health Organisation for Animal Health-World Health Organization. Global
early warning system for health threats and emerging risks at the human–animal–ecosystems interface (GLEWS) [website]. Food and Agriculture
Organization of the United Nations, World Organisation for Animal Health and World Health Organization (http://www.glews.net/).
z Strengthening global health security and the human-animal interface. Geneva: World Health Organization; 2023 (https://www.who.int/activities/
strengthening-global-health-security-at-the-human-animal-interface).
z The control of neglected zoonotic diseases: from advocacy to action: report of the fourth international meeting held at WHO Headquarters, Geneva,
Switzerland, 19-20 November 2014. Geneva: World Health Organization; 2024 (https://apps.who.int/iris/handle/10665/183458).
z WHO Regional Office for South-East Asia, WHO Regional Office for the Western Pacific, Food and Agriculture Organization of the United Nations and
World Organisation for Animal Health. Zoonotic diseases: a guide to establishing collaboration between animal and human health sectors at the

WHO benchmarks for strengthening health emergency capacities

country level. Manila: WHO Regional Office for the Western Pacific; 2009 (https://apps.who.int/iris/handle/10665/206190).
z One health [website]. Geneva: World Health Organization; 2023 (https://www.who.int/health-topics/one-health#tab=tab_1).

z PVS Pathway [website]. Paris: World Organisation for Animal Health; 2023 (https://www.woah.org/en/what-we-offer/improving-veterinary-services/
pvs-pathway).
z One Health Zoonotic Disease Prioritization (OHZDP) [website]. Atlanta: Centers for Disease Control and Prevention; 2022 (https://www.cdc.gov/
onehealth/what-we-do/zoonotic-disease-prioritization/index.html).
88
 z Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries. Geneva: Food and Agriculture
Organization of the United Nations, World Health Organisation for Animal Health, and World Health Organization; 2019 (https://apps.who.int/iris/
handle/10665/325620).
z Performance of Veterinary Services (PVS) Pathway. Paris: World Health Organisation for Animal Health; 2023 (https://rr-europe.woah.org/en/our-
missions/veterinary-services/pvs-pathway/).
z IHR-PVS National Bridging Workshops [database]. Geneva: World Health Organization; 2023
(https://extranet.who.int/sph/ihr-pvs-bridging-workshop).
z Strengthening Veterinary Diagnostic Capacities: the FAO Laboratory Mapping Tool. Rome: Food and Agriculture Organization of the United Nations;
2016 (https://www.fao.org/documents/card/es/c/e13cf0b7-c8f4-4ff7-b340-439f40c677ec/).
z FAO Assessment Tool for Laboratories and AMR Surveillance Systems (FAO-ATLASS) [website]. Rome: Food and Agriculture Organization of the United
Nations; 2020 (https://www.fao.org/antimicrobial-resistance/resources/tools/fao-atlass/en/).
z Terrestrial Animal Health Code. Paris: World Organisation for Animal Health; 2022 (https://www.woah.org/en/what-we-do/standards/codes-and-
manuals/terrestrial-code-online-access/?id=169&L=1&htmfile=chapitre_vet_legislation.htm).
z Food and Agriculture Organization of the United Nations, World Health Organisation for Animal Health & World Health Organization Tripartite Joint Risk
Assessment Operational Tool (JRA OT). Geneva: Food and Agriculture Organization of the United Nations, World Organisation for Animal Health and
World Health Organization; 2020 (https://www.who.int/initiatives/tripartite-zoonosis-guide/joint-risk-assessment-operational-tool).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

WHO benchmarks for strengthening health emergency capacities

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
89
 06
Food safety
A functional system is in place for surveillance and response capacity of States Parties for foodborne disease and food contamination risks, or food safety
events, with effective communication and collaboration among sectors responsible for food safety.

IMPACT:
Timely detection and effective response to mitigate food safety emergencies, in collaboration with relevant sectors responsible for food safety.

MONITORING AND EVALUATION:

(1) Existence of indicator-based disease surveillance (IBS) or event-based disease surveillance (EBS) and supporting laboratory analysis to detect
and assign an aetiology for foodborne diseases or origin of contamination event and investigate hazards in foods linked to cases, outbreaks or
events. (2) Existence of a national food safety emergency plan. (3) Existence of a designated International Food Safety Authorities Network
(INFOSAN) emergency contact point and a WOAH focal point on animal production food safety with a central coordination mechanism in place.

WHO benchmarks for strengthening health emergency capacities

90
 BENCHMARK 6.1: Surveillance systems are in place for the detection and monitoring of foodborne diseases and food contamination
OBJECTIVE: To strengthen surveillance systems for foodborne diseases and food contamination

CAPACITY LEVEL BENCHMARK ACTIONS

z No or very limited surveillance system in place for foodborne disease or for food contamination (chemical and

01 microbiological) monitoring.
NO CAPACITY

z Review foodborne disease surveillance and food contamination monitoring capacity to assess gaps and needs, and

02 examine diseases and syndromes already under surveillance in the country that may indicate foodborne diseases.
LIMITED z Develop guidelines and SOPs for the detection of foodborne events through indicator-/event-based disease surveillance37.
CAPACITY z Establish indicator-based disease surveillance for notifiable syndromes and diseases such as diarrhoea (i.e. develop a
database to store data, alert thresholds, regular analysis of notifiable diseases, cause analysis of undetectable outbreaks,
documentation and protocol/SOPs).
z Establish event-based disease surveillance (i.e. identify national focal point, specify if the event being reported is suspected
as foodborne, train health workers to recognize and report foodborne events).
z Adapt the rapid risk assessment (RRA) process to accommodate foodborne diseases and conduct at the national level38.
z Identify a mechanism or multisector team with relevant agencies to coordinate the development and implementation of
foodborne disease surveillance, food contamination monitoring system(s), data sharing and staff that can contribute to
RRAs.
z Identify high risk settings such as farms, industries, points of entry, markets, mass gathering events, etc. that require

WHO benchmarks for strengthening health emergency capacities

specific attention and focus on food safety control and consumer safety and protection.
z Review the legal framework for surveillance and monitoring of foodborne diseases and food contamination to ensure
alignment between the human and animal health sectors, food business operators and food safety legislation.
37
Refer to stage 1 strengthening surveillance of and response to foodborne diseases in Using indicator- and event-based surveillance to detect foodborne events https://apps.who.int/iris/
bitstream/handle/10665/259471/9789241513241-eng.pdf
38
Refer to stage 1 rapid risk assessment of foodborne events in Using indicator- and event-based surveillance to detect foodborne events https://apps.who.int/iris/bitstream/hand
le/10665/259471/9789241513241-eng.pdf
91
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8
z Train food/sanitary inspectors to report events39.
z Train animal health inspectors to report the occurrence of zoonotic diseases that could be foodborne.

z Continue to implement actions (as suggested above) for both indicator- and event-based disease surveillance systems at

03 national and subnational levels where possible (subnational)40.

DEVELOPED z Establish laboratory-based surveillance (i.e. select priority foodborne pathogens, sampling protocols, detection
CAPACITY methodologies, database for laboratory-based surveillance data and data reporting protocols).
z Develop a strategy to monitor trends and detect foodborne events, and incorporate strategy into the national
communicable disease surveillance strategy.
z Train laboratory and health workers on obligations to report notifiable diseases, including those with non-diarrhoeal
symptoms.
z Expand the existing notifiable disease surveillance database to receive notifications about individual cases from health
workers and laboratories.
z Provide resources for the investigation of foodborne disease or food contamination events at the national level. This should
include investigations into hazards in foods linked to cases, outbreaks or events.
z Designate one/multiple national reference centre(s) with appropriate geographical coverage across the country to support
the surveillance and response system.
z Develop an IT system for recording, analyzing and sharing data collected during detection and monitoring of foodborne
diseases and food contamination at the national and subnational levels.

WHO benchmarks for strengthening health emergency capacities

z Organize informational and educational campaigns to raise awareness in communities and sensitize partners and
journalists on the management of foodborne diseases and food contamination in the country, through relevant sectors/
partners.
z Develop an operational communication mechanism including relevant stakeholders for food safety in the country.

Participation and contribution of other sectors to actions:

1, 2, 3, 6, 7, 8, 9, 10
92

39
An event is defined as a manifestation of disease or an occurrence that creates a potential for disease.
40
Refer to stage 2 strengthening surveillance of and response to foodborne diseases in Strengthening indicator-based surveillance https://apps.who.int/iris/bitstream/hand
le/10665/259472/9789241513258-eng.pdf.
 z Develop an integrated food chain surveillance system that allows integration of information from foodborne diseases and

04 food contamination surveillance systems into health information systems.

DEMONSTRATED z Designate and train staff to conduct RRA for foodborne diseases at the national and subnational levels with use of in-
CAPACITY country laboratory data. Food safety and laboratory staff should be standing members of RRA teams when an event is
suspected to be foodborne41.
z Increase use of in-country laboratory surveillance data to inform assessments and increase confidence in the overall risk
assessment through data that is more extensive, reliable, complete and high quality.
z Conduct joint risk assessments of acute foodborne events (chemical and microbiological), publish periodic reports (e.g. an
epidemiological bulletin) and identify appropriate risk management strategies through multisectoral involvement.
z Contribute to International Food Safety Authorities Network (INFOSAN) activities to share information internationally42.
z Share molecular patterns of relevant pathogens in an international database to support detection of foodborne outbreaks.
z Conduct SimEx/AAR/IAR (as relevant) to test the functionality of capacities for detection and monitoring of foodborne
diseases and food contamination.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

z Analyse the integrated food chain surveillance system for food regulators conducting risk analysis in accordance with

05 Codex Alimentarius Commission guidelines .

SUSTAINABLE z Maintain the level of function and expand the list of pathogens under integrated food chain surveillance, and periodically
CAPACITY update the priority list of foodborne diseases or syndromes for regulated procedures of surveillance and reporting.
z Regularly update stakeholder ToRs, strategies, SOPs and training packages for detection and monitoring of foodborne

WHO benchmarks for strengthening health emergency capacities

diseases and food contamination based on lessons learned and ensure that recommendations from M&E activities are
implemented.
z Facilitate a governance structure that allows data to be shared and includes a coordination and communication
mechanism.
41
Refer to stage 2 rapid risk assessment of foodborne events in Strengthening indicator-based surveillance https://apps.who.int/iris/bitstream/handle/10665/259472/9789241513258-eng.pdf.
42
FAO/WHO International Food Safety Authorities Network https://www.who.int/groups/international-food-safety-authorities-network-infosan
43
93

Codex Alimentarius Commission guidelines https://www.fao.org/fao-who-codexalimentarius/codex-texts/guidelines/en/

 z Regularly document and share country experiences across relevant sectors in surveillance and detection of foodborne

05 diseases, food contamination, food fraud and non-compliance issues, and participate in international initiatives to
SUSTAINABLE strengthen capacities globally.
CAPACITY z Identify gaps in knowledge and conduct relevant research studies to supplement surveillance and monitoring data.
z Apply whole genome sequencing techniques to foodborne disease surveillance and food monitoring.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

WHO benchmarks for strengthening health emergency capacities

94
 BENCHMARK 6.2: A functional mechanism is in place for the response and management of food safety emergencies
OBJECTIVE: To strengthen mechanisms for response and management of food safety emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z No mechanism for the response and management of food safety emergencies has been established or is in place, or is

01 very limited.
NO CAPACITY

z Review the legal framework for the response and management of food safety emergencies at the national and subnational

02 levels.
LIMITED z Identify and map key government agencies and cross-sector partners for roles and responsibilities in response and
CAPACITY management of food safety emergencies and contribution to RRAs.
z Develop a response plan, SOPs and guidelines for national food safety emergencies.
z Develop capacity to gather epidemiological and laboratory evidence during a response (i.e. train outbreak response teams
to conduct investigation, collect information to identify source of outbreak, conduct event database analysis, develop a list
of priority foodborne hazards and identify testing laboratories).
z Identify relevant medicines and medical products for preventing and treating priority foodborne diseases and food
contamination events that could potentially cause an outbreak.
z Regularly share data on food safety emergency management with national health authorities and include in the national
health database.
z Involve foodborne diseases experts in developing NHPSPs to define the country’s vision, policy directions and strategies

WHO benchmarks for strengthening health emergency capacities

for ensuring strengthening of capacity to manage foodborne diseases before, during and after emergencies.

INFOSAN:
z Designate an INFOSAN emergency point of contact in the government agency responsible for the response and
management of food safety emergencies and establish a communication system with the IHR NFP during food safety
emergencies. The parties are encouraged to refer to the IHR/INFOSAN communication template44.
44
Template for INFOSAN/IHR communication. https://www.who.int/publications/i/item/9789240012288
95
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8
z Identify and map high risk settings for food safety emergencies.
z Develop and share advocacy materials (by relevant sectors) to engage experts and raise community awareness about
mechanisms to respond to priority zoonotic diseases, foodborne diseases and food contamination events.

z Update the response plan, SOPs and guidance to include findings from analytical epidemiological studies conducted during

03 food safety emergencies at both national and subnational levels.

DEVELOPED z Draft new legislation or amend existing legislation to strengthen the legal basis for the response and management of food
CAPACITY safety emergencies at the national and subnational levels.
z Disseminate SOPs and guidelines for the response and management of food safety emergencies across stakeholder
networks.
z Develop strategies and guidance for orienting and communicating with partners, stakeholders, the general public,
international organizations and applicable regional and international networks on food safety guidelines45.
z Develop and disseminate risk communication messages to the public, through appropriate media, during food safety
emergencies46.
z Develop a food recall system (SOP) involving all relevant stakeholders (including the private sector) and include procedures
and regulations establishing traceability and recall systems and routine inspections that take place after a recall.
z Put in place specific questionnaires to be used to obtain a food history from cases during an outbreak to identify outbreak
sources, with questionnaires covering priority foodborne pathogens.
z Include new modules (based on change/adaptation needs assessment) in the training curricula for relevant health workers

WHO benchmarks for strengthening health emergency capacities

that cover the management of priority/novel foodborne emergencies. Define certifications and renumeration for trained
health workers as required.
45
Refer to Assuring food safety and quality: guidelines for strengthening national food control systems. Food and Agriculture Organization of the United Nations. 2003. https://www.fao.org/3/
y8705e/y8705e.pdf
46
Refer to Risk communication applied to food safety handbook. Food and Agriculture Organization of the United Nations and World Health Organization. 2016. https://www.fao.org/
publications/card/en/c/I5863E/
96
 INFOSAN
z Designate INFOSAN focal points with responsibility for food safety at appropriate levels in government agencies to form
a multisectoral working group for coordination, response and communication with IHR NFP (ensure there is at least one
focal point designated from public health, food inspection, veterinary, official laboratory, customs and quarantine and
agriculture sectors).

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9

z Report regularly to the national public health authorities all relevant information and updates on the management of

04 foodborne incidents and emergencies in the country (and outside the country).
DEMONSTRATED z Collect and collate routine health data, and regularly analyse data on management of foodborne diseases across the
CAPACITY country.
z Conduct SimEx/AAR (as relevant) for foodborne events to test the capacity of surveillance and monitoring systems and
include relevant sectors (animal health, environment, food business operators, etc).

INFOSAN:
z Establish a mechanism for regular information sharing between the INFOSAN emergency contact point, the INFOSAN
Secretariat, the IHR NFP, INFOSAN focal points and relevant sectors during a food safety emergency on the national and
international level.
z Test information sharing mechanisms at the international and global regional levels by performing SimEx/AAR (as relevant)
on a regular basis.
z Participate, all relevant parties (i.e. INFOSAN emergency contact point, INFOSAN focal points and the IHR NFP), in national

WHO benchmarks for strengthening health emergency capacities

workshops organized by the INFOSAN Secretariat to establish a roadmap to strengthen communication between involved
parties and with the INFOSAN Secretariat.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Organize and support cross-sectoral risk communication and community engagement (RCCE) initiatives to strengthen the
97

participation and commitment of the community, food chain actors from public and private sectors (including the informal
economy), and strategic and technical partners in the response and management of food safety emergencies at the
national and subnational levels.
 z Document and disseminate lessons and best practices for timeliness, information exchange, public health risk messaging,

05 efficiency and effectiveness of response, collaboration and communication for food safety events.
SUSTAINABLE z Review and update management and response plans and relevant legislation based on findings from SimEx/AAR (as
CAPACITY relevant).
z Continuously monitor medicines and medical products for preventing and treating priority foodborne diseases to track
adverse reactions, side effects and benefits over time.
z Share country experience in response and management of food safety emergencies and participate in international
initiatives to strengthen capacities globally.

INFOSAN:
z Conduct an audit on membership and update the designation of INFOSAN emergency contact points and focal points as
needed.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

Tools:
z Food Control System Assessment Tool: Introductory booklet. Geneva: Food and Agriculture Organization of the United Nations and World Health
Organization; 2021 (https://www.who.int/publications/i/item/9789240028371).
z Food safety [website]. Geneva: World Health Organization; 2023 (https://www.who.int/health-topics/food-safety#tab=tab_1).

z Using indicator- and event-based surveillance to detect foodborne events. Stage One Booklet: Strengthening surveillance of and response to foodborne
diseases. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/strengthening-surveillance-of-and-response-to-

WHO benchmarks for strengthening health emergency capacities

foodborne-diseases).
z Strengthening indicator-based surveillance. Stage Two Booklet: Strengthening surveillance of an response to foodborne diseases. Geneva: World
Health Organization; 2017 (https://www.who.int/publications/i/item/9789241513258).
z Integrated surveillance of antimicrobial resistance in foodborne bacteria: application of a one health approach: guidance from the WHO Advisory
Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR). Geneva: World Health Organization; 2027 (https://apps.who.int/iris/
handle/10665/255747).
98
 z Whole genome sequencing for foodborne disease surveillance: landscape paper. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/
handle/10665/272430).
z INFOSAN members’ guide. Web Annex. Template for INFOSAN/IHR communication: national protocol for information sharing with national and
international partners during food safety events and outbreaks of foodborne illness. Geneva: World Health Organization and Food and Agriculture
Organization of the United Nations; 2020 (https://www.who.int/publications/i/item/9789240012288).
z Estimating the burden of foodborne diseases: a practical handbook for countries: a guide for planning, implementing and reporting country-level burden
of foodborne disease. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/341634).
z Codes and manuals [website]. Paris: World Organisation for Animal Health; 2023 (https://www.woah.org/en/what-we-do/standards/codes-and-
manuals/).
z FAO/WHO International Food Safety Authorities Network (INFOSAN). Food and Agriculture Organization of the United Nations and World Health
Organization; 2023 (https://www.who.int/groups/international-food-safety-authorities-network-infosan).
z Assuring food safety and quality: Guidelines for strengthening national food control systems. Food and Agriculture Organization of the United Nations
and World Health Organization; 2003 (https://www.fao.org/publications/card/en/c/92f82d38-5557-4ca1-b361-be14cd129db6/).
z Risk communication applied to food safety handbook. Rome: Food and Agriculture Organization of the United Nations and World Health Organization;
2016 (https://www.fao.org/publications/card/en/c/I5863E/).
z Codex Alimentarius International Food Standards – Guidelines. Food and Agriculture Organization of the United Nations and World Health Organization;
2023 (https://www.fao.org/fao-who-codexalimentarius/codex-texts/guidelines/en/).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).

WHO benchmarks for strengthening health emergency capacities

z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
99
 07
Immunization
Immunization is key to the prevention and control of epidemic-prone vaccine-preventable diseases (VPDs). A national vaccine delivery system should be in
place, with nationwide reach, effective distribution, easy access for marginalized populations, adequate cold chain and ongoing quality control, to respond to
existing and new disease threats.

IMPACT:
Effective protection through achievement and maintenance of immunization against measles and other epidemic-prone VPDs. Measles
immunization is identified as a proxy indicator for overall immunization against VPDs as measles is a continuing cause of substantial avoidable
morbidity and mortality. Identification and implementation of targeted immunization activities to protect populations at risk of other epidemic-
prone VPDs of national importance (e.g. cholera, Japanese encephalitis, meningococcal disease, typhoid, yellow fever and COVID-19, etc.).
Diseases that are transferable from animals to humans, such as anthrax and rabies, are also included.

MONITORING AND EVALUATION:

90-95% coverage of the country’s 12 month old population with measles-containing-vaccine first-dose (MCV1), as demonstrated by coverage
surveys.

WHO benchmarks for strengthening health emergency capacities

100
 BENCHMARK 7.1: Optimum vaccine coverage (measles) as part of a national programme
OBJECTIVE: To increase vaccine coverage for priority vaccine-preventable diseases (VPDs) in the country

CAPACITY LEVEL BENCHMARK ACTIONS

z Less than 50% of the country’s 12 month old population has received measles-containing-vaccine first-dose (MCV1), as

01 demonstrated by coverage surveys or administrative data.

NO CAPACITY

z Assess and map existing coverage data to identify high risk areas and populations to target control of selected VPDs.

02 z Conduct stakeholder mapping and form a multistakeholder national advisory committee which will guide country policies
LIMITED and strategies for optimum vaccine coverage based on country risk profile for measles and other VPDs.
CAPACITY z Develop an immunization strategy with a comprehensive multiyear operational plan outlining and describing actions and
activities for increasing vaccine coverage at national and subnational levels.
z Evaluate immunization surveillance data, registries, data and reporting systems to identify areas for strengthening of
immunization data management.
z Develop and disseminate guidance and tools to increase routine immunization services, with a focus on MCV1 coverage
and conduct activities to achieve 50–69% MCV1 coverage in the country’s 12 month old population.
z Develop plans to perform catch-up campaigns or supplemental immunization activities, based on epidemiologic and
coverage data.
z Develop a standardized system of monitoring and reporting adverse events following immunization (AEFI).

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 5, 6

z Use mapping and assessment data to plan targeted routine and supplemental immunization activities in high risk areas

03 and populations.
DEVELOPED z Finalize, approve and operationalize the national immunization plan with activities to achieve 70–89% MCV1 coverage in
CAPACITY the country’s 12 month old population and introduce immunization into targeted populations.
101
 z Develop guidelines, SOPs, training materials and toolkits on pre- and post-service guidance for immunization, safety, waste
management and reporting and train health workers.
z Create and disseminate messaging tools to improve knowledge-based capacities (i.e. communication and education) of
health workers conducting community mobilization.
z Operationalize a national vaccine registry and standardized system of monitoring and reporting AEFI at all health facilities
and train health workers on these.
z Develop specific plans to ensure continuity of routine immunization activity, prevent interruption of services during health
emergencies and catch-up vaccination plans when interruptions have occurred.

Participation and contribution of other sectors to actions:

2, 3, 6
z Develop materials and activities to advocate for the importance of vaccination by ministries of education, labour, social
security, culture, etc. for relevant populations (children, workers, etc.).

z Conduct activities to achieve 90% MCV1 coverage in the country’s 12 month old population, implementing specific

04 strategies focused on reaching vulnerable and marginalized populations at the national and subnational levels to reduce
DEMONSTRATED inequities with the target of progressing to 95% national coverage in 2030.
CAPACITY z Develop and implement quality assurance standards and M&E mechanisms for immunization including data quality
reviews, and ensure sufficient health workers are appropriately trained.
z Promote immunizations and sensitize communities through routine messaging through traditional and social media and
engaging CSOs and religious leaders.
z Evaluate and validate the AEFI reporting system.

WHO benchmarks for strengthening health emergency capacities

z Develop a legal basis and strategy for closer collaboration between public and private institutions involved in implementing
the immunization strategy at the national and subnational levels.
z Organize SimEx/AAR/IAR (as relevant) to test the organization of immunization campaigns at national and subnational
levels and confirm they are functional as routine systems and during special circumstances such as a health emergency.
z Develop a system to track individual immunization status for priority VPDs while protecting privacy by leveraging
immunization registries, electronic databases and national identification number systems.
102
 z Work with relevant ministries to secure sustainable domestic funding (e.g. >12month funded operational plans) for
immunization activities.
z Recruit additional voices for immunization advocacy campaigns in the community (e.g. social, religious and traditional
leaders) and train them as champions to deliver messages on the importance of immunization for priority VPDs.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9

z Integrate the national vaccine registry with national health information systems, as appropriate.

05 z Conduct activities to ensure 95% of the country’s 12 month old population have received at least one dose of MCV.
SUSTAINABLE z Conduct formal surveys of underserved areas to ensure that coverage among vulnerable and marginalized populations is
CAPACITY >90%.
z Use results from SimEx/IAR/AAR (as relevant) to update and improve the national immunization strategy.
z Share country experiences in the management of vaccination campaigns for priority VPDs and engagement with
marginalized and vulnerable groups, and engage the country in peer-to-peer learning programmes at the subnational,
national and international levels.
z Develop programmes or incentives to encourage and support routine vaccination while respecting the autonomy of
beneficiaries.
z Develop educational programmes to promote the importance of vaccination and combat misinformation and
disinformation about vaccines.
z Develop innovative tools to support information and education campaigns on immunization including development of
new platforms, social media tools, and mobile and internet-based technologies based on lessons learned from previous

WHO benchmarks for strengthening health emergency capacities

campaigns, communications and social marketing efforts.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
103
 BENCHMARK 7.2: Provision of national vaccine access and delivery
OBJECTIVE: To strengthen capacity for vaccine access and delivery to target populations

CAPACITY LEVEL BENCHMARK ACTIONS

z No plan is in place for nationwide vaccine delivery, nor have plans been drafted to provide vaccines throughout the country

01 to target populations or inadequate vaccine procurement and forecasting has led to regular stockouts at the central or
NO CAPACITY district levels.

z Draft or review existing plans, policies and procedures for vaccine delivery and use results to guide vaccine procurement

02 and delivery of targeted vaccines.

LIMITED z Draft a list of essential vaccines for the country based on international recommendations and country risk profile.
CAPACITY z Review national laws and regulations for procuring vaccines from national and international sources during health
emergencies.
z Form a national multisectoral working group to coordinate vaccine procurement and delivery and developed national
guidance documents for vaccine stockpile and deployment and obtain approval from health ministry (and agriculture
ministry where applicable).
z Establish a cold chain for vaccine delivery to at least 40% of districts or 40% of the target population in the country.
z Complete a review to identify barriers to procuring, receiving, storing and deploying vaccines and develop a national
guideline for vaccine supply chain management, quality assurance and secured delivery to target populations at both
national and subnational levels before, during and after health emergencies.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 3, 4, 5, 6

z Conduct a detailed assessment of existing cold chain equipment, including functioning, and identify bottlenecks to

03 maintaining needed cold chain infrastructure at the district, state and provincial levels and use assessment data to
DEVELOPED operationalize a plan to service and procure cold chain infrastructure as needed.
CAPACITY z Operationalize national guidelines for vaccine delivery to target populations and develop and disseminate protocols, SOPs,
trainings, technical guidelines and toolkits for storage, transportation and deployment of vaccines to health workers and
104

staff.
 z Establish a cold chain for vaccine delivery to at least 40–59% of districts or 40–59% of the target population in the country.
z Establish guidance to prevent interruption of routine vaccination during health emergencies (with clear designation of
funding sources, minimum staff and cold chain capacity to ensure continuity of immunization services), specifying
procedures for procurement, efficient customs clearance, storage and transportation of vaccines.
z Form a strategic national vaccine stockpile based on the list of essential vaccines identified for the country, with security
and quality requirements met for sufficient vaccine access and delivery to target populations.
z Regularly invite national vaccine manufacturers to the national working group for coordination of vaccine access and
delivery, to facilitate dialogue and negotiation and to ensure affordability of vaccines before, during and after emergencies
to avoid speculation.
z Work with relevant partners to secure resources and investments in immunization.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Develop capacities for international and national transport of vaccines and vaccination material involving public and private
transport companies within and outside the country.
z Develop specific capacities in relevant sectors to manage vaccine logistics for specific vaccines including cooling
warehouses, cooling boxes, specific interim storage conditions, delivery and downstream distribution, etc.

z Procure and service cold chain equipment in areas identified by the detailed assessment to ensure vaccine delivery to at

04 least 60–79% of districts or 60–79% of the target population in the country.

DEMONSTRATED z Routinely train health workers and other immunization staff on protocols, SOPs, technical guidelines and toolkits for
CAPACITY vaccine storage, transportation and deployment.

WHO benchmarks for strengthening health emergency capacities

z Conduct quality assurance of cold chain equipment and delivery systems.
z Establish an inventory management system that monitors and communicates vaccine supply and requirements at all
needed levels.
z Develop and implement a strategy for vaccine distribution and identification of vulnerable populations to ensure equitable
access to vaccines.
z Monitor, evaluate and amend national and subnational vaccination projects and programmes based on lessons learned
105

from real or simulated implementation and changes needed in the community.

 z Involve the government in international initiatives for joint purchase of vaccines and facilitate negotiation with
manufacturers on prices as well as desired product profiles to avoid inflation and unfair competition during health
emergencies.
z Develop training and exercises for hazard-specific response and management plans with relevant sectors, agencies and
other stakeholders.
z Develop tools for staff in relevant sectors at national and subnational levels to work towards global standardization of all
steps of vaccines access and delivery.

Participation and contribution of other sectors to actions:

1, 2, 3, 5, 6, 7, 8, 9, 10
z Implement processes to ensure efficient customs clearance of vaccines by relevant authorities, particularly in emergency
contexts.

z Secure sustainable funding for vaccine delivery systems, including for procurement and routine repair of cold chain

05 equipment (e.g. costed and financed multiyear operation plans).

SUSTAINABLE z Establish cold chain for vaccine delivery to more than 80% of districts or more than 80% of the target population in the
CAPACITY country.
z Assess vaccine delivery in priority areas and/or populations (identified based on existing coverage, registry and/or
surveillance data), and use results to improve vaccine delivery.
z Routinely analyse the inventory management system to monitor vaccine supply needs and forecast requirements, with
anticipated procurement.
z Establish functional national bodies to assess and recommend an evidence-based national vaccine policy and routinely

WHO benchmarks for strengthening health emergency capacities

complete a qualitative and quantitative inventory of the strategic national vaccine stockpile.
z Engage research platforms to generate evidence on immunization to improve service delivery and meet the needs of
diverse communities, including identifying successful strategies to reduce inequities, improve the quality and delivery of
immunization services, improve delivery approaches for life-course immunization.

Participation and contribution of other sectors to actions:

1, 2, 3, 6
106
 BENCHMARK 7.3: An effective mechanism for mass vaccination of epidemics of vaccine preventable diseases (VPD) is in place
OBJECTIVE: To strengthen capacity for mass vaccination in response to VPD epidemics

CAPACITY LEVEL BENCHMARK ACTIONS

z No contingency plans or mechanisms for mass vaccination response to outbreaks of VPD are in place.

01
NO CAPACITY

z Include in the ToRs of a national advisory committee on immunization planning for mass vaccination for epidemics of

02 VPDs (including vaccines for novel pathogens) and a decision framework for use of mass vaccination.
LIMITED z Develop and include contingency plans for mass vaccination deployment for at least one priority VPD outbreak (e.g.
CAPACITY Ebola virus disease, measles, yellow fever, cholera, meningococcus, polio, etc.) – including the use of new vaccines – in
the national immunization plan. The strategy should include storage, cold chain and distribution capacities, required
consumables, potential target populations and engagement of relevant sectors for implementation.
z Conduct a situational analysis on fast-track approval and procurement process for new vaccines/pharmaceuticals – from
both new and existing suppliers – and identify regulatory and importation mechanisms for new and experimental vaccines
during epidemics of novel pathogens.
z Establish a technical working group endorsed by advisory committee on immunization to work as a knowledge hub to
get updates on research, development and global stock details related to vaccines for novel pathogens and report to the
advisory committee to support planning for mass vaccination campaigns as needed.
z Designate staff to lead planning and implementation of mass vaccination campaigns for VPD outbreaks.
z Include quality assessment and emergency approval for the use of new and experimental vaccines in epidemics of VPD

WHO benchmarks for strengthening health emergency capacities

into national fast-track policy for approval of new pharmaceutical products.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 6
107
 z Assess and streamline the regulatory processes for sourcing and importing vaccines for VPD outbreak response, including

03 new and existing vaccines.

DEVELOPED z Develop and implement national and subnational deployment plans, including basic microplanning, for multiple types of
CAPACITY VPD outbreaks including the use of new vaccines. Plans should examine potential impacts of various risk-based, equity-
based and other approaches.
z Develop and validate SOPs related to the roles and responsibilities of health workers and others for the emergency
procurement process of new vaccines in epidemics of novel pathogens to ensure safety, quality, supply chain
management, vaccination technique, AEFI reporting, etc.
z Develop a curricular framework, training plan and materials for mass vaccination campaigns for priority VPD outbreaks.
z Develop or adapt national systems to monitor coverage of new and experimental vaccines, vaccine safety and adequate
reporting of serious AEFIs (e.g. WHO target of a least one serious AEFI reported per 1,000,000 population per year) detailing
the roles, responsibilities and monitoring and reporting mechanism at all levels.
z Collaborate with existing RCCE efforts to develop proactive strategies to increase acceptance of mass vaccination and
address infodemics using real-time social listening with clear linkage to AEFI surveillance programs.
z Establish a mechanism for donor and donation management for access/availability of new vaccines for novel pathogens
and quality/safety assurance for in-country use.

Participation and contribution of other sectors to actions:

1, 2, 3, 5, 6, 7

z Conduct SimEx/AAR/IAR (as relevant) for mass vaccination campaigns during epidemics of VPD in collaboration with
relevant sectors, to identify functionality, bottlenecks, best practices and assess performance of RCCE activities. Revise

WHO benchmarks for strengthening health emergency capacities

04
DEMONSTRATED SOP and deployment plans accordingly.
CAPACITY z Validate training materials and tools and for mass vaccination campaigns during VPD outbreaks (including infodemic
management) and conduct training at subnational levels.
z Enhance integration between disease surveillance and other information systems (e.g. AEFI) to provide data for decision-
making in VPD outbreak response.
z Implement monitoring and reporting of coverage and safety of vaccines used in mass vaccination campaigns at all levels.
108
 z Increase storage capacity and improve logistic management information systems for vaccines and consumable supplies
at subnational and local levels, as needed.
z Develop tailored strategies and relevant criteria for mass vaccination campaigns to ensure equity and equality in access
to vaccination (including hospitals, community vaccination centres, mobile vaccination sites, home visits to disabled and
elderly, etc).
z Implement emergency budget/provisions for reallocation of funds to emergency mass vaccination campaigns, as a
national priority.

Participation and contribution of other sectors to actions:

1, 5, 6, 7

z Sustain supply of vaccines for mass vaccination campaigns and test vaccine surge capacities, storage capacities and

05 distribution systems at all levels and resolve challenges identified.

SUSTAINABLE z Secure contingency funding for mass vaccination of epidemics of VPD in the national health budget, including ability to
CAPACITY reallocate funding during health emergencies.
z Sustain microplans for reaching all individuals within target populations during mass vaccination campaigns for VPD
outbreaks.
z Develop vaccination contingency plans for responding to novel disease scenarios.
z Share best practices and lessons learned in mass vaccination campaigns, with a focus on ensuring access/availability of
vaccines, at national and international forums to engage the country in peer-to-peer learning.
z Develop innovative tools to support information and education campaigns on mass vaccination including development of
new platforms, social media tools, and mobile and internet-based technologies based on lessons learned from previous

WHO benchmarks for strengthening health emergency capacities

campaigns, communications and social marketing efforts.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Effective contribution by relevant sectors for the sustainable supply of vaccines.
109
 Tools:
z Essential Programme on Immunization [website]. Geneva: World Health Organization; 2023 (https://www.who.int/teams/immunization-vaccines-and-
biologicals/essential-programme-on-immunization).
z Measles & Rubella Initiative, American Red Cross, Centers for Disease Control and Prevention, United Nations Children’s Fund, United Nations
Foundation and World Health Organization. Global Vaccine Access Plan [website]. Geneva: World Health Organization; 2023 (https://www.who.int/
teams/immunization-vaccines-and-biologicals/strategies/global-vaccine-action-plan).
z Measles and rubella strategic framework: 2021-2030. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/measles-
and-rubella-strategic-framework-2021-2030).
z Bill & Melinda Gates Foundation, Centers for Disease Control and Prevention, World Health Organization, United Nations Children’s Fund, John Snow
Inc, GAVI the Vaccine Alliance. Global Routine Immunization Strategies and Practices (GRISP). A companion document to the Global Vaccine Action
Plan. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/global-routine-immunization-strategies-and-practices-
(grisp)).
z Planning and implementing high-quality supplementary immunization activities for injectable vaccines using an example of measles and rubella
vaccines: field guide. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241511254).
z Training for mid-level Managers (MLM): module 3: immunization safety. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/337054).
z Immunizations, Vaccines and Biologicals. WHO recommendations for routine immunization – summary tables. Geneva: World Health Organization;
2023 (https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/who-recommendations-for-routine-immunization---summary-
tables).
z Surveillance standards for vaccine-preventable diseases, 2nd edition. Geneva: World Health Organization; 2018 (https://www.who.int/publications/i/

WHO benchmarks for strengthening health emergency capacities

item/surveillance-standards-for-vaccine-preventable-diseases-2nd-edition).
z Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Geneva: World Health Organization; 2020 (https://www.who.int/teams/
immunization-vaccines-and-biologicals/strategies/ia2030).
z Guidance on operational microplanning for COVID-19 vaccination, revised 2 May 2023. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/i/item/WHO-2019-nCoV-vaccination-microplanning-2023.1).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).
110
 z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419).

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111
 08
Biosafety and biosecurity
A whole-of-government multisectoral national biosafety47 and biosecurity48 system with biological agents of high consequence49 identified, held, secured
and monitored in a minimal number of facilities according to best practices50. Country-specific biosafety and biosecurity legislation, laboratory licensing
and pathogen control measures are in place as appropriate, and on include risk- and evidence-based approaches. Biological risk management training
and educational outreach are conducted to promote a shared culture of responsibility51. Reduce high consequence research activities where appropriate
to mitigate risks associated with dual-use research of concern and proliferation of biological agents of high consequence, for examples. Safe and secure
transport and transfer of infectious substances are ensured..

IMPACT:
A comprehensive, sustainable and legally embedded national oversight programme for biosafety and biosecurity which includes the safe and
secure use, storage, disposal and containment of biological agents of high consequence in all laboratory and holding facilities across human
health, animal health and agricultural sectors. Strengthened, sustainable biological risk management best practices are in place in relevant
sectors and safe and compliant transport of infectious substances occurs according to national and international regulations.

MONITORING AND EVALUATION:

(1) Existence of a national framework for biosafety and biosecurity, strain collections and containment laboratories that includes identification

WHO benchmarks for strengthening health emergency capacities

and storage of national strain collections in a minimal number of facilities from relevant sectors. (2) Existence of a comprehensive oversight and
monitoring system.

47
Laboratory biosafety describes the containment principles, technologies and practices that are implemented to prevent unintentional exposure to pathogens and toxins or their accidental
release (refer to WHO’s Laboratory biosafety manual, 4th edition).
48
Laboratory biosecurity describes the protection, control and accountability for valuable biological materials within laboratories, as well as information related to these materials and dual-use
research, to prevent their unauthorized access, loss, theft, misuse, diversion or intentional release.
49
Refer to The Australia Group’s list of human and animal pathogens and toxins for export control.
50
Minimal/best practices, as referred in WHO’s Laboratory biosafety manual, 4th edition.
112

51
Refer to Responsible life sciences research for global health security: a guidance document.
 BENCHMARK 8.1: Whole-of-government biosafety and biosecurity system is in place for relevant sectors including human, animal (domestic animals
and wildlife) and agricultural facilities
OBJECTIVE: To develop and implement a biosafety and biosecurity system for relevant sectors including human, animal (domestic animals and
wildlife) and agricultural facilities to minimize the risk of accidental or intentional infection of laboratory staff or release of biological agents of high
consequence

CAPACITY LEVEL BENCHMARK ACTIONS

z Elements of a comprehensive national biosafety and biosecurity system, such as policy instruments and proper financing,

01 are not in place.

NO CAPACITY

z Establish a multisectoral technical advisory board to advise and guide decision-makers in relation to risk- and evidence-

02 based recommendations for mitigating and managing biosafety and biosecurity threats and incidents that may arise.
LIMITED z Review and develop or revise national legislation and regulations for biosafety and biosecurity in the human health, animal
CAPACITY health and agricultural sectors.
z Identify and document human and animal health facilities that store and maintain biological agents of high consequence
and toxins and health professionals responsible for them.
z Identify all departments, facilities and settings that handle or may handle biological agents of high consequence and toxins
in relevant sectors (e.g. food safety, agriculture, points of entry, internal security, fire services, defence, customs, postal
services, waste management, agriculture, etc.).
z Establish a mechanism for laboratory licensing in relevant sectors and ensure that biosafety and biosecurity requirements
are included in general licensing requirements.

WHO benchmarks for strengthening health emergency capacities

z Conduct assessments of current biosafety and biosecurity practices, procedures and policies at the national level.
z Develop biological management measures, including options for containment, operational handling and failure of reporting
systems.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
113

z Conduct a biosafety and biosecurity assessment of animal health laboratories to identify critical needs.
 z Develop a national biosafety and biosecurity regulatory framework, including guidelines and recordkeeping obligations for

03 all laboratories working with biological agents of high consequence.

DEVELOPED z Develop and maintain inventories for biological agents of high consequence.
CAPACITY z Secure biological agents of high consequence and toxins at a minimum number of national level laboratories.
z Develop and test SOPs that include standard requirements of PPE and other safety measures for departments, facilities
and settings that store, maintain or handle biological agents of high consequence and toxins.
z Establish an information security system for all sensitive documentation in facilities where biological agents of high
consequence and toxins are stored.
z Develop a strategy for identifying and preventing biohacking and unsafe research performed outside of official laboratories,
including safety oversight associated with biosafety regulations in collaboration with internal security and defence staff.
z Implement national biosafety and biosecurity regulations and guidelines in relevant sectors (e.g. human health, animal
health, agriculture, defence, etc.) with standardized classification and accreditation that cover pathogen control and
personnel reliability programme requirements.
z Recommend alternative laboratory techniques that are associated with a lower risk to replace the need for proliferation of
biological agents of high consequence.
z Develop incident and emergency response programmes for facilities storing biological agents of high consequence and
toxins.
z Develop and implement equipment operation and maintenance plans at laboratories storing biological agents of high
consequence or security concern.
z Establish biosafety and biosecurity officers and, where necessary, biosafety and biosecurity committees at least in national
reference laboratories (with potential expansion to all laboratories across relevant sectors), supported by the appropriate

WHO benchmarks for strengthening health emergency capacities

regulatory base, training or certification, and competency.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
z Conduct a risk assessment and survey for accidental or intentional misuse of biological agents of high consequence and
toxins in relevant sectors.
114
 z Implement the biosafety and biosecurity national framework in all laboratories at the national and subnational levels.

04 z Develop site-specific biosafety and biosecurity supporting documents that include incident and emergency response
DEMONSTRATED plans (e.g. in case of explosion, fire, flood, worker exposure, accident or illness, major spillage, waste management, etc.) for
CAPACITY laboratories at national and subnational levels.
z Develop SOPs for identifying and addressing high consequence research, such as dual-use aspects of research, and
include a responsible code of conduct for scientists and other staff.
z Develop and implement an incident reporting system that includes identifying incidents, reporting according to regulations,
and addressing action items that improve safety and security. Share reports with the relevant sectors.
z Establish external monitoring and oversight of biosafety and biosecurity programmes and activities.
z Develop guidelines and procedures for the management of suspicious packages (for example, Anthrax letters) in
collaboration with relevant sectors (e.g. police, defence, postal services, customs, etc.) at national and subnational levels.
z Develop a national strategic stock of medicines (including antibiotics, antitoxins, serums and vaccines) for prevention or
emergency treatment related to biosafety or biosecurity threats and incidents.
z Conduct SimEx to test procedures for the management of biosafety and biosecurity threats and incidents and confirm
functionality.
z Develop (in collaboration with occupational health services and other relevant parties) protocols for emergency care of
workers and victims of biosafety- and biosecurity-related incidents, procedures for emergency medical evacuation to
specialized health facilities, and decontamination protocols.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9

WHO benchmarks for strengthening health emergency capacities

z Share records of biosafety- and biosecurity-related threats and incidents occurring in relevant sectors with health
authorities.
115
 z Secure sustainable funding and oversight and enforcement mechanisms to support biosafety and biosecurity programmes

05 and initiatives at the ministry level.

SUSTAINABLE z Maintain records of all biosafety and biosecurity accidents that happen in the country to preserve institutional memory,
CAPACITY inform risk assessment and mitigation review, and enable improvements to biosafety and biosecurity policies and
practices.
z Establish mandatory reporting of all laboratory-associated infections, at least on annual basis.
z Adjust strategy, guidance and protocols for management of biosafety and biosecurity threats and incidents based on M&E
exercises.
z Evaluate implementation of national biosafety and biosecurity legislations and practices, and document and generate best
practices for biosafety and biosecurity arrangements which are aligned with international best practices at all levels.
z Contribute to international surveillance information sharing and risk assessments for biosafety and biosecurity at the
global level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

WHO benchmarks for strengthening health emergency capacities

116
 BENCHMARK 8.2: Biosafety and biosecurity training and practices in relevant sectors including human health, animal health (domestic animals and
wildlife) and agriculture are in place
OBJECTIVE: To develop a public health workforce that is trained and available to enable early detection, prevention, preparedness and response to
potential events of international concern at all levels of the health system to effectively implement IHR

CAPACITY LEVEL BENCHMARK ACTIONS

z No biosafety and biosecurity training programme or plans are in place in any sector.

01
NO CAPACITY

z Assess biosafety and biosecurity training needs and gaps in relevant sectors.

02 z Conduct an engagement meeting to develop biosafety and biosecurity training programmes that align academic curricula
LIMITED with international best practices.
CAPACITY z Develop training programmes for both trainers and trainees as required.
z Emphasize risk- and evidence-based approaches to biosafety and biosecurity and include risk assessment in training
programmes and curricula.
z Identify and create a directory of laboratory staff that have basic training, at least, in biosafety and biosecurity working in
laboratories and related fields.
z Identify laboratory staff by category that require training in biosafety and biosecurity, determine the level of training
required and conduct required training regularly.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6
117
 z Adapt in-service and continuing education training curricula, SOPs, toolkits, good microbiological practices and

03 procedures, risk assessment and procedures to comply with biosafety and biosecurity rules and regulations and align with
DEVELOPED international best practices.
CAPACITY z Train and oversee facilities that are housing or working with biological agents of high consequence and toxins to comply
with biosafety and biosecurity rules and regulations.
z Begin developing sustained academic curricula, continuing education and training programmes for biosafety and
biosecurity that align with international best practices.
z Develop and/or adapt biosafety and biosecurity training module for specialized and continuing education of healthcare
professionals.

Participation and contribution of other sectors to actions:

1, 2, 3
z Develop specific training programmes on biosafety and biosecurity for staff in relevant sectors (e.g. animal health, defence,
security, points of entry, etc.).

z Implement training programmes and oversight to assess compliance with biosafety and biosecurity rules and regulations,

04 and ensure alignment with international best practices.

DEMONSTRATED z Implement sustainable training programmes, that are aligned with international best practices, in institutions that train
CAPACITY those who maintain or work with biological agents of high consequence and toxins.
z Review training programmes and needs assessments on a regular basis and update training materials and curricula as
required.
z Conduct mandatory training on biosafety and biosecurity for all staff working with biological agents and biological

WHO benchmarks for strengthening health emergency capacities

materials of high consequence and toxins.

Participation and contribution of other sectors to actions:

1, 2, 3, 4
z Align relevant sector training programmes in biosafety and biosecurity with health sector trainings.
118
 z Guarantee sustained funding from the national government to support training programmes.

05 z Include biosafety and biosecurity training courses in university curricula of pre-training education in human and animal
SUSTAINABLE health programmes.
CAPACITY z Implement periodic training programmes on emergency response procedures.
z Participate in international initiatives to support capacity-building and staff training at the global level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

Tools:
z Laboratory biosafety manual, 4th edition. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240011311).

z WHO guidance on implementing regulatory requirements for biosafety and biosecurity in biomedical laboratories: a stepwise approach. Geneva: World
Health Organization; 2020 (https://apps.who.int/iris/handle/10665/332244).
z Guide to participating in the confidence-building measures of the biological weapons convention. Revised edition 2015. Geneva: United Nations Office
for Disarmament Affairs; 2015 (https://disarmament.unoda.org/publications/more/cbm-guide).
z Responsible life sciences research for global health security: a guidance document. Geneva: World Health Organization; 2010 (https://apps.who.int/iris/
handle/10665/70507).
z List of human and animal pathogens and toxins for export control [website]. The Australia Group; 2022 (https://www.dfat.gov.au/publications/minisite/
theaustraliagroupnet/site/en/human_animal_pathogens.html).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

WHO benchmarks for strengthening health emergency capacities

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
119
 09
National laboratory system
Surveillance with a national laboratory system52 including relevant sectors, particularly human and animal (domestic animals and wildlife) health, and
effective modern point-of-care and laboratory-based diagnostics are in place.

IMPACT:
Effective use of a nationwide laboratory system, including relevant sectors, capable of timely, safely and accurately detecting and characterizing
pathogens causing epidemic-prone disease, including both known and unknown threats, from all parts of the country. Expanded deployment,
utilization and sustainable use of modern, safe, secure, affordable and appropriate diagnostics tests or devices is established.

MONITORING AND EVALUATION:

(1) A nationwide laboratory system that is able to reliably conduct tests53 for priority diseases using appropriately identified and collected
specimens that are transported safely and securely to accredited laboratories from the majority (at least 80%) of subnational levels/districts in
the country. (2) Existence of national quality laboratory standards and systems for licensing laboratories.

WHO benchmarks for strengthening health emergency capacities

52
A national laboratory system is a collaborative community of clinical laboratories, public health laboratories and many individual partners who initiate tests and/or use test results.
53
The test list in each country includes six testing methods selected to align with the IHR’s immediately notifiable list and WHO’s top 10 causes of death in low-income countries: polymerase
chain reaction testing for influenza virus; virus culture for poliovirus; serology for HIV; microscopy for M. tuberculosis; rapid diagnostic testing for Plasmodium spp.; and bacterial culture for
Salmonella enterica serotype typhi. These six methods are critical to the detection of epidemic-prone emerging diseases. Competency in these methods is indicated by successful testing for
the specific pathogens listed. The remaining tests should be selected by the country based on major national public health concerns.
120
 BENCHMARK 9.1: Specimen referral and transport system is in place for relevant sectors
OBJECTIVE: To strengthen specimen referral and transport system

CAPACITY LEVEL BENCHMARK ACTIONS

z No system in place for transporting specimens from peripheral/rural/district levels to national laboratories, or only ad hoc

01 transportation is available.
NO CAPACITY

z Map existing laboratory capacity for priority diseases and establish referral networks for priority pathogens.

02 z Map any existing general or disease specific specimen transport networks.

LIMITED z Draft national guidance for the collection, management, storage and transportation of specimens for priority diseases and
CAPACITY disseminate to all levels.
z Develop training packages for health workers on specimen collection (e.g. stool, throat swab, urine, blood, etc.), secured
packing and storage before transportation for suspected cases of priority diseases.
z Establish a service agreement with a courier company (public or private) where gaps exist and cannot be filled by existing
transportation and referral systems. The service agreement should include defined safety and quality norms and standards
for transportation of priority specimens in the public sector throughout all major subdivisions of the country and with the
possibility to expand capacity when required.
z Establish agreements with neighbouring and partner countries to facilitate border crossing with a dangerous specimen for
timely and appropriate testing of samples abroad as required.
z Establish mechanisms to ship specimens internationally in a timely manner for diagnosis or confirmation including:

WHO benchmarks for strengthening health emergency capacities

ƒ Prepare material transfer agreements
ƒ Identify courier companies with capacity to ship specimens
ƒ Document availability of staff certified to pack and ship infectious materials
ƒ Assess all logistic needs for specimen referral and transport systems.
z Involve relevant sectors for specimen referral and transport systems both at national and subnational levels.
121
 z Develop and maintain a regularly updated list of specimen transportation systems operating in relevant sectors.
z Establish a mechanism for utilizing shipping from relevant sectors to transport a broader range of specimens when
capacity is limited.

Participation and contribution of other sectors to actions:

1, 2, 3, 5, 6, 7, 8, 9, 10
z Establish a mechanism for transporting animal specimens to animal health laboratories within district or at the subnational
and national level or obtain access to national or international reference laboratories for priority zoonotic diseases.
z Develop or revise tools, guidance, SOPs on specimen referral and transport for priority zoonotic diseases.

z Expand service agreements with courier services (public or private) for transporting most priority pathogens from

03 subnational to national level (or from all subnational levels to reference laboratories).
DEVELOPED z Train health workers on sample collection, secured packing and storage before transportation for suspected cases of
CAPACITY priority diseases.
z Train staff from courier companies and health facilities on appropriate management of specimens from suspected cases
of priority diseases.
z Establish formal agreements with neighbouring and partner countries if they are responsible for testing referred
specimens.
z Provide prepositioned outbreak investigation kits (i.e. sample collection and transportation kits) at subnational levels and
facilities as applicable.
z Develop a system for data collection, analysis and M&E for specimen referral and transport system, including turnaround
time and specimen integrity.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 3, 4, 5, 6
z Develop strategy, tools and procedures in relevant sectors to reinforce the safety and security of specimen referral and
transport.
z Conduct trainings on sample shipment and referral in relevant sectors.
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 z Establish an efficient transport mechanism for all priority disease specimens from all levels.

04 z Provide prepositioned outbreak investigation kits (i.e. sample collection and transportation kits) at all levels and facilities.
DEMONSTRATED z Conduct regular reviews of specimen transportation systems to confirm that specimens are being transported promptly
CAPACITY and in a manner that maintains safety and specimen quality.
z Establish a system to collect and test specimens from hard-to-reach areas.
z Organize and support training programmes on M&E of specimen referral and transport system, for all relevant stakeholders
(e.g. courier companies, customs, animal health and environment officers, etc.).
z Conduct SimEx/AAR/IAR (as relevant), with relevant sectors, to assess the functionality of specimen referral systems in
health facilities (including public and private) at all levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

z Conduct training exercises to develop a pool of shippers that is trained on infectious substances and is always available,

05 including for international shipments.

SUSTAINABLE z Allocate sustainable funding to maintain national standards of specimen collection, handling, preservation, protection,
CAPACITY transportation, disposal, packaging, and import and export procedures.
z Implement a national mechanism for collecting safety data and incident reporting for any transport incidents involving
infectious substances.
z Share experiences in specimen referral and transport system and engage the country in peer-to-peer learning programmes
at the subnational, national and international levels.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4
123
 BENCHMARK 9.2: Laboratory quality system is in place
OBJECTIVE: To ensure laboratory quality implementation

CAPACITY LEVEL BENCHMARK ACTIONS

z There are no quality standards for laboratories in place or under development.

01
NO CAPACITY

z Establish an independent unit or laboratory working group at the national level to oversee laboratory services and develop

02 national laboratory strategy and quality standards.

LIMITED z Develop minimum standards for certification or licensing, using international standards adapted to local settings, as part of
CAPACITY the laboratory regulation system.
z Develop a roadmap for laboratory inspections, licensing and accreditation, in line with the national laboratory strategy.
z Identify and map laboratories (public and private sector) based on prevailing national standards for licensing, certification
and accreditation at all levels.
z Establish a quality assessment programme for national or central laboratories for diagnostics of diseases with epidemic
potential.
z Develop and disseminate SOPs, along with checklist(s), for maintaining laboratory quality standards in both public and
private health sectors.
z Identify modules that include laboratory quality standards in the curricula of undergraduate and postgraduate studies in
relevant fields (e.g. medicine, laboratory technicians and other relevant health workers) and propose revisions and updates

WHO benchmarks for strengthening health emergency capacities

as needed.
z Identify existing legal frameworks for laboratory quality management system as applicable to all relevant laboratories.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Map existing quality standards in relevant sectors.
z Provide basic training on quality assessment for focal points from relevant sector laboratories (e.g. animal, agriculture,
124

etc.).
 z Develop and publish national guidance on registration procedures for in vitro diagnostic devices and other relevant devices.

03 z Establish a national quality assessment programme for peripheral laboratories testing for diseases with epidemic potential.
DEVELOPED z Implement a system of inspecting and licensing laboratories, including using local adaptations of international standards
CAPACITY and norms and obtaining required funding and human resources, including training/retraining of laboratory staff in the
inspection of laboratories according to minimum standards.
z Implement minimum standards for certification or licensing using international standards adapted to the local setting,
develop a system for regulation of laboratories, and allocate sufficient funding and human resources for implementation.
z Train and/or retrain health workers on laboratory quality principles and procedures.
z Update undergraduate and postgraduate curricula of relevant fields (e.g. medicine, laboratory technicians and other
relevant health workers) to include laboratory quality standards in relevant modules.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 6
z Identify minimum standards to obtain licenses for laboratories in relevant sectors.
z Enhance laboratory quality management system involving experts from relevant sectors.
z Provide advanced trainings on international laboratory standards (e.g. ISO) and other standards for implementation of
quality assessment systems in relevant sectors.

z Implement a mandatory licensing programme for national and subnational public health laboratories (including

04 laboratories in the private sector) and issue licenses in conformity with national quality standards.
DEMONSTRATED z Obtain WHO accreditation for selected laboratories for disease specific testing (e.g. polio, HIV genotyping, measles, etc.).
CAPACITY

WHO benchmarks for strengthening health emergency capacities

z Implement national quality standards for both public and private sector laboratories that align with international norms and
standards.
z Conduct quality assurance programmes for all core tests.
z Design a domestic external quality assessment programme for all priority tests or oversee testing with international
external quality assessment schemes.
z Conduct planned or unannounced quality assessments and inspections of public and private laboratories, in line with
the national laboratory strategy and involving relevant sectors (including human and animal health, food safety, security,
125

energy, water and sanitation, waste management, agriculture, etc.).

 z Support operational research programmes to generate evidence on laboratory quality management systems to improve
laboratory quality at all levels.
z Conduct regular M&E for laboratory quality assurance programmes.

Participation and contribution of other sectors to actions:

1, 3, 4, 5, 6, 7, 8
z Implementation of laboratory licensing processes by relevant sectors.

z Accredit all national reference laboratories in line with international standards (e.g. ISO 15189 for health laboratories).

05 z Update existing laboratory strategies, guidelines and procedures for laboratory quality based on lessons learned from M&E
SUSTAINABLE activities.
CAPACITY z Implement a national external quality assurance programme including microbiology, virology, serology, parasitology, etc. in
relevant sector laboratories (public and private).
z Organize corrective actions based on the results of external quality assessments and recommendations from reviews and
supervisions.
z Improve the national plan for quality management system compliance at all levels in public and private laboratories
through continuous quality improvement, based on analysis of country experiences.
z Allocate sustainable funding for laboratory quality assurance programmes.
z Share experiences in laboratory quality management system and engage the country in peer-to-peer learning programmes
at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6, 7
z Comply with external quality assurance programmes and implement recommendations.
z Accredit all national reference laboratories in accordance with international standards in relevant sectors.
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 BENCHMARK 9.3: Laboratory testing for detection of priority diseases is in place
OBJECTIVE: To strengthen laboratory testing capacities for detection of priority diseases

CAPACITY LEVEL BENCHMARK ACTIONS

z Country has not taken a risk-based approach to determine testing modalities for priority diseases.

01 z Testing for priority diseases relies only on point of care testing (POCT) and/or other simple testing modalities such as
NO CAPACITY microscopy.

z Review or develop a list of priority diseases for the country and update (compile) supporting evidence to perform a national

02 risk assessment for each disease.

LIMITED z Develop surveillance data and prioritization methods and a national laboratory testing strategy for each priority disease
CAPACITY based on risk assessment findings.
z Map/list all laboratories in the country performing public health functions and/or testing for priority diseases.
z Assess laboratory algorithms, standards and testing capacities (including equipment inventory) in all laboratories for all
identified priority diseases.
z Implement rapid testing (antigen and antibody), microscopy, and serological and/or molecular assays for detecting select
endemic and priority diseases, based on national testing algorithms.
z Develop a plan for conducting assessment visits in national reference laboratories (for priority diseases) to assess
capacities in conformity with the national testing strategy, and produce a capacity-building plan for each laboratory to
address identified gaps.
z Identify (and train, if necessary) a pool of individuals capable of performing assessment visits, and provide ongoing

WHO benchmarks for strengthening health emergency capacities

support to national reference laboratories to ensure the implementation of capacity-building plans.
z Develop and disseminate testing SOPs along with quality control SOPs for all core tests for priority diseases.
z Establish clear SOPs and necessary agreements with international laboratories to perform diagnostic and confirmatory
testing of specimens and support outbreak detection and responses when local capacity is not available.
z Develop hands-on training curricula for laboratory staff that includes task-based training, refresher training and mentoring
in relevant technical and administrative areas for priority diseases.
127
 z Review law, legislation and regulations relevant to laboratory capacities to perform one or more tests for detection of
priority diseases, at national and subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
z Develop a mechanism for sharing laboratory testing information between relevant sectors.
z Develop animal health laboratory capacities to detect zoonotic diseases of national importance (e.g. equipment,
infrastructure, human resources, training, etc.).
z For animal health sector:
ƒ Assess regulations, legislation, policies for diagnostic services by animal health laboratories
ƒ Develop a laboratory system strategy for animal health laboratories including tier-specific roles
ƒ Put in place basic level of field-based testing (e.g. pen side rapid kits)
ƒ Provide training on a few diagnostic procedures including serological testing
ƒ Provide basic training or preliminary advocacy on laboratory leadership and management conducted (e.g. Global
Laboratory Leadership Programme)
ƒ Access to reagents, equipment, consumables and procurement by animal health laboratories.

z Review or update or develop national laboratory policies to reflect strategies and procedures developed for testing priority

03 diseases.
DEVELOPED z Train and equip laboratories from relevant sectors involved in laboratory detection of the country’s endemic and priority
CAPACITY diseases, based on the national testing algorithms and national laboratory administrative and technical structures.

WHO benchmarks for strengthening health emergency capacities

z Supply required equipment to support laboratory tests for priority diseases (such as molecular testing, bacterial culture
with AST and access to sequencing, etc.) based on laboratory level in the tiered laboratory network and adhere to
recommended maintenance procedures.
z Develop a plan for conducting assessment visits in subnational laboratories that test for priority diseases to assess
capacities in conformity with the national testing strategy and produce a capacity-building plan for each laboratory to
address identified gaps.
z Identify (and train, if necessary) a subnational pool of individuals capable of performing assessment visits and provide
128

ongoing support to national reference laboratories to ensure the implementation of capacity-building plans.
 z Implement national proficiency and quality assurance processes for all tests conducted for the country’s endemic and
priority diseases.
z Develop capacity for in-country production and procurement processes for acquiring necessary media and reagents to
perform laboratory tests for priority diseases.
z Provide funding to implement capacity-building plans for national reference laboratories performing testing for priority
diseases as well as ongoing monitoring and assessment visits to assure implementation.
z Establish mechanisms and protocols for timely and appropriate sharing of information generated by laboratory testing in
relevant sectors, especially linking laboratory data with surveillance and risk assessment.
z Identify essential tests that the country is currently unable to perform, and prioritize developing that capacity within one
year (with domestic or donor funding).
z Conduct SimEx or AAR (as relevant) to test the functionality of laboratory testing capacities for detecting priority diseases
at the national level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
z Map laboratory capacity in relevant sectors for testing human specimens during emergencies.
z Conduct proficiency testing in animal health laboratories for priority zoonotic diseases and encourage pairing of
laboratories between human and animal health sectors.
z Draft or review regulations, legislation and policies for animal health laboratories to ensure that they contain essential
elements of diagnostic services, including but not limited to:
ƒ Regular participation in regional laboratory networks and collaboration with regional laboratories when national

WHO benchmarks for strengthening health emergency capacities

testing capacities are not available;
ƒ Trainings on diagnostic techniques, including molecular and sequencing capacities (or access to these capacities)
and other areas such as laboratory leadership;
ƒ Available resources for procurement of reagents, equipment and consumables by animal health laboratories.
129
 z Equip subnational laboratories to perform public health functions/testing for all priority diseases using advanced tests (e.g.

04 molecular/nucleic acid tests, bacterial culture, AST, etc.).

DEMONSTRATED z Implement routine sequencing of laboratory samples for endemic and priority diseases as part of national laboratory
CAPACITY strategic plan activities and during outbreaks.
z Establish sustainable procurement and stock management systems for laboratory reagents and consumables for all
endemic and priority diseases during routine operations and outbreaks.
z Implement assessment and oversight plans for capacity-building in both national reference laboratories and subnational
laboratories performing testing for priority diseases.
z Establish collaboration agreements to outsource testing for priority diseases to laboratories in other countries or the
private sector when required.
z Conduct SimEx and AAR (as relevant) to test the functionality of laboratory testing capacities for detection of priority
diseases at both national and subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Assess laboratory capacity in relevant sectors to test human specimens during emergencies.
z Equip and train animal health laboratories to diagnose zoonotic diseases that are not currently present in the country but
are present in the region.
z Implement regulations, legislation and policies in animal health laboratories for:
ƒ Essential elements of diagnostic services with underdeveloped capacity
ƒ Full implementation of laboratory networking for animal health laboratories strategy

WHO benchmarks for strengthening health emergency capacities

ƒ Sharing of data, expertise and information among animal health laboratory network.
z Participate in external quality assurance programmes (EQAP) for some priority diseases.
130
 z Review and update the available evidence base, risk assessments and testing strategies for priority diseases, based on

05 national surveillance and collection of priority data.

SUSTAINABLE z Secure sustainable national financing for the laboratory system to support ongoing testing of priority diseases.
CAPACITY z Conduct regular inventory and replenish the national strategic stockpile of products and devices to perform tests for the
detection of all priority diseases in the event of a health emergency.
z Monitor turnaround times for confirming new, emerging, unknown and high consequence pathogens (including the use of
metagenomic and whole genome sequencing) and implement improvement actions regularly.
z Review and update national training curricula to align with current testing capacities and priorities.
z Maintain a consistent pool of individuals available to perform assessment visits in national and subnational laboratories
performing testing for priority diseases, with appropriate resources to support ongoing capacity-building efforts.
z Document and share country experiences in laboratory testing for priority diseases and engage the country in peer-to-peer
learning programmes at the subregional, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Participate in reviewing and updating the available evidence base, risk assessments and testing strategies for priority
diseases that have risk of potential spill over.
z Document and share experiences in laboratory testing for detecting priority zoonotic diseases.

WHO benchmarks for strengthening health emergency capacities

131
 BENCHMARK 9.4: An effective national diagnostic network is in place
OBJECTIVE: To establish an effective national diagnostic network

CAPACITY LEVEL BENCHMARK ACTIONS

z No evidence of use of rapid and accurate point-of-care, farm-based diagnostics and/or laboratory-based diagnostics, and

01 no tier-specific diagnostic testing strategies are documented.

NO CAPACITY

z Develop a national laboratory policy or regulation that formalizes a tiered diagnostic structure and enables collaboration,

02 information sharing and specimen referral between different tiers of the system, relevant sectors and private laboratories.
LIMITED z Assess national diagnostic capacity and use findings to develop a national plan for strengthening national diagnostic
CAPACITY capacity, taking into account available resources within the national health system administration at all levels.
z Develop a tiered laboratory network structure to test and monitor the country’s priority diseases, ensuring efficient linkages
between tiers along the national referral system.
z Identify existing point of care and rapid diagnostic tests that are available in-country for the detection of priority diseases.
z Assess the feasibility for procurement, validation and use of new point of care and rapid diagnostic tests for priority
diseases that are not currently available in-country.
z Develop national guidance on the initial evaluation and field validation/quality assurance requirements for all new point of
care tests, rapid diagnostic tests and/or in vitro diagnostics introduced for priority diseases.
z Develop a legal basis for strengthening collaboration between public and private sector laboratories and partner agencies
at both national and subnational levels.

WHO benchmarks for strengthening health emergency capacities

z Identify international laboratories with testing capacity for confirmatory diagnostic testing if such capacities are not
currently available in-country.

Participation and contribution of other sectors to actions:

1, 3, 4, 5, 6, 7, 8
z Provide a national laboratory policy that identifies expected capacities at each level of the animal health laboratory system.
z Assess and map animal health laboratories as part of the national diagnostic network.
132

z Develop a legal basis to strengthen collaboration between laboratories of relevant sectors.

 z Develop and disseminate SOPs for tiered testing for each priority disease, including point of care and rapid diagnostic tests

03 and specimen referral systems, ideally within the framework of a national laboratory policy for each priority disease.
DEVELOPED z Develop in-service training plans for all staff that align with national tiered testing approaches and include task-based
CAPACITY training, refresher training, and mentoring in relevant technical and administrative areas.
z Allocate resources (human and material) to conduct appropriate diagnostic testing at the subnational level in line with the
SOPs for tiered testing or national laboratory policy.
z Develop a real-time laboratory information management system (LIMS) that can be deployed across the tiered network
and interoperable with other health information management systems.
z Collect data from diagnostic networks across the country, share with relevant national authorities including epidemiology
departments, and collate with all other health data for regular analysis and planning.
z Conduct SimEx and AAR (as relevant) to monitor and evaluate functionality of the national diagnostic network in routine
systems and during health emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 6
z Develop mechanisms for availability, accessibility and affordability of laboratory material for all laboratories in the national
diagnostic network, including public and private laboratories.
z Incorporate animal health laboratories into the laboratory networking strategy, including tier-specific roles and
responsibilities.

z Monitor the implementation of point of care and rapid diagnostic tests using national guidance for field validation and
quality assurance processes.

WHO benchmarks for strengthening health emergency capacities

04
DEMONSTRATED z Develop and implement a plan to increase national testing capacity for all priority diseases, including cross-training
CAPACITY national laboratory staff in different testing methods.
z Adopt LIMS across the tiered network and within the health system for all priority diseases in the country and support
laboratory data reporting by electronic-based methods.
z Establish real-time data sharing with national authorities including epidemiological departments and surveillance and
response systems.
133
 z Review stockpiles of diagnostics for priority diseases and ensure stock replenishment and rotation according to
anticipated expiration dates of reagents.
z Implement in-service training by ensuring appropriate task-based training, for example using a continuing professional
education programme.
z Allocate sustainable funding for laboratory procurement, capacity-building and point-of-care diagnostics.

Participation and contribution of other sectors to actions:

1, 2, 4, 5, 6, 7
z Develop and implement plans to increase national testing capacity for all priority diseases in relevant sectors to support
human health laboratory during emergencies.
z Implement the laboratory networking strategy for animal health at the national level, with established linkages between
animal health surveillance units and laboratories.

z Secure sustainable financing for all tiers of the national laboratory system to support ongoing testing and sequencing of all

05 endemic and priority diseases in the country.

SUSTAINABLE z Develop capacities to conduct advanced molecular and serological testing for confirmation of priority diseases, including
CAPACITY the ability to conduct molecular subtyping.
z Revise and update strategies, guidelines, operational plans and SOPs for the national diagnostic laboratory network based
on lessons learned and ensure implementation of recommendations from M&E activities conducted.
z Use analysed data results from diagnostic networks and to provide evidence to support adjustment of NHPSPs.
z Share experiences in management of a national diagnostic network and engage the country in peer-to-peer learning
programmes at the subregional, national and international levels.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 5
z Document and share lessons learned and best practices in delivering laboratory services during health emergencies in
relevant sectors, including private and animal health.
z Connect animal health and other relevant laboratory networks to regional and global networks.
z Regularly conduct simulations, such as joint laboratory exercises, to assess and review strategies in place.
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 Tools:
z World Health Organization, Clinical and Laboratory Standards Institute WHO Collaborating Center and Center for Disease Control and
Prevention. Laboratory quality management system handbook. Geneva: World Health Organization; 2011 (https://www.who.int/publications/i/
item/9789241548274).
z Laboratory Quality Stepwise Implementation Tool [website]. Geneva: World Health Organization; 2015 (https://extranet.who.int/lqsi/content/
homepage).
WHO LQSI tool in the form of a website that provides a stepwise plan to guide medical laboratories toward implementing a quality management
system in compliance with ISO 15189 or national standard with similar requirements.
z Stepwise implementation of a quality management system for a health laboratory. Cairo: WHO Regional Office for the Eastern Mediterranean; 2016
(https://apps.who.int/iris/handle/10665/249570).
z Methodology for Prioritizing Severe Emerging Diseases for Research and Development. Geneva: World Health Organization; 2017 (https://cdn.who.int/
media/docs/default-source/blue-print/prioritizing-methodology.pdf?sfvrsn=a8e808c_4).
WHO guidance to identify global disease threats; methods can be applied to identifying priority diseases for laboratory testing in countries.
z Strengthening Laboratory Management Toward Accreditation (SLMTA) [website]. Atlanta: Centers for Disease Control and Prevention (https://www.
slmta.org/).
A structured quality improvement program that teaches laboratory managers how to implement practical quality management systems in resource-
limited settings.
z Laboratory Quality Management System Training Toolkit. Geneva: World Health Organization; 2023 (https://extranet.who.int/hslp/content/LQMS-
training-toolkit).
WHO toolkit to train laboratory managers, senior biologists and technologists in quality management systems Stepwise implementation of a quality

WHO benchmarks for strengthening health emergency capacities

management system for a health laboratory. WHO EMRO publication adapting the ISO 15189 standard to the context and realities of resource-limited
countries, where the requirements of the ISO standard may be too stringent to implement.
z PVS Pathway [website]. Paris: World Organisation for Animal Health; 2023 (https://www.woah.org/en/what-we-offer/improving-veterinary-services/
pvs-pathway/targeted-support/sustainable-laboratory-support/oie-pvs-pathway-laboratory-reports/).
z Strengthening veterinary diagnostic capacities: the FAO Laboratory Mapping Tool. Rome: Food and Agriculture Organization of the United Nations;
2016 (https://www.fao.org/documents/card/en/c/e13cf0b7-c8f4-4ff7-b340-439f40c677ec/).
135
 z The selection and use of essential in vitro diagnostics - TRS 1031. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/
item/9789240019102).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419).

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136
 10
Surveillance
Surveillance is defined under the IHR as the systematic ongoing collection, collation and analysis of data for public health purposes and the timely dissemination
of public health information for action. Annex 1 of the IHR outlines core capacities required for surveillance at local/primary, subnational and national public
health response levels, including detection, reporting, notification, verification and collaboration activities.

To address the challenges highlighted by the COVID-19 pandemic and other past and current emergencies, the collaborative surveillance concept has
been introduced as a core building block of the WHO Framework for Strengthening Global Architecture for Health Emergency Preparedness, Response, and
Resilience (HEPR), which proposes key objectives and capabilities for strengthening public health intelligence for improved decision-making. Collaborative
surveillance is defined as “the systematic strengthening of capacity and collaboration among diverse stakeholders, both within and beyond the health sector,
with the ultimate goal of enhancing public health intelligence and improving evidence for decision making”54. This concept promotes the strengthening of
routine surveillance capacities (including public health and laboratory surveillance) and health systems monitoring, and collaboration between and beyond
these systems to collectively support diverse surveillance objectives and decision-maker needs on a routine ongoing basis and toward health emergency
prevention, preparedness, response and recovery.

Benchmark actions listed below are limited to areas related defined by the current JEE indicators (3rd edition):

z D2.1. Earlier warning surveillance function

WHO benchmarks for strengthening health emergency capacities

z D2.2. Event verification and investigation; and
z D2.3. Analysis and information sharing.

Wherever possible, countries should consider the full range of collaborative surveillance objectives, capacities, and subcapabilities in addition to those
outlined here, as well as other related benchmarks, during the prioritization of actions.

54
Defining collaborative surveillance: a core concept for strengthening the global architecture for health emergency preparedness, response, and resilience (HEPR).
137
 IMPACT:
Coordinated surveillance systems that collectively address the full range of objectives for monitoring, detecting and responding to prioritized
hazards and risks55. Strengthened public health intelligence for improved decision making through routine collaboration across key dimensions56.

MONITORING AND EVALUATION:

(1) Surveillance for locally prioritized hazards conducted according to international standards. (2) Regular analysis, dissemination and reporting
of surveillance data.

WHO benchmarks for strengthening health emergency capacities

55
Each national and subnational authority should undertake evidence-based assessments of public health risks for planning and prioritization of surveillance activities. Routine and enhanced
surveillance activities to address priorities should consider the full event lifecycle: addressing both routine monitoring and emergency needs, including through all stages of emergencies –
preparedness, prevention, detection, event and response monitoring, and recovery.
56
Collaborative surveillance defines four key dimensions of collaboration, including as across diseases and threat surveillance systems, across sectors, across emergency cycles and across
geographic levels. Collaboration across key dimensions must be designed and incentivized to satisfy mutual needs, without overloading systems. This may include, for example: routine
138

sharing data, information and intelligence; sharing workforce capacities; applying common/interoperable data platforms and standards to link data sources; conducting joint assessments,
investigations and interventions; and strategic alignment of priorities and plans.
 BENCHMARK 10.1: Early warning surveillance systems are well established and functional
OBJECTIVE: To establish a well functional early warning surveillance system

CAPACITY LEVEL BENCHMARK ACTIONS

z National public health surveillance strategies, capacities and coordination mechanisms do not exist.

01
NO CAPACITY

Develop a national public health surveillance strategy, capacities and coordination mechanism based on IHR
requirements and priority hazards:
02
LIMITED z Develop a national public health surveillance strategy, capacities and coordination mechanism based on IHR requirements
CAPACITY and priority risks.
z Identify priority events, diseases and conditions under surveillance based on an all hazards approach.
z Designate a national public health authority to coordinate surveillance (dedicated unit or department) with surveillance
focal persons at subnational and local levels.
z Finalize operational plans and processes, including training and guidance.
z Disseminate guidelines and SOPs for health and public health workers (e.g. clinicians, laboratorians, surveillance officers)
to support detection and assessment of prioritized risks.
z Map surveillance stakeholders to improve coordination, avoid duplication of efforts, and identify resources for management
and control of priority diseases and risks, including human resources, equipment, digital tools and infrastructure.

Establish surveillance mechanisms for the detection of prioritized hazards:

WHO benchmarks for strengthening health emergency capacities

z Establish core indicator-based surveillance (IBS) and event-based surveillance (EBS)57 for priority case and event detection
including priority diseases, and disseminate case definitions at national and subnational levels including:
ƒ Establish health facility and laboratory-based systems for nationally notifiable diseases and conditions (including
unusual events);
57
Suggested foundational surveillance approached to address an early warning objective, where contextually appropriate. Other core surveillance approached are necessary for routine/event
monitoring and informing interventions (e.g. health service capacity, access and usage monitoring; sentinel surveillance for influenza and other respiratory viruses; laboratory networks for
monitoring pathogen characteristics; special investigations and studies).
139
 ƒ Establish community-based surveillance with an emphasis on underserved areas/groups and vulnerable populations,
in collaboration with community health worker (CHW)/community health volunteer (CHV) networks operating at the
animal-human-environment interface.
z Establish national level public health intelligence functions linked to response capacities.
z Form a multisectoral country task force (with ToRs) to detect, verify and manage events and threats at the animal-human-
environmental interface, following a One Health approach and bringing together relevant sectors at the national and
subnational levels.
z Establish monitoring and periodic evaluations/reviews of surveillance systems, including review of coverage and gaps for
populations and geographic areas with increased vulnerability to prioritize community-based surveillance needs.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10
z Orient public health surveillance team on the capacity levels of relevant sectors (e.g. animal health, environmental health).
z Coordinate and collaborate with public health surveillance teams from relevant sectors.

Reinforce, implement and enhance public health surveillance strategies, capacities, and coordination and
collaboration mechanisms at the national level:
03
DEVELOPED z Map cross-sectoral surveillance stakeholders and identify focal points for better data/information/intelligence exchange,
CAPACITY coordination and collaboration.
z Conduct multisectoral assessments58 of public health risks at the national level and match surveillance capacities to
prioritized hazards.
z Train health and public health workers (e.g. clinicians, laboratorians, surveillance officers) on SOPs for detecting and

WHO benchmarks for strengthening health emergency capacities

assessing prioritized risks.
z Develop strategies and mechanisms for cross-border surveillance, such as at points of entry, and regular data- and
information-sharing between public health authorities in neighbouring countries

Improve existing IBS and EBS systems and establish enhanced surveillance approaches:
z Expand core IBS and EBS systems, extending coverage to all relevant public and private health services, and other relevant
healthcare providers.
140

58
For example, using the WHO Strategic toolkit for assessing risks (STAR), or equivalent.
 z Establish immediate and weekly reporting mechanisms and feedback loops for reporting units, investigate and assess the
reported cases or events with outbreak potential for public health response, link to laboratory results and share information
with relevant sectors.
z Conduct regular AAR/IAR of major events.
z Establish and test complementary59 or more appropriate surveillance approaches to fill identified gaps for prioritized risks.
z Digitize surveillance processes where appropriate, giving prioritization to points of data collection.

Participation and contribution of other sectors to actions:

1, 2, 4, 5, 6, 7, 8, 9
z Train relevant workers (e.g. veterinarians, laboratorians, surveillance officers, etc.) on SOPs for detecting and assessing
prioritized risks in relevant sectors.
z Coordinate and collaborate with the public health surveillance team including orientation to other sector capacities (animal
health) at subnational level.
z Share information with public health decision-makers on any event that may impact health security.

Reinforce, implement and enhance public health surveillance strategies, capacities, and coordination and
collaboration mechanisms at national and subnational levels:
DEMONSTRATED
04 z Critically evaluate performance of the constellation of surveillance systems and capacities, including effectiveness and
CAPACITY efficiency in respective systems for achieving early warning objectives and driving timely decision-making against locally
prioritized risks. Document and disseminate findings and apply recommendations to update and strengthen overall
efficiency of strategies, systems and tools.
z Establish decentralized coordination and technical capacities at subnational levels to enable more timely decision-making

WHO benchmarks for strengthening health emergency capacities

and response.
z Extend training to all relevant health and public health workers (e.g. clinicians, laboratorians, surveillance officers, etc.) in
SOPs for detecting and assessing prioritized risks.

58
This may include for example, community-based IBS, health service capacity and usage monitoring, centralized media and social media-based EBS, targeted surveillance among specific
vulnerable populations (e.g. aged care facilities, IDP communities), syndromic surveillance in specific health service units (e.g. emergency departments), intelligence sharing among One
141

Health partners (e.g. animal health monitoring), and environmental surveillance (e.g. wastewater monitoring).
 z Establish community engagement and support communities to establish self-coordinated capacities and systems for
community-centred detection, notification and response through integrated approaches between communities, civil
societies, primary care and local government.

Well functioning core and enhanced surveillance through integration of systems and capacities, incorporation of
diverse insights and systems that can flexibly respond to diverse emergencies:
z Integrate or collaborate with surveillance activities where appropriate through consolidation of systems, and by:
ƒ Applying common/interoperable data platforms and standards
ƒ Routine exchange of data, information, intelligence and capacities between stakeholders
ƒ Conducting joint assessments, investigations and interventions
ƒ Strategic alignment of priorities and plans.
z Extend the use of digital tools across surveillance systems and levels to automate routine data management and reporting
processes, and enable greater linkage and interoperability between systems.
z Incorporate contemporary and multidisciplinary insights on hazards, vulnerabilities and risks60 (e.g. multidimensional
poverty index) to better interpret surveillance findings and complement early warning and response activities.
z Review limitations of routine surveillance capacity to surge during emergencies, adjust where possible and preselect
contingency tools to fill anticipated gaps.
z Conduct data collection and both routine and ad hoc reporting at health facilities at a high level of quality.
z Conduct joint operational research for the development and testing of surveillance best practices, tools and technologies,
and innovative approaches, and translate findings into system improvements.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 4, 5, 6, 7, 8, 9, 10
z Establish collaboration across key dimensions, ensuring that the exchange of data, information, intelligence and joint
activities are designed and incentivised to satisfy mutual needs without overloading systems.
z Incorporate training considerations for relevant workers (e.g. veterinarians, laboratorians, surveillance officers, etc.) into
SOPs for detecting and assessing prioritized risks in relevant sectors.
60
For example, integration of insights from animal health and environment sectors to predict/inform evolving risks, collation and use of indicators of population susceptibility (e.g. vaccine
coverage, mobility, multidimensional poverty index, etc.), and integration of social science insights to contextualize surveillance findings.
142
 Sustain public health surveillance strategies and capacities by widening and deepening collaboration across all
key dimensions, routinely exercising to right size collective capacities and ensuring sustainability:
05
SUSTAINABLE z Undertake systematic monitoring, evaluation and learning (as outlined in above steps) to continuously identify and correct
CAPACITY limitations in routine systems.
z Assess the flexibility of routine surveillance capacity to rapidly surge and adapt during large scale emergencies and plan
and adjust where possible.

Sustain and streamline core and enhanced surveillance through integration of systems and capacities,
incorporation of diverse insights and systems that can flexibly respond to diverse emergencies:
z Establish and reinforce decentralized surveillance coordination and technical capacities at primary public health levels to
enable local use of data for local decision-making and response.
z Routinely apply surveillance findings together with information on hazards, vulnerabilities and risks for predicting and pre-
emptively responding to emerging risks (even before the first cases).
z Contribute to local, regional and global surveillance capacity through regional/international networks, support other
countries to strengthen their surveillance system and participate in international initiatives to strengthen capacities
globally.
z Establish a mechanism to ensure continuous improvement in data quality at health facilities by monitoring, evaluating and
adapting data collection and reporting of routine and ad hoc events.
z Advance joint operational research for the development and testing of surveillance best practices, tools and technologies,
and innovative approaches, and translate findings into system improvements.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6, 7
z Reinforce collaboration across all key dimensions, ensuring that the exchange of data, information, intelligence and joint
activities are designed and incentivised to satisfy mutual needs without overloading systems.
z Sustain contributions to surveillance capacity evaluations and support strategies and mechanisms to integrate and
enhance collaboration.
143
 BENCHMARK 10.2: Well functioning event verification and investigation systems are in place
OBJECTIVE: To establish a robust well functioning early warning, alert and response (EWAR)61 capacity

CAPACITY LEVEL BENCHMARK ACTIONS

z Method, process or mechanisms for verifying and investigating detected events does not exist.

01
NO CAPACITY

Develop EWAR core functions:

02 z Designate national focal points to prepare and coordinate EWAR capacities and undertake core public health intelligence
LIMITED functions. Establish ToRs to identify and document roles and responsibilities of relevant staff and stakeholders at all levels.
CAPACITY
z Prepare for EWAR implementation at national and subnational levels by assessing the capacity of routine surveillance
systems, coordination mechanisms, laboratory support and linkage to response.
z Identify existing surveillance data flows and how signal, event and alert data and information are managed at each level.
z Establish tools and systems for standardized collection, management, reporting and sharing of EWAR-associated data.
z Develop or adapt electronic tools for surveillance of public health and health security using unconventional data sources
(e.g. traditional media, digital medias, social networks, etc.).
z Link with and establish mechanisms to report alerts internationally and verify signals in line with IHR requirements.
z Develop contextually appropriate methods and SOPs for each level’s EWAR core functions and processes.
z Establish multidisciplinary rapid response teams (RRTs) to undertake outbreak/ health emergency investigation and
response.

WHO benchmarks for strengthening health emergency capacities

61
EWAR core functions must operate both routinely and be enhanced during emergencies. These include capacities and processes to undertake early warning (rapid detection and triage of
signals that might indicate an outbreak from IBS, EBS or other data sources); alert management (systematic process of managing all incoming information from signal verification to risk
144

assessment and characteristics); and response (triggering public health actions, case finding, and ongoing enhanced surveillance to inform response activities). Key components are further
detailed in the WHO Early warning alert and response (EWAR) in emergencies: an operational guide.
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8
z Review opportunities for multisectoral collaboration for the detection, verification and assessment of potential public
health events.
z Develop and participate in cross-sectoral collaborations with health sector to exchange data, information and intelligence
between One Health partners and conduct joint verification of signals, investigations and risk assessments of events
related to zoonoses.

Implement/strengthen EWAR core functions at national and subnational levels:

03 z Designate subnational focal points to coordinate and undertake core functions.
DEVELOPED z Establish rapid communication pathways between teams operating across levels and sectors.
CAPACITY
z Conduct training and activate EWAR capacities, systems and SOPs at national and subnational levels.
z Digitize EWAR processes as a function of routine surveillance systems where appropriate.
z Improve data flows and routine reporting mechanisms at all levels.
z Interconnect systems with decision-making authorities and resourced capacity for pre-emptive (before the first case) and
early action. Identify focal persons/units to receive event details and risk assessments.
z Train public health workers and RRTs and provide adequate resources to undertake outbreak/public health investigations
and responses for prioritized risks.
z Develop and implement mechanisms for routine monitoring and periodic evaluation of core EWAR functions.
z Monitor the performance of EWAR functions, systems and capacities across levels and update the EWAR as required.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8, 9
z Implement multisectoral communication and collaboration, such as routine exchange of data, information and intelligence
between One Health partners, joint verification of signals, and investigations and risk assessments of events related to
zoonoses.
145
 Reinforce EWAR core functions at national and subnational levels, and strengthen collaboration across sectors:
04 z Establish fully operational core functions at the national and subnational level to provide the timely triage, verification,
DEMONSTRATED risk assessment and characterization, investigation, and response to reported cases or events, as well as standardized
CAPACITY collection, management, reporting and sharing of associated data. Identify limitations in systems and fill gaps where
possible.
z Extend use of digital tools across levels to automate routine data management and reporting processes where appropriate.
z Incorporate contemporary and multidisciplinary insights on hazards, vulnerabilities and risks to complement early warning
activities.
z Reinforce outbreak/health emergency investigation and response capacities62 at national and subnational levels.
z Establish systems that protect electronic tools from cyberattacks to secure sharing of critical information such as personal
data, medical confidentiality and classified information.
z Conduct SimEx/AAR/IAR (as relevant) to evaluate the performance of functions, systems and capacities across EWAR
levels.
z Document and disseminate SimEx/AAR/IAR findings (as relevant) and apply recommendations to strengthen overall
strategies, systems and tools.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Increase collaboration between One Health partners including routine exchange of data and information, incorporation of
trained personnel from multiple sectors in RRTs, and undertaking joint signal verification, alert generation, risk assessment
of events, investigation and response to relevant alerts.

WHO benchmarks for strengthening health emergency capacities

62
The focus of efforts to strengthen outbreak/public health emergency investigation and response capacities will vary depending on resource availability, locally prioritized risks and contexts.
These may generally include: prepositioning contingency tools (i.e. select and resource tools, and train response workforce on how to use them), data management, analytical capacity for
146

undertaking enhanced surveillance and information management during an emergency (e.g. case investigation and line listing, contact tracing, maintaining situational reporting/briefings,
etc.), establishing multidisciplinary capacities for special epidemiological/laboratory/clinical studies, etc.
 Reinforce EWAR core functions and collaborations at national and subnational levels, implement/strengthen
complementary activities at primary public health levels, and routinely test systems to respond to emergencies:
05
SUSTAINABLE z Establish a mechanism to maintain that core functions and cross-sectoral collaboration are operating seamlessly at
CAPACITY national and subnational levels. Identify limitations in EWAR systems and fill gaps where possible.
z Conduct necessary training and activate complementary EWAR capacities, systems and SOPs at primary health level;
ensuring functions are interconnected with local decision-making and response authorities to affect timely local action.
z Document and share best practices nationally and internationally for peer-to-peer learning.

Participation and contribution of other sectors to actions:

1, 2, 3
z Reinforce collaboration across all key surveillance dimensions and ensure that the exchange of data, information,
intelligence and joint surveillance activities satisfy mutual needs without overloading systems.

WHO benchmarks for strengthening health emergency capacities

147
 BENCHMARK 10.3: Surveillance data and information are systematically analysed and shared to inform decision making for action
OBJECTIVE: To conduct timely and systematic analysis and sharing of data and information and enhance evidence for decision making and action

CAPACITY LEVEL BENCHMARK ACTIONS

z Systematic analyses of disease surveillance data for action not conducted or extended delays exist precluding timely

01 action.
NO CAPACITY

Develop routine analysis and reporting capacities for prioritized hazards under surveillance at national level:
02 z Review national capacities to undertake analyses of surveillance data.
LIMITED z Develop a training package for data management data collation, analysis, trend analysis and developing reports or weekly
CAPACITY
surveillance bulletins.
z Develop and disseminate guidelines and procedures to assess risks.
z Produce ad hoc analysis reports of outbreaks or other public health events based on needs or emerging events and
disseminate from the national level.
z Establish reporting standards and identify pathways for informing decision-making and response authorities of
surveillance findings, as well as broader dissemination.
z Map cross-sectoral surveillance stakeholders and identify focal points for coordination, collaboration and the exchange of
relevant data, information and intelligence.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6

Implement routine analysis and reporting for prioritized hazards under surveillance at national level:
03 z Conduct training on data analysis and report development at national and subnational levels.
DEVELOPED z Conduct annual or monthly analysis of surveillance data for continuous monitoring of events of potential concern for
CAPACITY
public health and health security, including routine trend analyses and data quality assessment at national level.
z Establish standards and training to integrate data and information sources from multisectoral partners.
148
 z Establish feedback loops for sharing analytic results, from national to subnational levels at a minimum and across sectors.
z Develop standards and training for quality data collection for routine and ad hoc reporting of unusual or unexpected events
at healthcare facility level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Develop standards and training for analysis of data by multiple sectors to support joint risk assessment.

Reinforce routine analysis and reporting for prioritized hazards under surveillance at national level, implement
complementary capacity at subnational levels and strengthen collaboration across sectors at all levels:
04
DEMONSTRATED z Develop or reinforce standards, content and format for epidemiological bulletins for national and subnational levels
CAPACITY and weekly epidemiological reports on priority diseases and ad hoc events, including analysis and risk assessment
disseminated at all levels.
z Develop or reinforce standards and training to analyse data from multiple information sources across sectors available at
all levels.
z Establish or reinforce capacity to routinely triangulate data from multiple health information and surveillance systems,
including from relevant sectors.
z Establish or reinforce existing real time analytical information sharing, including data visualizations and dashboards.
z Develop and implement a mechanism for M&E of timely data analysis and reporting for prioritized hazards under
surveillance at national and subnational levels.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5
z Train animal and environmental sector stakeholders in analysis methods contributing to cross-sectoral risk assessment.
149
 Reinforce routine analysis and reporting for prioritized diseases under surveillance at national and subnational
levels, implement complementary capacities at primary public health level and strengthen collaboration across
05
SUSTAINABLE
all key dimensions:
CAPACITY z Establish or reinforce dedicated analytic teams at national, subnational and primary levels, to link sectors and contextualize
epidemiological information across multiple disciplines.
z Reinforce analytical functions of common/interoperable electronic platforms and establish default automated analysis at
all EWAR levels.
z Establish or reinforce advanced analytical and modelling capacities at the national level.
z Develop or reinforce guidelines, standards, norms and quality requirements, as well as regularly review and update training
packages for analysis and risk assessment based on lessons learned.

Participation and contribution of other sectors to actions:

1, 2, 3, 4
z Routinely contribute, from multisectoral stakeholders, to joint analysis, risk assessment (both ad hoc and routine),
reporting and the generation of recommendations.

Tools:
z Defining Collaborative Surveillance: A core concept of the framework for strengthening the global architecture for health emergency preparedness,
response, and resilience (HEPR). Geneva: World Health Organization; 2023 (https://apps.who.int/iris/handle/10665/367927).
z Early warning, alert and response (EWAR) in emergencies: an operational guide. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/i/item/9789240063587).

WHO benchmarks for strengthening health emergency capacities

z Surveillance and information sharing operational tool: an operational tool of the tripartite zoonoses guide. Geneva: World Health Organization,
Food and Agriculture Organization of the United Nations, and World Organisation for Animal Health; 2022 (https://www.who.int/publications/i/
item/9789240053250).
z Strategic toolkit for assessing risks: a comprehensive toolkit for all-hazards health emergency risk assessment. Geneva: World Health Organization;
2021 (https://www.who.int/publications/i/item/9789240036086).
z A regional strategy for integrated disease surveillance: overcoming data fragmentation in the Eastern Mediterranean Region. Cairo: WHO Regional
150

Office for the Eastern Mediterranean; 2021 (https://apps.who.int/iris/handle/10665/352420).

 z Global Strategy on Comprehensive Vaccine-Preventable Disease Surveillance. Geneva: World Health Organization; 2020 (https://www.who.int/
publications/m/item/global-strategy-for-comprehensive-vaccine-preventable-disease-(vpd)-surveillance).
z Technical Guidelines for Integrated Disease Surveillance and Response in the African Region: Third edition. Brazzaville: WHO Regional Office for Africa;
2019 (https://www.afro.who.int/publications/technical-guidelines-integrated-disease-surveillance-and-response-african-region-third).
z Immunization Analysis and Insights. Vaccine preventable disease surveillance standards [website]. Geneva: World Health Organization; 2023
(https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/surveillance/surveillance-for-vpds/vpd-
surveillance-standards).
z Terrestrial Animal Health Code. Paris: World Organisation for Animal Health; 2022 (https://www.woah.org/en/what-we-do/standards/codes-and-
manuals/terrestrial-code-online-access/?id=169&L=1&htmfile=chapitre_vet_legislation.htm).
z Manual of diagnostic tests and vaccines for terrestrial animals. Twelfth edition 2023. Paris: World Organisation for Animal Health; 2023 (https://www.
woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-manual-online-access).
z International Health Regulations (2005) Third edition. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/
item/9789241580496).
z Communicable disease surveillance and response systems: a guide to planning. Geneva: World Health Organization; 2006 (https://apps.who.int/iris/
handle/10665/69330).
z WHO Recommended Surveillance Standards. Geneva: World Health Organization; 1999 (https://apps.who.int/iris/handle/10665/65517).

z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

WHO benchmarks for strengthening health emergency capacities

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
151
 11
Human resources
States Parties who invest in the development of competent and well-motivated health personnel at all levels of the health system put themselves in a
stronger position to effectively implement the IHR. This involves deliberate and consistent planning, resourcing, management and evaluation to ensure the
education and employment of a health workforce that is competent to prepare for, prevent, detect, assess, notify, report, respond to and recover from health
emergencies.

The workforce includes, but is not limited to, public health specialists and related occupations (e.g. biomedical technicians, biostatisticians epidemiologists,
laboratory scientists and technicians, etc.), the clinical professions (e.g. midwives, nurses, pharmacists, physicians, etc.) and others (e.g. social scientists,
communications personnel, occupational health personnel, information technology (IT) specialists, etc.). There is a corresponding and overlapping workforce
in the animal and environmental sectors (e.g. animal health professionals, environmental health personnel, veterinarians and para-veterinarians, etc.) that are
essential for health security measures. The workforce also includes personnel from a wide group of other allied occupations beyond the health sector who
contribute to addressing the determinants of health, such as personnel engaged in water and sanitation, food supply chains and road safety.

The pursuit of health security, universal health coverage and health-related development goals requires investment in national health system capacity, with a
focus on primary health care and public health. National and subnational system capacity is dependent on an integrated, multisectoral and multidisciplinary
workforce that can deliver all essential public health functions (EPHFs), including emergency preparedness and response. It is critical that countries develop
multisectoral workforce strategies that are informed by mapping and measuring the occupations that contribute to EPHF delivery, as well as regular health

WHO benchmarks for strengthening health emergency capacities

labour market analyses to assess health worker capacity requirements for the delivery of routine services and the ability to readily mobilize (surge) health
workers in the event of an emergency or disease outbreak, based on caseload weight and other defined measures.
152
 IMPACT:
Prevention, detection and response activities (including health promotion, occupational health safety and security, and appropriate care of those
affected) are conducted effectively and sustainably by a competent, coordinated, motivated and occupationally diverse multisectoral health
workforce.

MONITORING AND EVALUATION:

(1) The availability of a competent, supported and motivated health workforce to implement the IHR. (2) Existence of a corresponding workforce
in the animal sector.

WHO benchmarks for strengthening health emergency capacities

153
 BENCHMARK 11.1: An up-to-date multisectoral workforce strategy is in place
OBJECTIVE: To develop and implement a valid (recognized by law or official government protocols) and up-to-date (no older than 5 years) workforce
strategy for a functional multisectoral health workforce

CAPACITY LEVEL BENCHMARK ACTIONS

z No multisectoral workforce strategy or governance and leadership mechanisms are in place.

01
NO CAPACITY

z Identify a national coordination working group (with ToRs) including all relevant stakeholders and sectors who can

02 contribute to the development, strengthening and maintenance of a multisectoral workforce strategy.

LIMITED z Assess and document the country’s current health workforce strategy, including the education, training and other capacity
CAPACITY needs for strengthening of a multisectoral workforce.
z Develop a draft or quasi-functional multisectoral workforce strategy.
z Develop a One Health workforce strategy, if not already included, as part of the multisectoral workforce strategy.
z Build capacity to develop or improve human resources for health policy and strategies that quantify health workforce
needs, demands and supply under a variety of potential scenarios.

Participation and contribution of other sectors to actions:

1, 2, 3, 4
z Develop a plan to fund and implement the multisectoral workforce strategy (animal and other relevant sectors) including
donor and stakeholder contributions before and during a health emergency.

WHO benchmarks for strengthening health emergency capacities

z Develop protocols, SOPs and technical guidelines for regular review and updating of the multisectoral workforce strategy.

03 z Conduct advocacy to relevant stakeholders, including ministries of health, finance, planning and administration/civil
DEVELOPED service, to implement the strategy.
CAPACITY z Develop minimum standards for human health staffing levels, using methods such as the Workload Indicators of Staffing
Need.
154
 z Establish a national case for investment in human resources for health as a vital component of the Sustainable
Development Goals, universal health coverage, health security and universal access to healthcare.
z Develop a framework to promote the social, legal and economic protection and rights of health and care workers in health
emergencies including their occupational safety.
z Create appropriate job classifications and descriptions for health workers at all levels of relevant ministries, with clear
career progression.

Participation and contribution of other sectors to actions:

1, 2, 4, 5, 6
z Develop minimum standards for the staffing levels of personnel addressing One Health issues.
z Form a governance and leadership body (with ToRs, embedded within a competent national structure) in charge of the
management of human resources for health emergencies, bringing together government decision-makers, leaders in the
health ministry and other health related ministries and community leaders.

z Monitor and evaluate the implementation of the multisectoral workforce strategy (including financing and operations) to

04 track progress and barriers and document annual reports.

DEMONSTRATED z Allocate a sustained domestic budget to ensure implementation of the multisectoral workforce strategy.
CAPACITY z Document and disseminate annual reports of the completed and implemented multisectoral workforce strategic plan.
z Develop a strategic framework to nationally prioritize resources and investments in workforce development to support One
Health activities.
z Map and align investments in human resources for health with the current and future needs of the population and health
systems.

WHO benchmarks for strengthening health emergency capacities

z Distribute health and care workers to enable maximum improvements in health outcomes, social welfare, employment
creation and economic growth.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
155
 z Adopt, review and revise the multisectoral workforce strategy regularly .

05 z Incorporate appropriate incentive packages and strategies to attract, train and retain competent personnel to meet national
SUSTAINABLE and subnational needs within the multisectoral workforce strategy.
CAPACITY z Allocate funding for regular and fair payment of the health workforce at the national and subnational levels.
z Establish national health workforce registries of competent and practicing personnel and collect key performance
indicators.

Participation and contribution of other sectors to actions:

1, 2, 3

WHO benchmarks for strengthening health emergency capacities

63
156

Based on M&E results, latest scientific evidence and aligned with current policy guidance from WHO, including details on the workforce sustainability, staffing and incentive models, personnel
recruitment, development/training and retention mechanisms, planning and monitoring of human resources, and implementation of a career progression ladder.
 BENCHMARK 11.2: Human resources are available to effectively implement IHR
OBJECTIVE: To develop a health workforce that is available and competent to prevent, detect, assess, notify, report and respond to health emergencies
of domestic and international concern and health service provision (such as epidemic preparedness and control) at all levels of the health system to
effectively implement IHR.

CAPACITY LEVEL BENCHMARK ACTIONS

z The country has negligible human resources capacity in relevant sectors required to prevent, detect, assess, notify, report

01 and respond to health emergencies including epidemic preparedness and control.

NO CAPACITY

z Identify a responsible unit and advisory committee for the development of human resource capacity to meet IHR capacity

02 needs.
LIMITED z Conduct engagement meetings with relevant sectors to expand the multisectoral health workforce strategy to include IHR
CAPACITY capacity needs.
z Identify the needs, as well as current availability and distribution, of human resources for health capacities, including the
workforce for IHR implementation.
z Actively engage international organisations (IOs)/NGOs/civil society organized associate health worker groups (such as
community first aid responders and Red Cross/Crescent volunteers).
z Establish or strengthen national rapid response teams, ensuring they are multidisciplinary and multilevel.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

z Identify the human resources needs that are required to support preparedness and response.
z Identify licensed professionals with veterinary or paraveterinary skills to incorporate into the national rapid response
teams.
157
 z Monitor policies and plans to increase the multisectoral animal and human health workforce and promote the recruitment

03 and retention of qualified multidisciplinary staff.

DEVELOPED z Establish a database of human resources in relevant sectors and levels of the public health system that can provide
CAPACITY multidisciplinary health personnel during health emergencies with SOPs for updating and maintenance.
z Initiate annual reporting of the total active stock of health and care workers in the national health workforce accounts.
z Understand the size and profile of the workforce that contributes to the delivery of essential public health functions
(EPHFs) by conducting mapping and measurement of occupations at the national and subnational levels.
z Develop mechanisms to facilitate the rapid deployment of local and foreign health and care workers during health
emergencies (including workforce from the Global Strategy Preparedness Network (GSPN) and Global Outbreak Alert and
Response Network (GOARN)).
z Establish ToRs and job descriptions for subnational level (provincial, district) rapid response teams and public health
officers in charge of outbreak preparedness and response.
z Develop and implement capacity-building packages and plans including basic training for community health workers
and volunteers, civil societies and community based organizations (CBOs) on prevention, early detection, preparedness,
readiness and response to health emergencies at community and local levels.
z Establish a transparent process to select decision-makers and leaders who will be engaged in stewardship activities for
effective management of human resources for health emergencies.

Participation and contribution of other sectors to actions:

1, 2, 4, 5, 6, 7, 8
z Recruit licensed professionals with veterinary or paraveterinary skills.

WHO benchmarks for strengthening health emergency capacities

z Mobilize relevant workforces to increase the multisectoral workforce for IHR implementation.
z Provide information to the database of in-country multidisciplinary subject matter experts from relevant sectors.
z Provide relevant workforce for deployment during health emergencies.

z Use the data obtained from mapping and measurement of occupations to identify gaps in the national workforce capacity,

04 conduct evidence-based planning and policy making and create projections for future needs.
DEMONSTRATED z Mobilize resources to ensure each local level has the needed capacity for epidemiology, case management, laboratory
158

CAPACITY services, One Health and other specialties.

 z Develop and implement guidance and procedures for health and care workers (including community health workers and
health volunteers) to enable them to better contribute to emergency management activities including prevention, detection,
assessment, notification and response.
z Monitor and address public health workforce preparedness needs (quantity, quality) continuously at the national and
subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 4
z Provide resources at local levels to ensure One Health workforce capacity as needed.
z Empower strategic leaders of national public health agencies and/or equivalent to utilize communication channels with
direct access to high level decision-makers in government relevant to human resources for health.

z Conduct annual data collection on the workforce which contributes to the delivery of EPHFs and progressively incorporate

05 this reporting into the national health information systems and national health workforce accounts.
SUSTAINABLE z Use this data to update and inform the national multisectoral workforce strategy annually (Benchmark 11.1).
CAPACITY z Conduct periodic health labour market analyses to understand key policy questions and devise strategies to address
labour market gaps.
z Review national preparedness and response plans as well as legal and regulatory frameworks and establish protocols,
SOPs, technical guidelines and toolkits to send and receive multidisciplinary health personnel during health emergencies.
z Review, evaluate and update policies or procedures for sustainable appropriate human resources in all relevant sectors
according to IHR provisions.
z Establish a sustainable mechanism to ensure the availability of health and care workers to cover IHR needs in routine

WHO benchmarks for strengthening health emergency capacities

circumstances and during health emergencies, at national and subnational levels.
z Participate in regional/ international initiatives to support health emergency leadership coordination for human resources
for health across countries by relevant sectors.

Participation and contribution of other sectors to actions:

1, 2, 4, 5, 6, 7
z Review, evaluate and update policies and procedures for sustainable appropriate human resources in relevant sectors
159

according to the IHR provisions.

 BENCHMARK 11.3: Fit for purpose, competency-based education programmes are available for multisectoral workforce
OBJECTIVE: To develop functioning competency-based education programmes including workplace-based learning and in-service programmes aligned
with the multisectoral workforce strategy at all levels

CAPACITY LEVEL BENCHMARK ACTIONS

z No formal multisectoral competency-based training programme(s) is (are) in place or efforts are ad hoc.

01
NO CAPACITY

z Map the required workforce training needs for the different EPHFs and occupational groups aligning with the multisectoral

02 health workforce strategy.

LIMITED z Identify and document existing preservice and in-service training programmes, including educational outcomes, specific to
CAPACITY different health workforce occupational groups.
z Identify and document all trainings related to contingency planning, management of emergencies, RCCE and joint
exercises for multidisciplinary teams.
z Identify and document the quality of existing training programmes and educational provisions, including accreditation and
quality standards where known.
z Publish a national list of competency-based training programmes leading to licensing or certification available in the
country including national training institutes, professional bodies, schools of public health, nursing, midwifery, veterinary,
medical colleges and universities that provide continuing professional education (CPE).
z Map relevant public health multidisciplinary workforce curricula, with universities and partners, for all IHR human resource
requirements (such as field epidemiology training programme curricula, materials, mentors, evaluation procedures and

WHO benchmarks for strengthening health emergency capacities

accreditation).
z Develop competency-based training programmes to address the training needs at the national and subnational levels,
including transitions to practice with supportive supervision as a pathway, for example.
z Develop a mechanism to track training outcomes including the competence of learners, absorption and retention in the
labour market.
160
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8
z Map required workforce competencies in relevant sectors to align with the multisectoral health workforce strategy and
identify training needs for their workforce/cadres.
z Identify and document training programmes, curricula and educational programmes related to contingency planning,
management of emergencies, RCCE and joint exercises for multidisciplinary teams.
z Contribute to the development of competency-based training programmes for One Health.

z Establish competency-based standards for the workforce in each relevant sector to guide training.

03 z Operationalize competency-based education programmes that address identified training needs, including content on
DEVELOPED surveillance, outbreak preparedness and response.
CAPACITY z Develop and implement in-service competency-based training on surveillance, outbreak preparedness and response for
specific occupational groups at the national level, at minimum.
z Conduct at least one level of a field epidemiology training programme (FETP) (basic, intermediate or advanced) or
comparable applied epidemiology training programme.
z Organize trainings for managers and leaders to improve management and leadership skills in the workplace.
z Define rules and incentives to facilitate and ensure the participation of all health workers in relevant in-service training
programmes.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

z Participate in competency-based education, trainings and programmes where relevant to the sector.
z Conduct at least one level of a field epidemiology training programme for veterinarians (FETPV) or comparable training
programme including for other relevant One Health workforce occupations.
z Develop trainings for the legal workforce on public health law including public health emergency legal preparedness at the
national level.
161
 z Implement short competency-based trainings on surveillance, outbreak preparedness, response, incident command

04 system and RCCE for specific occupations at the national and subnational levels.
DEMONSTRATED z Develop measures to assess and monitor the implementation of in-service training programmes that are aligned with the
CAPACITY country’s training strategy.
z Conduct at least two levels of FETP (basic, intermediate and/or advanced) or comparable applied epidemiology training
programme(s) in the country, or in another country through an existing agreement.
z Explore and implement measures to organize and finance advanced trainings and continued education programmes in
public health, including epidemiology, laboratory, animal and environmental health.

Participation and contribution of other sectors to actions:

1, 2, 3, 4
z Organize, at the national level at minimum, in-service joint-training programmes with the health sector on surveillance for
professionals from relevant sectors, to help them better interact with health emergency experts.
z Conduct at least two levels of FETPV or comparable training programme including for other relevant One Health workforce
occupations in the country or in another country through an existing agreement.

z Build mechanisms that ensure strict adherence to nationally or internationally recognized standards for competency-

05 based training programmes where applicable.

SUSTAINABLE z Continue and expand CPE trainings and retention programmes for specialized health personnel involved in IHR
CAPACITY implementation in difficult to access areas.
z Expand current public health and FETP to include refresher courses alongside induction programmes for field
epidemiologists, regular in-service programmes and continuing professional development programmes.

WHO benchmarks for strengthening health emergency capacities

z Mobilize resources to ensure a trained workforce for all IHR relevant emergencies/hazards.
z Document and share country experiences on competency-based training, programmes and education for the health
workforce.
z Lead or participate in peer-to-peer initiatives to strengthen capacities globally.

Participation and contribution of other sectors to actions:

1, 3, 4, 6
162

z Document and share experiences on competency-based trainings, programmes and education for the workforce.
 BENCHMARK 11.4: Multisectoral workforce surge strategy for health emergencies is well established and functional
OBJECTIVE: To develop and implement a valid (recognized by law or official government protocols) an up-to-date (no older than 5 years) workforce
surge strategy for health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z The country does not have a national multisectoral workforce surge strategic plan for health emergencies, or is still under

01 development.
NO CAPACITY

z Initiate development of a multisectoral workforce surge strategic plan by the national coordination working group for

02 multisectoral workforce strategy to staff, roster, prepare and train the workforce at the national level.
LIMITED z Conduct a situational analysis on existing policies/plans and methods for multisectoral workforce surge during health
CAPACITY emergencies and identify gaps.
z Identify relevant agreements and/or MOUs needed between different health programmes to ensure a cohesive
multisectoral surge strategy for large scale activation.
z Conduct a gap analysis of surge capacity and training needs required in health and relevant sectors for health
emergencies.
z Initiate plans to disseminate the multisectoral workforce surge strategic plan for health emergencies to all relevant staff
and stakeholders.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

z Identify relevant agreements and/or MoUs needed between relevant sectors to ensure a cohesive multisectoral surge
strategy for large scale activation.
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 z Implement the multisectoral workforce surge strategic plan for health emergencies at national level.

03 z Develop or update policy for surge staffing for health emergency response for staff welfare, overtime and insurance
DEVELOPED measures.
CAPACITY z Develop training packages to orient and build the capacity of the multisectoral surge workforce.
z Develop and maintain a network of trained multisectoral surge teams at national level.
z Document and implement the procedures for predeployment, deployment and postdeployment of the multisectoral surge
workforce at national level.
z Develop ToRs for all relevant units and departments based on the multisectoral workforce surge strategic plan at all levels.
z Develop and implement rosters for surge workforce in the health sector at national level.
z Conduct SimEx/AAR/IAR (as relevant) to review the functionality of the multisectoral surge workforce strategic plan.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 8
z Develop rosters for surge workforce from relevant sectors for health emergencies.
z Identify training needs for surge workforce in relevant sectors health emergencies.
z Establish a mechanism for the workforce of relevant sectors to participate in multisectoral surge teams at national level for
health emergencies.

z Implement a multisectoral surge workforce strategic plan for health emergencies at all levels.

04 z Implement training packages and conduct training in advance of health emergencies for the multisectoral surge workforce
DEMONSTRATED at all levels.

WHO benchmarks for strengthening health emergency capacities

CAPACITY z Allocate a budget for welfare, overtime, insurance and transport facilities of surge workforce.
z Develop and implement rosters for surge workforce in the health sector at subnational level.
z Use data driven planning tools to inform and revise surge workforce requirements.
z Develop and implement methods to prioritize the mental wellbeing of the multisectoral surge workforce during and after
health emergencies.
z Establish capacity to send and receive multidisciplinary personnel within the country (shifting of resources), including
164

workforce from government and nongovernmental partners, as applicable.

 Participation and contribution of other sectors to actions:
1, 2, 3, 5, 6, 7
z Establish a mechanism for the workforce of relevant sectors to participate in multisectoral surge teams at subnational
level for health emergencies.

z Review and update the multisectoral surge workforce strategic plan at all levels, including incorporating the results from

05 M&E.
SUSTAINABLE z Evaluate and update training packages and rosters of multisectoral surge workforce.
CAPACITY z Document best practices and lessons learned from the implementation of the multisectoral workforce surge strategic plan.

Participation and contribution of other sectors to actions:

1, 2, 3
z Regularly participate in the review and updating of the multisectoral surge workforce strategic plan at all levels
z Sustain participation of the workforce from relevant sectors in multisectoral surge teams at all level for health
emergencies.

Tools:
z WHO Global Code of Practice on the International Recruitment of Health Personnel. Geneva: World Health Organization; 2010 (https://www.who.int/
publications/i/item/wha68.32).
z Workload Indicators of Staffing Need. Geneva: World Health Organization; 2010 (https://www.who.int/publications/i/item/9789241500197).

z Executive Board 128.R9. Health workforce strengthening. In: One Hundred and Twenty-Eighth Executive Board Session, Agenda Item 4.5. Geneva: World

WHO benchmarks for strengthening health emergency capacities

Health Organization; 2011 (https://www.who.int/publications/i/item/9789241500197).
z Global Strategy on human resources for health: Workforce 2030. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/
item/9789241511131).
z COVID-19: Operational guidance for maintaining essential health services during an outbreak: Interim guidance, 25 March 2020. Geneva: World Health
Organization; 2020 (https://apps.who.int/iris/handle/10665/331561).
z FETP Accreditation and Quality Improvement [website]. Training Programs in Epidemiology and Public Health Interventions Network. United States of
165

America: 2023 (https://www.tephinet.org/what-we-do/fetp-accreditation-and-quality-improvement).

 z Field Epidemiology Training Program (FETP) [website]. United States of America: Centers for Disease Control and Prevention; 2023 (https://www.cdc.
gov/globalhealth/healthprotection/fetp/index.htm).
z Veterinary and Veterinary Paraprofessional Education [website]. World Organisation for Animal Health; 2023 (https://www.woah.org/en/what-we-offer/
improving-veterinary-services/pvs-pathway/veterinary-and-veterinary-paraprofessional-education/).
z Health workforce policy and management in the context of the COVID-19 pandemic response. WHO interim guidance. 3 December 2020. Geneva:
World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/337333).
z National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response: roadmap
for aligning WHO and partner contributions. Geneva: World Health Organization; 2022 (https://apps.who.int/iris/handle/10665/354384).
z National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response:
Action plan (2022–2024) for aligning WHO and partner contributions. Geneva: World Health Organization; 2022 (https://apps.who.int/iris/
handle/10665/363519).
z Strengthening the health system response to COVID-19 - Surge planning tools [website]. Copenhagen: WHO Regional Office for Europe; 2023 (https://
www.who.int/europe/tools-and-toolkits/strengthening-the-health-system-response-to-covid-19/Surge-planning-tools).
z Working for Health 2022-2030 Action Plan: protection and performance. Geneva: World Health Organization; 2023 (https://www.who.int/publications/i/
item/9789240063402).
z McQuide PA, Finnegan A, Terry KA, Brown A, Toure CO, Tessougue J, et al. Applying WHO COVID-19 workforce estimate tools remotely in an African
context: a case report from Mali and Kenya. Hum Resour Health. 2022;19(Suppl 1):111. doi:10.1186/s12960-021-00653-5.
z Health labour market analysis guidebook. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/9789240035546).

z National health workforce accounts: a handbook. Second edition. Geneva: World Health Organization; 2023 (Forthcoming).

z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

WHO benchmarks for strengthening health emergency capacities

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419).
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 12
Health emergency management
This capacity focuses on management of health emergencies for enabling countries to be prepared and operationally ready for response to any health event,
including emergencies, as per the all-hazard requirement of IHR. Ensuring risk-based plans for emergency preparedness, readiness and response, robust
emergency management structures and mobilization of resources during an emergency is critical for a timely response to health emergencies.

IMPACT:
Multisectoral actors at national, subnational and local health response levels are well coordinated and have a common understanding of the
priority risks and are ready to implement timely, effective and efficient emergency response operations for outbreaks and other emergencies.
Countries have the necessary legal and regulatory processes to allow for rapid national or cross-border deployment and receipt of public health,
medical personnel and logistics and supplies during emergencies.

MONITORING AND EVALUATION:

(1) Existence of national strategic multihazard emergency assessments (risk profiles) and resource mapping. (2) Existence of emergency
readiness assessments. (3) Development of national health emergency operations centre plans and procedures. (4) Establishment of an
emergency response coordination mechanism or incident management system. (5) Evidence of at least one response to a health emergency
within the previous year that demonstrates that the country sent or received medical countermeasures and personnel according to written

WHO benchmarks for strengthening health emergency capacities

national or international protocols. (6) Existence of an emergency logistic and supply chain management system/mechanism. (7) Existence of
policies and procedures for research, development and innovation for emergency preparedness and response.
167
 BENCHMARK 12A.1: Effective risk profiling, readiness assessment and rapid risk assessment (RRA) processes are in place and strongly linked to health
emergency and disaster management plans and structures
OBJECTIVE: To develop capacities to conduct regular strategic (or equivalent) risk profiling, readiness assessment and RRAs to determine risks to be
prioritized for health emergency management and support decision-makers during emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z National all hazards risk profile not available based on a multihazard risk assessment or has not been updated in the past

01 five years and there is no formal mechanism for the readiness assessment for potential health emergencies.
NO CAPACITY

Risk profiling
02 z Designate a national authority to coordinate the development of a multihazard risk profile (dedicated unit/department).
LIMITED z Conduct contextual analysis to ensure that relevant factors (cultural, societal, economic, etc.) are taken into consideration
CAPACITY
during the risk profiling development process.
z Assess existing policies, legislation and legal basis, ethical rules, norms and standards to conduct risk assessments in
nonemergency and emergency periods.
z Develop a national risk profile, using a standardized approach with relevant focal points across health and relevant sectors.
z Share available/updated risk profile with multisectoral stakeholders to inform IHR-related planning and actions including
readiness and RRAs.

Readiness assessment
z Designate a national authority to coordinate a readiness assessment and identify priority anticipatory actions for high

WHO benchmarks for strengthening health emergency capacities

priority and imminent risks.
z Conduct a readiness assessment of operational capabilities at the national level using a validated readiness checklist64 for
a real or simulated high priority and imminent risk(s) and identify prioritized anticipatory actions to fill gaps.
z Share available/updated readiness assessment and prioritized anticipatory actions with multisectoral stakeholders to
inform IHR-related planning and actions.

64
168

Available from https://partnersplatform.who.int/en/

 RRA
z Conduct RRA for major acute public health events.
z Commence training of public health experts to conduct RRAs.
z Form a national working group (with ToRs) to lead and support the RRA process at national and subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11
z Identify and involve multisectoral stakeholders and trusted community leaders in risk profiling exercise at national level.
z Review available data, risk and capacity assessments across sectors to inform an all hazard risk assessment.

Risk profiling
03 z Form/reconvene a risk assessment implementation team to organize, prepare and conduct risk profiling exercises at the
DEVELOPED national level on a regular basis (i.e. every two years).
CAPACITY
z Train multisectoral risk assessment facilitators to conduct risk profiling exercises, including refresher sessions at the
national level, and maintain a risk assessment facilitator roster.
z Define data consolidation process to make use of multiple sources of information/analysis from different sectors, inclusive
of all hazards (i.e. natural, human-induced and environmental hazards) to inform the risk profile and anticipatory actions
for priority risks.
z Develop or update the national risk profile and share updated risk profile and prioritized risks regularly with relevant
multisectoral stakeholders to inform preparedness and readiness actions.

Readiness assessment

WHO benchmarks for strengthening health emergency capacities

z Form/reconvene a readiness multisectoral team to coordinate and conduct readiness assessments at the national level.
z Conduct or update the readiness assessment of operational readiness capabilities using a WHO recommended readiness
checklist for a real or simulated high priority and imminent risk(s) and identify prioritized anticipatory actions to fill gaps on
a regular basis.
z Develop/update and test the national operational contingency plans or equivalent for high priority and imminent risks
based on readiness assessment(s) and prioritized readiness anticipatory actions.
169

z Integrate the risk profile and prioritized readiness anticipatory actions into relevant national emergency management
mechanism(s), plans, strategies and frameworks.
 Rapid risk assessment
z Conduct RRAs systematically after the detection of an event with provision of updates to the assessment over time.
z Follow a systematic and stepwise methodology for the RRA process with SOPs after the detection of threats or events that
can lead to health emergencies. This includes assessment of hazard, exposure, context and level of impact of the negative
consequences of the event and their respective likelihood.
z Share RRA output with relevant stakeholders and partners.
z Use the output of the RRA to support the decision-making process.
z Train a multidisciplinary team that includes health, animal and environment sectors to conduct RRA.
z Engage relevant departments of the health ministry and other relevant governmental ministries and agencies in the
development of the initial RRAs and ongoing updates.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 ,13 ,14
z Develop and/or use orientation packages for multisectoral experts participating in risk profiling exercises.
z Raise awareness about the importance of risk assessments and application in relevant sectors.
z Involvement from relevant ministries, governmental agencies and nonhealth partners/stakeholders in the risk assessment
process, operationalization of readiness tools (including checklists) and capacity-building planning, including (but not
limited to): various ministries, disaster risk management authority, centralizing authority (such as the prime minister/
president’s office) and multisectoral stakeholders and partners.

Risk profiling

WHO benchmarks for strengthening health emergency capacities

04 z Designate an authority to coordinate the development of a multihazard risk profile at the subnational level(s) (dedicated
DEMONSTRATED unit/department).
CAPACITY
z Develop or update existing policies, legislation and legal basis, ethical rules, norms and standards to conduct risk
assessments in nonemergency and emergency periods.
z Define how risk profile and rapid risk assessment results will be applied to national and subnational planning mechanisms,
operational decision-making, partner engagement and capacity-building and apply as appropriate.
z Reinforce capacity to conduct multihazard risk profiling exercise(s) that can support national and subnational level profiling
170

exercises.
z Allocate funding to develop and maintain risk profiles at the national and subnational levels.
 Readiness assessment
z Designate an authority to coordinate readiness assessments and the development of operational contingency plan(s) at
the subnational level(s).
z Develop/review/update and test hazard specific national and subnational operational contingency plans or equivalent for
high priority and imminent risks based on readiness assessment(s) and prioritized readiness anticipatory actions.
z Establish rapid deployment mechanisms for the release of available contingency resources (human, financial, technical) for
prioritized readiness anticipatory actions on a no regrets basis.
z Apply hazard specific preparedness and readiness tools based on the risk profile and prioritized risks at the national and
subnational levels to inform actions.

RRA
z Establish or designate a RRA division in the health ministry to coordinate the management of risk assessment in all
programme divisions and provide appropriate resources for supporting risk assessment activities (staff, funds, material,
regular trainings).
z Use information from the most recent strategic risk assessment performed at national and/or subnational levels for RRA
to contextualize acute events.
z Conduct SimEx for RRA to identify gaps/best practices and update plan and risk assessment mechanisms accordingly.
z Include RRA trainings in the curricula of postgraduate studies in public heath, health administration, emergency medicine,
disaster management and other relevant fields.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

WHO benchmarks for strengthening health emergency capacities

z Establish the process for multisectoral partners to cross share relevant risk data, information and mapping to inform risk
profile development/maintenance.

RRA
z Establish cooperation agreements between partners, community representatives and the RRA division to ensure whole-of-
society, multisectoral/multidisciplinary risk assessments are conducted at national and subnational levels.
171
 Risk profiling
05 z Update risk profiles at the national and subnational levels on an annual basis (or as required based on emerging threats).
SUSTAINABLE z Incorporate research and risk modelling from academic institutions, scientific data and modelling into the national and
CAPACITY
subnational risk profile through a well defined process with a special focus on emerging threats.

Readiness assessment
z Apply hazard specific readiness tools based on high priority and imminent risks to assess and scale up readiness of the
health sector to respond to health emergencies.
z Regularly update health emergency strategy, contingency plans, legislation, risk informed capacity-building plans and other
relevant documents based on risk profiles and readiness assessments at the national and subnational levels.
z Establish or designate national and subnational mechanisms or processes to review the application of the risk profile
as related to national and subnational policies, contingency and capacity planning, readiness assessments and risk
management are fit for purpose on an annual basis (or as required based on emerging threats).
z Share country experiences, lessons learned and innovations on risk profiling and application of readiness tools within a
community of practice.

RRA
z Use conclusions and recommendations from RRAs to develop/update contingency or response plans during health
emergencies as well as to prioritise public health programmes and capacity-building planning.
z Develop and update RRA methods tailored to the country context and based on M&E results.
z Document country experiences in risk assessment (strategic and RRA), share best practices and engage the country in
peer-to-peer learning programmes at subnational, national level and international levels.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8, 9
z Coordinate and collaborate across stakeholders to ensure that the ongoing exchange of data, information, intelligence
and joint surveillance activities are in place to support development and periodic updates of risk profile at the national and
subnational levels.
z Contribute to the clear process for routine risk monitoring and updating the risk profile at national and subnational levels
172

from relevant sectors, based on updated information and changes to the risk situation.
 BENCHMARK 12A.2: Public health emergency operations centre (PHEOC) capacities, procedures and plans are in place
OBJECTIVE: Develop PHEOC capacities to enable countries to respond in a timely manner to all hazard emergencies and disasters

CAPACITY LEVEL BENCHMARK ACTIONS

z A PHEOC has not been identified at the national level and no PHEOC handbook is in place.

01
NO CAPACITY

z Conduct high level advocacy on the importance of creating functional PHEOCs with heads of state, ministries and

02 agencies.
LIMITED z Conduct a baseline assessment of emergency operations capacities and gaps including infrastructure (facility,
CAPACITY communication technology equipment, internet, software, office supplies and power), information systems, workforce,
legislation, policies and plans.
z Form a steering committee or other management structure to oversee the implementation and strengthening of PHEOC
and a policy group to provide strategic direction and allocation of resources.
z Incorporate the concept of operations for the entire emergency response system, including PHEOC, within the national
emergency response plan.
z Develop a PHEOC implementation plan, including resource mobilization plan, to meet the minimum requirements of a
functioning PHEOC.
z Complete a comprehensive mapping of existing legal mandates on health emergency management systems and PHEOCs.
z Draft a legal framework for the PHEOC to coordinate emergency operations and advocate for its enactment in the presence

WHO benchmarks for strengthening health emergency capacities

of leadership from the health ministry and relevant agencies.
z Identify/establish a designated facility for the PHEOC with limited capacities (e.g. space, information communication
technology infrastructure, information management, human resources with at least one designated core staff member,
access to required data, etc.) to perform the coordination of emergency operations.
z Develop a PHEOC handbook and other plans and procedures (multihazard response plan, hazard specific plans for priority
risks, business continuity plan, necessary SOPs, etc.) that include PHEOC activation and scaled level of response and
resource requirements at the national and subnational levels.
173

z Develop the national incident management system/response coordination structure

 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8, 9, 10
z Identify and involve multisectoral stakeholders and trusted community leaders in risk profiling exercise at national level.
z Review available data, risk and capacity assessments across sectors to inform an all hazard risk assessment.

z Enact the legal framework for operationalization of the PHEOC.

03 z Implement and validate health emergency preparedness and response plans, PHEOC handbook and SOPs in routine and
DEVELOPED emergency operations.
CAPACITY z Assign permanent staff for core PHEOC functions (operations and management in preparedness, response and recovery
phases).
z Identify staff to conduct core incident management system (IMS) functions within the national PHEOC.
z Develop standardized forms, templates and other tools for data/information management, task management, reporting,
briefing and record keeping.
z Determine data and information requirements (essential elements and critical requirements) to inform decision-making
and identify critical sources of information such as epidemic intelligence, laboratory system, risk assessments and
resources etc.
z Develop and implement MoUs and SOPs to establish communication, coordination, information management and sharing
of mechanisms between relevant stakeholders.
z Establish a PHEOC information system and an interoperability platform, linking the health information system, to capture
and manage required information and exchange information between the various existing information systems and
stakeholders.

WHO benchmarks for strengthening health emergency capacities

z Develop funding mechanisms to build, equip and operate PHEOCs at the national level and to access additional funds in
special circumstances.
z Develop a roster of subject matter experts and identify critical nonhealth sectors that would represent essential
participation in PHEOC functioning during a health emergency.
z Develop and implement a training programme for national PHEOC staff (routine and surge staff) on IMS function, roles and
PHEOC operations.
z Assess the need for creating and building an additional PHEOC at both the national and subnational levels and identify
174

priority regions for PHEOC establishment based on specific needs.

 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

z Review and update the national incident management system/response coordination structure.

04 z Align emergency operations centres (EOCs) existing in relevant sectors with the PHEOC and the national EOC for all
DEMONSTRATED hazards to ensure interoperability and harmonization of actions and interventions during health emergencies.
CAPACITY z Monitor, evaluate and improve the PHEOC facility, communication technology infrastructure, information management and
sharing platforms, emergency policies, plans, PHEOC handbook and procedures.
z Identify/develop alternative/additional PHEOCs at the national level and establish PHEOCs at the subnational level (based
on the risks and geographical need) with associated PHEOC handbooks.
z Mobilize and allocate sufficient and sustainable funds to build, equip, maintain and operate PHEOCs at the national
(including alternative PHEOCs) and subnational levels.
z Develop and implement a tracking of decision-making procedures for the activation of a PHEOC.
z Activate the national PHEOC within 120 minutes of receiving an early warning or information of an emergency requiring
PHEOC activation.
z Conduct SimEx/AAR/IAR (as relevant).
z Develop and implement a training programme for PHEOC staff (routine and surge staff) on IMS function, roles and PHEOC
operations at subnational levels and allocate dedicated resources.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9

WHO benchmarks for strengthening health emergency capacities

z Regularly review and communicate with stakeholders involved in health emergency management and PHEOC activities

05 including relevant sectors.

SUSTAINABLE z Maintain and regularly update the national database of trained and skilled PHEOC and surge personnel to support
CAPACITY preparedness and response coordination at all levels.
z Sustain resources for the implementation of PHEOCs and maintain a network of fully functional, funded PHEOCs and
trained staff on a 24/7 basis.
175
 z Test the activation, operation and deactivation of the PHEOC network which includes national, subnational or multisectoral
PHEOCs, using real or simulated events and update PHEOC handbooks annually.
z Sustain a regular training and exercise programme to train PHEOC and surge personnel at all levels based on the need or
gap analysis.
z Test, review and update PHEOC functions, plans, SOPs and trainings regularly at all levels, including for large scale and
concurrent emergencies, based on lessons learned and ensure follow up on the implementation of recommendations from
M&E activities.
z Participate in international initiatives including regional and global PHEOC exercises to support capacity-building for
functioning PHEOCs.
z Share experiences on PHEOC management and engage the country in peer-to-peer learning programmes at the
subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

WHO benchmarks for strengthening health emergency capacities

176
 BENCHMARK 12A.3: A functional multisectoral all hazard health emergency response management system65 is in place
OBJECTIVE: To develop a management and coordination mechanism for timely emergency response to all hazard health emergencies and disasters

CAPACITY LEVEL BENCHMARK ACTIONS

z A formal emergency response coordination mechanism is not in place.

01 z An IMS integrated with a national PHEOC or equivalent structure is not available or under development.
NO CAPACITY

z Establish a national health emergency coordination focal point that maintains regular contact with experts from human,

02 animal (domestic animals and wildlife) and environmental health as well as other relevant sectors.
LIMITED z Identify and develop linkages with key potential informants and response partners for health emergency operations that
CAPACITY can provide 24/7 coverage in all major health systems.
z Establish capacity for the availability of IHR NFP and other responsible parties to receive information about potential health
threats and to report a public health emergency of international concern as outlined in the IHR.
z Develop a plan and SOPs for an IMS which is integrated with the national PHEOC or equivalent structure, including
thresholds and levels of activation for the emergency response coordination mechanism, and develop SOPs for the
coordination of key health sector actors (such as surveillance, health facilities, emergency medical teams, mental health
departments) and other relevant sectors.
z Involve health emergency coordination focal points in the development of NHPSPs to define the country’s vision, policy
directions and strategies for ensuring coordination mechanisms for emergency response.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5

z Establish an IMS for managing emergency response at the national level, including participation of relevant sectors, and

03 integrate with national PHEOC or equivalent structure.

DEVELOPED z Adapt the country’s legal framework to facilitate the coordination of emergency response operations in relevant sectors at
CAPACITY both national and subnational levels.
65
177

These include entities, such as points of contact, EOCs or response committees to coordinate health sector actors and resources in response to emergencies, and to coordinate health sector
response with other sectors. Coordination mechanisms may apply IMSs to fulfil the coordination function.
 z Identify the roles and responsibilities of multisectoral stakeholders actively involved in the IMS and emergency response.
z Establish and maintain a roster of emergency operations staff with defined roles and functions.
z Develop a training plan linked to other relevant trainings for emergency operations staff, including IMS, and implement at
the national level, at a minimum.
z Develop advocacy material and training packages on coordination of emergency response for communities and all relevant
stakeholders.
z Develop a strategy, standards of conduct, training and advocacy material to prevent and address misconduct during
response operations including sexual exploitation and abuse of vulnerable population, staff harassment, etc.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

z Establish a health sector emergency response coordination mechanism with participation from health and relevant

04 sectors, linked to the national IMS and PHEOC or equivalent structure, with capacity to support the management of
DEMONSTRATED emergency responses at the subnational level.
CAPACITY z Train subnational level and local health sector staff on the emergency response coordination mechanism.
z Conduct SimEx/AAR/IAR (as relevant) with a focus on IMS, including coordination between national and subnational levels.
z Disseminate advocacy materials and training packages to raise awareness of communities and train or retrain relevant
stakeholders on their role(s) and responsibilities during an emergency response.
z Make safety and security training mandatory for all staff before being deployed in emergency response operations.
z Develop an anonymous and secured platform for reporting misconduct during response operations including sexual
exploitation and abuse of vulnerable population, staff harassment, etc. Make training and awareness raising campaigns to

WHO benchmarks for strengthening health emergency capacities

prevent and address misconduct during emergency operations mandatory for all multisectoral staff before being deployed
during and emergency response.
z Develop a platform for mental health support of staff returning from emergency response operations.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
178
 z Establish and sustain routine and emergency communications, which are linked to the national IMS and PHEOC or

05 equivalent structure, at national and subnational levels, with international coordination mechanisms through the focal
SUSTAINABLE points.
CAPACITY z Allocate sustainable funding for IMS activities at all levels.
z Evaluate, document and disseminate information on activations and, if done, include exercises to promote continuous
improvement in communication and coordination.
z Review and adjust plans, SOPs, advocacy material and training packages for IMS and coordination of the emergency
response based on lessons learned from SimEx/AAR/IAR (as relevant).
z Keep record and track data of security and safety incidents as well as all allegations of misconduct, conduct investigation
and take subsequent actions accordingly across all relevant sectors.
z Share experiences of coordination mechanisms for emergency response and engage the country in peer-to-peer learning
programmes at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

WHO benchmarks for strengthening health emergency capacities

179
 BENCHMARK 12A.4: A system is in place for timely and effectively providing surge health personnel and teams during a health emergency
OBJECTIVE: To develop a functional system for activating, sending, receiving and coordinating health personnel and teams during a health emergency

CAPACITY LEVEL BENCHMARK ACTIONS

z No national plan for health personnel deployment or team (sending and receiving) has been drafted, or is under

01 development.
NO CAPACITY z No plan for establishing national rapid response team (RRT)/emergency management team (EMT) has been drafted and
no coordination mechanisms for RRTs/EMTs or health personnel deployment have been described.

z Review national preparedness and response plans and legal and regulatory frameworks for preparing, sending,

02 coordinating and receiving health personnel with key stakeholder involvement.

LIMITED z Review national laws and regulations for the licensing and registration of health personnel, including RRTs/EMTs.
CAPACITY z Develop/update national plans, protocols, SOPs, technical guidelines and toolkits for preparing, mobilizing, sending,
receiving and coordinating health personnel deployment and teams, and for sharing information as appropriate.
z Conduct stakeholder mapping to determine baseline capacities/capabilities of relevant ministries and partner agencies for
the deployment of EMTs and RRTs.
z Appoint an EMT national focal point and request assistance in developing national EMTs as needed from multisectoral
organizations and partner agencies.
z Identify points of contact at ministries and/or relevant multisectoral organizations that can contribute to the deployment
of health personnel and liaise with trained EMT teams across sectors, such as military forces, for collaboration and rapid
deployment of health personnel during an emergency.

WHO benchmarks for strengthening health emergency capacities

z Develop SOPs and trainings for the procurement, storage, organization, transportation and distribution of personal
protective equipment, medical and nonmedical supplies and equipment for health personnel.
z Develop standardized plans for triage, IPC, clinical care and operational support during emergency incidents, considering
emergency and nonemergency related clinical presentations (based on agreed EMT standards).
z Develop tools for community engagement and education targeting acceptance of deployed health personnel.

Participation and contribution of other sectors to actions:

180

1, 2, 3, 4, 5, 6, 7, 8, 9
 z Develop and implement the technical procedures and legal provisions required to adopt and execute the national plan on

03 health personal and team deployment, adopting a quality assurance approach.

DEVELOPED z Conduct SimEx/AAR/IAR (as relevant) to test plans/SOPs/protocols which include sending, receiving and coordinating
CAPACITY health personnel and teams, and for the creation of an EMT coordination cell and/or case management pillar in the
national PHEOC.
z Establish a multisectoral expert group to advise government on the management and coordination of health personnel and
teams during health emergencies at the national and subnational levels.
z Draft and regularly update the mapping of partner agencies to ensure ownership in human resources for health
management coordination during health emergencies.
z Apply to the WHO EMT Initiative66 for mentorship and verification as an internationally classified EMT.
z Define criteria (health and nonhealth) for the activation and deployment of health personnel and teams during a health
emergency, at the national and subnational levels. Create a roster of national and local health experts that can be rapidly
activated and deployed during health emergencies at the national and subnational levels.
z Develop and implement standardized training plans for emergency staff based on standardized competencies for RRTs
and EMTs at the national level, with plans for rollout at subnational level.
z Include prompt processes for licensing and regulation to authorize full or partial practice of qualified foreign health workers
deployed specifically for emergency assistance.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

z Review the implementation plan of sending and receiving health personnel in at least one event response, or conduct a

WHO benchmarks for strengthening health emergency capacities

04 SimEx if no response has occurred in the past year.
DEMONSTRATED z Establish, maintain and train an updated roster of multisectoral qualified personnel to be activated in a health emergency.
CAPACITY z Conduct regular trainings for emergency response personnel based on standardized competencies at all levels.
z Establish a system for accreditation of national EMTs and obtain external validation of national EMTs.
z Develop and implement an occupational safety strategy (including psychological support) for health personnel deployed
during health emergencies at the national and subnational levels.
181

66
https://extranet.who.int/emt/
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5
z Development of sector-specific external evaluation mechanisms for multisectoral teams and capacities.

z Update plans, SOPs, protocols and trainings based on findings from SimEx/AAR/IAR and identify improvements to regular

05 health system operations resulting from personnel and team deployment during emergencies.
SUSTAINABLE z Identify and partner with regional and international partners (such as GOARN or the EMT Network via the WHO EMT
CAPACITY Secretariat) for mobilizing health personnel.
z Share experiences in the management of health personnel during health emergencies with subnational, national and
international partners.
z Maintain sustainable sources of funding for maintaining national EMT coordination and deployment mechanisms.
z Achieve certification as international RRTs/EMTs from WHO to support national health personnel deployment in health
emergencies.
z Routinely test and evaluate capacity for emergency deployment of health personnel (sending and receiving), including EMT
coordination cells and/or case management pillar operations within the national PHEOC, and the provision of continuing
education programmes to ensure deployment staff readiness.
z Play a mentoring role for other interested countries for RRT/EMT deployment whilst maintaining ethical standards
including for the international hiring of health workers and participate in a twinning arrangement to support at least one
country in their development of a national EMT.
z Support research programmes in service delivery and other areas related to the management and deployment of health
personnel during health emergencies.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6
182
 BENCHMARK 12A.5: A system is in place for emergency logistics and supply chain management67 during a health emergency
OBJECTIVE: To develop a functional system for activating and coordinating emergency logistics and supply chain management during a health
emergency

CAPACITY LEVEL BENCHMARK ACTIONS

z Emergency logistics and supply chain management system/mechanisms is under development and/or not able to provide

01 adequate support for health emergencies

NO CAPACITY

z Review national preparedness and response plans, legal and regulatory frameworks, and baseline capacity for procuring,

02 stockpiling and deploying medical countermeasures, including sector roles and responsibilities, involving all key
LIMITED stakeholders.
CAPACITY z Review national laws and regulations for the registration, procurement and use of medical devices, vaccines, drugs,
biologicals and medical supplies from national and/or international sources during health emergencies.
z Form a national expert group, bringing together all relevant experts, to advise decision-makers on how to strengthen
capacity for management of medical countermeasures during a health emergency.
z Draft a national plan to mobilize, receive, stockpile and deploy medical countermeasures, including SOPs for receiving
donations of medical countermeasures.
z Develop a legal framework and regulation to facilitate shipping and customs clearance of medical countermeasures during
a health emergency.
z Complete feasibility assessment for establishing a medical countermeasures procurement stockpile, including secure and
functional facilities at all levels.

WHO benchmarks for strengthening health emergency capacities

z Draft a list of essential medical countermeasures based on the country risk profile (medical devices, vaccines, drugs,
biologicals and medical supplies) for the management of high risk health emergencies at the national and subnational
levels.

67
Emergency logistics and supply chain system and mechanism include the capacity to purchase, store and deliver essentials products and materials necessary for a response (emergency
kits, protective equipment, diagnostics, medical consumables, therapeutics, drugs and biomedical equipment) wherever they may be required in adequate quantity and in a timely manner.
183

It also gathers and organizes the material, capacities and processes allowing for a rapid deployment and implementation of the response including emergency medical infrastructures,
transportations, emergency offices and telecommunications.
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Identify countermeasures required for use across relevant sectors (PPE for animal culling, for example).

z Adopt and implement the national plan to mobilize, receive, stockpile and deploy medical countermeasures, including

03 mapping resources within the country and with all relevant partners.
DEVELOPED z Develop standardized protocols and plans for storage, deployment, logistical and administrative support at all levels.
CAPACITY z Establish regulatory pathways for the use of medical countermeasures including appropriate authorizations, clearances,
ethical norms and permissions during investigations and responses.
z Create deployment protocols, SOPs, technical guidelines and toolkits including communication materials, trainings and
educational information to inform staff, the community and stakeholders.
z Develop a procedure for accelerated market authorization for novel and innovative drugs and medical products during
health emergencies.
z Develop a training plan for rapid logistics needs assessments, planning, management and distribution of stockpiles for
health emergencies and train early responders in the appropriate use and management of medical countermeasures.
z Conduct SimEx/AAR/IAR (as relevant) to test the implementation plan.
z Implement measures for the management and distribution of stockpiles at the national level and develop tools for regular
monitoring of quantity and quality control of the strategic stockpile of essential medical countermeasures at the national
and subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

WHO benchmarks for strengthening health emergency capacities

z Design and implement joint measures for effective supply chain management by relevant sectors during health
emergencies.
184
 z Review the implementation plan for sending, receiving, stockpiling and deploying medical countermeasures during at least

04 one response or conduct a SimEx if no response has occurred in the past year.
DEMONSTRATED z Develop and implement a strategy to ensure safe and secure access to medical countermeasures for the most vulnerable
CAPACITY groups, including forcibly displaced people, low income people, people living in unsafe areas, etc.
z Develop SOPs and train a sufficient number of health workers for rational prescription and utilization of medical
countermeasures to provide an appropriate response to health emergencies.
z Conduct regular monitoring and quality control missions of strategic stockpile of essential medical countermeasures at the
national and subnational levels.
z Implement rapid needs assessments, planning, management and distribution of stockpiles for health emergencies at
national and subnational levels.
z Complete trainings to support the management and distribution of stockpiles for health emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Expand procurement of countermeasures to the animal sector in the country plans, procedures or legal provisions.

z Test the management of the strategic stockpile regularly and update plans and strengthen capacities accordingly.

05 z Develop and routinely apply criteria to document progress of sending and receiving medical countermeasures during a
SUSTAINABLE response.
CAPACITY z Routinely test and evaluate capacity of for emergency deployment of medical countermeasures and update plans
accordingly.
z Develop a system for automatic replenishment of strategic stockpiles of essential medical countermeasures for health

WHO benchmarks for strengthening health emergency capacities

emergencies at the national and subnational levels.
z Establish partnerships with countries, regional and international partners that includes procurement, sharing and
distribution of medical countermeasures.
z Share experience in activation and coordination of medical countermeasures during a health emergency and engage the
country in peer-to-peer learning programme at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

185

1, 2, 3, 4, 5, 6
 BENCHMARK 12A.6 Research, development68 and innovation69 (RD&I) capacity for emergency management is in place
OBJECTIVE: To develop and implement a RD&I mechanism to generate evidence-based solutions for emergency preparedness and response through
research and development and dissemination of findings

CAPACITY LEVEL BENCHMARK ACTIONS

z Research and development activities (operational and implementation), including approvals of research, are conducted on

01 an ad hoc basis.
NO CAPACITY

z Establish a national multisectoral committee (with ToRs) with relevant stakeholders and sectors to contribute to the

02 development, updating and implementation of a national RD&I agenda for health emergencies based on the country risk
LIMITED profile and to coordinate dissemination of evidence70.
CAPACITY z Develop a national strategy, action plan or framework to guide RD&I for emergency preparedness and response including
dissemination and advocacy strategy.
z Map existing national entities (public and private) which provide funding for research and development.
z Develop a national regulatory review process71 for conducting RD&I in country.
z Assess capacities (including local networks of stakeholders in relevant sectors) to conduct RD&I activities before, during
and after health emergencies both at the national and subnational levels.
z Map existing scientific evidence dissemination platforms.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

WHO benchmarks for strengthening health emergency capacities

z Identify focal points in all relevant organizations and sectors who can contribute to RD&I on health emergency
preparedness and response.
68
R&D are activities that focus on the innovation of new or improved knowledge, products and services through systematic and methodical work.
69
Health innovation refers to the development of new or improved health policies, systems, products and technologies, services and delivery methods that improve people’s health, with a
special focus on the needs of vulnerable populations. https://www.who.int/teams/digital-health-and-innovation/health-innovation-for-impact
70
The working group can be constituted by a national public health institute, health ministry and across relevant ministries, academia, research institutes, regional bodies or access to regional
networks.
71
Regulatory review refers to the approval, initiation and conduct of periodic review of biomedical research involving human subjects. The primary purpose of such review is to ensure the
186

protection of the rights and welfare of the human subjects (Institute of Medicine (US) Roundtable on Research and Development of Drugs, Biologics, and Medical Devices, Davis JR, Nolan VP,
Woodcock J, et al., editors. Assuring Data Quality and Validity in Clinical Trials for Regulatory Decision-Making: Workshop Report. Washington (DC): National Academies Press (US); 1999. FDA
Regulatory Review. https://www.ncbi.nlm.nih.gov/books/NBK224583/.
 z Implement a national RD&I strategy, action plan or framework which includes mechanisms and procedures for conducting

03 RD&I.
DEVELOPED z Secure sufficient funding, including from external sources if limited resources available from domestic funds, to support
CAPACITY RD&I activities.
z Implement the national regulatory review process for conducting RD&I in country.
z Identify institutions, within and outside of the country, that support RD&I activities.
z Create in-country networks of stakeholders from relevant sectors who can contribute to RD&I activities before, during and
after health emergencies.
z Develop or adapt RD&I orientation packages to train relevant staff on mechanisms and procedures to conduct research
before, during and after health emergencies, based on a training needs assessment.
z Train relevant staff across sectors and organizations at the national level on mechanisms and procedures for efficient
RD&I based on country context.
z Develop a platform or network for sharing and exchanging scientific information with relevant sectors during health
emergencies at local, subnational, national and international levels72.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Develop strategies for RD&I capacities in relevant sectors to conduct research on topics such as social science,
anthropology, economics, politics, etc. before, during and after health emergencies.
z Share RD&I from relevant sectors, including human, animal health, environment, chemical and radiological to support
coordinated RD&I efforts.

WHO benchmarks for strengthening health emergency capacities

z Establish a designated, domestic and externally funded, RD&I division to coordinate the management of RD&I including

04 health emergencies across all programme divisions with appropriate resources (staff, funds, material, facilities, etc.)
DEMONSTRATED and cooperation agreements with partners, donors and other countries to support multisectoral/multidisciplinary RD&I
CAPACITY activities in the country.
z Develop a mechanism to support the fast tracking and expansion of research capacities during health emergencies and
increase the frequency of activity during public health emergencies of international concern/novel emergencies to gather
the latest evidence and communicate with decision-makers.
187

72
To disseminate findings from RD&I widely among experts, decision-makers and communities and take into account potential sensitivity of innovation in local context (including social, cultural
and political contexts).
 z Increase collaboration and engagement between the research community and policy-makers, practitioners and
stakeholders.
z Share documented research activities, evidence and outcomes with decision-makers to support policy, practice and
guideline improvement.
z Expand training of relevant staff across sectors to subnational level and incorporate RD&I into undergraduate and
postgraduate studies in relevant programmes.
z Evaluate RD&I mechanisms, procedures and utilization of findings in health emergencies within AARs/IARs, as relevant.
z Collect and record adverse events from all phases of RD&I from all sectors to evaluate and address incidents and preserve
transparency and trust in RD&I initiatives.
z Identify and promote opportunities for international cooperation on RD&I related to health emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Conduct cross-sectoral collaborative research on health emergencies with joint action to utilize evidence for preparedness
and response and advocacy.

z Maintain sustainable funding for RD&I from both domestic and international sources.

05 z Review RD&I strategy and activities based on recent health emergency risk assessments/RD&I evaluations and update
SUSTAINABLE accordingly.
CAPACITY z Establish and maintain prearrangements and MoUs to facilitate public-private partnership for multisectoral/
multidisciplinary RD&I during health emergencies.
z Review and update training packages and advocacy materials based on assessment and evaluation results.

WHO benchmarks for strengthening health emergency capacities

z Engage the country in peer-to-peer learning programmes for RD&I at the subnational, national and international levels.
z Enact evidence-informed policy, practice and guidance for emergency preparedness and response based on in-country
research.
z Review and update RD&I legislation and processes at national and subnational levels in relevant sectors.

Participation and contribution of other sectors to actions:

188

1, 2, 3, 4, 5, 6, 7
 Tools:
z Partners platform for health in emergencies [website]. Geneva: World Health Organization; 2023 (https://partnersplatform.who.int/en/).

z Emergency medical teams initiative [website]. Geneva: World Health Organization; 2020 (https://extranet.who.int/emt/).

z Health innovation for impact. Digital health [website]. Geneva: World Health Organization; 2023 (https://www.who.int/teams/digital-health-and-
innovation/health-innovation-for-impact).
z Institute of Medicine (US) Roundtable on Research and Development of Drugs, Biologics, and Medical Devices. Washington DC: Davis JR, Nolan VP,
Woodcock J, and Estabrook RW; 1999 (https://www.ncbi.nlm.nih.gov/books/NBK224577/).
z Strategic toolkit for assessing risks: a comprehensive toolkit for all-hazards health emergency risk assessment. Geneva: World Health Organization;
2021 (https://www.who.int/publications/i/item/9789240036086).
z Words into Action guidelines: National disaster risk assessment. Geneva: United Nations Office for Disaster Risk Reduction; 2017 (https://www.undrr.
org/publication/words-action-guidelines-national-disaster-risk-assessment).
z Rapid risk assessment of acute public health events. Geneva: World Health Organization; 2012 (https://apps.who.int/iris/handle/10665/70810).

z WHO Human Health Risk Assessment Toolkit: Chemical Hazards, second edition. Geneva: World Health Organization; 2021 (https://www.who.int/
publications/i/item/9789240035720).
z Joint Risk Assessment Operational Tool. Food and Agriculture Organization of the United Nations, World Health Organization and World Organisation for
Animal Health; 2020 (https://www.who.int/initiatives/tripartite-zoonosis-guide/joint-risk-assessment-operational-tool).
z Kandel N, Chungong S, and the WHO Technical Working Group of the Dynamic Preparedness Metric and Health Security Preparedness Department.
Dynamic preparedness metric: a paradigm shift to measure and act on preparedness. The Lancet Global Health. 2022; 10(5), e615–e616. doi: 10.1016/
S2214-109X(22)00097-3.
z Framework for a Public Health Emergency Operations Centre. Geneva: World Health Organization; 2015 (https://apps.who.int/iris/

WHO benchmarks for strengthening health emergency capacities

handle/10665/196135).
This document from WHO outlines the key concepts and essential requirements for developing and managing a PHEOC. It provides an outline for
developing and managing a PHEOC to achieve a goal.
z Handbook for developing a public health emergency operations centre part A: Policies, plans and procedures. Geneva: World Health Organization; 2018
(https://www.who.int/publications/i/item/handbook-for-developing-a-public-health-emergency-operations-centre-part-a).
z Handbook for developing a public health emergency operations centre part C: training and exercises. Geneva: World Health Organization; 2018 (https://
www.who.int/publications/i/item/handbook-for-developing-a-public-health-emergency-operations-centre-part-c).
189
 z Handbook for Public Health Emergency Operations Center Operations and Management. Brazzaville: WHO Regional Office for Africa; 2021 (https://www.
afro.who.int/publications/handbook-public-health-emergency-operations-center-operations-and-management).
z Public Health Emergency Operations Center (PHEOC) Legal Framework Guide: A Guide for the Development of a Legal Framework to Authorize the
Establishment and Operationalization of a PHEOC. Brazzaville: WHO Regional Office for Africa; 2021 (https://www.afro.who.int/publications/public-
health-emergency-operations-center-pheoc-legal-framework-guide-guide/).
z The Public Health Emergency Operations Centre (PHEOC) OpenWHO [website online course]. Geneva: World Health Organization; 2020 (https://
openwho.org/courses/PHEOC-EN).
z Balajee SA, Pasi OG, Etoundi AGM, Rzeszotarski P, Do TT, Hennessee I, et al. Sustainable Model for Public Health Emergency Operations Centers for
Global Settings. Emerg Infect Dis. 2017 Oct;23(13):S190–5. doi:10.3201/eid2313.170435.
z Incident Management System (Tier 1) OpenWHO [website online course]. Geneva: World Health Organization (https://openwho.org/courses/incident-
management-system).
A training course from WHO that is designed to help users gain a foundational understanding of the Incident management system structure and its
procedures at WHO.
z FEMA Emergency Management Institution. National Incident Management System (NIMS) [website]. United States of America: Federal Emergency
Management Agency; 2015 (https://training.fema.gov/nims/).
From the US Federal Emergency Management Agency, a series of free interactive online courses on incident management.
z Public Health Incident Leadership Training [website]. United States of America: Minnesota Department of Health; 2022 (https://www.health.state.mn.us/
communities/ep/training/useee/index.html).
A training for public health practitioners with leadership responsibilities during responses to disasters and events with public health implications.
z Hazard Information Profiles: Supplement to UNDRR-ISC Hazard Definition & Classification Review - Technical Report. Geneva: United Nations Office for
Disaster Risk Reduction; 2021 (https://www.undrr.org/publication/hazard-information-profiles-hips).

WHO benchmarks for strengthening health emergency capacities

Provides a common set of hazard definitions to governments and stakeholders to inform their strategies and actions on risk reduction and
management.
z International Coordinating Group on Vaccine Provision [website]. Geneva: World Health Organization; 2023 (https://www.who.int/groups/
icg#:~:text=The%20International%20Coordinating%20Group%20(ICG,to%20countries%20during%20major%20outbreaks).
Has information on mechanisms to manage and coordinate the provision of emergency vaccine supplies and antibiotics to countries during major
outbreaks. This includes vaccines for cholera, meningitis and yellow fever.
z Global Outbreak Alert and Response Network (GOARN) [website]. Geneva: Global Outbreak Alert and Response Network; 2023 (https://goarn.who.int/).
190

Provides information on how to prepare for field activity, to activate international support, to coordinate response in the field, to evaluate and follow up
outbreaks of international importance.
 z Classification and Minimum Standards for Emergency Medical Teams. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/
handle/10665/341857).
Describes the capacities and capabilities of EMTs, as well as their guiding principles and standards.
z The regulation and management of international emergency medical teams. Geneva: World Health Organization and International Federation of the Red
Cross and Red Crescent Societies; 2017 (https://disasterlaw.ifrc.org/media/1328).
Provides an overview of the issues in regulating and managing international emergency medical teams in a selection of large and small-scale sudden
onset disasters.
z COVID-19: Operational guidance for maintaining essential health services during an outbreak. Interim guidance, 25 March 2020. Geneva: World Health
Organization; 2020 (https://apps.who.int/iris/handle/10665/331561).
z An R&D Blueprint for Action to Prevent Epidemics. Geneva: World Health Organization; 2017 (https://www.who.int/publications/m/item/an-r-d-
blueprint-for-action-to-prevent-epidemics---update-2017).
z Establishing a global coordination mechanism of R&D to prevent and respond to epidemics – toward implementation of the GCM. Meeting Report from
28 March 2017, London, UK at the Welcome Trust for the R&D Blueprint. London: World Health Organization; 2017 (https://www.who.int/docs/default-
source/blue-print/gcm/blue-print-gcm2017-meetingsummary.pdf?sfvrsn=3f78ce1c_2).
z Seven principles for strengthening research capacity in low- and middle-income countries: simple ideas in a complex world. ESSENCE Good Practice
Document Series. Geneva: TDR/ World Health Organization; 2014 (https://tdr.who.int/publications/m/item/2014-06-19-seven-principles-for-
strengthening-research-capacity-in-low-and-middle-income-countries-simple-ideas-in-a-complex-world).
z Planning, monitoring and evaluation Framework for research capacity strengthening. Revision 2016. ESSENCE Good Practice Document Series. Geneva:
TDR/ World Health Organization; 2016 (https://tdr.who.int/docs/librariesprovider10/essence/essence-frwk-2016-web-pdf.pdf?sfvrsn=7282f353_6).
z WHO guidance on research methods for health emergency and disaster risk management. Geneva: World Health Organization; 2021 (https://apps.who.
int/iris/handle/10665/345591).

WHO benchmarks for strengthening health emergency capacities

z GLOSSARY of Health Emergency and Disaster Risk Management Terminology. Geneva: World Health Organization; 2020 (https://www.who.int/
publications/i/item/9789240003699).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public health
emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).
191

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
 Health emergency management additional benchmarks

BENCHMARK 12B.1: All hazard health emergency and disaster risk management (EDRM) are mainstreamed across IHR capacities
OBJECTIVE: To ensure all hazard health emergency and disaster risk management across the IHR capacities.

CAPACITY LEVEL BENCHMARK ACTIONS

z No integration of all hazard health EDRM into IHR capacities.

01
NO CAPACITY

z Conduct mapping of all areas requiring integration of all hazard health EDRM into IHR capacities at national and subnational

02 level.
LIMITED z Establish a working group with key health and relevant other sector stakeholders for the review and development of a
CAPACITY mechanism73 to mainstream all hazard health EDRM for IHR capacities.
z Designate a focal point/unit for all hazard health EDRM at the national level.
z Assess human resources capacities for all hazard health EDRM.
z Develop advocacy mechanisms to for all hazard health EDRM.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Provide information74, from relevant sectors, on the national disaster risk management architecture that is linked to the
health sector.

WHO benchmarks for strengthening health emergency capacities

z Map monitoring and early warning mechanisms related to different hazards across sectors.

73
Policies, strategies, guidelines, SOPs as needed.
192

74
Use multisectoral capacity assessment tools, such as the Capacity for Disaster Reduction Initiative (CADRI) partnership diagnostic tools and other health emergency and disaster risk
management assessment tools to identify capacity gaps for health EDRM.
 z Establish all hazard health EDRM coordination and planning mechanisms to mainstream health EDRM in health sectors.

03 z Conduct advocacy campaigns to introduce all hazard health EDRM at the national and subnational levels.
DEVELOPED z Integrate all hazard health EDRM into relevant health policies, strategies and plans at national level aligned with IHR and
CAPACITY international frameworks75,76.
z Develop, establish and test a coordination mechanism for the national health response to disasters, especially natural,
technological and societal.
z Map domestic and international financing sources for all hazard health EDRM and allocate financial resources to address
gaps and support capacity development for all hazard health ERDM.
z Develop and disseminate training packages on all hazard health EDRM at the national level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Update all hazard, whole-of-society/multisectoral plans and legislation for disaster risk management across relevant
sectors at national level.
z Review and update national disaster risk reduction (DRR) strategies to include health risks of emergencies and disasters.
z Establish and link early warning mechanisms related to different hazards across sectors at the national level.
z Establish a national platform or committee on emergency/disaster risk management, covering all hazards, with the health
sector represented.

z Integrate all hazard health EDRM considerations into all relevant health policies, strategies and plans at subnational level,

04 aligned with IHR and international frameworks.

DEMONSTRATED z Conduct regular reviews, M&E, SimEx/AAR/IAR (as relevant) to test the all hazard health EDRM coordination mechanisms at

WHO benchmarks for strengthening health emergency capacities

CAPACITY national and subnational levels.
z Establish a coordination mechanism for the health response to disasters, especially natural, technological and societal at
the subnational level.
z Develop and disseminate trainings on all hazard health EDRM at the subnational level considering specific subpopulations77.

75
Including Sendai Framework for Disaster Risk Reduction (UNDRR, 2015), Paris Agreement (2016), WHO Health EDRM Framework (2019).
76
To address the risks and needs of women and other groups identified as most at risk of being left behind as a result of disaster and climate change.
193

77
Including consideration for different levels of vulnerability, across prevention/mitigation, preparedness, response and recovery, including capacities for cross-border or multinational action,
taking into account the possible cascading effects of a disaster and critical interdependencies among sectors and stakeholders.
 z Scale up all hazard health EDRM in non-government sectors, including private sector.
z Document the economic impacts of disasters on health and socioeconomic systems.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Updated all hazard, whole-of-society/multisectoral plans for disaster risk management across relevant sectors at the
subnational level.
z Implement national DRR strategies to include health risks of emergencies and disasters at national and subnational levels.
z Establish and link early warning mechanisms related to different hazards across sectors at the subnational level.

z Evaluate the integration of all hazard health EDRM into IHR capacities and update the mechanisms as needed78.

05 z Secure anticipatory finance mechanisms that are designed to address all hazard health EDRM for IHR capacities.
SUSTAINABLE z Conduct all hazard health EDRM research and development at the national and subnational levels.
CAPACITY
z Evaluate the coordination mechanism for the health response to disasters, especially natural, technological and societal at
the subnational level.
z Engage the country in peer-to-peer learning programmes at the subnational, national and international levels.
z Include considerations for all hazard health EDRM in undergraduate and postgraduate curricula for health professionals in
universities and other learning programmes.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Evaluate the integration of all hazard health EDRM in DRR strategies and update the strategies based on the findings.

WHO benchmarks for strengthening health emergency capacities

194

78
To address the risks and need of women and other groups identified as most at risk of being left behind as a result of disaster and climate change.
 BENCHMARK 12B.2: Safe and resilient hospitals and health facilities are in place to rapidly respond to emergencies79
OBJECTIVE: To assess, develop and establish safe and resilient hospital and health facility capabilities as part of the Hospital Safety Programme80 (HSP)
before, during and after emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z No strategies or plans in place for HSP capabilities for safe and resilient hospitals and health facilities.

01
NO CAPACITY

z Map HSP capabilities81 in policies, norms and legislation at national and subnational levels and identify gaps.

02 z Develop standards for hospital accreditation for safety, resilience and preparedness that correspond to the mapping of HSP
LIMITED capabilities.
CAPACITY z Identify a focal point for hospital preparedness and mass casualty management at the national level for coordination and
service delivery.
z Develop minimum standards of hospital workforce, including capacity-building of medical teams for rapid response as part
of HSP resources management.
z Assess the current level of resources for workforce/rapid response medical teams, equipment and supplies as part of HSP
resources management.
z Conduct a hospital safety and risk management assessment for health facilities.
z Establish and train a hospital incident management (IM) team and function, identify a hospital IM leader and determine
relevant SOPs.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 5, 6

79
Hospitals and health facilities share interdependencies with multiple IHR benchmarks, e.g. Human Resources, National Laboratory Systems, Infection Prevention and Control, Surveillance
Systems and Medical Counter Measures, Health Services Provision that collaboratively support maintaining continuity of Essential Health Services (EHS) and have interdependencies that
extend into Community Engagement via whole-of-society partners and their engagement.
80
The Hospital Safety Index is a tool that helps to assess the probability that a hospital or health facility will continue to function in emergency situations, based on structural, non-structural and
functional factors, and provides a snapshot of areas that need to be addressed to ensure that the services remain accessible and functioning at maximum capacity during and immediately
195

following the impact of a disaster. Hospital safety index: guide for evaluators, second edition. Geneva: World Health Organization; 2015
81
Policies, legislation, laws and regulations, guidelines, SOPs and functionality for hospital resiliency, mass casualty management and incorporation of green technologies.
 z Establish minimum standards that are reflected in policy, norms and legislation for HSP hospital design and construction at

03 the national level (e.g. mass casualty management and referral pathways).
DEVELOPED z Implement recommendations of the hospital risk assessment into policies, strategies and plans at the national level.
CAPACITY z Develop and implement hospital safety plans as part of national HSP coordination of service delivery.
z Develop, test and establish hospital coordination systems82 at the national level.
z Develop a mechanism to coordinate with nongovernment sectors including private hospitals and facilities.
z Establish and implement minimum construction standards for safe and secure hospitals, including the protection of
resources (workforce, equipment and supplies), at the national level across relevant sectors83.
z Develop a training package to implement the HSP and disseminate at the national level.
z Develop and test a flexible hospital IM structure84 to engage across hospital departments.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

z Establish minimum standards for HSP policy, norms and legislation of hospital design and construction at the subnational

04 level (e.g. mass casualty management and referral pathways).

DEMONSTRATED z Implement coordinated service delivery of hospital safety plans as part of the national HSP at the subnational level .
CAPACITY z Conduct resource management trainings to implement the HSP at the subnational level.
z Implement minimum construction standards for safe and secure hospitals, including the protection of resources (workforce,
equipment and supplies) at the subnational level across relevant sectors.
z Allocate funding to ensure safe and resilient hospitals and health facilities at the national and subnational levels.

WHO benchmarks for strengthening health emergency capacities

z Implement the recommendations of the hospital risk assessment, into policies, strategies and plans at the subnational level.
z Conduct SimEx/AARs/IAR (as relevant) to evaluate hospital and health facility safety and resilience.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
82
Coordination systems includes stockpiles of supplies of local, national and international health assistance, workforce and resource sharing.
83
Such a non-government, private, military hospitals etc.
196

84
With clear lines of accountability, roles and responsibilities, and has the capacity to communicate with patients and the public in accordance with hospital policy.
85
Coordination systems includes stockpiles of supplies of local, national and international health assistance, workforce and resource sharing.
 z Evaluate HSP at the national and subnational levels and update programmes based on findings.

05 z Regularly conduct refresher trainings to implement the HSP at all levels including nongovernment sectors.
SUSTAINABLE z Document and share best practices and lessons learned from HSP in health emergencies and engage the country in peer-
CAPACITY to-peer learning at the subnational, national and international levels.
z Sustain contingency and operational funding to maintain safe and resilient hospitals and health facilities.
z Develop an all hazards hospital and mass casualty research and development strategy, and conduct research activities.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

197
 BENCHMARK 12B.3: Emergency resources, needs and gaps are identified and mapped, and information shared with decision-makers and partners based
on country risk profiles to inform resource strategies and activities.
OBJECTIVE: To develop inventories and maps of available resources for emergency preparedness and response and plan for effective utilization based on
country risk profiles.

CAPACITY LEVEL BENCHMARK ACTIONS

z No formal resource mapping or planning for effective utilization of emergency resources is in place.

01
NO CAPACITY

z Identify stakeholders across sectors to be involved in the identification, mapping and utilization of resources for emergency

02 preparedness and response.

LIMITED z Map current national level resources to support health sector emergency preparedness, readiness and response at the
CAPACITY national level, including human resources, finances, infrastructure, logistics and supplies (such as health facilities, public
health emergency operation centres, transport, vehicles, cold chain capacities, telecommunications, warehousing, supply
routes, etc.).
z Identify health sector needs and gaps (financial, technical and in-kind) based on the mapping of resources.
z Identify and engage relevant ministries and/or partners who can support heath sector needs and gaps based on the
mapping of resources.
z Review existing legal frameworks to facilitate emergency resources identification, mapping and utilization at the national
and subnational levels, and draft additional legal provisions if necessary.
z Develop country public health profile including mapping of resources and high risk areas for major daily health issues with

WHO benchmarks for strengthening health emergency capacities

public health experts.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
198
 z Map current resources to support emergency preparedness, readiness and response in relevant sectors at the national level.

03 z Identify needs and gaps (financial, technical and in-kind) in relevant sectors based on the mapping of resources.
DEVELOPED z Develop national level inventories based on resource mapping for emergency preparedness and response.
CAPACITY
z Identify and engage relevant ministries and/or partners who can support relevant sector needs and gaps based on the
mapping of resources.
z Refer to the country public health risk profile and identify public health resources at national and subnational levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

z Identify sector-specific country risk profiles for mapping, planning and prioritization of resources for prevention, mitigation

04 and preparedness activities toward all hazards.

DEMONSTRATED z Map current resources to support emergency preparedness, readiness and response in health and relevant sectors at the
CAPACITY subnational level.
z Develop subnational level inventories based on resource mapping for emergency preparedness and response.
z Identify and engage relevant ministries and/or partners who can support subnational needs and gaps based on the
mapping of resources across health and relevant sectors.
z Secure funding for resource mapping and developing inventories based on country risk profiles, at all levels, across all
relevant sectors.
z Review national level resources (critical stock levels for priority risks) on an annual basis or when needed.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6
199
 z Review and update national and subnational resource maps for all hazards that have a potential to cause health

05 emergencies on a regular basis (at least every 3 years) based on the risk profile.
SUSTAINABLE z Adjust deployment of resources to areas most at need at national and subnational levels, based on updated resource
CAPACITY mapping.
z Secure funding to conduct rapid resource needs assessments during emergency situations.
z Engage the country in peer-to-peer learning programmes at the subnational, national and international levels to support
capacity-building for mapping and utilization of emergency resources.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

WHO benchmarks for strengthening health emergency capacities

200
 BENCHMARK 12B.4: Multisectoral planning for health emergency preparedness and response is in place
OBJECTIVE: To develop and implement multisectoral and multihazard health emergency preparedness measures including emergency response plans at
all levels of governance

CAPACITY LEVEL BENCHMARK ACTIONS

z Multisectoral and multihazard health emergency preparedness and response measures are not planned or implemented

01 properly, or efforts are ad hoc.

NO CAPACITY

z Map key ministries and multisectoral stakeholders involved in multihazard health emergency preparedness and response

02 including human, animal (domestic and wildlife) and environmental health sectors, meteorology, border control, food and
LIMITED drug agency, military, private agricultural sector, emergency services, interior, defence, transport, media and finance.
CAPACITY z Conduct capacity assessments of each stakeholder to support emergency preparedness for priority risks at the national
level, as appropriate, and clearly define the roles and responsibilities for each sector.
z Form a multisectoral technical advisory group, with clear leadership and governance, gathering experts from relevant
sectors to develop a multisectoral multihazard emergency response plan at the national level.
z Review current health sector multihazard emergency response plans and other response plans for specific hazards.
z Develop or update the national health sector multihazard emergency response plan, including a performance monitoring
framework with indicators, criteria and timelines.
z Involve emergency preparedness experts in the development of NHPSPs to define the country’s vision, policy directions and
strategies for ensuring strengthening of health system capacity for emergency preparedness.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6

z Institutionalize (through MoUs, SOPs, ToRs) the multisectoral coordination for health emergency preparedness and

03 response and any necessary legal instruments and guidelines for implementation of measures.
DEVELOPED z Implement emergency preparedness measures at the national level by human health, animal health and other relevant
CAPACITY sectors, including for points of entry and mass gathering events, and assess the need for additional measures, including
201

policies, procedures, SOPs and financial mechanisms, required to strengthen emergency preparedness.
 z Develop, review, implement and assess the multisectoral multihazard emergency response plan at the national level,
including conducting a national level SimEx/AAR/IAR (as relevant) to test and adjust the plan based on outcomes.
z Develop advocacy and training strategies for strengthening emergency preparedness measures and the multisectoral
multihazard emergency response plan at the national level.
z Disseminate advocacy materials and conduct trainings to raise awareness within the community and media and train
relevant multisectoral experts on the multisectoral multihazard emergency preparedness and response plan at the national
level.
z Secure capacity required for emergency preparedness measures for specific hazards or risk scenarios, including
contingency planning, additional training and equipment.
z Develop mechanisms and SOPs to implement domestic and international surge capacity as part of the multisectoral
multihazard emergency response plan.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

z Implement and monitor emergency preparedness measures at national and subnational levels by human health, animal

04 health and relevant sectors, including at points of entry and mass gathering events.
DEMONSTRATED z Conduct capacity-building and awareness raising programmes for specific community groups (e.g. three wheeler drivers/
CAPACITY cab drivers who can support transport of casualties, community leaders, youth groups, media, religious leaders etc.) and
communities to ensure participatory approach in preparedness and response to emergencies.
z Develop, update and implement multisectoral multihazard subnational and local emergency response plans.
z Conduct SimEx/AAR/IAR (as relevant) at national and subnational levels to test the multisectoral multihazard emergency

WHO benchmarks for strengthening health emergency capacities

response plan with a focus on coordination and communication between the national and subnational levels of government
and sectors, and adjust plans based on outcomes.
z Implement training for emergency preparedness and response at subnational levels.
z Review and develop emergency response plans for cross-border and multicountry events with regional counterparts and
international partners.
202
 z Review emergency plans regarding other public health topics (e.g. humanitarian preparedness and response plans) for
alignment with the national multisectoral multihazard plans for health emergency preparedness and response and adjust as
needed.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Review relevant sector-specific plans for alignment with the national multisectoral multihazard plans for health emergency
preparedness and response and adjust as needed.

z Regularly conduct SimEx/AAR/IAR (as relevant) to test multisectoral multihazard emergency response plans at national

05 and subnational levels involving relevant sectors. Implement measures to build capacities based on outcomes and
SUSTAINABLE recommendations and adjust plans based on lessons learned.
CAPACITY z Conduct international SimEx to test multisectoral multihazard emergency response plans for multiple country events.
Adjust plans and strengthen emergency preparedness based on outcomes and recommendations.
z Assign dedicated human resources and sustain regular budget funding to support the coordination and implementation of
emergency preparedness measures by human health, animal health and relevant sectors.
z Develop a mechanism to ensure that dedicated resources, including manpower and funding, are in place for testing and
implementation of multisectoral multihazard emergency response plans, contingency plans and SOPs at national and
subnational levels including an emergency financing mechanism for emergency response.
z Engage the country in peer-to-peer learning programmes at the subnational, national and international levels, including
initiatives to support capacity-building for multisectoral multihazard emergency preparedness in compliance with the IHR at
the global level.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5
z Provide a good governance environment to enable effective implementation of the multisectoral multihazard emergency
preparedness and response plans for IHR with reliable institutions, good domestic policies and respect of citizens’ rights
and liberties.
203
 Tools:
z Health emergency and disaster risk management framework. Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/326106).

z Strategic toolkit for assessing risks: a comprehensive toolkit for all-hazards health emergency risk assessment. Geneva: World Health Organization;
2021.(https://apps.who.int/iris/handle/10665/348763).
z Words into Action Guidelines. National Disaster Risk Assessment. Governance Systems, Methodologies, and Use of Results. Geneva: United Nations
Office for Disaster Risk Reduction; 2017 (https://www.unisdr.org/files/52828_nationaldisasterriskassessmentpart1.pdf).
z Rapid Risk Assessment of Acute Public Health Events. Geneva: World Health Organization; 2012 (https://apps.who.int/iris/handle/10665/70810).

z WHO Human Health Risk Assessment Toolkit: Chemical Hazards, second edition. Geneva: World Health Organization; 2021 (https://www.who.int/
publications/i/item/9789240035720).
z Joint Risk Assessment Operational Tool. Food and Agriculture Organization of the United Nations, World Health Organization and World Organisation for
Animal Health; 2020 (https://www.who.int/initiatives/tripartite-zoonosis-guide/joint-risk-assessment-operational-tool).
z Kandel N, Chungong S, and the WHO Technical Working Group of the Dynamic Preparedness Metric and Health Security Preparedness Department.
Dynamic preparedness metric: a paradigm shift to measure and act on preparedness. The Lancet Global Health. 2022; 10(5), e615–e616. doi: 10.1016/
S2214-109X(22)00097-3.
z Hospital safety index: guide for evaluators, 2nd edition. Geneva: World Health Organization & Pan American Health Organization; 2015 (https://apps.who.
int/iris/handle/10665/258966).
z Capacity for Disaster Reduction Initiative (CADRI) tool [website]. CARDI; 2021 (https://www.cadri.net/cadritool/home).
Supports countries to develop integrated strategies to address climate and disaster risk.
z Sendai Framework for Disaster Risk Reduction. 2015-2030. Geneva: United Nations Office for Disaster Risk Reduction; 2015 (https://www.undrr.org/
publication/sendai-framework-disaster-risk-reduction-2015-2030).

WHO benchmarks for strengthening health emergency capacities

z The Paris Agreement [website]. United Nations Climate Change; 2023 (https://unfccc.int/process-and-meetings/the-paris-agreement).

z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public health
emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
204

handle/10665/333419)
 13
Linking public health and security authorities
The country conducts a rapid, multisectoral response for any event of suspected or confirmed deliberate origin, including the capacity to link public health
and law enforcement, and to provide timely international assistance.

IMPACT:
Development and implementation of a memorandum of understanding (MoU) or other similar framework outlining roles, responsibilities and best
practices for sharing relevant information among appropriate human and animal health, law enforcement and defence personnel, and validation
of the MoU through periodic exercises and simulations. Countries have systems to conduct and support joint epidemiological and criminal
investigations to identify and respond to suspected biological, chemical or radiological incidents of suspected deliberate origin in collaboration
with States Parties’ Biological and Toxin Weapons Convention (BTWC), FAO, International Atomic Energy Agency (IAEA), International Criminal
Police Organization (INTERPOL), WOAH, Organisation for the Prohibition of Chemical Weapons (OPCW), the United Nations Secretary-General’s
Mechanism for Investigation of Alleged Use of Chemical and Biological Weapons, WHO and other relevant regional and international organizations
as appropriate.

MONITORING AND EVALUATION:

Evidence of at least one response in the previous year that effectively links public health and law enforcement, or a formal exercise or simulation
involving leadership from the country’s public health and law enforcement communities.

WHO benchmarks for strengthening health emergency capacities

205
 BENCHMARK 13.1: Public health and security authorities (law enforcement, border control, customs) are linked during a suspected or confirmed
biological, chemical or radiological event
OBJECTIVE: To strengthen the linkage between public health and security authorities for a rapid multisectoral response to suspected or confirmed
biological, chemical or radiological event

CAPACITY LEVEL BENCHMARK ACTIONS

z No legislation, relationships, protocols, MoUs or other agreements exist between public health, animal health, radiological

01 safety, chemical safety and security authorities to address all hazards.

NO CAPACITY

z Identify sectors responsible for response to potential IHR related hazards (biological, chemical and radiation).

02 z Identify points of contact to assist with the implementation of prevention, detection and response activities at government
LIMITED agencies across multiple sectors (such as public health, animal health, security authorities, agriculture, chemical, radiation).
CAPACITY z Determine the roles and responsibilities for responding to various threats and other incidents of concern through a review of
national response plans, policies and procedures, or other means such as an engagement meeting.
z Assess risk of significant biological (and chemical or radiological) incidents of concern to the country.
z Develop triggers for sharing information on biological threats or other incidents of concern (such as chemical and
radiological) with relevant multisectoral agencies.
z Establish an informal or formal communications process to share information, based on identified triggers, related to
biological threats or other incidents of concern (such as chemical and radiological) among relevant multisectoral agencies
(such as public health, animal health and security authorities).

WHO benchmarks for strengthening health emergency capacities

z Train staff on joint risk assessment and application of triggers, and sharing of information among all sectors relevant to
hazards.
z Develop and disseminate advocacy material to raise awareness of staff in relevant sectors about their role for the
management of biological threats or other incidents of concern (such as chemical and radiological).

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
206
 z Establish communications with animal health and security/law enforcement points of contact who would need to

03 collaborate in the case of a suspected deliberate event.

DEVELOPED z Identify appropriate activities (such as notifications, assessments, investigation, laboratory testing) for response to
CAPACITY biological threats or other incidents of concern (such as chemical and radiological), which will be covered by a written
protocol or MoU between sectors.
z Develop logistical plans to include multisectoral agencies, including law enforcement, if appropriate, in the PHEOC.
z Determine sample collection, transport, storage, security and testing requirements among relevant sectors (such as
public health, security authorities, agriculture) for biological threats and other incidents of concern (such as chemical and
radiological).
z Finalize a written protocol or MoU that formalizes and institutionalizes interactions between relevant multisectoral agencies
(public health, animal health and security authorities).
z Develop SOPs defining the process and communication mechanisms for assessing and responding to suspected deliberate
international events.
z Develop training curriculum using country specific content (such as regulations/authorities, agency roles/responsibilities
and case studies).
z Organize advocacy events to sensitize staff from relevant sectors on roles and responsibilities during a suspected or
confirmed biological threat or other incidents of concern (such as chemical and radiological) event.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Map capacities in relevant sectors for emergency preparedness and response to biological threats or other incidents of
concern (such as radiological and chemical) to establish a baseline for collaboration.

WHO benchmarks for strengthening health emergency capacities

z Conduct regular trainings in relevant sectors.

04 z Conduct at least one health emergency response, or SimEx, per year that includes appropriate information sharing between
DEMONSTRATED public health and security authorities using the formal protocol or MoU.
CAPACITY z Document findings of the response or SimEx, highlight the gaps and best practices, and adjust protocols as appropriate.
z Conduct and document joint training of public health, animal health and security authorities to orient, exercise and
institutionalize the knowledge of MoUs and other agreements related to all hazards.
207

Participation and contribution of other sectors to actions:

1, 2, 3, 4
 z Conduct and document regular joint training/exercise programmes at national and subnational levels for public health,

05 animal health and security authorities to exercise and institutionalize knowledge of MoUs and other agreements related to
SUSTAINABLE all hazards.
CAPACITY z Expand joint risk assessment, exchange of information, reporting and implementation activities to all levels.
z Conduct an evaluation to determine whether information about events of joint concern is shared in a timely and effective
manner at all levels as outlined in formal MoUs or other agreements/protocols, that the response is appropriate and
effective, and that corrective action is taken based on evaluation.
z Review and update the SOPs, protocols, MoUs, trainings, etc. for collaboration between public health and security
authorities based on lessons learned from M&E and follow up from the implementation of recommendations.
z Involve the country in international initiatives for linking public health and security authorities to share lessons learned and
best practices during suspected or confirmed biological, chemical or radiological events at the global level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Sustain linkage between security authorities and public health sector for joint management of suspected or confirmed
biological, chemical or radiological events through ToRs for relevant security authorities.

Tools:
z Multisectoral preparedness coordination framework: best practices, case studies and key elements of advancing multisectoral coordination for health
emergency preparedness and health security. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240006232).
z National civil-military collaboration framework for strengthen health emergency preparedness. Geneva: World Health Organization; 2021 (https://apps.

WHO benchmarks for strengthening health emergency capacities

who.int/iris/handle/10665/343571).
z WHO–WOAH Operational framework for good governance at the human¬–animal interface: Bridging WHO and OIE tools for the assessment of national
capacities. World Health Organization and World Organisation for Animal Health; 2014 (https://www.who.int/publications/i/item/who-oie-operational-
framework-for-good-governance-at-the-human-animal-interface).
z Chapter 3.4 Veterinary legislation. In Terrestrial Animal Health Code. Paris: World Organisation for Animal Health; 2022 (https://www.woah.org/en/what-
we-do/standards/codes-and-manuals/terrestrial-code-online-access/?id=169&L=1&htmfile=chapitre_vet_legislation.htm).
208
 z Convention on the prohibition of the development, production, stockpiling and use of chemical weapons and on their destruction. The Hague:
Organisation for the Prohibition of Chemical Weapons; 2020 (https://www.opcw.org/chemical-weapons-convention/download-convention).
z Treaty on the non-proliferation of nuclear weapons. Information Circular. Vienna: International Atomic Energy Agency; 1970 (https://www.iaea.org/
sites/default/files/publications/documents/infcircs/1970/infcirc140.pdf).
z Guide to Participating in the Confidence-Building Measures of the Biological Weapons Convention. Geneva: United Nations Office for Disarmament
Affairs; 2015 (https://disarmament.unoda.org/publications/more/cbm-guide).
z Biological Weapons Convention [website]. Geneva: United Nations Office for Disarmament Affairs; 2023 (https://disarmament.unoda.org/biological-
weapons/).
z Joint Criminal and Epidemiological Investigations Handbook (2016) International Edition. United States of America: FBI; 2016 (https://www.fbi.gov/file-
repository/joint-criminal-and-epidemiological-investigations-handbook-2016-international-edition/view).
z Biological Threat Reduction Strategy. Paris: World Organisation for Animal Health; 2015 (https://www.woah.org/en/what-we-do/global-initiatives/
biological-threat-reduction/).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).

WHO benchmarks for strengthening health emergency capacities

209
 14
Health services provision
Resilient national health systems are essential for countries to prevent, detect, respond to and recover from public health events, while ensuring the
maintenance of health systems functions, including the continued delivery of essential health services (EHS) at all levels. Particularly in emergencies, health
services provision for both event-related case management and routine health services are equally as important. Moreover, ensuring minimal disruption in
health service utilization before, during and after an emergency – and across the varied contexts within a country – is also a critical aspect of a resilient
health system.

IMPACT:
Resilient health systems that are capable of delivering emergency related clinical care, and optimal utilization of health services while ensuring
continuity of health systems functions including delivery of essential health services in emergencies.

MONITORING AND EVALUATION:

(1) Evidence of demonstrated application of case management procedures for events caused by IHR relevant hazards. (2) Optimal utilization of
health services, including during emergencies. (3) Ensuring continuity of essential health services in emergencies.

WHO benchmarks for strengthening health emergency capacities

210
 BENCHMARK 14.1: Case management procedures are implemented for relevant IHR hazards
OBJECTIVE: To develop and implement case management procedures for all relevant IHR hazards

CAPACITY LEVEL BENCHMARK ACTIONS

z No case management guidelines are available for priority health events86.

01
NO CAPACITY

z Develop a list of priority diseases and IHR relevant hazards based on the country risk profile at national and subnational

02 levels.
LIMITED z Establish a scientific advisory board involving senior health experts, including academia, to lead the development of
CAPACITY standardized case management guidelines87 for priority diseases and IHR relevant hazards.
z Develop standardized case management guidelines for priority diseases and IHR relevant hazards.
z Develop triggers for sharing and recording information on diseases, conditions and public health emergencies of
international concern with relevant multisectoral agencies.
z Develop dissemination plans (including training packages) for case management guidelines for all levels targeting all
relevant health workers.
z Map health system resources available to manage cases of priority diseases and simultaneously maintain routine essential
health services, including a primary health care approach.
z Develop a package of health services required for effective, safe, high quality case management in priority health
emergencies and adapt to be relevant at all levels of care.

WHO benchmarks for strengthening health emergency capacities

z Adapt case management training package to be relevant to the roles of key stakeholders from relevant sectors and
disseminate accordingly.

Participation and contribution of other sectors to actions:

2, 4, 8

86
e.g. epidemic prone diseases, trauma, chemical events, radiation emergencies, etc.
87
To identify novel approaches for case management of IHR hazards/case management guidelines for new diseases and advise the development/update of case management guidelines in the
211

country.
 z Disseminate case management guidelines at the national level and to points of entry, and test implementation.

03 z Develop and disseminate SOPs for the management and transport of potentially infectious patients, including patient
DEVELOPED referral, transportation mechanisms and referral centres based on priority risks at the national level.
CAPACITY z Review and adapt the legal framework for quality, safe and secure implementation of case management procedures for
relevant IHR hazards at the national and subnational levels.
z Train relevant health workers at the national level, including managers and decision-makers, on case management
guidelines (as applicable to the target audience) and update preservice training curricula for health professionals to include
current guidelines on case management of priority diseases.
z Prioritize investment in prehospital care facilitates/patient transport mechanisms.
z Conduct multidisciplinary SimEx/AAR/IAR (as relevant) at the national level including review of the effectiveness and
efficiency of case management guidelines.
z Develop and maintain an up-to-date roster of health workers trained in case management of priority risks/diseases, based
on national and subnational risk profiles.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
z Provide a list of trained personnel from relevant sectors for the case management roster, including the private sector.

z Disseminate case management guidelines and SOPs for the management and transport of potentially infectious patients at

04 the subnational level.

DEMONSTRATED z Review case management, patient referral, transportation mechanisms, management and transportation of potentially
CAPACITY infectious patients and document in accordance with guidelines and SOPs based on actual experience or a specific exercise

WHO benchmarks for strengthening health emergency capacities

to evaluate these procedures.
z Consider specific requirements for vulnerable groups including children, woman, elderly, forcibly displaced people, etc. are
included in case management processes, guidelines and SOPs for relevant IHR hazards.
z Conduct regular multidisciplinary SimEx/AAR/IAR (as relevant) with participation from all levels of health service delivery,
and update case management guidelines and SOPs based on recommendations.

Participation and contribution of other sectors to actions:

212

1, 2, 3, 4
 z Establish a mechanism to allow for the continuous presence of trained staff and resources for case management, patient

05 referral and transportation for all IHR relevant emergencies/hazards.

SUSTAINABLE z Document and disseminate lessons learned from case management for IHR relevant emergencies.
CAPACITY z Train local community health workers on case management guidelines and SOPs for management and transport of
patients potentially infected with priority diseases.
z Engage the country in country peer-to-peer learning programmes at the subnational, national and international levels.
z Support research programmes to generate evidence on the development and implementation of guidelines and SOPs for
case management, patient referral and transportation for management of IHR relevant emergencies, including community
perspectives.
z Establish an institutionalized mechanism for M&E of the implementation of recommendations/application of lessons from
SimEx/AAR/IAR (as relevant), etc.

Participation and contribution of other sectors to actions:

1, 2, 4, 5, 6
z Include the management of priority diseases/events during health emergencies in relevant sector’s protocols, policies,
plans, etc., with identification of necessary resources to support collaboration with the health sector, recognizing the
widespread impacts of health emergencies on all sectors and society.

WHO benchmarks for strengthening health emergency capacities

213
 BENCHMARK 14.2: Mechanism for continuity of essential health services (EHS) during a health emergency is well established
OBJECTIVE: To ensure continuity of EHS during an emergency

CAPACITY LEVEL BENCHMARK ACTIONS

z EHS package is not defined and there are no plans or guidelines for continuity of EHS during emergencies.

01
NO CAPACITY

z Define or update the EHS package for the country based on population health needs, with consideration to the continuity of

02 services during a health emergency.

LIMITED z Conduct a situational analysis of current preparedness activities for the continuation of EHS during emergencies.
CAPACITY z Review existing emergency preparedness and response plans/health sector plans to identify the level of inclusion of
continuity of EHS (including population based services) during emergencies.
z Include continuity of EHS package during emergencies into the national health strategic plan and national emergency
preparedness and response plans, with provision to provide EHS package to all, including vulnerable groups and those
affected by unintended and inequitable consequences of policy measures such as shutdowns/curfews during emergencies.
z Conduct assessments to identify the risks and capacity at all levels of care including primary care, hospitals and field health
services to provide EHS and continuation of EHS during health emergencies.
z Involve health system focal points in developing PHEOC plans/protocols with clear identification of the role of health system
focal points in PHEOC actions, IMS, ToRs, etc. to support the continuation of EHS during health emergencies.
z Involve PHEOC focal persons in health service continuity planning and health sector strategic and operational plans to

WHO benchmarks for strengthening health emergency capacities

maintain coherence between emergency preparedness and response and health service continuity plans.

Participation and contribution of other sectors to actions:

3, 4, 5, 6
z Identify and list all relevant multisectoral stakeholders to support continued delivery of EHS during emergencies, such as
prehospital care, transport, delivery of medicine, WASH, supply chain and logistics support, housing, social services and
education.
214

z Incorporate the continued delivery of EHS during a health emergency into the ToRs of relevant sectors.
 z Establish and test a well functioning, safe, effective, quality and equitable EHS delivery, including access to primary care,

03 before, during and after emergencies.

DEVELOPED z Develop and test mechanism for monitoring EHS continuity before, during and after emergencies, including identification of
CAPACITY vulnerable groups who need to be specially considered during specific types of emergencies.
z Develop and test mechanisms for the protection of medical staff, effective staff rotation and optimum IPC methodologies to
ensure continuity of EHS through maintaining safe staffing levels.
z Develop mechanisms to support the continuity of EHS at the health facility level during an emergency, such as effective
triage and adapted access to primary health care services.
z Train health workers and decision-makers, on their roles to maintain EHS during emergencies and mechanisms developed
to support EHS continuity.
z List critical health service operations/functions that need to be continued88 during health emergencies in the health ministry
and all relevant related departments at the national and subnational levels.
z Map private and nongovernment institutions that can be mobilized during emergencies and agree on roles and
responsibilities before, during and after emergencies to ensure continuity of EHS alongside emergency service provision.

Participation and contribution of other sectors to actions:

7
z Conduct a risk assessment in relevant sectors to identify and list critical operations and functions that need to be continued
during emergencies to the support delivery of EHS.
z Develop continuity planning of essential functions that support the continuity of EHS by relevant sectors including private
and nongovernment institutions.

WHO benchmarks for strengthening health emergency capacities

z Develop/update an integrated health information system (surveillance, service delivery, service utilization data) with quality

04 data flow and reporting mechanisms from both public and private sector with an allocated budget for decision-making and
DEMONSTRATED continuity of EHS.
CAPACITY z Implement mechanism/system to monitor continuity of EHS before, during and after emergencies.
z Monitor health services data, considering the risk for disruptions during emergency response operations, in coordination
with other emergency related data including readiness and response.
88
Which can be maintained at the same place, relocated, performed remotely or temporarily suspended during an emergency and develop mutual aid arrangements between health facilities
215

within the same catchment area to facilitate service continuity in emergency contexts.
 z Use data on service delivery continuity to inform decision-making on EHS and optimum emergency response care during
emergencies.
z Routinely monitor the availability of health service continuity plans at subnational and health facility levels.
z Conduct SimEx/AAR/IAR (as relevant) at national and subnational levels to test the functionality of EHS continuation plans/
guidelines during emergencies.
z Allocate contingency funds that are accessible at subnational and health facility levels for addressing challenges related to
continuing EHS during emergencies.
z Develop and finalize prearrangements and MoUs to facilitate EHS continuity during emergency responses, such as
relocation of offices, additional transport and accommodation, internet connectivity solutions during an emergency and
provision for rapid recruitment of staff at the national and subnational levels during an emergency, including private and
nongovernment sectors.

Participation and contribution of other sectors to actions:

1, 3, 6, 7, 8
z Maintain regular communication and coordination mechanisms/platforms between sectors to ensure continuity of EHS
before, during and after emergencies.
z Support from relevant sectors to the health ministry before, during and after emergencies as outlined in prearrangements
and MoUs.

z Update and test plans regularly based on the recommendations from SimEx/AAR/IAR and all relevant M&E processes.

05 z Identify and conduct health system research on the continuation of EHS during emergencies.
SUSTAINABLE z Share the best practices of EHS during emergencies among subnational, national and international forums.

WHO benchmarks for strengthening health emergency capacities

CAPACITY
z Institutionalize/mainstream joint working between emergency, humanitarian response, health system, disease, primary
health care, life course specific and other vertical programmes at policy, planning and operational levels for EHS continuity.
z Allocate sufficient resources to the health ministry and all relevant departments for effective maintenance and restoration of
critical functions and services to continue EHS at acceptable predefined levels following an emergency.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
216

z Update other sector’s roles in maintaining EHS during emergencies as part of sector-specific protocols, plans, policies,
training etc.
 BENCHMARK 14.3: Mechanism is in place to ensure effective utilization of health services before, during and after health emergencies at all levels of
health service delivery
OBJECTIVE: To ensure effective utilization of health services before, during and after emergencies at all levels of health service delivery

CAPACITY LEVEL BENCHMARK ACTIONS

z Very limited service utilization during and beyond emergencies.

01
NO CAPACITY

z Map existing health services facilities required to deliver safe, effective, quality and equitable health services before, during

02 and after emergencies at the national level.

LIMITED z Conduct a situational analysis of previous or current practices of health service utilization during emergency response, or
CAPACITY estimate based on the best available data if no recent health emergency response has occurred.
z Establish a technical working group with relevant stakeholders to develop and/or update a functional mechanism89,
including SOPs90 to increase or maintain the utilization of health services before, during and after emergencies.
z Develop standards for effective health service utilization for all levels of health services, both in government and
nongovernment sectors including private sector, before, during and after emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

z Map existing health service facilities required to deliver safe, effective, quality and equitable health services before, during

WHO benchmarks for strengthening health emergency capacities

03 and after emergencies at the subnational level, including nongovernment and private sector health facilities.
DEVELOPED z Develop a plan to strengthen health facilities that do not have capacity to provide safe, effective, quality and equitable health
CAPACITY services before, during and after health emergencies.
z Develop and formalize MoUs with nongovernment health facilities, including private sector, to support health service
utilization before, during and after emergencies.
z Disseminate and implement SOPs to increase or maintain the utilization of health services before, during and after
emergencies at the national level.
217

89
Focused on the roles and responsibilities of health facilities before, during and after emergencies.
90
SOPs focusing on managing different types of health emergencies (like epidemics, disasters (floods, earthquakes), others)
 z Disseminate and implement standards for effective health service utilization for health services, both in government and
nongovernment sectors including private sector, before, during and after emergencies at the national level.
z Conduct SimEx/AAR/IAR (as relevant) to review/test the SOPs and standards of effective health service utilization at the
national level.
z Develop a mechanism and capacity to conduct health service utilization data analysis and interpretation91 before, during
and after emergencies.

Participation and contribution of other sectors to actions:

1, 3, 4, 5, 6
z Support from relevant sectors to provide health services before, during and after emergencies, as appropriate to existing
capacities.
z Support from relevant sectors to strengthen government health facilities and improve capacity for health service utilisation.

z Allocate resources to implement plans to strengthen selected health facilities to provide safe, effective, quality and equitable

04 health services before, during and after emergencies.

DEMONSTRATED z Disseminate and implement SOPs to increase or maintain the utilization of health services before, during and after
CAPACITY emergencies at the subnational level, including nongovernment and private health facilities.
z Disseminate and implement standards for effective health service utilization for health services, both in government and
nongovernment sectors including private sector, before, during and after emergencies at the subnational level.
z Monitor and evaluate health service utilization data before, during and after emergencies.
z Conduct analysis and disseminate results for health service utilization before, during and after emergencies and notify when
there is disruption in health service utilization during emergencies.

WHO benchmarks for strengthening health emergency capacities

z Update mechanisms, SOPs and standards based on the result of M&E, including the results of reviews and SimEx.
z Compile health service utilization data from across all facilities and relevant sectors.

Participation and contribution of other sectors to actions:

2, 3, 5, 6, 7
z Providing resource support from relevant sectors to health sector during major emergencies.
91
Analysis by disaggregation by geographical, gender, income, catchment area, urban/rural, private/state facilities, etc.
218
 z Disseminate the updated mechanisms, SOPs and standards to all health facilities.

05 z Conduct reviews of events (SimEx/AAR/IAR, as relevant) regularly on health service utilization at all levels.
SUSTAINABLE z Share or use the results of reviews and analysis of health services utilization to inform the updating or development of
CAPACITY national health sector strategic plan.
z Share experiences (best practices/lessons learned) and peer-to-peer learning on health service utilization before, during
and after emergencies at regional/national and global forums.

Participation and contribution of other sectors to actions:

1, 2, 4

Tools:
z Emergency Response Framework (ERF), second edition. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/
item/9789241512299).
z Maintaining essential health services: operational guidance for the COVID-19 context: interim guidance, 1 June 2020. Geneva: World Health Organization;
2020 (https://www.who.int/publications/i/item/WHO-2019-nCoV-essential_health_services-2020.2).
z Maintaining essential health services during emergencies [website]. Geneva: World Health Organization; 2023 (https://www.who.int/teams/primary-
health-care/health-systems-resilience/essential-services-during-emergencies).
z Strategic toolkit for assessing risks: a comprehensive toolkit for all-hazards health emergency risk assessment. Geneva: World Health Organization; 2021
(https://www.who.int/publications/i/item/9789240036086).
z Health service continuity planning for public health emergencies: a handbook for health facilities. Geneva: World Health Organization; 2021 (https://www.

WHO benchmarks for strengthening health emergency capacities

who.int/publications/i/item/9789240033337).
z Health systems for health security: a framework for developing capacities for international health regulations, and components in health systems and
other sectors that work in synergy to meet the demands imposed by health emergencies. Geneva: World Health Organization; 2021 (https://www.who.int/
publications/i/item/9789240029682).
z Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: WHO position paper.
Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/WHO-UHL-PHC-SP-2021.01).
219
 z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419).

WHO benchmarks for strengthening health emergency capacities

220
 15
Infection prevention and control
Countries should have strong, effective infection prevention and control (IPC) programmes that enable safe health care and essential services delivery
and prevention and control of health care acquired infections (HCAIs). It is critical to initially ensure that at least the minimum requirements for IPC are
in place, both at the national and facility level, and to gradually progress to the full achievement of all requirements within the WHO IPC core components
recommendations.

IMPACT:
Prevent HCAIs and emergence and spread of AMR.

MONITORING AND EVALUATION:

(1) National IPC programme strategy has been developed and disseminated. (2) Implementation of national IPC programme plans, with monitoring
and reporting of HCAIs. (3) Established national standards and resources for safe health facilities.

WHO benchmarks for strengthening health emergency capacities

221
 BENCHMARK 15.1: National and health facility level infection prevention and control (IPC) programmes are in place
OBJECTIVE: To have active IPC programmes implemented at national and healthcare facility levels

CAPACITY LEVEL BENCHMARK ACTIONS

z An active national IPC programme or operational plan according to WHO minimum requirements is not available or is under

01 development.
NO CAPACITY

z Appoint a full time, dedicated and trained IPC focal point at the national level with defined ToRs.

02 z Establish a national IPC working group/committee involving all relevant stakeholders for IPC in health and relevant sectors,
LIMITED with ToRs, including developing a legal framework for the implementation of IPC programmes at the national, subnational
CAPACITY and facility levels.
z Identify an IPC focal person in health facilities to interact with the national IPC working group/committee.
z Develop/adapt national IPC guidelines92 and SOPs according to the WHO minimum requirements for IPC programmes93.
z Develop IPC components for the national health emergency preparedness, readiness and response operational plan94.
z Use the WHO national IPC assessment tool for minimum requirements (IPCAT-MR) to identify and document gaps in the
current IPC programme95.
z Develop evidence-based strategic documents (policies, laws, strategies, etc.) to reinforce responsibility and commitment of
the health sector in IPC management at national, subnational and facility levels.
z Develop and advocate for a secure dedicated budget for IPC implementation based on plans, informed by local context
budget cycles, local political/legal landscape analyses and impact assessments, utilizing local civil society organizations.

WHO benchmarks for strengthening health emergency capacities

Disseminate strategic documents on IPC management to all relevant stakeholders who may provide potential domestic and
external sources of funding.
z Establish linkages to complementary areas/programmes (e.g. water, sanitation and hygiene (WASH), quality, patient safety).
92
Based upon the WHO Guidelines on core components of infection prevention and control programmes at the national and acute healthcare facility level and on the WHO Framework and toolkit
for infection prevention and control in outbreak preparedness, readiness and response at the healthcare facility level.
93
These should include, at minimum: hand hygiene, decontamination of medical devices and patient care articles, environmental cleaning, healthcare waste management, standard and
transmission-based precautions, injection safety, healthcare worker protection, aseptic techniques and triage.
94
Including ToRs to convene a national task force or committee to address IPC preparedness, readiness and response. This task force/committee can be the same committee as described in action 2.
222

95
IPCAT-MR will identify precise areas/core components requiring action. Also consider the key elements of other WHO frameworks and toolkits for infection prevention and control in outbreak
preparedness, readiness and response at the national level and the healthcare facility level and identify elements requiring action.
 Participation and contribution of other sectors to actions:
2, 4, 5, 7, 8
z Identify other sector focal points for services related to IPC in hospitals and community health facilities (such as
environment, education, etc.).

z Disseminate national IPC guidelines to all health facilities.

03 z Design an operational plan, informed by assessment results, following the five step implementation cycle outlined in the
DEVELOPED WHO Interim practical manual at national level96 including input from WASH, RCCE and relevant sectors.
CAPACITY z Identify and allocate adequate financial resources for the implementation of the operational plan97.
z Appoint IPC committees and trained, dedicated IPC focal points98 in selected healthcare facilities99 with defined ToRs.
z Develop a national IPC curricula for new employee orientation, in-service training and national training programme for
health workers based on national standards and guidelines. Include IPC modules in specific preservice health-oriented
degrees (such as nursing, medicine, etc.).
z Monitor IPC and WASH implementation in selected healthcare facilities100.
z Develop a national system for M&E of IPC programmes in health facilities for regular monitoring and periodic evaluation
of IPC indicators including implementation of standard precautions (such as hand hygiene, WASH and other related IPC
practices).
z Develop and share the IPC and WASH operational plans with national, subnational and local IPC committees and
incorporate their feedback/guidance.

WHO benchmarks for strengthening health emergency capacities

96
Utilizing the Framework and toolkit for IPC in outbreak preparedness, readiness and response at the national level to assist in developing plans for IPC in emergencies including establishment of
an IPC task force or committee, plans for surge capacity, training of health workers, budget for supplies, communication plans.
97
This budget should also include implementation at selected health facilities.
98
Designated IPC officials at health facility level should be in accordance with WHO core competencies for IPC professionals.
99
Selected facilities might include referral, regional and/or large tertiary teaching hospitals.
100
223

The following tools can be used to support IPC and WASH monitoring in selected facilities: infection prevention and control assessment framework (IPCAF), hand hygiene self-assessment
framework (HHSAF), hand hygiene compliance observational tools and/or the complimentary WASH framework improvement tool (WASH FIT) tool.
 Participation and contribution of other sectors to actions:
3, 5, 6, 7, 8
z Develop necessary infrastructure and supplies to enable implementation of IPC norms, standards and practices in special
settings such as points of entry, industrial plants, waste management companies, sewage systems, schools and other
community settings, etc.
z Include the importance of IPC/WASH including hand hygiene techniques, cough etiquette and other IPC measures to be
adhered to by citizens and school children/students in all school curricula as appropriate to age.
z Involvement from NGOs and other donor agencies to provide support in developing infrastructure and technical expertise
for IPC, particularly at the health facility level, and for the development of a M&E framework for health professionals.

z Use IPC assessment tools at national level (IPCAT2) to identify areas still requiring action and update the operational plan101.

04 z Mandate and support IPC improvement at all health facilities, recommending the use of the IPC assessment framework
DEMONSTRATED (IPCAF) and the WASH FIT tool.
CAPACITY z Include specific interventions related to IPC for AMR prevention, tailored to the local epidemiological situation, in
operational/action plans.
z Conduct IPC and WASH trainings for health workers at the commencement of employment, at regular intervals throughout
employment and at specific trainings for health workers and IPC focal points at all levels and all health facilities.
z Evaluate the status of IPC outbreak preparedness and readiness by organizing SimEx/AAR/IAR (as relevant) to test the
functionality of IPC capacities for responding to health emergencies.
z Monitor IPC implementation in all health facilities to evaluate IPC outcomes, with a target of 75% achieving WHO IPC
minimum requirements.
z Adjust and increase budgetary allocations, using financial audit and disbursement data, from dedicated budget for IPC

WHO benchmarks for strengthening health emergency capacities

implementation, to support activities that require further implementation, additional financial resources and to ensure
financial transparency.
z Establish national IPC incident command structures for outbreak emergencies with other ministries and stakeholders.

101
Update and implement operational plans, informed by regular assessment results and following the five-step implementation cycle outlined in the WHO Interim practical manual supporting
national implementation of the WHO Guidelines on core components of infection prevention and control programmes. Ensure all recommended IPC priority core components are progressively
224

achieved at the national and facility level according to WHO minimum requirements/action checklists for the priority core components identified. Supplement IPCAF with more detailed analysis
and planning on water, sanitation, cleaning and healthcare waste with WASH FIT.
 Participation and contribution of other sectors to actions:
2, 4, 5, 7, 8
z Conduct training on WASH and IPC measures in relevant sectors.
z Prioritize and allocate space in the media sector to develop public awareness on roles and responsibilities in IPC in
healthcare facilities.
z Develop standards for IPC measures in all relevant settings (outside of health facilities) such as points of entry, industrial
plants, schools, community settings, etc.
z Routinely monitor health facility environments for functioning WASH infrastructures and services in relevant.

z Provide sustainable support to health facility IPC programmes at all levels.

05 z Conduct annual IPC and WASH FIT assessments at healthcare facilities as part of their review cycle to address long term
SUSTAINABLE sustainability.
CAPACITY z Conduct continuous monitoring of progress in fulfilling the IPC core components (such as assessments repeated annually
or more often), tracking changes and scores to develop a long term improvement plan.
z Analyse and regularly report national IPC and WASH data and support discussion on actions to incorporate lessons learned
in a long term improvement plan.
z Revise and update IPC and WASH guidance materials such as strategies, plans, SOPs and training materials, based on
lessons learned and ongoing assessment results.
z Evaluate the status of health workers’ protection against occupational infections and update as required (plans, SOPs,
trainings, etc.).
z Share country experiences in IPC and WASH and participate in international initiatives to strengthen capacities globally.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Conduct regular monitoring and periodic evaluation of good hygiene and infection prevention measures in all relevant
settings (outside of health facilities) such as points of entry, industrial plants, school, community settings, etc.
z Regularly update IPC related norms and standards (based on lessons learned) for management of special settings such as
points of entry, industrial plants, waste management companies, sewage systems, schools and other community settings,
225

etc. based on normal and special health events in the country or globally.
 BENCHMARK 15.2: A functioning health care acquired infection (HCAI) surveillance system is in place for public health decision-making
OBJECTIVE: To develop and maintain a functioning and effective system for HCAI surveillance (for ongoing surveillance of endemic HCAIs, including
AMR pathogens, and for early detection of pathogens prone to infectious disease outbreaks) at national and health facility levels

CAPACITY LEVEL BENCHMARK ACTIONS

z National HCAI surveillance system or national strategic plan for HCAIs surveillance, including endemic HCAIs, antimicrobial

01 resistant pathogens and pathogens prone to infectious disease outbreaks, is not available or is under development.
NO CAPACITY

z Review the availability and functional status of HCAI surveillance in the country.

02 z Identify the development of a HCAI surveillance system as a priority in national working group/committee for IPC.
LIMITED z Set up a national multidisciplinary technical advisory group for HCAI surveillance, establish a surveillance coordinating
CAPACITY centre for HCAI and designate a national reference laboratory.
z Design a HCAI surveillance system and designate as a priority action in health sector plans and budgets.
z Identify focal points at the national level for HCAI surveillance with linkages to communicable disease, AMR surveillance
and WASH monitoring.
z Develop a national HCAI surveillance plan that includes standardized definitions and targeted organisms (including
AMR pathogens), appropriate methods for surveillance and linkages with existing communicable or integrated disease
surveillance systems.
z Identify and document minimum resources required to establish HCAI surveillance at the national level and selected
tertiary facilities.

WHO benchmarks for strengthening health emergency capacities

z Develop training materials for professionals responsible for conducting HCAI surveillance at all health facility levels based
on national standards/guidelines.

Participation and contribution of other sectors to actions:

2, 3, 7
z Identify other sector focal points for developing and maintaining HCAI surveillance.
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 z Establish a national HCAI surveillance system as a core component of the national IPC programme, and implement HCAI

03 surveillance (including endemic HCAIs, AMR pathogens and pathogens prone to infectious disease outbreaks) in selected
DEVELOPED tertiary and secondary health facilities in a stepwise manner.
CAPACITY z Develop laboratory capacity and provide resources to identify and report HCAI through a national surveillance system with
linkages to communicable disease surveillance systems.
z Include HCAI training into trainings for IPC focal points and relevant health workers within health facilities and conduct
trainings regularly.
z Identify and allocate trained staff (or provide training to staff) to develop, implement and maintain HCAI surveillance
programme at select health facilities102.
z Coordinate with national and subnational surveillance networks that include syndromic and microbiologic surveillance for
diseases with outbreak potential.
z Use data for benchmarking purposes (for example, establishing baselines for comparison).
z Provide timely feedback reports to relevant stakeholders on the national situation of HCAI and special events, including
recommendations.

Participation and contribution of other sectors to actions:

2, 7
z Prioritization, by NGOs and other donor agencies, to support establishing HCAI surveillance system and develop technical
expertise using national standards/guidelines and associated training materials.

z Establish a national HCAI surveillance system (including endemic HCAIs, AMR pathogens and pathogens prone to
infectious disease outbreaks, through integrated or separate systems) in all secondary and tertiary health facilities.

WHO benchmarks for strengthening health emergency capacities

DEMONSTRATED
04 z Establish an M&E system, including to assess data quality (for example, review of case report forms, microbiology results,
CAPACITY denominator determination) and surveillance programme attributes (for example, sensitivity, specificity, user acceptability).
z Collect, analyse and provide feedback based on data from HCAI surveillance system to relevant authorities, including AMR
focal points, and update plans and actions as required.
z Establish clear and regular reporting lines from facility to the national level.
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102
Selected facilities might include referral, regional and/or large tertiary teaching hospitals.
 z Conduct nationwide training in all facilities on HCAI surveillance for IPC focal points and other health workers responsible
at the facility level at regular intervals.
z Identify and support healthcare facilities that are unable to adhere to the HCAI surveillance programme.
z Develop and implement linkages between hospital systems and national microbiology and other laboratory capacities to
ensure surveillance, early detection and laboratory surge capacity for the rapid identification of diseases with outbreak
potential.

Participation and contribution of other sectors to actions:

3, 7

z Establish national networks for HCAI surveillance, also in connection to international networks (such as the European HCAI

05 surveillance networks), as appropriate.

SUSTAINABLE z Continuously document the incidence of patient and healthcare worker infections and the effectiveness of measures to
CAPACITY reduce occurrence.
z Revise and update national strategic plans for HCAI surveillance based on data collected/M&E results.
z Use data collected to develop targeted prevention efforts, evaluate impact and re-evaluate on a regular basis.
z Regularly identify champion hospitals for adherence to HCAI surveillance standards including infections caused by
emerging and/or antimicrobial resistant pathogens among humans and ensure feedback is given in a national forum (i.e.
reports including data analyses, recommendations, highlights of special events, outbreaks and control measures, etc.).
z Share country experience in HCAI surveillance and participate in international initiatives to strengthen capacities globally.

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228
 BENCHMARK 15.3: Provide a safe environment in all healthcare facilities
OBJECTIVE: To ensure a safe environment in all healthcare facilities for health workers, patients, caregivers, visitors and any other service provider/user

CAPACITY LEVEL BENCHMARK ACTIONS

z National standards and resources for an environment enabling IPC (such as WASH, screening, triage, isolation areas and

01 sterilization services in healthcare facilities), including appropriate infrastructure, materials and equipment are not available
NO CAPACITY or are under development.
z Standards for reduction of workload and overcrowding for optimization of staffing levels in healthcare facilities are not
available or under development.

z Review international guidelines103 and the current national status of healthcare facilities in relation to water, sanitation,

02 hygiene, cleaning, waste and energy services and document gaps or areas for improvement104.
LIMITED z Identify and document gaps in WHO core components for IPC programmes number seven and eight and develop national
CAPACITY plan for a safe built environment (core component 8) and overcrowding and optimization of staff levels (core component
7)105.
z Define standards for IPC and WASH both in hospital and community (primary) health care settings106.
z Develop training materials based on national guidelines and standards for the development of a safe built environment,
including when to start and stop isolation of patients, donning and doffing PPE and engineering and environmental
controls.
z Develop norms and standards in developing the safe built environment of healthcare facilities in relation to IPC, with special
reference to crowd control measures, triage facilities, isolation rooms, ventilation, sewerage facilities, waste management, etc.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5
103
Including WHO guidelines on environmental services in healthcare, drinking water safety, sanitation, healthcare waste as well as the WHO core components of IPC programmes at acute health
care facility level for recommendations on core component seven (workload, staffing and bed occupancy at the facility level) and eight (built environment, materials and equipment for infection
prevention and control at the facility level). Include consideration of the WHO Minimum requirements for infection prevention and control programmes and relevant chapters in the WHO
Interim practical manual supporting national implementation of the WHO Guidelines on core components of infection prevention and control programmes.
104
Including referring to latest WHO/UNICEF national estimates.
105
The development of this plan should be done using the WHO IPC assessment tool for minimum requirements at the facility level (IPCAF-MR for primary, secondary and tertiary levels
229

respectively) alongside WHO/UNICEF/WASH Fit tools. These plans should also clearly identify roles and responsibilities of key staff and/or community members.
106
These standards should be based on the WHO Minimum requirements for infection prevention and control programmes and WHO standards on drinking water, sanitation, and healthcare waste.
Develop and disseminate SOPs to implement these standards, including checklists.
 z Implement the WHO IPCAF component eight minimum requirements for a safe built environment107.

03 z Mandate and support IPC improvement at all healthcare facilities, based on assessment results using the IPCAF and
DEVELOPED complimentary WASH FIT tools or national equivalents and use standard checklists to monitor the safety of the hospital
CAPACITY environment at regular intervals and take corrective measures.
z Update national building standards, standards for safe water, sanitation, hygiene, waste and clean energy services for
healthcare facilities to enable compliance with IPC measures.
z Identify, document and practice minimum requirements for staffing, workload and bed occupancy standards to ensure IPC
at healthcare facilities.
z Establish hand hygiene facilities to adhere to hand hygiene requirements in both hospitals and community healthcare
facilities.

Participation and contribution of other sectors to actions:

1, 2, 3, 5
z Support, by NGOs and other donor agencies, to develop infrastructure and technical expertise for IPC.
z Establish and maintain sufficient supply of logistics to allow for a safe environment at health facilities.

z Organize procurement and make available a sufficient quantity of PPE, hygiene and disinfection products and other IPC

04 related supplies for health workers108.

DEMONSTRATED z Develop more advanced standards for water and sanitation services in healthcare facilities, including considering low
CAPACITY carbon and environmentally sustainable healthcare facility standards.
z Identify gaps and implement improvement actions in selected reference health facilities for safety in relation to WASH and
energy services, built logistics, human resources and equipment and report to higher authorities to take corrective action

WHO benchmarks for strengthening health emergency capacities

using IPC assessment and WASH tools.
z Update national and facility IPC action plans based on identified gaps and priority action areas.
z Routinely monitor and evaluate health facility environment to ensure that patient care activities are conducted in a clean
and/or hygienic environment, as well as the existence of functioning WASH infrastructures and services, appropriate IPC
materials and equipment, and an adequate number and appropriate positioning of hand hygiene facilities, etc.
107
Water, sanitation, hygiene, waste and energy services in healthcare facilities, including appropriate infrastructure, materials, regular budget and equipment for IPC as well as standards for
reduction of overcrowding and optimization of staffing levels in healthcare facilities in stepwise manner.
230

108
Work to reduce unnecessary and overuse of PPE (e.g. hand hygiene rather than gloves when not indicated) and reduce environmental impact of waste.
 z Clearly outline requirements for PPE and supplies (including cleaning supplies and equipment, alcohol based hand rub,
soap, etc.), and establish contingency plans in the event of supply shortages.

Participation and contribution of other sectors to actions:

3, 7

z Update health facility level plans regularly based on lessons learned and gap analysis/evaluations to identify priority areas

05 and monitor progress.

SUSTAINABLE z Implement minimum requirements for a safe built environment, materials and equipment for IPC at the facility level at all
CAPACITY levels, supported by a sustainable funding mechanism.
z Provide sustainable financial and other support to healthcare facility IPC programmes at all levels.
z Prioritize a sustainable budget for hospital safety in relation to IPC.
z Prioritize funding to ensure safety and quality standards of environment in healthcare facilities in relation to IPC by
domestic funds and donor funding mechanisms.
z Identify and document best practices/lessons learned, and engage the country in peer-to-peer learning programmes at the
subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

Tools:
z Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Geneva: World

WHO benchmarks for strengthening health emergency capacities

Health Organization; 2016 (https://www.who.int/publications/i/item/9789241549929).
z Interim Practical Manual: supporting national implementation of the WHO Guidelines on Core Competencies of Infection Prevention and Control
Programmes. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/WHO-HIS-SDS-2017-8).
z Core components for infection prevention and control programmes (implementation tools and resources). Geneva: World Health Organization; 2023
(https://www.who.int/teams/integrated-health-services/infection-prevention-control/core-components).
z Minimum requirements for infection prevention and control programmes. Geneva: World Health Organization; 2019 (https://www.who.int/publications/i/
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item/9789241516945).
 z Global Antimicrobial Resistance and Use Surveillance System (GLASS) [website]. Geneva: World Health Organization; 2023 (https://www.who.int/
initiatives/glass).
z Diagnostic stewardship: a guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016 (https://
www.who.int/publications/i/item/WHO-DGO-AMR-2016.3).
z Infection prevention and control assessment framework at the facility level. Geneva: World Health Organization; 2018 (https://www.who.int/
publications/i/item/WHO-HIS-SDS-2018.9).
z Instructions for the national infection prevention and control assessment tool 2 (IPCAT2). Geneva: World Health Organization; 2017. (https://apps.who.
int/iris/handle/10665/330078).
z Assessment tool of the minimum requirements for infection prevention and control programmes at the national level. Geneva: World Health
Organization; 2021 (https://www.who.int/publications/m/item/assessment-tool-of-the-minimum-requirements-for-infection-prevention-and-control-
programmes-at-the-national-level).
z Hand Hygiene Self-Assessment Framework. Geneva: World Health Organization; 2010 (https://www.who.int/teams/integrated-health-services/
infection-prevention-control/hand-hygiene/monitoring-tools).
z Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241509763).

z National systems to support drinking-water, sanitation and hygiene: global status report 2019. UN-Water global analysis and assessment of sanitation
and drinking-water (GLASS) 2019 report. Geneva: World Health Organization; 2019 (https://www.unwater.org/publications/un-water-glaas-2019-
national-systems-support-drinking-water-sanitation-and-hygiene).
z Compendium of WHO and other UN guidance on health and environment [website]. Geneva: World Health Organization; 2023 (https://www.who.int/
tools/compendium-on-health-and-environment).
z Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the national level. Geneva: World
Health Organization; 2021 (https://www.who.int/publications/i/item/9789240032729).

WHO benchmarks for strengthening health emergency capacities

z Policy brief for the legal framework on infection prevention and control. Addis Ababa; Africa CDC and African Union; 2022 (https://africacdc.org/
download/policy-brief-for-the-legal-framework-on-infection-prevention-and-control/).
z Core competencies for infection prevention and control professionals. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/
item/9789240011656).
z WASH FIT: a practical guide for improving quality of care through water, sanitation and hygiene in health care facilities. Second edition. Geneva: World
Health Organization; 2022 (https://www.who.int/publications/i/item/9789240043237).
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 z WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) [website]. World Health Organization and UNICEF
(https://washdata.org/).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

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 16
Risk communication, community engagement & infodemic management
Risk communication, community engagement and infodemic management share a focus on effective communication, co-design, community involvement,
addressing misinformation, empowering individuals, building trust and fostering collaboration. By integrating these capacities into health systems, States
Parties can enhance overall preparedness and response to outbreaks and emergencies and ensure that emergency functions are effectively implemented.
Effective and integrated risk communication, community engagement and infodemic management is driven by coherent and coordinated health communication
and community participation systems with clearly defined mechanisms, functions and dedicated resources to support key activities, and are often supported
by the same system. Key activities include internal and partner communication, multistakeholder and community engagement, participatory risk assessment
and community planning, community/local testing of plans and operational structures, social listening, rumour management, community-level early warning
systems, and strategies for tackling mis- and disinformation.

Risk communication
Risk communication is the real-time exchange of information, advice and opinions between experts or officials and people who face health threats. Risk
communication enables people to make informed decisions to mitigate the effects of a threat and take protective and preventive measures. Timely and
effective dialogue between concerned authorities, stakeholders and the population at risk is multisectoral, leverages existing functions, includes proactive
dissemination of information, social listening, and adapts approaches based on community feedback. Risk communication approaches and strategies
consider the social, religious, cultural, political and economic context in which threats occur, with dissemination through appropriate and trusted channels
(e.g. media, social media, mass awareness campaigns, health promotion platforms, social mobilization, stakeholders and trusted community leaders) to

WHO benchmarks for strengthening health emergency capacities

support uptake among target populations. .

IMPACT:
Effective risk communication guides people to better understand risks they face and make informed decisions about how to mitigate effects
of risks and how to take protective and preventive measures. Messages and interventions are shaped by social and contextual realities, and
234

authorities and experts listen to and address people’s concerns and needs so advice is relevant, tailored and timely.
 MONITORING AND EVALUATION:
(1) Formal multisectoral risk communication plans, arrangements and systems are in place. (2) Coordination mechanisms for internal and
partner communication, data exchange and shaping of the information environment exist and are functional. (3) Risk communication materials
are culturally appropriate and acceptable to target populations, regularly updated and disseminated rapidly through appropriate channels. (4)
Communication mechanisms have been established with at-risk populations at the community level.

Community engagement
Health security can only be achieved when health systems work with resilient communities. Resilient communities have the capacity to report all available
essential information to the appropriate level of healthcare response, rapidly implement preliminary control measures, coordinate with health systems and
co-create solutions as the emergency evolves.

Community engagement develops relationships and structures for stakeholders to work together to promote well-being, achieve positive health outcomes
and empower communities to lead, plan and implement initiatives. Community engagement builds resilient communities by implementing relevant policies,
enabling legislation, providing resources, providing quality services, mobilizing expertise and maximizing community capacities with long-term commitment
and investment. Sustained community engagement with the health system co-develops solutions and adapts and localizes health emergency programmes
by working collaboratively with groups of people affiliated by geographic proximity, identity, ways of communication, shared interest or similar situations, or
health conditions. National emergency preparedness, readiness and response structures should be designed with community-centred approaches integrated
within national coordination mechanisms. Community engagement includes additional benchmarks 16B.2 and 16B.3.

IMPACT:

WHO benchmarks for strengthening health emergency capacities

Community engagement supports two-way communication for localized and effective preparedness initiatives and response operations and
encourages individual and population behaviour change. Community engagement contributes to raising and maintaining trust towards local
authorities, health providers, public health measures and response actors. Community engagement across the health emergency cycle enables
the design of solutions that are owned by communities, underpinned by local practices, values and norms, and strengthen local health systems
to prevent, detect and respond to health emergencies.
235
 MONITORING AND EVALUATION:
(1) Community engagement is integrated in the development and implementation of national and local health emergency management plans.
(2) Local actors including government, primary health care, community organizations and partners play an active role in community engagement
for health emergency management and provision of EHS. (3) Capacity of local officials and community volunteers to contribute to planning,
implementation and monitoring of health preparedness and response efforts.

Infodemic management
Infodemic management monitors the information environment that communities live in to understand how it shapes their perceptions and health behaviours.
Health workers and health systems can also be impacted by infodemic harms, such as loss of public trust, stigmatization or violence against health workers
and by patients delaying care-seeking or taking non-approved treatments. Infodemic harms can be addressed and resilience can built in communities
and health systems against health misinformation by rapidly addressing precursors and components such as questions, concerns, information voids, and
circulating narratives.

In today’s increasingly connected world, health information is shared rapidly and amplified through digital channels while also influencing offline conversations,
traditional media news cycles or less-digitally connected communities. In this evolving information environment, individuals can access many sources of
health information beyond public authorities. Health misinformation narratives can often take advantage of the dynamics and design of the information
environment, such as algorithms and content moderation policies of internet platforms and varying levels of digital, media and health literacy among readers.
Infodemic management strategies are relevant to all levels of society, including health systems, to help reduce impacts of health emergencies at individual,
community, health system and societal levels by using a deep understanding of the underlying reasons how and why narratives gain traction and become
part of broader social conversations. Infodemic management includes additional benchmark 16C.1.

WHO benchmarks for strengthening health emergency capacities

IMPACT:
Effective infodemic management supports health systems to prepare and proactively prevent the harm infodemics can cause during an emergency
when information, confusion, questions, concerns, information voids and narratives surge in communities. Infodemic monitoring analyzes diverse
data sources such as social listening, health information systems and partners (e.g. factcheckers), to identify and implement misinformation
resilience strategies and rapidly meet people’s information and service needs during a health emergency. Infodemic insights identify strategies
236

and structures that can strengthen resilience of the health system, health workers or communities to health misinformation. During an outbreak,
 rapid infodemic insights inform faster response to the questions, concerns and needs people express in different communities of focus. Insights
support the promotion of health information equity and tailoring of emergency response strategies, health policy, health guidance, treatments,
diagnostics, vaccines, public health and social measures (PHSM), engagement, communication and service delivery.

MONITORING AND EVALUATION:

(1) Existence of formal infodemic management plans and SOPs as well as arrangements and systems for routine development, gathering and use
of infodemic insights for preparedness, prevention and response in emergencies, including in vulnerable communities. (2) Infodemic management
function is formalized as part of emergency preparedness and prevention plans and is coordinated across all stakeholders disseminating health
information, evidence or guidance. (3) Networks and rosters exist for surge capacity to support infodemic management and digital provision
of accurate and reliable health information during a health emergency. (4) The information environment is mapped at national and subnational
levels and routine data sources are identified within and outside the health system for inclusion in routine infodemic monitoring and data sharing
and policies are put in place for privacy and governance considerations.

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237
 Risk communication
BENCHMARK 16A.1: Risk communication and community engagement (RCCE) systems with mechanisms for functions and resources are in place and
integrated within broader health emergency programmes
OBJECTIVE: To build and strengthen a system for timely, effective, relevant and tailored communication of risk before, during and after health
emergencies, enabling those affected to take protective, preventative and supportive actions.

CAPACITY LEVEL BENCHMARK ACTIONS

z Mechanisms for RCCE functions and resources including behavioural and cultural insights, are under development or

01 implementation and coordination of RCCE activities are conducted on an ad hoc basis

NO CAPACITY

z Develop and test systems109 for the implementation of RCCE, including mechanisms for community and multisectoral
02 engagement and infodemic management.
LIMITED z Identify dedicated RCCE focal points and appoint spokespersons110 at national and subnational levels.
CAPACITY z Establish coordination mechanisms111 with relevant sectors including ministries, partners and other stakeholders at national
and subnational levels.
z Develop a national multihazard emergency RCCE plan and policy112 based on IHR requirements and priority risks, for at least
three priority risks.
z Develop a budget and forecast human and financial resource needs for activating RCCE plans during a health emergency.
z Develop113 RCCE training packages.
z Develop and test mechanisms to support data to drive RCCE action114.

WHO benchmarks for strengthening health emergency capacities

109
Define governance and leadership mechanisms for RCCE by mapping people or units responsible for RCCE and define ToRs for joint working.
110
Develop a contact list of RCCE focal points and plan to keep the list updated. Set up meetings and networking platforms for RCCE focal points and focal points from other areas such as
surveillance, risk assessment and health programmes.
111
Agree and map coordination mechanisms, for example, to clarify roles, to map communication flows and set up SOPs between units, agencies/organizations.
112
Define the country’s vision, policy and strategic commitment to RCCE and map key stakeholder groups, including at risk communities. Define key activities and channels for engagement and
readiness activation mechanisms.
113
Target RCCE training based on assessment of existing capacities and needs within key stakeholder groups, including government ministries, health staff, frontline health officials, community
health workers, social mobilizers, community engagement practitioners and key partner agencies.
114
238

Such as SOPs for routine analyses of target audiences based on online and offline social listening, MoUs with providers of technology for message development, surveys or rapid qualitative
studies for identification of local perceptions and concerns.
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Identify data sources within relevant sectors and develop partnerships with public health sector to collect and share data
and evidence to strengthen RCCE policy and practice.

z Apply systems for the implementation of RCCE, including mechanisms for community and multisectoral engagement and

03 infodemic management.
DEVELOPED z Expand networks and reinforce communication channels between RCCE focal points, including within the health ministry
CAPACITY and relevant sectors for health emergencies and across different functions of an emergency response115.
z Implement mechanism for data to drive RCCE action at the national level.
z Develop and test SOPs, guidelines, agreements and/or MoUs for effective coordination of RCCE and infodemic
management among relevant key stakeholders at national and subnational levels.
z Review116, test117 and update national multihazard emergency RCCE plans and policies based on IHR requirements for all
priority risks.
z Organize and conduct trainings for staff at national and subnational levels to raise awareness about the importance of risk
communication, review and adapt trainings based on capacity-building needs118.
z Build a network with specific communities such as education, faith based, arts/culture, employers, etc., to coordinate RCCE
and infodemic management activities, adapt messages and guidance.
z Establish M&E systems to evaluate the implementation of risk communication and infodemic management activities
during health emergencies, including rapid approaches that enable intervention adaptation to improve outcomes.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6, 7, 8
z Identify focal points for risk communication within relevant sectors and share infodemic insights to ensure harmonization
of communication messages across sectors.

115
Including surveillance, laboratory, patient care, infection prevention and control, logistics, human resources, planning, budgeting and finance.
116
Review national multihazard plans to include all priority risks and to align relevant existing policies, legislation and legal frameworks.
117
Test and improve capacities, resources and activation mechanisms for operational readiness through tabletop exercises or SimEx for different priority threats.
239

118
Including capacity-building on effective communication, behaviour change communication, communication for behavioural impact, social marketing techniques, drafting media communiques,
developing information, education and communication materials, and social listening.
 z Allocate dedicated resources for an effective RCCE system, including skilled personnel, volunteers and financial resources

04 to form dedicated teams with a budget for implementing activities at the national and subnational levels.
DEMONSTRATED z Create a repository of tools, products, templates and mechanisms for the rapid development of new products as needed.
CAPACITY z Expand networks and mechanisms for systematic exchange between the RCCE function and other essential functions of
an emergency response119, health system120 and outside the health system121.
z Implement mechanisms for data to drive RCCE action at the subnational level, using evidence of best practices in routine
collection of data and analyses to inform practice.
z Expand M&E systems to evaluate the implementation of risk communication and infodemic management activities
during health emergencies, including rapid approaches that enable intervention adaptation to improve outcomes at the
subnational level.
z Conduct SimEx/AAR/IAR (as relevant) to test plans including SOPs, guidelines, agreements and/or MOUs for effective
RCCE coordination among relevant key stakeholders and identify and address gaps in capacity, coordination and resources
at national and subnational levels.
z Update training needs based on outcomes of M&E activities that identify capacity gaps.
z Engage communities such as employers/unions, faith based, arts/culture, hospitality/tourism, transport, universities,
entertainment, etc. in RCCE activities.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

WHO benchmarks for strengthening health emergency capacities

119
Such as surveillance, laboratory, patient care, infection prevention and control, logistics, human resources, planning, budgeting and finance.
120
Such as immunization registries, routine infectious disease surveillance systems, health care, etc.
121
Such as mobility data from telecommunication companies, engagement and search metrics from internet platforms, etc.
122
240

For example, strengthening infrastructure for routine, rapid evidence generation and evidence synthesis to inform practice, drive intervention development and identify factors that influence
transferability to other and similar contexts.
 z Sustain domestic budget line and appropriate budget for RCCE national and subnational level activities throughout the

05 emergency life cycle.

SUSTAINABLE z Document and disseminate evidence and data driven approaches to inform RCCE action .
CAPACITY z Update/amend existing policies, legislation and legal basis for RCCE for health emergencies and unusual events based on
lessons learned.
z Use the results of RCCE evaluations to systematically improve programmes, practices and interventions.
z Maintain a regular coordination mechanism between agencies, organizations and key stakeholders at national and
subnational levels, including conducting SimEx/AAR/IAR (as relevant) and simulation trainings.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

241
 BENCHMARK 16A.2: Mechanisms to deliver quality, timely, impactful risk communication are operational
OBJECTIVE: To implement strong risk communication practices with community involvement for preparedness, readiness and response to health
emergencies to enable populations at risk to take protective, preventative and supportive actions.

CAPACITY LEVEL BENCHMARK ACTIONS

z Mechanisms for public communication are under development or implemented on an ad hoc basis by non-specialist

01 professionals with a near exclusive focus on conventional media.

NO CAPACITY

z Establish an advisory committee including representatives from health and other relevant sectors and develop a mechanism
02 to coordinate communication among subnational, national and international stakeholders123.
LIMITED z Set up mechanisms for risk communication messages, products and intervention development including process and
CAPACITY engagement of trained teams linked with relevant technical focal points124.
z Identify mechanisms for social listening and community feedback and collate with existing materials for RCCE to drive
action125.
z Map mainstream national and local media (all types) and social media platforms and develop networks.
z Develop a media engagement strategy, involving stakeholders from the media sector including social media.

Participation and contribution of other sectors to actions:

1,2, 3, 4, 5

z Test the mechanism to coordinate communication among stakeholders and apply it during emergencies at the national

WHO benchmarks for strengthening health emergency capacities

03 level across emergency response areas.
DEVELOPED z Engage and train community leaders, champions, CSOs, religious and traditional leaders, and others for risk
CAPACITY communication at national and subnational levels.

123
Including the health ministry and internal stakeholders, hospitals partners, civil society groups (including female oriented organizations), private sector, nongovernmental organizations,
religious and traditional leaders, etc.
124
Identify and engage with a trained team for message development, message clearance in collaboration with relevant focal points, message testing, creative content development, artwork and
dissemination in health emergencies and unusual events. Identify a mechanism to coordinate messages with other response areas (such as surveillance, laboratory, patient care, infection
prevention and control, logistics, human resources, planning, budgeting, and finance).
242

125
Such as online and offline social listening, surveys or rapid qualitative studies for identification of local perceptions and concerns.
 z Establish and test feedback mechanisms for risk communication such as a hotline or call centre126,127 to activate within 24
hours of an emergency at the national level.
z Develop and disseminate risk communication products in different formats and relevant local languages based on
information from RCCE to drive action at the national level.
z Test and apply different modes of communication to reach different groups of audiences using different communication
channels128.
z Implement media engagement strategy and build partnerships with media networks129 at the national level.
z Conduct training for appointed spokespersons on risk communication on a regular basis.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

z Implement the coordination mechanism among stakeholders during a health emergency at the national and subnational

04 levels.
DEMONSTRATED z Establish and test feedback mechanisms for risk communication such as a hotline or call centre to activate within 24
CAPACITY hours of an emergency at the subnational level.
z Review and identify gaps and vulnerabilities in established networks of trusted community leaders and champions130 at the
subnational level.
z Develop and disseminate risk communication products in different formats and relevant local languages based on
information from RCCE to drive action131 at the subnational level.
z Implement media engagement strategies and build partnerships with media networks at the subnational level.

WHO benchmarks for strengthening health emergency capacities

126
To respond to questions from the community, disseminate official risk communication messages and collect information.
127
Such as a SOP for a referral system through the call centre, MoUs with relevant telecommunication partners, training material and training schedules for operators of the national public health
emergency call centre and, language mapping for call centres to answer calls in priority local languages based on the country’s demography.
128
Communication networks, platforms, methods, modes such as face-to-face meetings, print materials, local announcement through public addressing systems, online, TV or radio, telephone
messages or as a ringing tone, etc.
129
Such as online anti-misinformation communities, factcheckers, science communication groups, journalists and key focal points to develop engagements built on mutual understanding,
credibility and to establish trust.
130
Such as religious leaders, traditional healers and community networks.
243

131
Including those based on systematic online and offline daily media monitoring and compiling and analyzing feedback and reports to spokespersons and other relevant authorities before, during
and after emergencies.
 z Identify and involve journalists representing all media stations and key focal points from relevant media outlets and engage
regularly132 in ways that build mutual understanding, trust and credibility.
z Develop mechanisms to monitor risk communication messages developed and shared by key stakeholders at national and
subnational levels.
z Conduct SimEx/AAR/IAR (as relevant) for risk communication to identify the level of implementation of risk
communications plans, identify gaps and best practices.

Participation and contribution of other sectors to actions:

1,2, 3, 4, 5, 6, 7, 8
z Implement agreed and tested processes by priority sectors, including government, private, non-governmental
organizations (NGOs), development partners and CSOs, to work with the health sector to disseminate risk communication
messages to the community.
z Support the health ministry for surge support as needed in identifying community questions and needs, tailoring and
testing messages, and amplifying message reach and uptake.

z Evaluate the coordination mechanism for risk communication and sustain engagement with stakeholders including media.

05 z Update media engagement strategies, feedback mechanisms and usage of hotlines or call centres based on results from
SUSTAINABLE M&E activities.
CAPACITY z Update risk communication plans based on results of SimEx/AAR/IAR (as relevant) on a regular basis.
z Sustain data driven mechanisms for risk communication product and intervention development133.
z Document and disseminate best practices and lessons learned.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1,2, 3, 4, 5

132
e.g. in-person briefings, targeted press releases, press conferences, media seminars, etc.
133
Routinely use data collected through online and offline social listening systems or formative research to drive risk communication messages testing and other product development. Proactively
244

advance mechanisms for evidence and data driven approaches to inform RCCE action. For example, evidence syntheses to inform strategy and to influence the transferability of best practices
to other settings.
 Tools:
z WHO guidance on Risk Communication [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/risk-communications/
guidance).
z Communicating Risk in Public Health Emergencies: a WHO guideline for emergency risk communication (ERC) policy and practice. Geneva: World Health
Organization; 2018 (https://www.who.int/publications/i/item/9789241550208).
z Risk communication and community engagement (RCCE) [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/risk-
communications).
z The Collective Service. For a Community-led Response [website]. British Red Cross Collective Service; 2022 (https://www.rcce-collective.net/).

z World Health Organization strategy for engaging religious leaders, faith-based organization and faith communities in health emergencies. Geneva: World
Health Organization; 2021 (https://apps.who.int/iris/handle/10665/347871).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public health
emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

245
 Community engagement
BENCHMARK 16B.1: Community engagement is integrated and prioritized within the management of health emergencies and unusual events
OBJECTIVE: To systemically integrate and prioritize community engagement into relevant policies, programmes, frameworks and infrastructure, and
actively involve communities in the codesign and implementation of interventions for management of health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z Mechanisms for community engagement in health emergencies, including policies, plans, guidelines, programmes and/or

01 SOPs, are in development.

NO CAPACITY z Community engagement activities are largely one way information sharing activities and limited to disease control
programmes.
z Community engagement efforts are not systematically linked to the emergency response.

z Identify unit/focal point within the health emergency management office or health ministry equivalent, with ToRs to
02 coordinate efforts for community engagement in health emergencies with relevant units/departments, programmes and
LIMITED sectors and for social mobilization, health promotion or community engagement for emergency response.
CAPACITY z Form a multisectoral and multiagency national working group/steering committee to streamline and prioritize community
engagement efforts for health emergencies across relevant sectors.
z Review available policies, legislation, plans, guidelines and frameworks relevant to health emergencies across relevant sectors
to identify the level of inclusion of community engagement, and to identify and document gaps.
z Conduct contextual analysis considering cultural, political, social, economic and geographic factors to develop/update
community engagement strategy/guidelines/SOPs for health emergencies.

WHO benchmarks for strengthening health emergency capacities

z Identify and list trusted community engagement advocates, influencers and key stakeholder groups at the national level for
health emergencies across relevant sectors.
z Define and integrate the roles of communities and civil society in health emergency strategies/plans and establish a
mechanism for community participation in decision making and actions to prepare for and respond to health emergencies134.
z Conduct baseline surveys to provide information135 on a population`s risk or ability to withstand common hazards.

134
246

Including consultations/gathering feedback from communities.

135
Mapping languages, living conditions, religious and cultural practices, trust channels of communication, influencers, etc.
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Identify focal points in relevant sectors for consultation and coordination during emergencies to support community
engagement activities.

z Develop, test and disseminate national protocol for community mobilization for health emergencies136 along with an

03 identified mechanism for dedicated community engagement teams to reach out to affected or at risk populations during
DEVELOPED emergencies.
CAPACITY z Identify focal points and define the roles of subnational and local governments and primary health care staff to ensure
community engagement in health emergencies, including for community level detection, early warning, logistics
management, etc.
z Map key stakeholders such as community leaders, faith based organizations and civil society to contribute to the
development and implementation of health emergency preparedness and response plans.
z Conduct participatory community risk assessment, context analysis, hazard mapping, health profiling, vulnerability
mapping, capacity assessment, context analysis and readiness planning in priority communities through inclusive
approaches with involvement of NGOs, CSOs and CBOs and networks.
z Develop and test a mechanism for communities to be actively involved in emergency response and codesign of emergency
response initiatives.
z Establish formal/informal, ongoing feedback mechanisms before, during and after emergencies between at risk or affected
populations and response authorities with special reference to vulnerable and marginalized groups137.
z Integrate community engagement in the M&E framework for health emergencies and outbreak response at all levels
(including SimEx/AAR/IAR, as relevant).

WHO benchmarks for strengthening health emergency capacities

z Train community engagement teams, including volunteers, regularly on community engagement before, during and after
emergencies and establish surge capacity mechanisms for community engagement.
z Advocate and practice community engagement and public-private-people partnership mechanisms with CSOs, CBOs and
NGO networks for emergency response at the national level.

136
Preparedness, prevention and response to outbreaks and other hazards or emergencies (such as involvement in early warning and detection, immediate notification and containment, contact
247

tracing, specimen collection and referral), and translate messages into major country languages.
137
Such as linkages with hotlines, social behaviour research, direct communication platforms, etc.
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7, 8, 9
z Integrate community engagement mechanisms into existing national DRR and emergency response frameworks.

z Implement national protocol for community mobilization for health emergencies at all levels.

04 z Involve communities to codesign and implement emergency management initiatives138.

DEMONSTRATED z Allocate a dedicated budget for community engagement for health emergencies, including outbreak preparedness and
CAPACITY response, at all levels.
z Monitor community engagement with target communities before, during and after emergencies and community trust
related indicators as part of M&E for health emergencies and outbreak response at all levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

z Update existing plans, guidelines and SOPs for community engagement based on lessons learned and best practices from

05 SimEx/AAR/IAR (as relevant).

SUSTAINABLE z Revise legal frameworks and policies on how local governments can engage with CSOs/CBOs for community engagement
CAPACITY at the community/local level to support emergency preparedness and response.
z Include community stakeholders in the planning and conduct of SimEx/AAR/IAR (as relevant) for local emergencies.
z Share experiences and best practices on community engagement in health emergencies through peer-to-peer learning
programmes at the subnational, national and international levels.
z Document and publish research to reflect experiences and lessons learned in community engagement throughout the

WHO benchmarks for strengthening health emergency capacities

health emergency cycle.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

138
248

Initiatives include local or district plans e.g. readiness, contingency, response and business continuity plans. Codesign and implementation shall include stakeholders such as community
leaders, faith based organizations and civil society, which are mapped and systematically engaged throughout the process.
 Tools:
z Minimum Quality Standards and Indicators in Community Engagement. Amman: UNICEF Middle East and North Africa; 2020 (https://www.unicef.org/
mena/reports/community-engagement-standards).
z Community engagement: a health promotion guide for universal health coverage in the hands of the people. Geneva: World Health Organization; 2020
(https://apps.who.int/iris/handle/10665/334379).
z World Health Organization, Food and Agriculture Organization of the United Nations & United Nations Children’s Fund (UNICEF). Communication for
behavioural impact (COMBI): a toolkit for behavioural and social communication in outbreak response. Luxembourg: World Health Organization; 2012
(https://apps.who.int/iris/handle/10665/75170?ua=1).
z Social + Behavioural Change [website]. New York, United States of America: UNICEF; 2023 (https://www.sbcguidance.org/).

z Clinical and Translational Science Awards Foundations for Accelerated Discovery and Efficient Translation. Principles of Community Engagement
(Second Edition) Progress Report 2009-2011. United States of America: National Institutes of Health (NIH), Department of Health and Human Services
and USA Government; 2011 (https://ncats.nih.gov/ctsa_2011/ch5_v2.html).
z Engagement of crisis-affected people in humanitarian action. Background Paper. Addis Ababa: ALNAP; 2014 (https://reliefweb.int/report/world/
engagement-crisis-affected-people-humanitarian-action-background-paper).
z WHO Community Engagement Framework for Quality, People-centred and resilient health services. Geneva: World Health Organization; 2017
(https://apps.who.int/iris/handle/10665/259280).
z WHO Faith Network [website]. Geneva: World Health Organization; 2023 (https://www.who.int/groups/who-faith-network).

z World Health Organization strategy for engaging religious leaders, faith-based organization and faith communities in health emergencies. Geneva:
World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/347871).
Areas of focus: Fostering and building partnerships, inclusion, capacity, and resilience.

WHO benchmarks for strengthening health emergency capacities

z From words to action: Towards a community-centred approach to preparedness and response in health emergencies. Geneva: International Federation
of Red Cross and Red Crescent Societies; 2019 (https://www.gpmb.org/annual-reports/overview/item/from-words-to-action-towards-a-community-
centred-approach-to-preparedness-and-response-in-health-emergencies).
z Enhanced Vulnerability and Capacity Assessment Toolbox [website]. Geneva: International Federation of the Red Cross and Red Crescent Societies;
2018 (https://www.ifrcvca.org/toolbox).
z Community Engagement Hub. United Kingdom: British Red Cross (https://www.communityengagementhub.org/).
249
 z Community Engagement and Accountability Toolkit. United Kingdom: British Red Cross (https://communityengagementhub.org/guides-and-tools/cea-
toolkit/).
z World Health Organization, International Federation of the Red Cross and Red Crescent Societies, Global Outbreak Alert and Response Network
& UNICEF. Operational Guide for Engaging Communities in Contact Tracing. Geneva: World Health Organization; 2021 (https://www.who.int/
publications/i/item/WHO-2019-nCoV-Contact_tracing-Community_engagement-2021.1-eng).
z The FSN Network and CORE Group. Make Me a Change Agent: A Multisectoral SBC Resource for Community Workers and Field Staff. Washington DC:
The Tops Program; 2015 (https://www.fsnnetwork.org/resource/make-me-change-agent-multisectoral-sbc-resource-community-workers-and-field-
staff).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

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250
 Risk communication, community engagement & infodemic management additional
benchmarks
Community engagement
BENCHMARK 16B.2: Inclusive community centred governance and management of health emergencies is in place
OBJECTIVE: To ensure communities and civil societies participate in decision making, priority setting and resource allocation and to apply community
engagement approaches in risk assessment, health emergency planning, prevention, preparedness, readiness, case detection, early warning, response
and services to build community ownership, trust, accountability and resilience

CAPACITY LEVEL BENCHMARK ACTIONS

z Community engagement efforts are not systematically linked to the emergency response.

01
NO CAPACITY

z Identify and map major CSOs, NGOs, community networks and other sector stakeholders139 working in health emergency
02 related areas at national and subnational levels.
LIMITED z Codevelop, with communities, frameworks, guidance and tools for community engagement, social mobilization and health
CAPACITY promotion teams to connect with affected or at risk populations during health emergencies.
z Identify priority communities for preparedness, readiness and response capacity-building based on national risk assessment,
readiness assessment, programme reviews and other information.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3

z Map the capacities of community partners and networks existing at the subnational and local levels in health and other

03 relevant sectors for community management of health emergencies.

DEVELOPED z Conduct participatory community risk assessment, context analysis, hazard mapping, health profiling, vulnerability
CAPACITY mapping, capacity assessment and readiness planning in priority communities through inclusive approaches with
involvement from NGOs, CSOs, CBOs and other relevant community networks.
251

139
One Health, DRR, WASH, zoonotic diseases, food safety and security, such as farmer associations, agricultural organizations, food vendors, transportation, livelihood, etc.
 z Co develop, with communities, and disseminate local guidelines, SOPs, tools and templates for community mapping,
assessments, planning (such as contingency plans), case detection, early warning and response coordination in health
emergencies.
z Train community stakeholders, along with CSOs, CBOs and NGOs in case detection, early warning and response
coordination for health emergencies.
z Plan and conduct pilot activities for local level health emergency SimEx (including drills and other exercises), with
participation from community stakeholders and actors.
z Develop, test and implement local models and pilot projects on community knowledge management including
identification of health priorities, resource mapping, community-based surveillance and local response coordination and
governance using community engagement approaches.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6

z Conduct nationwide participatory community risk assessment, vulnerability mapping, capacity assessment, context

04 analysis and readiness planning at the local level and in communities.

DEMONSTRATED z Conduct risks assessments and community planning on a regular schedule.
CAPACITY z Conduct, plan and implement community level drills, SimEx/AAR/IAR (as relevant) with participation from community
actors140.
z Allocate resources to local governments, communities and CBOs according to local plans for community management of
health emergencies.
z Implement countrywide programmes for communities to build local emergency response systems aligned to community

WHO benchmarks for strengthening health emergency capacities

structures, such as community stockpiling of essential supplies (first aid kits, health emergency kits, PPE).
z Implement countrywide systems on community knowledge management including community case detection, early
warning and local response coordination and governance.
z Identify research needs to address knowledge gaps on community management of health emergencies in vulnerable
situations.
252

140
Including village representatives, CSOs, CBOs, religious groups and other community networks.
 z Involve local/community institutions (including schools, workplaces, private entities, NGOs, etc.) in health sector
emergency planning and preparedness activities.
z Establish a multisectoral body for health emergencies (preparedness and response) at the local level including non-
traditionally involved community stakeholders and networks such as employers/unions, faith based community, etc.
z Identify and register individuals in situations of vulnerability, such as patients needing long term care, children without
vaccination, elderly and persons with disabilities.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10

z Evaluate/review community management of health emergencies, including the participation of community stakeholders.

05 z Allocate resources at subnational and/or local level for risk assessment, community health emergency planning, SimEx/
SUSTAINABLE IAR/AAR (as relevant) with participation from community stakeholders.
CAPACITY z Develop reports and case studies on effective management of health emergencies from a community perspective at the
subnational/local level.
z Share country experiences in community health emergency management and participatory public health and engage in
peer-to-peer learning programmes at the subnational level (between regions) and/or international level.
z Implement dynamic data and evidence generation by communities to inform research and support programmes for health
emergency management, outbreak preparedness and response, DRR, risk assessment and programme implementation.
z Disseminate, promote and support evidence-based interventions among stakeholders in developing and implementing
community engagement programmes in health emergency management.

Participation and contribution of other sectors to actions:

WHO benchmarks for strengthening health emergency capacities

1, 2, 3, 4, 5, 6
253
 BENCHMARK 16B.3: Capacity-building mechanisms for multisectoral community health workforce and community engagement in the management of
health emergencies and resilience building are well established
OBJECTIVE: To develop capacity-building mechanisms to improve community engagement for the management of health emergencies and to empower
communities with necessary resources and tools to take timely actions to prevent, detect and respond to health emergencies in their communities.

CAPACITY LEVEL BENCHMARK ACTIONS

z Capacity-building mechanisms for engaging and empowering communities for health emergency preparedness and

01 response are fragmented and without national strategy and support.

NO CAPACITY

z Identify key national experts to develop minimum standards, capacity development frameworks/plans for community health
02 workforce capacity-building for community engagement in health emergencies.
LIMITED z Map existing national community engagement capacity-building programmes and tools in DRR and other relevant sectors141.
CAPACITY z Establish a national network of experts/practitioners who can support community engagement for health emergency
management.
z Develop and test minimum standards, capacity development frameworks/plans for community health workforce as well as
competencies for the health workforce at all levels on community engagement for health emergencies142.
z Establish a platform for disseminating learning opportunities for national focal point(s) for community engagement and
social mobilization in health emergencies and outbreak response and develop trainings and knowledge products on topics
such as community level health emergency management, engagement with populations in situations of vulnerability143 and
community engagement skills144.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5

141
Such as education, transportation, security and tourism, through a One Health approach.
142
Considering current needs, types of workforce, community capacities, workforce competencies and ToRs, current knowledge and skills level.
143
Such as refugees, internally displaced populations, ethnic minorities, etc. (or integrate as part of existing capacity-building).
254

144
Such as community dialogue and participation, interpersonal communication, coordination skills and processes, collaborative teams, social and behavioural change, health literacy, etc.
 z Disseminate minimum standards, capacity development frameworks/plans for community health workforce as well as

03 competencies for the health workforce on community engagement for health emergencies.
DEVELOPED z Develop and disseminate training packages on minimum standards, capacity development frameworks/plans for
CAPACITY community health workforce and competencies on community engagement in health emergencies at the national level.
z Implement mechanism to support community engagement in health emergency design, programming, advocacy,
emergency response planning, M&E, research, training activities and implementation.
z Develop and test capacity-building packages on community engagement for health emergency preparedness and
response for multidisciplinary actors in health including private sector, health professionals in workplaces and schools,
traditional healers, burial attendants, etc.
z Develop and test SOPs for surge capacity for the rapid deployment of officers and staff trained in community engagement
during health emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

z Review the functionality of national network of experts/practitioners who can support on community engagement for

04 health emergency management before, during and after an emergency.

DEMONSTRATED z Implement SOPs for surge capacity for the rapid deployment of officers and staff trained in community engagement during
CAPACITY health emergencies.
z Develop and maintain a roster of health and community workers trained in community engagement in health emergency
management for rapid deployment to target communities.
z Established mechanisms to provide insurance, indemnification and compensation to staff and volunteers injured or

WHO benchmarks for strengthening health emergency capacities

sickened during community engagement work.
z Utilize the learning platform for refresher training at the national and subnational levels.
z Conduct M&E to review coordination, interoperability and readiness for emergency response required for community
engagement.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
255
 z Update the SOPs, minimum standards, capacity development frameworks/plans for community engagement for health

05 emergency management before, during and after emergencies based on M&E results and update training packages as
SUSTAINABLE needed.
CAPACITY z Review and update mechanisms to provide insurance, indemnification and compensation to staff and volunteers injured or
sickened during community engagement work.
z Review and update capacity-building programmes, including the learning platform to disseminate training and knowledge
for community engagement.
z Document and disseminate best practices and lessons learned of community engagement before, during and after
emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4

WHO benchmarks for strengthening health emergency capacities

256
 Infodemic management
BENCHMARK 16C.1: An infodemic management system for health emergencies and unusual events is in place
OBJECTIVE: To develop a system for monitoring and managing infodemics before, during and after health emergencies and unusual events

CAPACITY LEVEL BENCHMARK ACTIONS

z Aspects of infodemic management are under development or conducted on an ad hoc basis.

01
NO CAPACITY

z Establish an infodemic management unit/team, with ToRs, in the health ministry and/or the national institute of public health.
02 z Conduct multisectoral landscape analysis to identify stakeholders and potential partners as well as opportunities and
LIMITED weaknesses in health information seeking and use.
CAPACITY z Identify and connect with stakeholders and teams who have relevant job profiles and functions related to infodemic
management145.
z Develop and test a national multihazard multisectoral infodemic management strategy146 and plan.
z Develop a basic editorial style for published heath information products147 and start health authority webpages148 and social
media channels.
z Produce social listening and infodemic insight reports to inform specific routine health programme activities that require
infodemic management support149 on an as needed basis.
z Integrate infodemic management capacities and strategies in the national multihazard risk communication and community
engagement plan and health emergency incident management system SOPs.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
2, 3, 4, 5, 6, 7

145
Such as health promotion, health communication, social media engagement, health information systems, digital health, risk communication, behavioural insights and community engagement.
146
Content moderation strategy for all official social media channels to determine when to rebut, prebunk or debunk health misinformation.
147
Example: permalinks, dating each piece of content or health guidance, using terms that have been pretested and are well understood by the target population.
148
257

Including a maintained and up-to-date webpage where most common questions and misinformation are addressed to provide factcheckers and media with reliable links.
149
Such as support of health promotion or supplementary immunization activity campaigns.
 z Implement the national multihazard multisectoral infodemic management strategy and plan at the national level.

03 z Develop SOPs for analysis, access to data sources to conduct rapid infodemic insights analysis and to respond to ad hoc
DEVELOPED requests from the IMS.
CAPACITY z Identify networks and staff for surge support capacity during outbreaks, who are trained in infodemic management tools
and practices, at the national level.
z Establish and test a mechanism for rapid content development to support infodemic response using infodemic insights150.
z Develop, test and implement multisectoral infodemic monitoring and evaluation tools151 at the national level.
z Develop and disseminate training packages and tools to support health workers to effectively address questions from their
patients and media and for the management of misinformation at the national level.
z Implement the basic editorial style for published heath information products and update health authority webpages and
social media channels regularly at the national level.
z Establish a coordination mechanism for infodemic management including health information publishers152 at the national
level.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Use job aids and toolkits, in relevant sectors, that explain the specificity of working with health misinformation as
compared to other kinds of misinformation domains.
z Identify and participate in trainings for relevant sectors to collaborate with infodemic management teams before, during
and after health emergencies and unusual health events.

z Implement the national multihazard multisectoral infodemic management strategy and plan at the subnational level.

WHO benchmarks for strengthening health emergency capacities

04 z Implement SOPs for analysis and access to data sources to conduct rapid infodemic insights analysis regularly before,
DEMONSTRATED during and after emergencies.
CAPACITY z Implement multisectoral infodemic monitoring and evaluation tools and use information for decision-making at the
subnational level.
150
Infodemic insights focused on narratives; where possible, incorporate individual and community perspectives in this process.
151
Such as risk assessment criteria and matrices, social listening taxonomies, SOPs for search engine optimization, accessibility and usability are defined and used in analysis and response to
questions, concerns, information voids, circulating narratives and mis- and disinformation.
258

152
Such as expert groups, health regulatory authorities, medical associations, libraries, health reference web sites and other publishers for credible and accurate health information, and
unstructured digital communities and networks whose values support health information promotion (such as world of work, community influencers, etc.).
 z Develop and disseminate training packages and tools to support health workers to effectively address questions from their
patients and media and for the management of misinformation at the subnational level.
z Identify, develop and deploy infodemic management interventions153.
z Develop SOPs, tools and partnerships to detect, address and mitigate disinformation and cyberattacks154 and delineate
multisectoral responsibility for response.
z Conduct a review (SimEx/AAR/IAR, as relevant) on infodemic management before, during and after emergencies at
national and subnational levels.
z Develop infodemic management capacities in CSOs, academic institutions and other partners engaged in health
emergency preparedness, health promotion and health service delivery.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

z Update infodemic management strategies, plans, SOPs and trainings based on lessons learned and best practices from

05 review, testing and research based evidence.

SUSTAINABLE z Prioritize infodemiology as a funded research area with multisectoral engagement and CSO/CBO/NGO involvement.
CAPACITY z Integrate infodemic management into relevant health policies.
z Allocate dedicated budget for infodemic management.
z Utilize advanced analytical innovations for analysis of narratives and social networks by infodemic management unit155.
z Participate in policy dialogues with relevant sectors of government and of society on mitigating harms from
misinformation, protecting freedom of speech, promoting internet governance, and online content moderation in the
context of misinformation and health service delivery during health emergencies and unusual events.

WHO benchmarks for strengthening health emergency capacities

z Sustain systems for long term monitoring, evaluation and improvement of policies, interventions and strategies for
infodemic management156.

153
These interventions include those that promote resilience to health misinformation, reduce circulation of health misinformation, promote spread of accurate credible health information, and
address policy and structural barriers for effective infodemic management.
154
To detect, report and address deceptive marketing practices and consumer rights violations in areas of health information dissemination.
155
Advanced analytics include language agnostic or across multiple languages, type of digital content beyond text based analysis, can produce infodemic insights on a more rapid basis and in
259

real time and updates on information environment landscape analysis every 6 months.
156
Including for detection of unintended consequences and for ensuring ethical social listening and infodemic management.
 z Document and disseminate best practices and lessons learned on infodemic management.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

Tools:
z Infodemic [website]. Geneva: World Health Organization; 2023 (https://www.who.int/health-topics/infodemic#tab=tab_1).

z WHO launches pilot of AI-powered public-access social listening tool [website]. Geneva: World Health Organization; 2021 (https://www.who.int/news-
room/feature-stories/detail/who-launches-pilot-of-ai-powered-public-access-social-listening-tool#:~:text=The%20EARS%20platform%20is%20
powered,scale%2C%20in%20real%2Dtime).
z 3rd WHO training on infodemic management. 16 Nov - 9 Dec 2021, cosponsored by US CDC, UNICEF and RCCE collective service [website]. Geneva:
World Health Organization; 2021 (https://www.who.int/teams/risk-communication/infodemic-management/3rd-who-training-on-infodemic-
management).
z How to build an infodemic insights report in six steps. Geneva: World Health Organization and the United Nations Children Fund (UNICEF); 2023
(https://apps.who.int/iris/handle/10665/370317).
z Infodemic management 101 OpenWho [website online course). Geneva: World Health Organization; 2021 (https://openwho.org/courses/infodemic-
management-101).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).

WHO benchmarks for strengthening health emergency capacities

z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
260
 17
Points of entry and border health
States Parties must designate international airports and ports (and, where justified for public health reasons, a State Party may designate ground crossings) at
which it must implement and maintain core public health capacities required to prevent, detect and manage a variety of public health risks using a multisectoral
approach (IHR Annex 1B). The management of health threats and events at points of entry (PoE) requires effective communication and collaboration among
many sectors, including health, foreign affairs, customs, interior affairs, security, transport, tourism and migration, among others. In addition, States Parties
must also have effective multisectoral capacities at the national level to decide upon the adequate use of travel-related measures during a health emergency.

IMPACT:
Timely detection of and effective response to any potential hazards that occur at or may be spread via PoE.

MONITORING AND EVALUATION:

(1) Routine core capacities (as prescribed in the IHR Annex 1B 1) are implemented at all times at all designated PoEs with an all hazard and
multisectoral approach, integrated into national surveillance systems, exercised (as appropriate), reviewed, evaluated, updated and improved
on a regular basis. (2) All PoE health emergency contingency plans for all hazard events are developed and integrated into national emergency
response plans, exercised (as appropriate), reviewed, evaluated and updated on a regular basis. (4) A risk-based approach is taken toward the
use of international travel-related measures during health emergencies. (3) National multisectoral process and mechanisms to determine the

WHO benchmarks for strengthening health emergency capacities

adoption of international travel related measures on a risk-based manner are being implemented at national and subnational levels, including
guidelines and SOPs for their implementation, and are exercised (as appropriate), reviewed, evaluated and updated on a regular basis or in
response to an event or emergency.
261
 BENCHMARK 17.1: Routine core capacities at points of entry (PoEs) are in place
OBJECTIVE: To have established routine capacities at designated PoEs

CAPACITY LEVEL BENCHMARK ACTIONS

z Country has not undertaken a strategic risk assessment to designate individual PoEs.

01
NO CAPACITY

z Conduct strategic risk and capacity assessments to inform and prioritize selection of key PoEs for IHR designation.
02 z Designate PoEs according to IHR requirements and identify competent authorities at designated PoE.
LIMITED z Identify key relevant stakeholders for establishing and maintaining core capacities at each designated PoE in a multisectoral
CAPACITY manner.
z Develop a plan to establish and maintain all the routine capacities prescribed in the IHR Annex 1B.
z Establish some capacities at some designated PoEs such as the development and implementation of SOPs and training
packages for routine capacities, the provision of adequate resources including space, equipment and premises for the
management of public health events, and resources for the inspection of conveyances and the control of vectors and
reservoirs in and near PoEs as per the requirements in IHR Annex 1B.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Participation by all relevant stakeholders across sectors (e.g. transport, customs, migration, law enforcement, environment,
veterinary services, food safety) to inform decisions on their potential designation under the IHR.

WHO benchmarks for strengthening health emergency capacities

z Allocate sustainable funds for the implementation of the plan to have all routine capacities prescribed in IHR Annex 1B in

03 place and functioning in at least some designated PoEs, for all hazards, including biological.
DEVELOPED z Conduct regular trainings to ensure that all relevant staff at some designated PoEs are knowledgeable about the SOPs for
CAPACITY the establishment and maintenance of core capacities for all hazards, and that these are functional, as per IHR Annex 1B.
z Integrate surveillance activities in at least some designated PoEs within the national surveillance system for all hazards,
including biological.
262
 z Conduct regular M&E exercises, such as SimEx/AAR/IAR (as relevant), to assess the functionality and sustainability of core
capacities at some designated PoEs.

Participation and contribution of other sectors to actions:

1, 2, 3, 4
z Sharing of information and pooling of available resources regularly by key stakeholders in relevant sectors with the public
health sector to maintain routine core capacities at some PoEs.

z Allocate adequate resources to maintain routine capacities for all hazard prevention, detection and response at all

04 designated PoEs.
DEMONSTRATED z Implement the plan to have all routine capacities prescribed in IHR Annex 1B in place and functioning in all designated
CAPACITY PoEs and for all hazards.
z Develop and implement SOPs for the establishment and maintenance of functional core capacities as per Annex 1B and
train and assign staff at all designated PoEs to respond to routine public health events for all hazards.
z Integrate all designated PoEs into the national surveillance systems for all hazards with the involvement of relevant
sectors.
z Formalize agreements with neighbouring countries for rapid and secured sharing of data and information on health risks
and emergency events at and around PoEs, in particular at ground crossings in high risk areas and where communities
adjacent to borders are deeply integrated.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5

WHO benchmarks for strengthening health emergency capacities

z Support from finance ministry and foreign affairs ministry to mobilize national resources, and external resources if needed,
to maintain the routine capacities at all designated PoEs.
263
 z Mobilize staff and provide sustainable funds for the regular implementation of M&E activities to ensure the continuous

05 functionality of all core capacities at all designated PoEs.

SUSTAINABLE z Use results from M&E, SimEx/AAR/IAR (as relevant) to fill any existing gaps identified in the operationalization of core
CAPACITY capacities at all designated PoEs.
z Share information and experiences on the continuous improvement and maintenance of routine capacities at PoEs by
engaging the country in peer-to-peer learning programmes at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3

WHO benchmarks for strengthening health emergency capacities

264
 BENCHMARK 17.2: Public health responses at PoEs are in place
OBJECTIVE: To strengthen capacity for effective public health response at PoEs

CAPACITY LEVEL BENCHMARK ACTIONS

z Public health emergency contingency plans for each designated point of entry to respond to health emergencies are not in

01 place or are in the process of being developed.

NO CAPACITY

z Identify designated PoEs that do not have a multisectoral health emergency contingency plan in place, or where a plan is
02 under development, and identify and convene all relevant stakeholders that need to be involved in the development of the
LIMITED multisectoral health emergency contingency plan at each designated PoE.
CAPACITY z Review and map the relevant laws, guidance and SOPs related to the response to a health emergency caused by a biological
hazard in at least some designated PoEs including in relation to sensitive issues such as: information sharing, management
of personal data, implementation of measures such as quarantine or closure of borders, etc.
z Conduct a public health risk assessment at/around some designated PoEs, including both sides of the border in the case of
ground crossings, to identify priority biological hazards as well as vulnerable populations that may be at higher risk.
z Develop a multisectoral health emergency contingency plan for events caused by biological hazards, including SOPs and
guidance following risk assessment, in at least some designated PoEs according to IHR Annex 1.
z Identify surge capacity to respond to a potential cross-border emergency public health threat at/around PoEs and document
the means to mobilize such surge capacity in the PoE multisectoral health emergency contingency plan and/or SOPs.
z Train border health staff on the multisectoral health emergency contingency plan and related guidance and SOPs for
responding to events due to biological hazards in some designated PoEs, and develop a regular training programme to

WHO benchmarks for strengthening health emergency capacities

promote continuous learning and refresher training for border health staff and possible surge staff.
z Allocate all necessary resources and associated funding, including human resources, infrastructure, equipment and other
materials, for the implementation of the emergency contingency plan during response to a health emergency caused by
biological hazards in some designated PoEs.
265
 Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6, 7
z Participation, by all relevant stakeholders across sectors, in the development and implementation of the PoE multisectoral
health emergency contingency plan for biological hazards, including through the identification of the necessary resources
for the implementation of cross-sectoral actions, the allocation of surge staff when needed and the implementation of
training programmes.

z Develop a multisectoral health emergency contingency plan for biological hazards in all designated PoEs with guidance

03 and SOPs for responding to public health events caused by biological hazards.
DEVELOPED z Integrate all designated PoEs, and some non-designated PoEs, into the national surveillance system to ensure the timely
CAPACITY sharing of information to inform the public health response.
z Integrate all designated PoEs into the national emergency preparedness and response plan with the involvement of
relevant sectors and services.
z Allocate resources including funds to all designated PoEs for implementation of the plan during public health events
caused by biological hazards.
z Demonstrate capacity to apply health measures related to travellers at PoEs and PoE environment for early detection,
assessment and containment of public health risks, isolation and safe transfer of sick travellers to appropriate medical
facilities at all designated PoEs.
z Organize regular trainings on and demonstrate knowledge of the required health related documents and the correct use of
information for detecting, reporting, assessing and providing first control measures to public health events, according to
type and kind of conveyances.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6
z Provide recommendations by relevant stakeholders to update, or develop new legislation or policies if required, to ensure
that the PoE multisectoral health emergency contingency plans are well integrated into other emergency response plans at
the PoE, subnational and national levels.
z Organize and support advocacy initiatives across relevant sectors for synchronized management of health emergencies at
PoEs through training, raising awareness of communities and sensitizing partners and journalists to ensure that accurate
266

information and education messages are disseminated across these networks.

 z Include all hazards (chemical, biological, radiological and nuclear) in the multisectoral health emergency contingency plan

04 in all designated PoEs and integrate into national emergency response plans.
DEMONSTRATED z Train staff of all designated PoEs on guidance and SOPs for responding to events due to any type of hazard, including care
CAPACITY of affected animals and referral mechanism in collaboration with the animal sector.
z Allocate resources including funds to all designated PoEs for implementation of the plan during any type of hazard event,
including care of affected animals and referral mechanism to veterinary services.
z Demonstrate capacity to apply all recommended health measures to travellers, animals and cargo, conveyances including
to disinfect, de-rat, disinsect, decontaminate or otherwise treat baggage, cargo, containers, conveyances, goods and postal
parcels.
z Establish isolation units to isolate and quarantine suspected human or animal cases of communicable diseases and
establish a strategic stockpile157 of essential medical countermeasures based on the health emergency risk assessment
conducted at all designated PoEs.
z Constitute a roster of trained staff ready to be deployed as surge at PoEs to support rapid implementation of emergency
activities in line with national and international recommendations.
z Establish a PHEOC at major designated PoEs with material and functional equipment, updated SOPs and staff trained.
z Conduct SimEx/AAR/IAR (as relevant) at regular intervals to test and review response capacities of all designated PoEs
and document results.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Involvement of relevant sectors in the implementation of the plan, including in the design and implementation of related
trainings and the identification of surge staff.

WHO benchmarks for strengthening health emergency capacities

z Identification by the animal health sector of veterinary centres to provide diagnostic tests, assessment and recommended
measures related to affected animals identified at PoEs.
267

157
The stockpile will be made of relevant medical devices, vaccines, drugs, biologicals, personal protective equipment and other medical supplies for early response to public health emergencies.
 z Demonstrate action to address recommendations for improvement based on the results of SimEx/AAR/IAR (as relevant).

05 z Update the PoE multisectoral health emergency contingency plan and related mechanisms, guidance and SOPs based on
SUSTAINABLE findings from evaluations and tests.
CAPACITY z Share best practices for continuous improvement with all relevant stakeholders.
z Communicate public health risks and related mitigation measures to multisectoral partners operating at PoEs, including
conveyance and PoE facility operators.
z Support research programmes to generate evidence on capacities required to manage health emergencies at PoEs.
z Share experiences from capacity development for the management of health emergencies at PoEs and engage the country
in peer-to-peer learning programmes at the subnational, national and international levels.
z Draft, review and/or test joint strategies and procedures with neighbouring countries for the management of cross border
or international health emergencies at designated PoEs.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Support by relevant sectors to communicate public health risks and related mitigation measures in a joint and coherent
manner at the level of PoE.
z Involvement of all relevant stakeholders to support research programmes and sharing of experiences on all hazard health
emergency response at PoEs.

WHO benchmarks for strengthening health emergency capacities

268
 BENCHMARK 17.3: An effective multisectoral mechanism for risk-based approach to international travel related measures is in place
OBJECTIVE: To strengthen multisectoral capacities for applying a risk-based approach to the use of international travel related measures during health
emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z National multisectoral mechanism to conduct risk-based approaches for strategic planning for international travel-

01 related measures, including prevention, detection/investigation, response and recovery is not available, is ad hoc or
NO CAPACITY underdevelopment.

z Identify and map key stakeholders for the development and implementation of international travel-related measures including
02 prevention, detection/ investigation, response and recovery in relevant sectors (health, transportation, migration, customs,
LIMITED tourism, etc.) taking into consideration the entire traveller pathway from departure to transit and destination.
CAPACITY z Develop a national multisectoral strategy and advisory committee with ToRs (with identified roles and responsibilities) to
streamline public health risk assessments, the implementation of recommended international travel-related risk mitigation
measures (e.g. screening, contact tracing, quarantine, testing, immunization requirements, etc.), and risk communication.
z Review existing mechanisms for conducting risk assessments to inform travel related measures and related policy and legal
documentation in the country.
z Identify gaps and methods to streamline the risk assessment and communication processes for international travel related
threats which may require the use of travel-related measures.
z Develop a training package for multisectoral staff to operationalize international travel related measures at PoEs, national and
subnational levels.
z Develop a RCCE strategy to explain the rationale underpinning international travel related measures, create feedback loop

WHO benchmarks for strengthening health emergency capacities

mechanisms with affected populations and increase trust in the overall response.
z Identify cadre requirement/service requirement in health sector at designated PoEs to implement international travel related
measures.
z Document and test communication procedures between PoE and health authorities (through MoUs/other protocols).
Document, share and regularly update, contact details.

Participation and contribution of other sectors to actions:

269

1, 2, 3, 4, 5, 6, 7, 8
 z Develop or update legislation (relevant to screening, quarantine, testing, contact tracing, etc.) to enable the implementation

03 of international travel related measures based on identified risk level.

DEVELOPED z Convene the advisory committee/multisectoral stakeholder committee regularly and on occasions of at risk warnings to
CAPACITY implement relevant international travel related measures with rational collective decision-making.
z Develop SOPs/guidance for the operationalization of risk-based international travel-related measures when required at
national, subnational and PoE levels.
z Identify all relevant partners/agencies (from the public and private sector) that will be involved in or affected by
international travel related measures, maintain a database including contacts and introduce the strategy and related SOP/
guidance for active implementation.
z Operationalize the training package for multisectoral staff to implement international travel related measures at PoE,
national and subnational levels when required.
z Identify a focal point (unit/department/team) in the health ministry to coordinate with public health staff at designated
PoEs, relevant multisectoral stakeholders and international agencies to receive early warnings for the implementation,
calibration and lifting of risk-based international travel related measures.
z Provide adequate health staff and identify surge capacity for designated PoEs and other relevant health institutes as well
as logistics (such as entry and exit screening, testing laboratories, etc.) for the implementation of international travel
related measures.
z Identify designated centres to provide travel health assessments, immunization based on travel requirements and
prophylaxis as required.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 7, 8

WHO benchmarks for strengthening health emergency capacities

z Contribute (by relevant sectors) to the collective decision-making, implementation and communication of risk-based
international travel related measures at national and subnational levels and at PoEs, as required.
270
 z Identify multisectoral stakeholders/institutes/agencies at the subnational level to implement risk-based approach for

04 international travel related measures and maintain a database including contact details.
DEMONSTRATED z Conduct trainings on SOPs/guidelines for relevant multisectoral staff at all levels including the subnational level.
CAPACITY z Establish quick communication channels with relevant multisectoral stakeholders at all levels including subnational level.
z Implement risk-based strategies/SOPs/guidelines on national multisectoral process for international travel related
measures at the subnational level while continuing functioning at the national level.
z Implement appropriate RCCE practices to share information on the public health risk and mitigation measures, including
international travel-related measures, with all relevant stakeholders including the general public.
z Develop an M&E system to monitor the process and assess effectiveness and impact of the international travel measures
implemented, including any potential unintended consequences.
z Conduct regular risk assessments to update and adjust international travel-related measures, applying new information on
their effectiveness and impact as it becomes available.
z Conduct SimEx regularly on different components of international travel related measures (such as entry/exist screening,
contact tracing, quarantine) at different levels with involvement of multisectoral staff.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Actively participate (by all relevant actors) in the decision-making and implementation of international travel-related
measures at national and subnational levels.
z Share information on effectiveness and impact of international travel measures by all relevant stakeholders to ensure
timely course correction.

WHO benchmarks for strengthening health emergency capacities

z Conduct and document SimEx/AAR/IAR (as relevant) at least annually at premises of designated PoEs for entry/exit

05 screening, communication, testing, transport for referral hospitals, etc. using risk-based scenarios with multisectoral
SUSTAINABLE stakeholders.
CAPACITY z Conduct regular monitoring of the functionality and evaluation of the effectiveness and impact of risk-based international
travel related measures within country.
z Update SOPs/guidelines based on results of SimEx/AAR/IAR (as relevant), addressing identified gaps.
271
 z Continue implementation of national multisectoral processes and mechanisms to determine the adoption of international
travel related measures at all levels and that they are exercised (as appropriate), reviewed, evaluated and updated on a
regular basis, in response to an event or emergency.
z Provide regular updates from risk assessment teams with an all hazard approach to timely initiate relevant international
travel related measures commensurate with risk level, with multisectoral involvement.
z Maintain good collaboration with regional and global networks/agencies for early warning and travel health.
z Identify best practices and share among multisectoral teams at all levels and with international platforms for peer learning.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Update legislations and plans in relevant sectors to support sustainable implementation.

Tools:
z International Health Regulations (2005): assessment tool for core capacity requirements at designated airports, ports and ground crossings. Geneva:
World Health Organization; 2009 (https://apps.who.int/iris/handle/10665/70839).
This document was developed to support States Parties in assessing existing capacities and capacity needs at points of entry when deciding which
airports, ports and ground crossings to designate under Article 20.1 and Annex 1B. It includes an Excel spreadsheet file model for IHR core capacities
assessment at ports, airports and ground crossings.
z Coordinated public health surveillance between points of entry and national health surveillance systems: advising principles. 1st edition. Geneva: World
Health Organization; 2014 (https://apps.who.int/iris/handle/10665/144805).
This document provides steps for implementing/strengthening communication mechanisms and defines criteria for deciding what and how events

WHO benchmarks for strengthening health emergency capacities

should be reported between points of entry and the national health surveillance system.
z Handbook for the management of public health events in air transport: updated with information on Ebola virus disease and Middle East respiratory
syndrome coronavirus. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/handle/10665/204628).
This document is complementary to other WHO publications addressing risk assessment at a national level, contingency planning at points of entry,
establishment of capacities and application of emergency plans at the airport level.
272
 z Handbook for management of public health events on board ships. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/
handle/10665/205796).
This document aims to provide technical advice to competent authorities at the port level for management of public health events aboard ships. It
complements other WHO publications addressing risk assessment at the national level; contingency planning at ports, airports and ground crossings;
and establishment of capacities and application of emergency plans at the port level.
z Handbook for inspection of ships and issuance of ship sanitation certificates. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/
handle/10665/44594).
This handbook is based on the IHR (2005) provisions regarding ship inspections and issue of Ship Sanitation Certificates. It provides guidance for
preparing and performing inspection, completing the certificates and applying public health measures within the framework of the IHR (2005).
z Vector surveillance and control at ports, airports, and ground crossings. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/
handle/10665/204660).
This handbook provides technical advice for developing a comprehensive programme for systematic monitoring of disease vectors and integrated
vector control at points of entry, based on IHR requirements.
z WHO interim guidance for Ebola event management at points of entry. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/
handle/10665/131827).
Technical guidance set on Ebola virus disease preparedness and response aims to: (i) provide early detection of potentially infected persons; (ii)
assist in implementing WHO recommendations related to Ebola management; and (iii) prevent the international spread of the disease while allowing
authorities to avoid unnecessary restrictions and delays at points of entry.
z Technical considerations for implementing a risk-based approach to international travel in the context of COVID-19: Interim guidance, 2 July 2021.
Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/WHO-2019-nCoV-Risk-based-international-travel-2021.1).
z WHO Guide to ship sanitation. Third edition. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/handle/10665/43193).

WHO benchmarks for strengthening health emergency capacities

The primary aim of the revised guide to ship sanitation is to present the public health significance of ships in terms of disease and to highlight the
importance of applying appropriate control measures.
z Guide to hygiene and sanitation in aviation. 3rd Edition. Geneva: World Health Organization; 2009 (https://apps.who.int/iris/handle/10665/44164).
This document addresses water and cleaning and disinfection of facilities with guidelines that provide procedures and quality specifications that are to
be achieved.
273
 z International Health Regulations (2005): a guide for public health emergency contingency planning at designated points of entry. Geneva: World Health
Organization; 2012 (https://www.who.int/publications/i/item/9789290615668).
This guide was designed to assist WHO Member States, both large and small, to bridge the gap between the legal requirements of IHR and the
pragmatic readiness and response capacity for public health emergencies at designated points of entry.
z Handbook for public health capacity-building at ground crossings and cross-border collaboration. Geneva: World Health Organization; 2020 (https://
www.who.int/publications/i/item/handbook-for-public-health-capacity-building-at-ground-crossings-and-cross-border-collaboration).
z WHO aircraft disinfection methods and procedures. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/
item/9789240014459).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

274
 18
Chemical events
States Parties will have surveillance and response capacity for chemical risks or events. This requires effective communication and collaboration among
the sectors responsible for chemical safety, including health, occupational health, emergency management, industry, transportation, safe waste disposal,
agriculture, animal health and the environment..

IMPACT:
Timely detection of and effective response to potential chemical risks and/or events in collaboration with other sectors responsible for chemical
safety, industries, transportation and safe waste disposal.

MONITORING AND EVALUATION:

Mechanisms and an enabling environment are established and functioning for preventing, detecting and responding to chemical events or
emergencies.

WHO benchmarks for strengthening health emergency capacities

275
 BENCHMARK 18.1: Mechanisms are in place for surveillance, alert and response to chemical events or emergencies, supported by an enabling
environment
OBJECTIVE: To establish policies, legislation, plans and capacities for surveillance, alert and response to chemical events or emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z No mechanism to detect and respond to chemical events, poisonings or emergencies is in place.

01 z National policies, plans or legislation for chemical event surveillance, alert and response do not exist.
NO CAPACITY

z Assess existing policies, legislation, plans and capacities for chemical event surveillance, alert and response in relevant
02 sectors and existing laboratory capacities for the analysis of human and environmental samples to inform the assessment
LIMITED and manage investigation of chemical events and poisonings.
CAPACITY z Establish a multisectoral steering committee consisting of key stakeholders from relevant sectors with identified roles,
responsibilities and ToRs to enable agreed risk profiling, prioritization, planning and implementation.
z Develop strategies, guidelines/manuals and SOPs for surveillance, alert and response to chemical events and emergencies
including for laboratories and develop training packages on these guidelines and SOPs.
z Conduct risk profiling to identify hazard sources (including sites, transport and issues at point of use), likelihood and severity,
based on populations at risk and potential nature of an incident.
z Identify and describe priority chemical events to inform planning. This process can include conducting an inventory of
potentially hazardous chemical sites and manufacturing facilities and a review of past chemical events.
z Assess capacities for chemical event surveillance, alert and response, including health sector workforce, identification and
availability of medical countermeasures and antidotes for high risk chemical hazards and overall health system response

WHO benchmarks for strengthening health emergency capacities

capacity.
z Develop a roadmap/action plan to support the delivery of a sustainable national poisons centre, or equivalent.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7
z Identify and map all public and private sector stakeholders involved in chemical industries or activities generating chemical
276

risks and establish focal points for coordination and collaboration for chemical event surveillance, alert and response.
z Conduct a multiagency situational analysis/review to understand data availability, data sources, pathway of data flow and
receptors towards the development of the surveillance system for chemicals.
 z Develop all the necessary policies and legislation for chemical event surveillance, alert and response.

03 z Develop event response plans at all levels with the involvement of relevant stakeholders and ensure the following:
DEVELOPED ƒ Map and review all hazardous sites and facilities
CAPACITY
ƒ Define roles and responsibilities of relevant agencies for response during events
ƒ Prepare protocols for the investigation and verification of chemical events and poisoning, including through laboratory
testing
ƒ Assess training needs and develop a training plan
ƒ Conduct training of personnel at relevant agencies and facilities
ƒ Implement SOPs for coordination and collaboration during chemical events.
z Establish a surveillance system based on the strategy, guidelines, SOPs for surveillance, alert and response to chemical
events.
z Put in place agreements with designated quality assured laboratories (national or in other countries) for timely analysis of
biological and environmental samples with suspected chemical exposure.
z Establish a system for a national poisons centre to receive information on the composition of hazardous products
(detergents, paints, adhesives, etc.) imported and sold in the country.
z Develop capacities for diagnosis and treatment of chemical poisonings and establish a poison information service, as a
part of the national poisons centre, that operates at least during office hours. Procure and ensure access to a stockpile of
medical countermeasures and antidotes required for high risk chemical hazards.
z Collect technical factsheets on chemical hazards based on the list of priority chemical events in the country and develop or
adapt them according to the risk profile and country context. Distribute the list to all relevant stakeholders.

WHO benchmarks for strengthening health emergency capacities

z Establish networks with all relevant sectors for preparedness and response to chemical and radiation emergencies.
z Develop plans for the management of chemical waste.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9
277
 z Establish links with key international chemical/toxicology networks158 to provide support for the management of chemical

04 events and poisonings.

DEMONSTRATED z Conduct regular training on surveillance, alert and response to chemical events and poisonings for relevant personnel,
CAPACITY including sensitizing all relevant health and other sector workers on medical protocols.
z Share, on a routine basis, information on chemical events, chemical event risk assessments and response actions with
relevant agencies.
z Monitor, on a routine basis, the timeliness of the information sharing mechanism about events and potential risk.
z Provide adequate resources to the national poison information service159 to operate on a 24/7 basis and integrate the
poisons information service into the public health surveillance system.
z Organize advocacy initiatives including disseminating accurate messages on chemical risks and conducting community
awareness of chemical safety, including what to do in the case of a chemical poisoning/event and the contact details of
national poisons centres/information services.
z Conduct SimEx/AAR/IAR (as relevant) at designated hospitals or emergency units on managing mass casualty incidents
for chemical events (decontamination/PPE usage/handling casualties, etc.)
z Implement plans to establish an effective chemical waste management system in the country including collection, storage,
decontamination and treatment.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5 ,6, 7, 8

z Document and use M&E findings to assess, review and strengthen surveillance, alert and response including coordination

05 and communication and update plans and SOPs.

WHO benchmarks for strengthening health emergency capacities

SUSTAINABLE z Sustain a mechanism to conduct risk assessment and update risk profiling on a regular basis.
CAPACITY z Allocate adequate resources including dedicated funds for the poison centre(s).
z Develop a mechanism to integrate the systems of public health surveillance and environmental monitoring that capture
and assess chemical exposures from different sources.

158
Examples include the WHO global and regional toxicology networks and other regional networks, such as in the European Union, professional toxicology associations.
159
278

The poisons centre should be sufficiently staffed and resourced to provide a robust and reliable 24/7 service. The poisons centre should be well used by the population it serves (check number
of calls per day). Refer to Guidelines for establishing a poison centre (WHO, 2021)
 z Sustain a mechanism to ensure response capacity160 at national and subnational levels.
z Support research programmes to generate evidence on surveillance, alert and response to chemical events or
emergencies.
z Share country experience in surveillance, alert and response to chemical events or emergencies and engage the country in
peer-to-peer learning programmes at the subnational, national and international levels.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

Tools:
z Chemicals road map: workbook. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/handle/10665/273136).

z IOMF tool box for decision making in chemicals management. OECD (https://www.iomctoolbox.org/).

z WHO Manual for the Public Health Management of Chemical Incidents. Geneva: World Health Organization; 2009 (https://www.who.int/publications/i/
item/9789241598149).
z International Health Regulations (2005) and chemical events. Geneva: World Health Organization; 2015 (https://apps.who.int/iris/
handle/10665/249532).
z Guidelines for establishing a poison centre. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/338657).

z Manual for investigating suspected outbreaks of illnesses of possible chemical etiology: guidance for investigation and control. Geneva: World Health
Organization; 2021 (https://www.who.int/publications/i/item/9789240021754).
z Initial clinical management of patients exposed to chemical weapons: interim guidance document. Geneva: World Health Organization; 2014 (https://

WHO benchmarks for strengthening health emergency capacities

apps.who.int/iris/handle/10665/329541).
z Chemical releases caused by natural hazard events and disasters: information for public health authorities. Geneva: World Health Organization; 2018
(https://apps.who.int/iris/handle/10665/272390).

160
This includes setting minimum requirements for: local emergency planning and response activities (i.e. arrangements for scaling up capabilities of local emergency response, national support
279

mechanisms and infrastructure and alerting mechanisms); inspection of hazardous sites and assessment of emergency plans; and operators to comply and liaison with local governments.
see also: WHO manual: The public health management of chemical incidents. Geneva: World Health Organization; 2009.
 z International Chemical Safety Cards (ICSCs) [database]. Geneva: International Labour Organization; 2018 (https://www.ilo.org/dyn/icsc/showcard.
listCards3).
z International Programme on Chemical Safety and Organisation for Economic Co-operation and Development (IPCS). IPCS risk assessment
terminology. Geneva: World Health Organization; 2004 (https://apps.who.int/iris/handle/10665/42908).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

280
 19
Radiation emergencies
States Parties will have surveillance and response capacity for radiological and nuclear emergencies. This requires effective coordination, communication and
collaboration among all sectors involved in radiation emergency preparedness and response, including health, industry, transport, environmental protection,
food safety and consumer protection, law enforcement, civil defence and others.

IMPACT:
Timely detection and effective response to potential radiological and nuclear emergencies with cross-sectoral coordination.

MONITORING AND EVALUATION:

Mechanisms and an enabling environment are established and functioning for preventing, detecting and responding to radiological and nuclear
emergencies.

WHO benchmarks for strengthening health emergency capacities

281
 BENCHMARK 19.1: Mechanisms are in place for detecting and responding to radiological and nuclear emergencies, supported by an enabling
environment
OBJECTIVE: TO Establish policies, legislation, plans and capacities to detect and respond to radiological and nuclear emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z No mechanism (such as policies, plans, coordination and communication) is in place for the detection, assessment and

01 response to radiation emergencies.

NO CAPACITY

z Conduct a comprehensive assessment of potential radiological risks in the country, identify potential radiation emergency
02 scenarios and map high risk areas, most vulnerable regions and sites.
LIMITED z Review and identify gaps in legislation, policies and plans for the detection, assessment and response to radiation
CAPACITY emergencies.
z Identify key technical experts from relevant sectors to develop technical guidelines or SOPs for the management of radiation
emergencies (including risk assessment, reporting, event confirmation, notification and investigation).
z Develop policies, strategies, costed plans and SOPs for the detection, assessment and response to radiation emergencies,
including provisions for coordination and communication between relevant national authorities clearly indicating roles and
responsibilities (including those for the health authorities and IHR national focal points).
z Disseminate policies, plans and legislation for radiological event surveillance, alert and response to relevant stakeholders.
z Develop capacity to monitor radiation exposure in the environment, food and drinking water.
z Identify medical countermeasures required for radiation emergencies depending on the national risk profile, and develop a

WHO benchmarks for strengthening health emergency capacities

plan for procurement or access to such countermeasures.
z National competent authority licenses all activities involving radiation sources and collects and maintains a database of
available information on existing and potential radiological or nuclear hazards at the national and subnational levels.
z Identify, map and maintain a directory of stakeholders (including public and private sector) involved in all activities using,
generating, or disposing radiation and radioactive sources and responsible for radiation related hazards and emergency
responses.
282
 z Establish a multidisciplinary cross-sectoral coordination mechanism including sectors involved in radiation protection,
nuclear safety, meteorological services, environment, food safety, health, trade, travel, law enforcement, civil defence, security
and other relevant sectors involved in the surveillance, alert and response to radiation emergencies at the national and
subnational levels according to the national emergency response plan.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10

z Develop, evaluate and/or update technical guidelines or SOPs for the management of radiation emergencies (including risk

03 assessment, reporting, event confirmation and notification, and investigation).

DEVELOPED z Procure and establish access to a national stockpile of medical supplies required for nuclear and radiation emergency
CAPACITY countermeasures (as recommended by the WHO policy advice on stockpiles, 2023), and develop SOPs for use, storage,
deployment and replenishment.
z Designate health facilities and develop/maintain the capacity for clinical management of radiation injuries and plan for
building sustainable capacity for healthcare facility response to radiation emergencies.
z Develop case management guidelines to manage radiation injuries, contaminated casualties and internal contamination
(either as a standalone guideline or as part of the case management guidelines for all hazards).
z Train relevant health workers on the protocols and guidelines including management of radiation injuries, handling of
contaminated casualties and radioactive waste in hospitals and ensure health facilities have arrangements in place to
support these actions.
z Develop a mechanism for systematic information exchange between competent radiological authorities and human health
surveillance units about radiological events and potential risks.

WHO benchmarks for strengthening health emergency capacities

z Develop mechanisms to alert the population in a nuclear emergency (as well as for other disasters and emergencies) and
disseminate recommendations, taking into account the potential shutdown or failure of classic communication channels.
z Develop policies, protocols and strategies for national and international transport of radioactive materials, samples and
waste management and ensure the logistical requirements for transportation are in place.
z Develop guidelines for the management of radiological waste including that from hospitals and medical services.
z Establish a waste management site with the required capacity for monitoring it.
283

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10
 z Establish arrangements to rapidly facilitate the monitoring of populations at risk of having been contaminated in order to

04 mitigate contamination as necessary and/or provide reassurance that people are not contaminated at levels which require
DEMONSTRATED mitigation.
CAPACITY z Develop and conduct emergency response drills, SimEx/AAR/IAR (as relevant) on radiation emergencies and update the
response plan, mechanisms and guidelines accordingly.
z Respond to any radiological threats with joint risk assessment, investigation and implementation of the response plan.
z Share information with relevant stakeholders regularly on the risk and threats that are potential for emergencies.
z Regularly monitor (quantity and quality) of the national stockpile of medical nuclear and radiation emergency
countermeasures.
z Expand health facilities with capacity to manage patients of radiation emergencies.
z Provide arrangements for evacuation and relocation plans for high risk regions, premises and facilities.by national
competent authority.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7

z Document and disseminate best practices of test results and reviews.

05 z Conduct regular training of staff of health facilities to manage patients in the event of a radiation emergency.
SUSTAINABLE z Regularly review and adapt response plan, mechanisms and guidelines based on findings from emergency response drills
CAPACITY and SimEx/AAR/IAR (as relevant).
z Sustain a mechanism to establish the response capacity at national and subnational levels.
z Support research programmes to generate evidence for detecting and responding to radiological and nuclear emergencies

WHO benchmarks for strengthening health emergency capacities

for planning, prioritizing and decision-making processes.
z Share country experiences in surveillance, alert and response to radiological or nuclear events or emergencies and play a
mentoring role with other countries.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6
284
 Tools:
z Food and Agriculture Organization of the United Nations, International Atomic Energy Agency, International Civil Aviation Organization, International
Labour Organization, International Maritime Organization, Interpol, OECD Nuclear Energy Agency, Pan American Health Organization, Preparatory
Commission of the Comprehensive Nuclear-Test-Ban Treaty Organization, United Nations Environment Programme, United Nations Office for the
Coordination of Humanitarian Affairs, World Health Organization, World Meteorological Organization. Preparedness and Response for a Nuclear or
Radiological Emergency, IAEA Safety Standard Series No. GSR Part 7. Vienna: IEAA; 2015 (https://www.iaea.org/publications/10905/preparedness-
and-response-for-a-nuclear-or-radiological-emergency).
z Considerations in the Development of a Protection Strategy for a Nuclear or Radiological Emergency, Emergency Preparedness and Response. Vienna:
IAEA; 2021 (https://www.iaea.org/publications/14801/considerations-in-the-development-of-a-protection-strategy-for-a-nuclear-or-radiological-
emergency).
z Iodine thyroid blocking: Guidelines for use in planning for and responding to radiological and nuclear emergencies. Geneva: World Health Organization;
2017 (https://www.who.int/publications/i/item/9789241550185).
z TMT Handbook. Handbook for the management of the public in the event of a malevolent use of ionising radiation. Norway: SCK CEN, Norwegian
Radiation Protection Authority, Health Protection Agency, Radiation and Nuclear Safety Authority, World Health Organization, Enviros Consulting Ltd,
Central Laboratory for Radiological Protection; 2009 (www.tmthandbook.org).
z Radiation Emergencies [website]. Geneva: World Health Organization; 2023 (https://www.who.int/health-topics/radiation-emergencies/#tab=tab_1).

z Incident and Emergency Center [website]. Vienna: IAEA; 2023 (https://www.iaea.org/about/organizational-structure/department-of-nuclear-safety-

and-security/incident-and-emergency-centre).
z International Atomic Energy Agency [website]. Vienna: IAEA; 2023 (https://www.iaea.org/).

z IAEA safety glossary: 2018 edition. Vienna: IAEA; 2019 (https://www.iaea.org/publications/11098/iaea-safety-glossary-2018-edition).

z National stockpiles for radiological and nuclear emergencies: policy advice. Geneva: World Health Organization; 2023 (https://www.who.int/

WHO benchmarks for strengthening health emergency capacities

publications/i/item/9789240067875).
z Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).

z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).
285

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
 20
Public health and social measures
Public health and social measures (PHSM) are nonpharmaceutical interventions implemented by individuals, communities, governments and institutions to
reduce the risk and scale of epidemic- and pandemic-prone infectious disease transmission. They range from surveillance, contact tracing, mask wearing
and physical distancing to social measures, such as restricting mass gatherings and modifying school and business openings and closures. PHSM play
an immediate and critical role throughout the different stages of health emergencies and contribute to decreasing the burden on health systems so that
essential health services can continue and effective vaccines and therapeutics can be developed and deployed with their effects maximized to protect the
health of communities. If PHSM are not implemented with a focus on equity and consideration of risks and benefits, they can have unintended negative
consequences on the health and well-being of individuals, societies and economies, such as by increasing loneliness, food insecurity, the risk of domestic
violence and reducing household income and productivity.

IMPACT:
PHSM are systematically integrated into health emergency management plans, policies, financing, governance and leadership in all relevant
sectors at national, subnational and community levels across the health emergency actions, with consideration for interventions that are evidence-
driven, context-specific and sensitive to trade-offs between benefits and unintended negative consequences for individuals and communities.

MONITORING AND EVALUATION:

WHO benchmarks for strengthening health emergency capacities

(1) Establishment of a functional, multisectoral and multilevel (i.e. from the national government to the community level) structure for coordination
and integration of PHSM in existing governance and leadership mechanisms. (2) Context-specific, evidence-driven decisions on introducing,
adjusting and lifting PHSM, including systematic considerations to trade-offs between health benefits and unintended negative consequences.
(3) Establishment of a vertical governance mechanism to ensure sufficient communication and coordination between levels of government
(community, subnational and national) for PHSM.
286
 BENCHMARK 20.1: Leadership and governance dedicated to public health and social measures (PHSM) is in place in relevant sectors, at all levels and
between levels
OBJECTIVE: To establish and strengthen functional, multisectoral leadership and governance for PHSM that is embedded in health emergency
preparedness, response management and health system strengthening

CAPACITY LEVEL BENCHMARK ACTIONS

z No systematic, dedicated mechanism to guide implementation and adjustment of PHSM for emergency management.

01
NO CAPACITY

z Review current legislation and legal frameworks relevant to supporting and enabling PHSM implementation and identify any
02 gaps.
LIMITED z Assess and identify gaps in capacities of health and nonhealth sectors to implement, adjust and monitor PHSM to address
CAPACITY priority hazards for health emergencies.
z Involve multilevel161, multisectoral stakeholders in defining national strategies for PHSM and systematically integrating PHSM
in national and subnational emergency management plans/policies.
z Form a national working group with stakeholders from relevant sectors to develop common standards and strategic work
plans for health emergency preparedness and response.
z Link continuous risk assessments of epidemiological changes, health system capacity and contextual factors to PHSM policy
design, to inform the introduction, adjustment and phasing out of PHSM at national and subnational levels.
z Develop a mechanism to systematically include the evaluation of PHSM in health emergency AARs/IARs.

WHO benchmarks for strengthening health emergency capacities

Participation and contribution of other sectors to actions:
1, 2, 3, 4, 5, 6
287

161
I.e. from the national government to the community level
 z Establish a dedicated PHSM team in the health ministry to coordinate and manage PHSM strategic and operational

03 activities, including PHSM policy monitoring and advice, coordination, leadership and research.
DEVELOPED z Form an interdisciplinary, multilevel expert advisory group at the national level to maximize the use of best available
CAPACITY evidence on PHSM and employ precautionary principles when robust context specific data and research are limited to
enable and strengthen evidence-informed decision-making for PHSM.
z Initiate multilevel, multisectoral tracking of PHSM policy, implementation and adherence at the beginning of a health
emergency and maintain tracking to inform adjustment and phasing out of PHSM as required.
z Regularly assess the benefits versus unintended negative consequences of PHSM during health emergencies and
implement relevant social protection policies to reduce negative consequences across health, social and economic factors.
z Train and provide ongoing development opportunities for policy-makers and practitioners in health and nonhealth sectors
to introduce, implement, adjust and phase out context specific, equitable and balanced PHSM policies.
z Systematically integrate PHSM indicators into existing M&E efforts for health emergency management and health systems
core capacities.
z Conduct AARs/IARs for PHSM policy, implementation, adjustment and adherence including experts from relevant sectors,
communities and professional associations.
z Secure staff, funds, materials and facilities to mainstream and strengthen PHSM in health emergency management
while identifying resources and developing mechanisms to swiftly raise and allocate funds for rapid expansion of country
capacity for PHSM during health emergencies.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8

WHO benchmarks for strengthening health emergency capacities

z Systematic involvement from all relevant stakeholders in PHSM leadership and governance including M&E, reporting and
strategic planning.
z Regularly share timely information from PHSM focal points in relevant sectors to help inform PHSM actions.
288
 z Review and adjust PHSM policies and implementation based on timely and regular assessment of data through close

04 community engagements and communicate effectively and transparently to the public.

DEMONSTRATED z Develop a sustainable financial and human resource plan at all levels for PHSM coordination.
CAPACITY z Routinely monitor PHSM and related population response and uptake in a harmonized manner.
z Expand partnerships for a whole-of-society approach for collaborative capacity-building, strategic planning and monitoring
of PHSM.
z Develop partnerships with and build core capacities of CSOs and community leaders to increase community engagement,
trust and adherence to PHSM.
z Develop a national research agenda for PHSM and provide support to conduct studies to measure the effectiveness,
impact and contextual factors related to PHSM.
z Utilize a whole-of-society, whole-of-government approach to integrate PHSM in NHPSPs.
z Establish whole-of-government mechanisms with well defined governance and mandates to implement relevant PHSM.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5, 6, 7, 8
z Establish a coordinating team among PHSM focal points in all relevant sectors and identify a network of experts from
relevant disciplines for collaboration and consultation on PHSM.
z Integrate policies and strategies to strengthen research capacities in nonhealth sectors and catalyse PHSM research,
including studies on the social and economic impacts of PHSM.

z Review and adjust existing legislation, regulations, mechanisms and mandates of all relevant sectors based on M&E
outcomes for effective implementation of PHSM.

WHO benchmarks for strengthening health emergency capacities

05
SUSTAINABLE z Establish and continuously update a network of multidisciplinary experts trained in precautionary principles, risk-based
CAPACITY approaches, evidence synthesis and knowledge translation for multihazard PHSM decisions before emergencies and
activation during health emergencies.
z Disseminate good practices, lessons learned and outcomes of PHSM among experts, decision-makers, community, etc. in
consideration of contextual factors.
z Document and share lessons learned and experiences in implementing and improving PHSM by engaging the country in
peer-to-peer learning programmes at the subnational, national and international levels.
289
 z Provide strategic and technical support to other countries as requested including through bilateral and regional
arrangements.

Participation and contribution of other sectors to actions:

1, 2, 3, 4, 5
z Establish plans for whole-of-society approaches to fully engage communities in PHSM decisions and implementation.
z Collaboration across all relevant sectors to develop legislation and policies that offer adequate social protection for
individuals and communities, especially those in vulnerable conditions, to mitigate social and economic consequences of
PHSM.

Tools:
z Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza. Geneva: World Health
Organization; 2019 (https://www.who.int/publications/i/item/non-pharmaceutical-public-health-measuresfor-mitigating-the-risk-and-impact-of-
epidemic-and-pandemic-influenza).
z Considerations for implementing and adjusting public health and social measures in the context of COVID-19. Interim guidance – 30 March 2023.
Geneva: World Health Organization; 2023 (https://www.who.int/publications/i/item/who-2019-ncov-adjusting-ph-measures-2023.1).
z Measuring the effectiveness and impact of public health and social measures [website]. Geneva: World Health Organization; 2023 (https://www.who.
int/activities/measuring-the-effectiveness-and-impact-of-public-health-and-social-measures).
z Report of the WHO global technical consultation on public health and social measures during health emergencies: online meeting, 31 August to 2
September 2021. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/352096).

WHO benchmarks for strengthening health emergency capacities

z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
290
 21
Additional benchmarks for health emergency capacities beyond IHR
The 62 benchmarks above focus on strengthening health emergency capacities for IHR and HEPR, the following 18 additional benchmarks focus on HEPR
capacities beyond IHR. Please see Annex 2 for mapping of all benchmarks against IHR MEF (JEE and SPAR) and HEPR.

Collaborative surveillance
Health service capacity, access and usage monitoring
Collaborative surveillance objectives include establishing comprehensive surveillance mechanisms that encompass various health-related factors to detect
and monitor diseases, threats and vulnerabilities. By implementing such systems, countries can enhance their ability to identify and respond to emerging
health risks in a timely and effective manner. Health service monitoring is an integral component to achieve this, working in conjunction with public health
surveillance to enhance emergency preparedness and response. Enhancing these systems may provide a dynamic assessment of health system resilience,
enabling effective emergency planning and response efforts by informing the optimization of healthcare services and interventions, and contributing to
response monitoring activities.

Health service monitoring complements public health surveillance for emergency preparedness and response by providing a dynamic picture of the resilience
of health systems, this includes: regular monitoring and reporting of key metrics on health service capacities, access and usage to provide a dynamic picture
of contemporary and projected system resilience; and health service monitoring capacities interconnected with response mechanisms, with the necessary

WHO benchmarks for strengthening health emergency capacities

flexibility to surge and adapt surveillance to all types of emergencies, including capacity to rapidly assess impacts of major disasters. Data derived from
the monitoring of health service capacity, access and usage should be systematically integrated with contextual insights, including insights on risk and
vulnerability, derived from other diverse sources of data.
291
 IMPACT:
Health emergency management is enhanced by monitoring health service availability, capacity, access and usage, alongside complementing
public health surveillance, to respond in a more timely and effective manner.

MONITORING AND EVALUATION:

(1) Key metrics related to health service availability, capacities, access and usage are defined and monitoring implemented. (2) Health service
availability, capacities, access and usage monitoring is integrated and intraoperational with specialized health information systems162. (3) Health
service monitoring as an integral part of the healthcare system.

WHO benchmarks for strengthening health emergency capacities

162
Such as health management and information systems, logistic management and information systems, human resources information system, health facility registry, and routine surveillance
292

systems and community-based surveys.

 BENCHMARK H1.1: A resilient monitoring system is established and fully functional to routinely monitor the key metrics of health service availability,
capacity, access and usage
OBJECTIVE: To establish a systematic routine monitoring mechanism of key metrics for health service availability capacity, access and usage, aiming to
support effective health emergency preparedness, planning and response efforts

CAPACITY LEVEL BENCHMARK ACTIONS

z There are no existing mechanisms for systematic routine monitoring of key metrics for health service availability, capacity,

01 access and usage, or efforts are ad hoc.

NO CAPACITY

z Assess existing monitoring systems for health service capacity, access and usage to identify gaps, strengths and areas for
02 improvement.
LIMITED z Form steering and technical working committees (with ToR) to develop a national health service capacity, access and usage
CAPACITY monitoring framework, including the context of emergencies.
z Define the key metrics of health service capacity, access and usage to be incorporated into the national monitoring framework
and identify existing and new data sources for monitoring the key metrics.
z Assign a nodal agency/entity responsible for coordination and communication in relation to development and implementation
of the monitoring framework.
z Conduct stakeholder analysis within and beyond health sectors for monitoring of health service capacity, access and usage.
z Explore pathways for community engagement to incorporate local level readiness and capacities into the national monitoring
framework.

WHO benchmarks for strengthening health emergency capacities

z Collect, compile and analyze lessons learned from health emergencies to inform data sources, analysis and utilization of key
metrics related to health service capacity, access and usage, with a particular focus on health emergency management and
the continuity of essential health services.

z Develop a national health service capacity, access and usage monitoring framework that illustrates strategies, approaches,

03 tools and resources to systematically monitor the defined key metrics for health service availability, capacity, access and
DEVELOPED usage.
CAPACITY z Identify, adapt and implement internationally recommended standards and tools to ensure consistent and accurate data
293

collection.
 z Establish mechanisms to connect routine health information systems, including health service monitoring, with the public
health surveillance system to facilitate data integration and sharing.
z Develop a data governance and sharing policy along with a data quality and structure assurance mechanism to facilitate
data sharing and quality.
z Develop capacity-building trainings, services and rescources for the collection, analysis and interpretation of data for
relevant health personnel.
z Design a mechanism to facilitate interconnectedness between health service monitoring capacities and health emergency
response mechanisms, to support a coordinated and agile health emergency response.
z Foster collaboration and information sharing among health and other relevant sectors to enhance coordination and data
exchange for health service monitoring.
z Develop and implement community engagement strategies to actively involve local communities in health service capacity,
access and usage monitoring.

z Implement the national health service capacity, access and usage monitoring framework in a phased manner across all

04 levels (national, subnational and local).

DEMONSTRATED z Enable integration and interoperability of key metrics of health service availability, capacity, access and usage in routine
CAPACITY specialized health information systems such as health management and information systems, logistic management and
information systems, human resources information systems, health facility registries, and routine surveillance systems
and community-based surveys.
z Implement capacity-building initiatives and training programs aimed at enhancing the skills and knowledge of relevant
healthcare personnel.
z Conduct periodic evaluations and audits of the monitoring systems to assess effectiveness and identify opportunities for

WHO benchmarks for strengthening health emergency capacities

improvement.
z Conduct periodic surveys/SimEx/AAR/IAR (as relevant) to explore factors of service utilization, barriers to access and
community needs during and after emergencies.
z Develop and implement protocols and systems that enable seamless data sharing and communication between health
service monitoring and emergency response entities.
z Explore and implement innovative technologies and approaches for data analytics, data quality and real time reporting, to
294

further enhance the timeliness, accuracy and flexibility of health service monitoring to respond to diverse emergencies with
minimal impact on routine data collection.
 z Enhance community collaboration to optimize information collection on vulnerability, risk mapping, demand and access to
health services.
z Increase collaborative partnerships with nonhealth sectors to facilitate efficient monitoring of health service availability,
capacity, access and usage during health emergencies.

z Regularly review and update the national health service capacity, access and usage monitoring framework to adapt to

05 evolving health challanges, emerging needs and M&E outcomes.

SUSTAINABLE z Institutionalize health service monitoring as an integral part of the healthcare system, ensuring dedicated resources and
CAPACITY funding for long term sustainability.
z Conduct regular M&E to assess the integration and interoperability of health service monitoring and public health
surveillance.
z Regularly engage in capacity-building initiatives and training programs to further enhance the skills and knowledge of
relevant healthcare personnel.
z Consolidate and strengthen community collaboration for comprehensive information collection on vulnerability, risk
mapping, and the demand and access of health services.
z Promote knowledge sharing and best practices through regional and global networks, contributing to the advancement of
health service monitoring methodologies.

Tools:
z Defining collaborative surveillance: a core concept for strengthening the global architecture for health emergency preparedness, response, and
resilience (HEPR). Geneva: World Health Organization; 2023 (https://www.who.int/publications/i/item/9789240074064).

WHO benchmarks for strengthening health emergency capacities

z “Crafting the mosaic” a framework for resilient surveillance for respiratory viruses of epidemic and pandemic potential. Geneva: World Health
Organization; 2023 (https://www.who.int/publications/i/item/9789240070288).
z Health Service Data. World Health Organization. (https://www.who.int/data/data-collection-tools/health-service-data)

z SCORE for Health Data Technical Package. World Health Organization. (https://www.who.int/data/data-collection-tools/score)

z Sharing and reuse of health-related data for research purposes: WHO policy and implementation guidance. Geneva: World Health Organization; 2022
(https://www.who.int/publications/i/item/9789240044968).
295
 z Social innovation in health monitoring and evaluation framework. Geneva: World Health Organization; 2021 (https://fctc.who.int/publications/i/item/
social-innovation-in-health-monitoring-and-evaluation-framework).
z Analyzing and using routine data to monitor the effects of COVID-19 on essential health services, A Practical guide for national and subnational
decision-makers, interim guidance, Geneva: World Health Organization: 2021 (https://www.who.int/publications/i/item/who-2019-nCoV-essential-
health-services-monitoring-2021-1)
z Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens. Geneva: World
Health Organization and the United Nations Children’s Fund (UNICEF); 2022. Licence: CC BY-NC-SA 3.0 IGO (https://www.who.int/publications/i/
item/9789240044210)
z Harmonized Health Facility Assessment (HHFA). World Health Organization. (https://www.who.int/data/data-collection-tools/harmonized-health-
facility-assessment/introduction)
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).   
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).     
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).      
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)     

WHO benchmarks for strengthening health emergency capacities

296
 Genomic surveillance
The goal of genomic surveillance is to strengthen and scale up the monitoring of pathogens with pandemic and epidemic potential, enabling appropriate
public health actions within local to global surveillance systems. This necessitates the expansion of laboratory capacity and collaboration, particularly in
the field of genomics. Robust diagnostics and laboratory capacity are crucial, allowing for swift response to emergencies and leveraging the involvement
of all sectors within the One Health framework. This includes: facilitating access to genomic and phenotypic characterization of pathogens; sufficient and
purpose-built laboratory capacity; implementing quality management systems for laboratory testing; and fostering an innovation and research ecosystem
that responds to the local, national and global needs for affordable and scalable technologies.

IMPACT:
Timely public health decision-making is informed by genomic surveillance for pathogens with pandemic and epidemic potential.

MONITORING AND EVALUATION:

(1) Genomic surveillance systems are established and operational, either in country or through access to networks/regional laboratories, to
analyze pathogens of pandemic and epidemic potential. (2) A national genomic surveillance strategy or action plan for pathogens with pandemic
and epidemic potential is available and implemented. (3) Collaboration with global surveillance systems is established and adherence to global
data sharing standards is maintained.

WHO benchmarks for strengthening health emergency capacities

297
 BENCHMARK H1.2: Genomic surveillance systems are in place and functional
OBJECTIVE: To strengthen and sustain genomic surveillance capabilities to enable timely and effective decision-making for pathogens with pandemic/
epidemic potential, within a One Health framework

CAPACITY LEVEL BENCHMARK ACTIONS

z Genomic surveillance systems are not in place, genomic sequencing is conducted ad hoc, or the country does not have

01 access to networks or regional laboratories with genomic sequencing capacities to support national pandemic/epidemic
NO CAPACITY surveillance systems or disease control programmes163.

z Identify a national multisectoral committee (with ToR) with relevant stakeholders to contribute to the strengthening of
02 genomic surveillance and coordinate effective collaboration between stakeholders such as national public health institutes
LIMITED and relevant partners.
CAPACITY z Map existing or potential genomic surveillance capacity within the country, including an alignment with existing laboratory
capacity assessments to assess potential capability for performing genomic sequencing (facilities, personnel, equipment,
logistics, etc.).
z Map existing pathways to access a network or regional laboratory for genomic sequencing and analytical capacities, and use
regional or international laboratories to conduct sequencing for pandemic/epidemic surveillance systems or disease control
programmes.
z Use genomic surveillance reports/assessments generated by WHO or international reference laboratory networks to inform
local public health decisions.
z Develop a national genomic surveillance strategy or action plan for pathogens with pandemic and epidemic potential164,
including identifying the key pandemic/epidemic genomic surveillance use cases relevant to country context.

WHO benchmarks for strengthening health emergency capacities

z Develop material and mechanism to advocate for the integration of genomic surveillance for routine pandemic/epidemic
surveillance systems or disease control programmes.

163
Pandemic/epidemic surveillance systems or disease control programme use cases include, but are not limited to, SARS-CoV-2, influenza, arbovirus, cholera, viral haemorrhagic fevers, polio,
measles and rubella.
298

164
Considerations for developing a national genomic surveillance strategy or action plan for pathogens with pandemic and epidemic potential. Geneva: World Health Organization; 2023. Licence:
CC BY-NC-SA 3.0 IGO
 z Implement the national genomic surveillance strategy or action plan for pathogens with pandemic/epidemic potential,

03 including the development or implementation of guidelines, procedures and tools to support effective implementation.
DEVELOPED z Increase access to efficient sampling, collection, sequencing, analysis, interpretation and surge capacities, through access
CAPACITY to networks and regional laboratories, and continue to regularly use regional or international laboratories to conduct
sequencing for pandemic/epidemic surveillance systems or disease control programmes until capacities are developed
within the country.
z Identify relevant (WHO) global standards on data sharing for genomic surveillance and establish mechanisms to align
current agreements, data sharing platforms and privacy protection as relevant.
z Continue to use genomic surveillance reports/assessments generated by WHO or international reference laboratory
networks to inform local public health decisions.
z Conduct advocacy to relevant stakeholders, including multisectoral ministries, agencies and funding agencies to support
implementation of national strategy or action plan.
z Establish collaborations with international reference laboratories, research networks or training/knowledge exchange
platforms to support the use of genomic surveillance as part of pandemic/epidemic surveillance system or disease control
programmes.

z Regularly revise the national genomic surveillance strategy or action plan to reflect current threats and adapt to potential

04 future threats, and relevant related guidelines, procedures and tools are assessed regularly and updated accordingly.
DEMONSTRATED z Increase in-country sequencing infrastructure165 and human workforce for sequencing or access to regional or
CAPACITY international laboratories as part of pandemic/epidemic surveillance systems or disease control programmes.
z Generate and use genetic sequencing data to inform risk assessments and public health decisions both locally and
regionally/globally.

WHO benchmarks for strengthening health emergency capacities

z Test the quality and timeliness of the national genomic surveillance system through SimEx/AAR/IAR (as relevant) to
confirm the system’s readiness for a novel pathogen response.
z Participate in quality assessment programmes in genomic sequencing.
z Apply global data access principles, agreements and standards for responsible use of genetic sequence data.
299

165
Including sufficient, stable and secure data management systems.
 z Advance collaborations with international reference laboratories, research networks and training/knowledge exchange
platforms to support use of genomic surveillance as part of pandemic/epidemic disease control programmes and
participate in relevant training programmes.
z Establish national financing for at least one genomic surveillance pandemic/epidemic use case.
z Participate in genomic surveillance global/regional norms, standards and system setting activities.

z Review and update the national genomic surveillance strategy or action plan based on M&E outcomes.

05 z Establish a network of national and subnational laboratories that provide specimens or genomic data in a timely manner to
SUSTAINABLE inform national genomic surveillance objectives for priority pandemic/epidemic pathogen use cases.
CAPACITY z Routinely test the quality and timeliness of the national genomic surveillance system through SimEx/AAR/IAR (as relevant)
to confirm the system’s readiness for a novel pathogen response.
z Routinely participate in quality assessment programmes for genomic sequencing, and implement a national quality
assessment programme if appropriate.
z Routinely apply data access principles, agreements and standards for responsible use of genetic sequence data.
z Generate and use genetic sequencing data to inform risk assessments and public health decisions both locally and
regionally/globally.
z Secure national financing for all priority pandemic/epidemics genomic surveillance use cases.
z Use national expertise in genomic surveillance to drive, inform and guide global norms, standards and systems.

Tools:

WHO benchmarks for strengthening health emergency capacities

z Global genomic surveillance strategy for pathogens with pandemic and epidemic potential, 2022–2032. Geneva: World Health Organization; 2022
(https://www.who.int/publications/i/item/9789240046979).
z Considerations for developing a national genomic surveillance strategy or action plan for pathogens with pandemic and epidemic potential. Geneva:
World Health Organization; 2023 (https://www.who.int/publications/i/item/9789240076563).
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
300
 z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).  
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).    
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

301
 Collaborative surveillance data systems and networks
Collaboration surveillance requires mechanisms that draw upon key surveillance dimensions to generate actionable intelligence for decision-makers. Such
mechanisms are powered by innovative and multidisciplinary capabilities at national and subnational levels to forecast, detect and assess risks and monitor
risk-informed response actions. By understanding risks and potential health consequences, countries can apply evidence to inform their plans and prioritize
key actions to prepare for emergencies, scale up anticipatory actions and mitigate the impacts of events. The capabilities required to enable this collaborative
approach include: establishing a modern public health surveillance infrastructure; the development and sharing of tools for data collection, analysis and
sharing; analytical capacities represented through data visualization for interpretation and decision-making; and national multisectoral networks which
support data sharing.

IMPACT:
Event detection, risk assessment and public health decision-making is supported by collaborative surveillance systems which provide standardized,
shared data that is analyzed and accessible, through a One Health approach.

MONITORING AND EVALUATION:

(1) Integrated, interoperable and standardized data systems and data sharing platforms are established and functional across relevant sectors.
(2) National networks are established and functional to support data information sharing and collaboration.

WHO benchmarks for strengthening health emergency capacities

302
 BENCHMARK H1.3: Integrated, interoperable and standardized data systems and data sharing platforms are established and functional
OBJECTIVE: To develop and maintain an integrated, interoperable, standardized data system for surveillance data sharing, integration and visual
interpretation

CAPACITY LEVEL BENCHMARK ACTIONS

z Integrated, interoperable and standardized data systems including data sharing platforms are not available, used on an ad

01 hoc basis or provide inconsistent integration across a few surveillance data systems.
NO CAPACITY

z Conduct stakeholder mapping and establish a multisectoral committee for coordination of an integrated, interoperable,
02 standardized data system and data sharing platform.
LIMITED z Review existing legal frameworks across relevant sectors to assess compatibility to develop integrated, interoperable,
CAPACITY standardized data systems and data sharing.
z Conduct analysis of existing data and surveillance systems (e.g. disease specific, veterinary and environmental surveillance)
and existing data sharing mechanisms and identify opportunities and challenges for integration, interoperability and
standardization.
z Develop a national strategic plan for integration, interoperability and data standardization across data systems, including data
sharing platforms and visual interpretation.
z Identify a mechanism to develop data sharing platforms and dashboard frameworks to support data sharing and analysis.
z Establish a communication channel with designated contact persons from relevant sectors and participating agencies/
entities for effective communication and coordination.

WHO benchmarks for strengthening health emergency capacities

z Develop advocacy materials and orient relevant stakeholders on the importance of integration, interoperability, data
standardizations, visual interpretation and data sharing platforms for timely communication of potential hazards and risks.

z Disseminate to all relevant sectors, and implement the national strategic plan for integration, interoperability and data

03 standardization across data systems, including data sharing platforms and visual interpretation.
DEVELOPED z Develop guidelines and SOPs for data system integration, interoperability and standardization as well as data sharing
CAPACITY mechanisms to support implementation of the national strategic plan at the national level.
303

z Develop data sharing platforms and dashboard frameworks to support data sharing and analysis.
 z Develop tools for visual interpretation of integrated data on data sharing platforms and dashboards, including data
analyses, and ensure compatibility with existing surveillance data collection. Develop accompanying advocacy and user
guides to facilitate roll out and encourage use of visual interpretations.
z Increase the number of existing surveillance data systems that share data in a standardized manner and contribute to joint
analysis and visual interpretations.
z Adapt legal frameworks across relevant sectors, as required, to support integrated, interoperable, standardized data
systems and data sharing.
z Develop training materials and disseminate to relevant stakeholders in health and other relevant sectors for management,
use and interpretation of integrated data sharing system outputs.

z Secure ongoing budget allocation for implementation of the national strategic plan, based on costing.

04 z Adapt guidelines and SOPs for data system integration, interoperability and standardization as well as data sharing
DEMONSTRATED mechanisms to support implementation of the national strategic plan at the subnational level.
CAPACITY z Increase the number of surveillance data systems that share data in a standardized manner and contribute to joint analysis
and visual interpretations, including at the subnational level.
z Conduct SimEx/AAR/IAR (as relevant) to evaluate data sharing, systematic integration, system intraoperability and use of
visual interpretations in a real or simulated event.
z Provide available technical, institutional and human resources for the maintenance and quality assurance of integrated
data sharing systems.

z Review, update and adapt the national strategic plan for integration, interoperability and data standardization across data

05 systems, including data sharing platforms and visual interpretation based on results from M&E activities.

WHO benchmarks for strengthening health emergency capacities

SUSTAINABLE z Secure sustainable funding and allocation of resources on an annual basis to support sustained functionality, quality
CAPACITY assessment, maintenance and improvements to integrated data sharing systems.
z Incorporate findings from shared data analyses and visual interpretations into national health emergency response,
planning and preparedness activities on a routine basis.
z Incorporate findings from shared data analyses and visual interpretations into research conducted in the country.
z Document and share best practices for integrated data sharing systems and visual interpretations, and engage the country
in peer-to-peer learning programmes at the subnational, national and international levels.
304
 BENCHMARK H1.4: Integrated networks are created and functional to support surveillance information sharing and collaboration
OBJECTIVE: To establish and maintain national networks across relevant sectors, partners and organizations that support activities for surveillance
information sharing and collaboration through establishing relationships and protocols

CAPACITY LEVEL BENCHMARK ACTIONS

z No national networks exist to support surveillance information sharing and collaboration, or collaboration is conducted in

01 an ad hoc or sector-specific manner.

NO CAPACITY

z Conduct a comprehensive assessment of existing stakeholders, sectors, organizations and partners involved in health
02 surveillance (including non-traditional partners) to identify potential network participants.
LIMITED z Establish a multisectoral committee (with ToR), with representatives from relevant sectors, organizations and partners
CAPACITY involved in surveillance in the country to guide the development and maintenance of national information sharing and
networks.
z Perform an assessment of existing national networks within the country, including networks of small size or with intersectoral
collaboration, to determine current networks and opportunities for growth.
z Establish ToRs for national networks including mission, membership, meetings, secretariat, responsibilities, reporting and
organization.
z Review current country contribution to regional and global surveillance networks.
z Promote awareness and engagement among stakeholders of the benefits of networks, emphasizing the importance of
sharing information and resources to enhance collaborative surveillance.

WHO benchmarks for strengthening health emergency capacities

z Networks to establish basic protocols for secure data access, confidentiality, and information and intelligence sharing to

03 support collaboration within and between sectors relevant to surveillance. Ensure alignment with any existing national
DEVELOPED strategic plans for integration, interoperability and data standardization, including data sharing platforms and visual
CAPACITY interpretation.
z Networks to establish SOPs for data sharing amongst network members, with consideration to existing data systems and
sharing platforms.
305
 z Networks to establish mechanisms to share capacities across sectors, organizations and health system levels within the
country to increase overall capacity and integrate learning.
z Develop mechanisms and opportunities to contribute to regional and global platforms’ strategic agendas and knowledge
exchange.

z Implement protocols and SOPs developed by networks across all relevant sectors, organizations and partners to facilitate

04 data access and information and intelligence sharing.

DEMONSTRATED z Regularly report on networks’ activities, achievements and challenges.
CAPACITY z Share capacities across sectors, as relevant, and across health system levels within the country to support information
sharing and collaboration capacities at the national and subnational levels.
z Participate in regional and global platforms for global surveillance networks including knowledge exchange and support for
developing community trust in information.
z Secure ongoing funding for networks, including resources from various sectors, organizations and partners.

z Demonstrate that information sharing across relevant network stakeholders, resources and knowledge generated from

05 networks was used to support health emergency management response, planning or preparedness activities.
SUSTAINABLE z Secure regular and sustainable in-country funding for ongoing collaborative surveillance networks across relevant sectors.
CAPACITY z Continuously improve and refine networks’ ToRs to ensure adaptability and responsiveness to emerging needs and threats,
technological advancements, and evolving best practices in information sharing.
z Document and share best practices in developing in-country networks and engage country in peer-to-peer learning
programmes at the subnational, national and international levels.
z Actively increase engagement in regional and global platforms and engage the country in international activities to support

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information sharing and collaboration at a global level.

Tools:
z “Crafting the mosaic”: a framework for resilient surveillance for respiratory viruses of epidemic and pandemic potential. Geneva: World Health
Organization; 2023 (https://www.who.int/publications/i/item/9789240070288).
z Cross-border collaboration on emerging infectious diseases. World Health Organization. Regional Office for South-East Asia; 2007. (https://iris.who.int/
306

handle/10665/204925)
 z Sharing and reuse of health-related data for research purposes: WHO policy and implementation guidance, Geneva: World Health Organization; 2023.
Licence: CC BY-NC-SA 3.0 IGO (https://www.who.int/publications/i/item/9789240044968)
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).  
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).    
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

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307
 Community protection
Integrated vector control
Effective vector control is a core intervention to protect communities and prevent the spread of vector-borne diseases in already vulnerable areas. Integrated
community driven vector control aims to provide a standardized framework for the following areas which are crucial for preventing and controlling vector-
borne diseases:

z Risk assessment and mapping of vulnerable areas: Assessment of risk during preparedness and readiness is essential to identify vulnerable areas that
should be prioritized for prevention and control efforts.
z Harnessing local knowledge and data: The active use of local insights and data to inform the planning, designing and scaling of vector control tools and
interventions. By incorporating context specific information, interventions can be tailored to meet the unique needs and challenges of the community.
z Mobilizing and supporting communities: Recognizing the essential role of community involvement in developing and implementing local vector control
interventions through a One Health approach. By empowering communities and fostering active participation, interventions can leverage community
knowledge, resources and networks for more effective and sustainable outcomes.
z Continuous review, lessons learned, and monitoring and evaluation: Ongoing assessment and learning is important in vector control interventions. By
systematically reviewing interventions, capturing lessons learned, and monitoring and evaluating their impact, interventions can be refined and adapted
over time to enhance local effectiveness and efficiency.

IMPACT:
Contextually informed, community driven vector control interventions lead to a significant reduction in vector-borne disease outbreaks.

WHO benchmarks for strengthening health emergency capacities

MONITORING AND EVALUATION:
(1) Communities are fully engaged during assessment, planning and designing of vector control efforts, and are effectively mobilized in intervention
implementation. (2) Local knowledge and data inform the planning, design and scaling of vector control interventions at the community level.
308
 BENCHMARK H2.1: Integrated vector control management systems are in place
OBJECTIVE: To establish and implement a multisectoral community integrated vector control management approach to reduce vector-borne disease
outbreaks

CAPACITY LEVEL BENCHMARK ACTIONS

z Integrated community driven vector control management systems are not in place, or efforts are ad hoc.

01
NO CAPACITY

z Establish a multisectoral coordination committee (with ToR), with representatives from One Health, other relevant sectors and
02 the community, to facilitate planning, design, development of vector control management systems with local knowledge and
LIMITED data, and community implementation of interventions.
CAPACITY z Assess existing vector control efforts and data management systems for the degree of integration of community level
knowledge and data into plans, policies and interventions alongside mapping key stakeholders and community engagement.
z Conduct a risk assessment and vulnerability mapping for vector-borne diseases, if not already available.
z Establish mechanisms for community engagement and communication, including channels for local knowledge and data to
be integrated into vector control management systems, to facilitate risk communication, and to mobilize communities toward
joint assessment and identification of contextualized interventions.
z Develop a national strategy for community engagement and mobilization in vector control.

z Develop and implement integrated community driven vector control strategies and plans that can be tailored to meet the
needs and challenges of a community, and which provide a channel for local knowledge and data integration.

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03
DEVELOPED z Develop, or update, the national vector surveillance system to include vector control efforts and outbreak preparedness and
CAPACITY response through integrated community driven vector control management systems.
z Integrate the national strategy for community engagement and mobilization in vector control into relevant national health
security plans and policies.
z Establish robust systems for M&E of integrated vector control management systems, including local data collection,
analysis and reporting and community engagement, to assess the coverage and effectiveness of vector control
interventions.
309
 z Establish collaborative networks among entomologists, vector-borne disease control experts, social/behavioural scientists,
programme/project managers and community groups to facilitate knowledge sharing, joint analysis and coordinated
vector control efforts.
z Assess workforce and expertise in the control of vectors and reservoirs, including local and community levels.
z Establish proactive and strategic communication with relevant ministries to secure support for mobilizing national
resources, and if necessary, external resources, to ensure the allocation of sufficient funding for the implementation of
community integrated vector control efforts.
z Develop and conduct training programs and workshops to build the capacity of communities, health professionals, and
vector control personnel in implementing integrated community driven vector control interventions through a One Health
approach.

z Expand implementation of integrated community driven vector control interventions as per guiding strategies and plans,

04 considering best practices relevant or adaptable to the local context.

DEMONSTRATED z Continue to engage and mobilize communities to develop and implement local vector control interventions and harness
CAPACITY local knowledge for integrated vector control management systems through a One Health approach.
z Scale up vector control strategies, tools and interventions at national and subnational levels to extend reach all at risk
areas.
z Allocate funding from various sources, including government budgets, grants and partnerships, to support the
implementation and scaling up of integrated vector control interventions.
z Integrate local data with national vector surveillance systems and health information systems to guide vector control
efforts and outbreak preparedness and response at the community level.
z Conduct regular M&E of integrated vector control management systems, including local data collection, analysis and

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reporting, and community engagement.
z Conduct SimEx/AAR/IAR (as relevant) for integrated community driven vector control strategies and plans and
functionality at the community level.
310
 z Regularly review and update integrated vector control strategies, plans and interventions based on findings from M&E

05 activities to ensure local involvement in implementation and effective collection and use of local knowledge and data.
SUSTAINABLE Customize vector control strategies and plans by adapting to the specific needs and circumstances of local context.
CAPACITY z Sustain community engagement and participation in vector control activities through ongoing communication, education
and involvement in planning, design and development of vector control management systems and implementation of
interventions.
z Conduct research, development and innovation to support improvement in integrated vector control tools, strategies and
technologies, and participate in relevant international forums.
z Secure sustainable financing mechanisms through domestic budgets and by exploring innovative financing options.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).   
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).    
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/

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handle/10665/333419)
z Global vector control response 2017–2030. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/9789241512978).
311
 Community access to water, sanitation and hygiene (WASH)
Community access to safe water, sanitation and hygiene (WASH) interventions are crucial before, during and after health emergencies to support prevention,
preparedness, response and resilience. To achieve this, actions are mainly focused on needs assessment and planning, implementation, and monitoring and
evaluation of community driven WASH interventions. Active community engagement and participation in these actions are essential for effective ownership
and implementation, including tailoring interventions to local needs and the continuous improvement of WASH interventions.

z Needs assessment, planning and designing: By planning and designing WASH interventions in collaboration with communities, interventions can be
designed to meet specific needs and preferences. A collaborative approach considers the results of risk and needs assessments and adapts established
guidelines, best practices and available tools to the local context.
z Implementation: Implementation of safe community WASH services includes the provision of safe drinking water, toilets, hygiene facilities and hygiene
promotion training. The process should prioritize safe management of WASH facilities in communities and community health facilities before, during
and after health emergencies.

IMPACT:
Community driven WASH interventions foster sustainability and resilience, and result in improved health outcomes and enhanced overall well-
being through WASH-related diseases being significantly reduced.

MONITORING AND EVALUATION:

(1) Community engagement is at the forefront of needs assessment, planning and designing WASH interventions, ensuring active community
involvement and ownership throughout the process. (2) WASH interventions are tailored to local needs and continuously improved, integrating

WHO benchmarks for strengthening health emergency capacities

results from risk and rapid needs assessment and ongoing community participation to ensure effectiveness and relevance to local context.
312
 BENCHMARK H2.2: Community driven water, sanitation and hygiene (WASH) interventions are in place and effective
OBJECTIVE: To develop community capacities in planning, implementation and monitoring of safe WASH interventions to ensure sustainable access to
facilities

CAPACITY LEVEL BENCHMARK ACTIONS

z Community driven effective WASH interventions are not in place or efforts are ad hoc.

01
NO CAPACITY

z Conduct a situational analysis to understand the community’s water, sanitation and hygiene needs, considering existing
02 infrastructure, resources, local practices, vulnerable areas and water sources.
LIMITED z Engage key stakeholders, such as community members, local authorities and CSOs, to identify priorities and challenges
CAPACITY related to WASH interventions.
z Collaborate with local stakeholders, including government agencies, NGOs, international organizations and community
leaders, to establish partnerships and leverage resources to support WASH interventions.
z Set up a coordination mechanism, with defined roles and responsibilities, to ensure active community participation in the
development and implementation of WASH interventions.

z Develop national policies for community WASH, including governance mechanisms, financing and monitoring, as well as

03 the maintenance and scaling up of interventions during emergencies.

DEVELOPED z Conduct an assessment of WASH specific needs at the community level using relevant tools to identify areas requiring
CAPACITY adaptations or improvement according to local context. Includes risk assessment, hazard mapping, health profiling and

WHO benchmarks for strengthening health emergency capacities

vulnerability mapping.
z Develop and implement community driven WASH intervention plan based on situational analysis, risk and needs
assessment results, referring to established guidelines and best practices.
z Develop safe WASH services nationally in communities through capacity-building, community engagement and workforce
support based on regular needs assessments, including:
ƒ Build capacity of communities on WASH concepts, practices and management
313

ƒ Provide technical assistance and guidance to communities for planning and designing WASH interventions
 ƒ Facilitate community engagement activities to gather input and ensure active involvement in decision-making
processes and implementation
ƒ Build capacity of local institutions and CBOs to take a lead role in needs assessment, planning and implementing
WASH interventions
ƒ Support communities to develop local guidelines and protocols for WASH interventions based on best practices and
current evidence.

z Secure funding and resources necessary for the implementation of community WASH interventions.

04 z Build community capacity in monitoring, feedback and evaluation techniques to assess the effectiveness of WASH
DEMONSTRATED services.
CAPACITY z Co-design and establish comprehensive monitoring and evaluation systems to track the progress and impact of
community WASH interventions.
z Continuously improve and adapt WASH interventions based on feedback and evaluation results, emerging knowledge and
best practices.
z Develop hygiene promotion and awareness campaigns and conduct train the trainers programs for community members
to expand campaign reach.
z Provide training on community driven WASH to relevant multisectoral staff and key stakeholders in IPC and WASH-FIT
assessment of community facilities.
z Foster collaboration and knowledge sharing among communities to learn from each other’s experiences and successes in
WASH interventions.
z Conduct review meetings at national and subnational level convening multisectoral key stakeholders to assess
implementation progress of community driven WASH, and to identify and document best practices and lessons learned.

WHO benchmarks for strengthening health emergency capacities

z Transfer ownership of community driven WASH interventions to communities for long-term management and

05 maintenance.
SUSTAINABLE z Secure local funding mechanisms and partnerships to ensure the financial sustainability of community WASH services.
CAPACITY z Co-develop and implement innovative approaches for sustainable management of WASH facilities, such as rainwater
harvesting and decentralized wastewater treatment.
314
 z Strengthen community networks and alliances to advocate for WASH policies and secure ongoing support from
government authorities and other stakeholders.
z Integrate M&E of community WASH services as part of overall service delivery and primary health care.
z Document and share country experiences in community-driven WASH and engage the country in peer-to-peer learning
programmes at the subnational, national and international levels.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017. (https://apps.who.int/iris/handle/10665/254741).  
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

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315
 Food security, social welfare and protection
Social welfare and protection systems have been developed to achieve equity across all population groups in all circumstances. During health emergencies,
communities experience immediate and long-term economic consequences such as loss of jobs, closures of businesses and interruption in education, trade
and transportation. Strengthening social protection responses in health emergencies is vital to mitigate such impacts and ensure community resilience.
Social protection policies are an integral part of government policies with scaling up, expanding eligibility and ensuring access for vulnerable and at risk
populations during health emergencies a priority. Social protection is crucial to making societies better prepared for and more resilient to emergencies.
Social protection services can be delivered through insurance, pension or other benefit systems and in-kind services such as food or rent vouchers. Existing
programs can be expanded during emergencies, e.g. by broadening eligibility criteria and/or providing additional benefits. In particular, it is imperative to
implement public health and social measures (PHSM) in tandem with social protection policies in order to prioritize equity and social justice. This approach
ensures that response efforts maximize public health benefits while mitigating the unintended negative consequences of PHSM.

Food security is a right of all people, and it is vital in protecting communities in the context of health emergency preparedness, response and resilience.
Enhancing the resilience of food production and distribution systems before, during and after health emergencies needs to prioritized to further support
community resilience and well-being.

IMPACT:
Social welfare and protection systems expanded to support the well-being and resilience of communities before, during and after emergencies.
Food production, procurement and distribution systems are functional before, during and after health emergencies to ensure resilience of food
security systems and community well-being.

WHO benchmarks for strengthening health emergency capacities

MONITORING AND EVALUATION:
(1) Social welfare and protection policies for vulnerable and at risk populations are expanded and scaled up for health emergencies. (2) Resilient
infrastructure is developed or expanded to ensure the effective implementation of social protection policies and the delivery of essential goods
and services during health emergencies. (3) Policies and procedures are implemented and infrastructure expanded to ensure food security
through resilient food production and delivery systems to provide sufficient quantities of food, nutrition and raw materials to meet local demands
during health emergencies.
316
 BENCHMARK H2.3: Social welfare and protection systems are expanded and health emergency specific mechanisms are implemented
OBJECTIVE: To build on and expand existing social welfare and protection systems, and where needed establish new systems, that effectively support
the well-being and resilience of individuals, families and communities before, during and after health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z Social welfare and protection systems are not expanded for health emergencies or efforts before, during or after health

01 emergencies are ad hoc.

NO CAPACITY

z Assess existing social welfare and protection policies within the country to identify level of integration of health emergencies
02 within the existing system(s).
LIMITED z Assess the status of infrastructure logistical networks and organizational frameworks necessary for the seamless provision
CAPACITY of social welfare and protection during health emergencies.
z Conduct regular risk and vulnerability assessments, alongside assessments of the potential socioeconomic and health
impacts from health emergencies, for vulnerable and at risk populations to identify social protection policies for scale up and
expansion during health emergencies.
z Establish a steering committee with relevant stakeholders to scale up and expand existing social welfare and protection
policies, plans and procedures for health emergencies.

z Expand, or update as needed, social protection policies, plans and procedures that address the specific needs of vulnerable

03 and at risk populations in relation to health emergencies.

DEVELOPED z Establish infrastructure at the national level to support implementation of social protection policies and the and scale up of

WHO benchmarks for strengthening health emergency capacities

CAPACITY delivery of goods and services before, during and after health emergencies.
z Develop relevant procurement and supply chain systems that enable the timely acquisition and supply of essential
resources, goods and services related to social protection throughout all phases of a health emergency.
z Explore the opportunities for securing adequate financing to support sustainable social welfare and protection systems.
z Conduct targeted capacity-building tailored to the specific training needs of stakeholders responsible for implementing
social protection policies, plans and procedures in relation to health emergencies.
317
 z Implement coordinated efforts between government agencies, NGOs and other stakeholders including the private sector in
the delivery of goods and services related to social protection during health emergencies.
z Improve awareness of beneficiaries about the policies and procedures of social welfare and protection that could mitigate
impacts of health emergencies.

z Scale up social welfare and protection systems for health emergencies at all levels.

04 z Establish linkage between social welfare and protection systems and emergency response systems, ensuring seamless
DEMONSTRATED coordination and integration to address the needs of vulnerable and at risk populations due to health emergencies.
CAPACITY z Establish and maintain resilient infrastructure to support the scale up of social protection policies and the delivery of goods
and services before, during and after health emergencies at all levels.
z Strengthen coordination and collaboration among community leaders, CSOs and other stakeholders involved in social
welfare and protection initiatives.
z Develop strategic partnerships and collaborations with international organizations and donors for financial and technical
support, as needed.
z Establish M&E mechanisms to assess the scale up and implementation of social protection and welfare systems during
health emergencies.

z Regularly monitor and evaluate the effectiveness of scaling up social welfare and protection policies and procedures for

05 health emergencies and update relevant policies and procedures based on results.
SUSTAINABLE z Sustain the integration of health emergencies into social welfare and protection policies through policy reforms and
CAPACITY legislative measures.
z Secure sustainable financing for social welfare and protection systems through establishing a strategic communication

WHO benchmarks for strengthening health emergency capacities

channel with key stakeholders involved in domestic resource mobilization.
z Implement technology driven solutions for the efficient delivery and tracking of relevant goods and services to
communities.
z Document and share country experiences in the scale up of social welfare and protection during health emergencies and
engage the country in peer-to-peer learning programmes at the subnational, national and international levels.
z Sustain capacity-building initiatives, including knowledge generation and information sharing, to continue to strengthen the
resilience of social welfare and protection systems.
318
 BENCHMARK H2.4: Resilient food production and distribution systems are functional to ensure food security during health emergencies
OBJECTIVE: To enhance and maintain functional food production, procurement and distribution systems that are resilient and effective in ensuring
sufficient food supply before, during and after emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z Food production, procurement and distribution systems that are resilient to health emergencies are not in place or efforts

01 are ad hoc.
NO CAPACITY

z Conduct a situational analysis of existing food production, procurement and distribution systems including contingency plans
02 for strategic stockpiling to identify gaps and vulnerabilities during health emergencies.
LIMITED z Conduct an assessment of existing infrastructure, technological and logistical networks related to local food production to
CAPACITY identify potential gaps.
z Review relevant best practices and lessons learned from previous health emergencies related to food production,
procurement and distribution systems to identify effective strategies and insights for enhancing resilience.
z Explore partnership opportunities with local, national and international suppliers and producers to establish a diverse food
supply chain that is reliable during health emergencies.
z Designate a national entity or steering committee (with ToR) to be responsible for communication and coordination of the
development and implementation of policies, plans and procedures related to food production, procurement and distribution
systems before, during and after health emergencies.

z Develop policies, plans and procedures for the production, procurement and distribution of food, nutrition and raw

WHO benchmarks for strengthening health emergency capacities

03 materials during health emergencies.
DEVELOPED z Develop contingency plans for strategic food stockpiling, including operational guidelines, for health emergencies.
CAPACITY z Develop a plan for the establishment of needed infrastructure, technological and logistical networks that enhance the
capacity, efficiency and sustainability of local food production during health emergencies.
z Establish functional networks among local, national and international suppliers and producers for a reliable and diverse
food supply chain before, during after health emergencies.
319

z Train relevant stakeholders on procurement and distribution systems to be implemented during health emergencies,
including efficient resource allocation and timely delivery.
 z Enhance the capability of local producers and suppliers to be able to meet increased demand for food, nutrition and raw
materials during health emergencies.
z Institutionalize and operationalize the national entity or steering committee for communication, coordination and
implementation of food production, procurement and distribution systems during health emergencies.

z Implement policies, plans and procedures for the production, procurement and distribution of food, nutrition and raw

04 materials and strategic stockpiling during health emergencies at national and subnational levels.
DEMONSTRATED z Test the effectiveness of the contingency plan for stockpiling through conducting SimEx/AAR/IAR (as relevant).
CAPACITY z Increase the use of technology and innovation to enhance efficiency and sustainability of food production systems and
infrastructure relevant to health emergencies.
z Conduct in-country research through collaboration with relevant research institutions to identify emerging trends and
challenges and innovative food production, procurement and distribution strategies for health emergencies.
z Secure adequate funding by engaging in strategic communication with domestic and international organizations and
donors.
z Establish mechanisms for M&E of the food supply chain to assess the reliable delivery of essential food resources during
health emergencies.

z Conduct regular M&E of the established systems for producing, procuring and distributing food, nutrition and raw materials

05 before, during and after emergencies. Identify areas for improvement and implement necessary adjustments to policies,
SUSTAINABLE plans and procedures, using a data driven approach to support evidence-based decision making.
CAPACITY z Maintain and continuously improve infrastructure, technological and logistical networks for local food production, ensuring
long-term sustainability and adaptability to changing needs and challenges due to health emergencies.

WHO benchmarks for strengthening health emergency capacities

z Conduct research to explore underlying causes of vulnerabilities and inequities in food access during health emergencies.
z Sustain financing for food production, procurement and distribution systems with key stakeholders involved in domestic
resource mobilization.
z Advocate for policies and regulations (e.g. trade regulation) that promote global sustainable and resilient food production
systems, including support for small-scale farmers and local food markets with special reference to health emergencies.
320
 Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).   
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).  
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

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321
 Protection of livelihoods, business continuity and contunuity of education and learning
Communities experience significant impacts from health emergencies, including loss of income, interrupted learning and slowed economic productivity. It is
critical to safeguard social and economic welfare by taking a social determinants lens to population health and by enhancing existing and special provisions
of essential social and education services and assistance during health emergencies.

z Legislation and social systems/services and labour standards: The reinforcement or expansion of legislation for labour, social protection and education
along with standards and service coverage aiming to ensure the continuity of basic social and education services and protections during health
emergencies helps to mitigate the adverse effects of health emergencies and create a more secure and resilient workforce. This includes: social
protection benefits (social assistance, insurance and specific labour and other regulatory mechanisms, such as a moratorium on evictions); care (e.g.
pre-school), education and learning (e.g. when educational institutions are closed due to an emergency); encourage employment guarantee in the case
of long periods of closures or absences owing to illness; reduce precarious and unsafe work arrangements; ensure labour participation in decision-
making; facilitate flexible work options; and foster accountability among governments, businesses, and other organizations.
z Creation, management and allocation of funds and systems: The provision, creation, management and allocation of funds for emergencies as well as
how different systems have the capability to perform their usual functions or expand their functions and coverage during emergencies. Social systems
that are functioning below 100 percent coverage may need additional finances to expand their reach, in particular to disadvantaged populations. The
service and benefits offered may need to be more comprehensive during an emergency or as a result of emergencies. For example, schools that do
not have digital platforms may need to be provided with funds to increase access to digital learning. Funding is essential to provide support to affected
communities and those at the highest risk of being severely impacted by health emergencies.
z Physical and digital infrastructure: The development of physical and digital infrastructure plays a vital role in ensuring education and business continuity
and protecting livelihoods. By providing support and resources, communities can adapt and sustain their economic and daily living activities, as well as
social connections, in the face of disruptions caused by health emergencies. Robust physical and digital infrastructure facilitates smooth functioning of

WHO benchmarks for strengthening health emergency capacities

education and learning, businesses and promotes the resilience of livelihoods before, during and after emergencies.

It is crucial to promote and safeguard universal, inclusive and equitable quality education and learning opportunities for children and all individuals, regardless
of their age or circumstances. This includes: continuity of the development and implementation of relevant curriculum and evaluation tools to ensure
uninterrupted delivery of quality education to children, adolescents and adults; establishment of policies and services that provide school-based or school-
linked social support including food security, child protection, psychological support and other health services for children, and ensure continuity during
emergencies; and digital technologies and infrastructure should aim to support – and not replace – schools, offering inclusive and equitable face-to-face
322

learning as compatible with the emergency supported by a seamless transition between quality hybrid or distance learning modalities.
 IMPACT:
The protection of livelihoods and business continuity systems play a significant role in addressing the health, economic and social impacts of
health emergencies. All children, adolescents and adults have access to inclusive and effective learning opportunities before, during and after
emergencies.

MONITORING AND EVALUATION:

(1) Legislation and social systems/services and labour standards to ensure the continuity of basic social and education services and protections
are developed, services and systems are built with specific contingencies for emergencies, and during emergencies legislative and social
systems support the provision of services. (2) Contingency funds are channelled through existing systems of support where appropriate (e.g.
social protection, schools) or they are created with sustainability in mind to support the affected communities and those are at risk of being
severely impacted by health emergencies. (3) Robust physical and digital infrastructure are established for the smooth functioning of businesses,
protection of livelihoods and continuity of education and learning. (4) Inclusive and effective learning opportunities are in place for children,
adolescents and adults before, during and after emergencies.

WHO benchmarks for strengthening health emergency capacities

323
 BENCHMARK H2.5: The protection of livelihoods, business continuity and continuity of education and learning systems is in place and functional during
health emergencies
OBJECTIVE: To establish and enhance the protection of livelihoods, business continuity, and education and learning continuity systems to help address
the economic, education and social impacts of health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z The protection of livelihoods, business continuity and continuity of education and learning systems is not in place, or

01 efforts are conducted in an ad hoc manner.

NO CAPACITY

z Establish a dedicated task force to review current legislation regarding social protection/welfare and education systems for
02 the protection of livelihoods, business continuity and continuity of education and learning.
LIMITED z Collaborate with social protection services, community leaders and CSOs to assess existing legislation and social protection
CAPACITY coverage related to livelihoods for various population groups (e.g. formal sector, informal economy, professions, workers in
the care economy) and the continuity of business operations.
z Collaborate with educational institutions and relevant stakeholders to assess existing education systems’ resilience to health
emergencies, including remote, hybrid and in-person learning systems during health emergencies and capacity for equitable
and seamless transition between modalities.
z Collaborate with educational institutions and stakeholders to assess the resilience of school-linked and school-based
social protection and healthcare services (e.g. child protection, school meals, psychosocial support, immunization and other
healthcare services) including capability for continuity when schools are closed.
z Conduct a vulnerability assessment to identify priority groups and develop targeted support systems based on the level of

WHO benchmarks for strengthening health emergency capacities

vulnerability.
z Identify gaps in physical and digital infrastructure that may affect livelihood protection, business continuity and continuity of
education and learning during health emergencies.
z Collaborate with relevant stakeholders to raise awareness and advocate for universal health and social protection coverage
and the importance of labour standards, safe workplaces and flexible work arrangements.
324
 z Develop a strategic roadmap for policy and legal frameworks, along with financing modalities, to establish robust systems

03 to effectively protect livelihoods and ensure the seamless continuity of business operations and education activities during
DEVELOPED health emergencies including targeted support systems for identified priority groups.
CAPACITY z Establish a dedicated fund management system with transparent processes for efficient allocation of resources to support
vulnerable populations during emergencies.
z Develop and implement educational policies and programs including remote, hybrid and in-person learning modalities to
ensure inclusive, uninterrupted and effective learning opportunities for all individuals during health emergencies.
z Develop guidelines and resources for educators and learners to facilitate remote learning and adapt educational practices
to emergency situations.
z Develop and implement policies for alternative modalities to deliver school meals and other school-linked and school-
based social protection when schools are closed due to emergencies.
z Develop guidelines and resources for health professionals that deliver school-based or school-linked healthcare services
to facilitate telehealth consultations and other modalities to ensure the continuity of services when schools are closed or
partially closed due to emergencies.
z Develop and implement necessary reforms in legislation and social systems to ensure formal employment, safe
workplaces and facilitation of flexible work arrangements.
z Invest in the development of physical and digital infrastructure to enhance business continuity, livelihood protection and
continuity of education and learning.
z Establish a coordination mechanism among relevant stakeholders to exchange best practices and share resources for
supporting livelihoods, business continuity, and continuity of education services during health emergencies.

z Enhance compliance with legislation, social systems and services, including for social protection and education, and labour

WHO benchmarks for strengthening health emergency capacities

04 standards to provide long-term protection for livelihoods, educational and other social services, employment, and business
DEMONSTRATED continuity during health emergencies.
CAPACITY z Develop and implement a regular M&E mechanism to assess relevant legislation and social systems for the protection of
livelihoods and business continuity and continuity of education during health emergencies.
z Integrate emergency preparedness and response strategies into national education policies, to sustain continuous and
inclusive learning opportunities during health emergencies, as well as continuity of school-based and school-linked social
325

protection and healthcare services.

 z Protect the livelihoods of frontline care economy and support service workers before, during and after emergencies (e.g.
social workers, teachers, aged care workers, health workers, fire services, etc.).
z Upgrade educational infrastructure and digital networks to meet the changing needs of remote, hybrid and in-person
learning considering emerging technologies and educational advancements.
z Maintain and enhance physical and digital infrastructure to adapt to evolving challenges and ensure seamless business
operations, and livelihood protection during health emergencies.

z Regularly review and update guidelines, policy and legal frameworks based on M&E results for the protection of livelihood,

05 business continuity and continuity of education during health emergencies.

SUSTAINABLE z Allocate reliable and adequate resources through a self-sustaining funding mechanism for adapting or augmenting finance
CAPACITY flows during emergencies to support affected communities and foster resilient livelihoods, business operations and
education.
z Implement sustainable infrastructure practices, focusing on renewable energy, digital connectivity and environmentally
friendly solutions for long-term livelihood protection, business continuity and education continuity.
z Sustain continued capacity-building for inclusive and equitable approaches for protecting livelihoods, ensuring business
continuity and education continuity in health emergencies at regional and global levels.
z Participate in international collaboration and knowledge sharing networks to promote global resilience in protecting
livelihoods, ensuring business continuity, and sustaining education during emergencies.

Tools:
z Building back resilient: how can education systems prevent, prepare for and respond to health emergencies and pandemics? United National

WHO benchmarks for strengthening health emergency capacities

Educational, Scientific and Cultural Organization; 2021 (https://unesdoc.unesco.org/ark:/48223/pf0000375278).
z Strengthening Ministry of Education Engagement and Leadership in Rapid Education in Emergency Response Policy brief. United National Educational,
Scientific and Cultural Organization; 2022. (https://unesdoc.unesco.org/ark:/48223/pf0000383722/PDF/383722eng.pdf.multi).
z Investing better in universal social protection. Applying international social security standards in social protection policy and financing. International
Labour Organization; 2022 (https://www.ilo.org/global/publications/working-papers/WCMS_834216/lang--en/index.htm).
z Social protection responses to the COVID-19 pandemic in developing countries: strengthening resilience by building universal social protection.
326

International Labour Organization; 2020 (https://labordoc.ilo.org/discovery/fulldisplay/alma995075793502676/41ILO_INST:41ILO_V1).

 z ILO Standards and COVID-19 (coronavirus). International Labour Organization; 2020 (https://respect.international/wp-content/uploads/2020/07/ILO-
Standards-and-COVID-19-coronavirus.pdf).
z Place health equity at the heart of the COVID-19 sustainable response and recovery: Building prosperous lives for all in Wales. Public Health Wales NHS
Trust; 2021 (https://phwwhocc.co.uk/wp-content/uploads/2021/07/WHESRi-Covid-Report-Eng.pdf).
Example of a social determinants policy context assessment process
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).  
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419).

WHO benchmarks for strengthening health emergency capacities

327
 Addressing indirect health and mental health impacts of health emergencies
Communities experience heightened stress, anxiety and fear, and in some cases, increased risk of developing mental health conditions during health
emergencies. Estimates indicate that one in five people (22%) living in an area affected by conflict will experience a mental health condition such as depression,
anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia166. Meanwhile, countless more experience significant distress and impairment.
Disruption of routine health services as well as interventions implemented in response to health emergencies, such as PHSM, can have significant impacts
on health and mental health. Addressing indirect health and mental health impacts before, during and after emergencies is crucial.

Proactive measures to tackle these impacts prioritize reducing risks, promoting overall mental health and well-being, fostering resilience and developing
effective coping strategies. Safeguarding community health and mental health and psychosocial well-being during emergencies requires a comprehensive
approach that includes risk reduction and management, preparedness, readiness, response and building back better after crises. Designing systems for
scaling up community health services and mental health and psychosocial support (MHPSS) as a part of health emergency preparedness, and developing
and maintaining infrastructure for community health services and MHPSS need to be prioritized to mitigate indirect health and mental health impacts due to
emergencies. Designing preparedness systems for scaling up health services and MHPSS includes developing strategies, systems and minimum services
that ensure timely access to mental health and psychosocial support167, enabling communities to effectively address the indirect health and mental health
impacts that arise before, during and after health emergencies. By implementing these mechanisms, decision-makers and stakeholders can establish a
resilient approach to emergency preparedness and risk management that prioritizes the community health, mental health and well-being of individuals.
Developing and maintaining infrastructure for community health services and MHPSS includes the development and maintenance of physical and digital
infrastructure before emergencies occur, specifically for providing community health services and MHPSS.

IMPACT:

WHO benchmarks for strengthening health emergency capacities

Preparedness efforts to equitably scale up health services and MHPSS have resulted in the creation of a resilient system that significantly
reduces the indirect health and mental health impacts during health emergencies.

166
Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis.
Lancet. 2019;394(10194):240-248. doi: 10.1016/S0140-6736(19)30934-1.
167
The following resource provides a globally agreed package of minimum services to be provided during humanitarian emergencies: Mental Health and Psychosocial Support Services Package.
Inter-Agency Standing Committee; 2022. (https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-psychosocial-support-emergency-settings/iasc-minimum-
328

service-package-mental-health-and-psychosocial-support)
 MONITORING AND EVALUATION:
(1) A strategy for scaling of community health services and MHPSS, as a key part of health emergency preparedness, is developed and
implemented. (2) Physical and dynamic digital infrastructure and human resources are developed, strengthened and maintained to support the
delivery of community health services and MHPSS.

WHO benchmarks for strengthening health emergency capacities

329
 BENCHMARK H2.6: Strategic scaling of community health services and mental health and psychosocial support (MHPSS) are in place for health
emergencies
OBJECTIVE: To establish a resilient system to mitigate indirect health and mental health effects during health emergencies through preparedness efforts
to equitably scale up community health services and MHPSS

CAPACITY LEVEL BENCHMARK ACTIONS

z Strategic scaling of community health services and MHPSS is not in place during health emergency preparedness or

01 responses activities, or efforts are ad hoc.

NO CAPACITY

z Conduct a situational analysis of community health services and MHPSS for addressing indirect health and mental health
02 impacts of health emergencies.
LIMITED z Conduct a comprehensive needs and risk assessment to identify specific community health service and MHPSS gaps and
CAPACITY requirements within the community before, during and after emergencies.
z Conduct a review of multisectoral collaboration, including community engagement, for community health services and
MHPSS before, during and after emergencies to identify opportunities for further collaboration.
z Establish a mechanism for communication and joint development of plans, guidelines and protocols for strategically
scaling up community health services and MHPSS between healthcare providers, mental health professionals, community
organizations and emergency response agencies.

z Develop relevant plans, guidelines and protocols for the strategic scaling of community health services and MHPSS168
before, during and after health emergencies, based on existing guidance and incorporating strategies for communication

WHO benchmarks for strengthening health emergency capacities

03
DEVELOPED among service providers, resource allocation, equitable distribution of services, workforce training and allocation, and
CAPACITY community engagement.
z Review and update as needed the physical infrastructure of health facilities to meet the specific needs of community
health services and MHPSS during emergencies.
z Develop a dynamic digital infrastructure, including telemedicine and digital platforms, to facilitate remote access to health
services and MHPSS to support adaptation and continuity of care during emergencies.

168
330

Mental Health and Psychosocial Support Services Package. Inter-Agency Standing Committee; 2022. (https://interagencystandingcommittee.org/iasc-reference-group-mental-health-and-
psychosocial-support-emergency-settings/iasc-minimum-service-package-mental-health-and-psychosocial-support)
 z Develop and implement strategies for community outreach and awareness campaigns to promote mental health,
resilience, stress management, positive coping and self-care practices before, during and after emergencies.
z Train health providers and mental health professionals, and educate community leaders, on existing guidance for provision
of basic psychosocial support during emergencies.
z Develop and implement capacity-building and training programs for local community members to offer peer support, basic
psychosocial support and psychological first aid, and promote mental health in emergency situations.

z Scale up existing services to provide community health services and MHPSS, ensuring equitable access to care for all

04 community members, particularly vulnerable populations.

DEMONSTRATED z Maintain and update a dynamic digital infrastructure, including telemedicine and digital platforms, to facilitate remote
CAPACITY access to health services and MHPSS to ensure continuity of care during emergencies.
z Establish a mechanism to monitor and evaluate the implementation of scaling efforts through regular data collection and
analysis, including monitoring the reach, effectiveness and quality of community health services and MHPSS before, during
and after emergencies
z Conduct SimEx/AAR/IAR (as relevant) to assess the effectiveness approaches to addressing the indirect health and mental
health impacts during emergencies.
z Develop and test contingency plans for health services and MHPSS activities, including psychiatric hospitals, outpatient
services and community institutions, during emergencies.
z Advocate for the allocation of resources and support for initiatives that address indirect health and mental health impacts
of health emergencies.
z Develop and promote deinstitutionalization and comprehensive community-based mental health care and mental health
promotion to strengthen resilience during and after emergencies.

WHO benchmarks for strengthening health emergency capacities

z Regularly conduct M&E of scale up and functionality of community health services and MHPSS before, during and after

05 health emergencies and update plans, protocols and guidelines based results and evolving community needs.
SUSTAINABLE z Integrate the scaling efforts for health services and MHPSS into standard practice.
CAPACITY z Allocate sustainable funding to secure human, logistical and technological resources to build sustainable capacity for the
continuity of community health services and MHPSS before, during and after emergencies.
331
 z Enhance the digital infrastructure by implementing advanced telemedicine systems and digital platforms that leverage
cutting edge technologies such as machine learning and data analytics to provide comprehensive and integrated health
services and MHPSS remotely.
z Document and share best practices for scaling health services and MHPSS before, during and after emergencies and
engage the country in peer-to-peer learning programmes at the subnational, national and international levels.

Tools:
z Mental Health and Psychosocial Support Services Package. Inter-Agency Standing Committee; 2022. (https://interagencystandingcommittee.org/iasc-
reference-group-mental-health-and-psychosocial-support-emergency-settings/iasc-minimum-service-package-mental-health-and-psychosocial-
support)
z Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a
systematic review and meta-analysis. Lancet. 2019;394(10194):240-248. doi: 10.1016/S0140-6736(19)30934-1.
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).  
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

WHO benchmarks for strengthening health emergency capacities

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419).
332
 Access to countermeasures
Standardized platforms, regulatory and legal frameworks for clinical trials, product review and development
Standardized platforms for equitable and scalable clinical trials and adapted regulatory and legal frameworks to enable timely trials, product review and
approval are essential capabilities to ensure access to crucial countermeasures during health emergencies. Standardized platforms for equitable and
scalable clinical trials strengthen outbreak research capacity and streamline trial implementation to address public health threats. This includes: national
research capability assessment to guide capacity strengthening; strengthened capacity to conduct research in outbreaks through use of platform trials that
enable faster data gathering and increased statistical power of results; global and regional technical and operational support for national trial implementation
through training on good clinical practice, and initial set-up and support for essential trial infrastructure; standardized trial designs and core protocols
for each pathogen and outbreak; mapping of planned, completed and in-progress clinical trials and latest evidence base relevant to candidate medical
countermeasures against priority diseases; and recruitment of patients into trials and sharing of product specific research outcomes through community
engagement activities as defined by the Good Participatory Practice (GPP) guidelines.

Additionally, timely access to crucial medical products and efficient regulatory responses during emergencies support access to countermeasures and support
rapid responses to health emergencies, including: the use of the global benchmarking tool for the evaluation of national regulatory authority capabilities;
implementation of institutional development plans; agile product regulatory requirements and procedures during emergencies; coordination mechanisms
between regulators, and between regulators and researchers during emergencies; accelerated countermeasures review and approval through increased
regulatory reliance, harmonization and convergence; and participation in expedited emergency use listing and performance qualification processes by WHO
to rapidly evaluate and approve critical products for emergencies, as relevant.

IMPACT:

WHO benchmarks for strengthening health emergency capacities

Strengthened outbreak research capacity within the country supports rapid, efficient and evidence-based health emergency preparedness and
response. Access to crucial medical countermeasures during emergencies is improved for all populations.
333
 MONITORING AND EVALUATION:
(1) A national strategic plan for clinical trials and outbreak research has been developed and implemented, including platform trials, essential trial
infrastructure, pathogen/outbreak standardized trial designs and patient recruitment. (2) Standardized platforms for conducting equitable and
scalable clinical trials are established and functional. (3) Regulatory and legal frameworks for timely trials, product review and approval during
emergencies are developed and implemented, which provide an efficient regulatory response for timely access to crucial medical products.
(4) Adapted regulatory and legal frameworks for efficient regulatory response during emergencies are established and functional.

WHO benchmarks for strengthening health emergency capacities

334
 BENCHMARK H4.1: Standardized platforms for conducting equitable and scalable clinical trials are created and functional
OBJECTIVE: To establish standardized platforms for conducting equitable and scalable clinical trials, ensuring functionality and effectiveness in
outbreak research and ability to support health emergency response efforts

CAPACITY LEVEL BENCHMARK ACTIONS

z Standardized platforms for equitable and scalable clinical trials are not in place, or efforts for outbreak research are

01 conducted ad hoc.
NO CAPACITY

z Assess national research capacity, including outbreak research capacity, use of platform trials, clinical practice training,
02 essential trial infrastructure, standardized design, clinical trial mapping and patient recruitment practices.
LIMITED z Identify a focal agency for effective coordination and communication of clinical trial activities for outbreak research; to collate
CAPACITY research outcomes, such as standardized designs for specific pathogens; and track planned, completed and ongoing clinical
trials and latest evidence base relevant to candidate medical countermeasures for priority diseases.
z Identify potential, or additional, clinical research sites and establish hospital networks for conducting clinical trials.
z Organize advocacy sessions to raise awareness among policy-makers and other relevant authorities, health providers and
community members regarding the importance of clinical trials to generate knowledge for the development of medical
countermeasures against priority diseases.

z Develop a national strategic plan for clinical trials and outbreak research to strengthen national research capacities and

03 support the development of platform trials, essential trial infrastructure, pathogen/outbreak-standardized trial designs and
DEVELOPED patient recruitment.

WHO benchmarks for strengthening health emergency capacities

CAPACITY z Implement, as relevant, standardized trial designs and protocols for priority pathogens and outbreaks.
z Implement platform trials, as relevant, to support outbreak research capacity through faster data gathering and increased
statistical power of results.
z Develop training modules/packages and conduct training on good clinical practice.
z Collaborate with global and regional entities for technical and operational support on national trial set up and essential trial
infrastructure.
335
 z Develop community engagement activities (guided by the Good Participatory Practice guidelines169) to support recruitment
of patients into clinical trials and facilitate sharing of research outcomes.

z Regularly update mapping of clinical trials and the latest evidence base for candidate countermeasures for priority

04 diseases, to track coverage and facilitate expansion of outbreak research.

DEMONSTRATED z Engage communities in the recruitment of patients for clinical trials and sharing of product specific research outcomes.
CAPACITY z Identify gaps in research funding and develop and implement mechanisms to secure funding for clinical trials and research
collaborations.
z Develop and implement mechanisms to enhance the dissemination of clinical trials and outbreak research results to
various audiences.
z Conduct M&E of clinical trials, including platform and standardized trials, to assess functionality in outbreaks,
effectiveness, ethical patient recruitment and relevance of research to priority diseases.
z Participate in global mapping efforts of clinical trials to support comprehensive coverage of clinical trials and contribute to
the current evidence base relevant to medical countermeasures for priority diseases.
z Collaborate and share information among researchers, stakeholders and global/regional entities to maximize evidence-
based decision making and application of research evidence.

z Contribute to the development and dissemination of global standards and guidelines for standardized trial designs and

05 core protocols.
SUSTAINABLE z Sustain community engagement and participatory approaches in research to ensure transparency, quality, equity and
CAPACITY diverse participation in clinical trials and acceptance of research outcomes.

WHO benchmarks for strengthening health emergency capacities

z Secure sustainable funding for clinical trains and research collaborations.
z Sustain long-term research collaborations and networks with global and regional entities to support equitable and scalable
clinical trials.
z Regularly contribute to global mapping efforts of clinical trials and current evidence base relevant to medical
countermeasures for priority diseases.

169
336

Good Participatory Practice: Guidelines for biomedical HIV prevention trials, second edition. Geneva: Joint United Nations Programme on HIV/AIDS; 2011. (https://avac.org/resource/report/
good-participatory-practice-guidelines-for-biomedical-hiv-prevention-trials-second-edition/)
 BENCHMARK H4.2: Regulatory and legal frameworks are developed and functional for timely trials, product review and approval
OBJECTIVE: To develop and implement regulatory and legal frameworks for efficient regulatory response during health emergencies and timely access to
crucial medical products

CAPACITY LEVEL BENCHMARK ACTIONS

z No regulatory and legal frameworks are available for clinical trials, product review and approval during health emergencies,

01 or existing regulatory efforts are applied ad hoc.

NO CAPACITY

z Assess current regulatory and legal frameworks within the country for timely trials, product review and approval during health
02 emergencies. Include current capacities of the regulatory environment, such as regulatory requirements and procedures,
LIMITED coordination between regulators and researchers and accelerated countermeasures review and approval.
CAPACITY z Obtain technical assistance from global regulatory entities to develop an institutional development plan based on assessment
of capacities.
z Establish coordination mechanisms between regulators and researchers within the national context during health
emergencies.
z Explore opportunities for efficient regulatory response during health emergencies, including pathways for agile product
regulatory requirements and accelerated countermeasures review and approval.

z Participate in WHO evaluation of regulatory systems, as mandated by WHA Resolution 67.20, through the WHO Global

03 Benchmarking Tool for evaluation of national regulatory systems170.

DEVELOPED z Develop regulatory and legal frameworks for timely trials, product review and approval during health emergencies which

WHO benchmarks for strengthening health emergency capacities

CAPACITY provide timely access to crucial medical products through an efficient regulatory response.
z Utilize technical assistance from global regulatory entities to implement institutional development plan.
z Enhance coordination mechanisms between regulators and researchers at the national and regional levels to promote
effective information sharing and collaboration to address emerging challenges during health emergencies.
z Develop and implement mechanisms to support efficient regulatory response during health emergencies, including
pathways for agile product regulatory requirements and accelerated countermeasures review and approval.
337

170
WHO Global Benchmarking Tool (GBT) for evaluation of national regulatory systems. World Health Organization. (https://www.who.int/tools/global-benchmarking-tools)
 z Implement regulatory and legal frameworks for timely trials, product review and approval during health emergencies which

04 provide timely access to crucial medical products through an efficient regulatory response.
DEMONSTRATED z Continue participation in the WHO global benchmarking assessment of national regulatory systems, to monitor and
CAPACITY evaluate progress in efficiency and quality prior to issuing marketing authorizations and to conduct post-marketing
pharmacovigilance.
z Increase regulatory reliance, harmonization and convergence to facilitate accelerated medical countermeasures review and
approval during health emergencies.
z Monitor and evaluate coordination mechanisms between regulators and researchers and adapt as needed to support
effective collaboration and exchange of information for improved regulatory response during health emergencies.
z Refine and update agile product regulatory requirements and procedures based on lessons learned from previous health
emergencies and updated risk assessments for the country.

z Establish a comprehensive and sustainable framework for continued evaluation and improvement of national regulatory

05 authority capabilities, utilizing the WHO global benchmarking tool as a regular assessment mechanism.
SUSTAINABLE z Strengthen the country’s institutional development plan to ensure long-term sustainability and adaptability, considering
CAPACITY emerging regulatory challenges and evolving global regulatory landscapes, and contribute to global technical assistance
processes.
z Contribute to shaping global regulatory policies and frameworks, actively participating in international discussions and
initiatives to enhance regulatory response and advocating for timely access to critical medical products during health
emergencies.
z Participate in WHO emergency use listing171 and performance qualification processes, as relevant, to support the expediting
of vaccines, therapeutics and in vitro diagnostics during health emergencies.

WHO benchmarks for strengthening health emergency capacities

171
338

Regulation and prequalification: Emergency use list. World Health Organization. (https://www.who.int/teams/regulation-prequalification/eul#:~:text=The%20WHO%20Emergency%20Use%20
Listing,by%20a%20public%20health%20emergency.)
 Tools:
z Good Participatory Practice: Guidelines for biomedical HIV prevention trials, second edition. Geneva: Joint United Nations Programme on HIV/AIDS;
2011. (https://avac.org/resource/report/good-participatory-practice-guidelines-for-biomedical-hiv-prevention-trials-second-edition/)
z Guzman J, O’Connell E, Kikule K, et al. The WHO Global Benchmarking Tool: a game changer for strengthening national regulatory capacity. BMJ Global
Health. 2020;5:e003181. doi:10.1136/ bmjgh-2020-003181.
z WHO Global Benchmarking Tool (GBT) for evaluation of national regulatory systems. World Health Organization. (https://www.who.int/tools/global-
benchmarking-tools)
z Regulation and prequalification: Emergency use list. World Health Organization. (https://www.who.int/teams/regulation-prequalification/
eul#:~:text=The%20WHO%20Emergency%20Use%20Listing,by%20a%20public%20health%20emergency.)
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience.
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).  
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).    
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).     
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

339
 Medical countermeasure manufacturing platforms for health emergencies
Adaptable manufacturing platforms are dynamic systems that possess the capability to be modified and tailored according to specific manufacturing
requirements. These platforms are designed with the objective of enhancing regional production capacities of medical countermeasures and catering to the
diverse demands that arise from different regions and contexts.

Furthermore, distributed manufacturing that is facilitated by pre-negotiated agreements plays a pivotal role in ensuring the production and equitable
distribution of adequate supply of high priority and quality assured medical countermeasures. This process mainly relies on: setting up manufacturing
platforms with technology transfer support; agreements for access and benefits sharing priority pathogens; transfer of intellectual property rights through
licensing agreements and patent waivers; funding manufacturing facility setup and ongoing operations through at-risk capital financing mechanisms; and
national policies for prenegotiated technology transfer, access and benefit sharing, licensing, and financing agreements.

Similarly, an ever-ready capability for rapid mobilization is a critical component of manufacturing to increase capabilities, enhance preparedness and optimize
the production of medical countermeasures during emergencies, this includes: dual purpose manufacturing through the integration of emergency capacity
into the production of nonemergency products; technical assistance for dual purpose production lines; stable access to production inputs, such as raw
materials and utilities; and procurement prioritization from local and regional manufacturers to create demand side incentives.

IMPACT:
The rapid mobilization of medical countermeasure products is effectively implemented during health emergencies to meet country and regional
needs.

WHO benchmarks for strengthening health emergency capacities

MONITORING AND EVALUATION:
(1) Adaptable manufacturing platforms are created, modified and tailored to meet specific manufacturing requirements, enhancing the overall
flexibility and adaptability of the medical countermeasure production processes in-country and regionally. (2) Prenegotiated agreements support
the function of adaptable manufacturing platforms. (3) Manufacturing efforts are supported by ever-ready capabilities for rapid mobilization of
medical countermeasure production.
340
 BENCHMARK H4.3 Adaptable manufacturing platforms are established and functional, and supported by prenegotiated agreements
OBJECTIVE: To develop and implement national manufacturing platforms that support the demands of national and regional production requirements
through optimizing capacities and aligning manufacturing efforts with needs as supported by prenegotiated agreements

CAPACITY LEVEL BENCHMARK ACTIONS

z Adaptable manufacturing platforms, supported by prenegotiated agreements, are not in place or manufacturing efforts for

01 medical countermeasures are conducted ad hoc.

NO CAPACITY

z Establish a multisectoral coordination committee (with ToR) to guide communication and coordination of relevant entities for
02 medical countermeasure manufacturing activities.
LIMITED z Assess the current medical countermeasure manufacturing landscape in the country, including threat and vulnerability
CAPACITY mapping, demand forecasting, capability and capacity, and include a regional production needs analysis.
z Conduct a situational analysis reviewing the policy environment, input materials, production workforce, financing and
technical support for the manufacturing of medical countermeasures within the country.
z Engage relevant key stakeholders, including legislative or policy-makers, to develop a national manufacturing plan based on
national needs.
z Initiate discussions for access to sharing agreements for priority pathogens, as relevant the specific needs and vulnerabilities
of the country.

z Implement the national manufacturing plan at the national level.

z Develop national policies to support the implementation of prenegotiated technology transfer, access and benefit sharing,

WHO benchmarks for strengthening health emergency capacities

03
DEVELOPED licensing and financing agreements.
CAPACITY z Conduct a technical feasibility study to identify suitable technologies for regional manufacturing considering the forecasted
aggregate regional demands to prioritize how the country can support scale up.
z Develop and implement manufacturing platforms with basic technology transfer support, access and benefit sharing
agreements for priority pathogen countermeasures and ensure alignment with regional production capacities and
requirements.
341
 z Develop and implement licensing agreements and patent waivers for limited transfer of intellectual property rights to
support manufacturers to develop high priority medical countermeasures.
z Establish a capital financing mechanisms for manufacturing facility set up and ongoing operations.

z Expand implementation of the national manufacturing plan and national policies to support prenegotiated agreements.

04 z Expand access and benefit sharing agreements for a wider range of priority pathogens.
DEMONSTRATED z Secure funding for manufacturing facility set up and ongoing operations through more comprehensive at-risk capital
CAPACITY financing mechanisms.
z Facilitate the transfer of intellectual property rights through licensing agreements and patent waivers to manufacturers.
z Increase manufacturing platforms and technology transfer to support in-country or regional production of medical
countermeasures.
z Conduct M&E of the national manufacturing plan and implementation of national policies, such as through SimEx/AAR/IAR
(as relevant).

z Regularly review and update the national manufacturing plan and national policies based on M&E findings and the current

05 environment for regional technical support.

SUSTAINABLE z Review regional manufacturing needs and adapt in-country planning, development and implementation of medical
CAPACITY countermeasure production accordingly.
z Maintain high quality manufacturing platforms with evolving technological advancements to optimize regional
manufacturing requirements.
z Sustain international collaborations for access and benefit sharing, promoting global cooperation and knowledge
exchange.

WHO benchmarks for strengthening health emergency capacities

z Contribute to international systems for technology transfer, intellectual property rights through licensing and patent
wavers, and access and benefit sharing for priority pathogens.
z Secure sustainable funding mechanisms, including domestic funds and public-private partnerships, to ensure ongoing
manufacturing operations.
342
 BENCHMARK H4.4: Manufacturing capabilities are enhanced through ever-ready capabilities for rapid mobilization of medical countermeasure
production during health emergencies
OBJECTIVE: To establish ever-ready capability for rapid mobilization of medical countermeasure production during health emergencies through dual
purpose manufacturing integration and incentivization activities

CAPACITY LEVEL BENCHMARK ACTIONS

z An integrated dual purpose manufacturing system to support ever-ready capabilities is not in place or efforts to rapidly

01 mobilize medical countermeasures are conducted ad hoc.

NO CAPACITY

z Conduct a comprehensive assessment of existing production lines to identify viable opportunities to integrate emergency
02 capacity into the production of nonemergency products to create dual purpose manufacturing.
LIMITED z Assess available technical assistance for operating dual purpose production lines.
CAPACITY z Identify local and regional manufacturers with the capacity to produce medical countermeasures, assessing their readiness
for emergency procurement prioritization.
z Assess the current availability and reliability of production inputs, such as raw materials and utilities, identifying potential
vulnerabilities and areas for improvement to support medical countermeasure production and dual purpose manufacturing.
z Review mechanisms in the country to prioritize procurement of medical countermeasures from local and regional
manufacturers during health emergencies to create demand side incentives.

z Develop a dual purpose manufacturing plan and supporting procedures/guidelines for the modification of production lines
to accommodate dual purpose manufacturing, considering regulatory requirements and industry best practices.

WHO benchmarks for strengthening health emergency capacities

03
DEVELOPED z Implement the dual purpose manufacturing plan, integrating emergency capacity into the production of nonemergency
CAPACITY products.
z Develop strategies to ensure stable access to production inputs, including establishing contingency plans, diversifying
suppliers and fostering strategic partnerships.
z Develop a procurement prioritization strategy that establishes clear guidelines and criteria for selecting local and regional
manufacturers for emergency medical countermeasures.
343

z Establish M&E mechanisms to assess the performance of dual purpose manufacturing systems.
 z Implement the procurement prioritization strategy by actively engaging and contracting with selected local and regional

04 manufacturers.
DEMONSTRATED z Implement supply chain management practices for proactive monitoring of production inputs, optimizing inventory
CAPACITY management, and conduct regular assessments to ensure uninterrupted access to essential resources including raw
material and utilities.
z Conduct regular testing and SimEx (as relevant) to validate the readiness and responsiveness of dual purpose
manufacturing for health emergencies.

z Update plans, procedures and guidelines based on M&E results.

05 z Integrate dual purpose manufacturing for preparedness as an integral part of the overall national manufacturing strategy,
SUSTAINABLE ensuring sustainability and long-term viability of the approach.
CAPACITY z Sustain and enhance the procurement prioritization strategy including strengthening domestic manufacturing
collaboration and capabilities.
z Sustain collaboration and knowledge sharing with industry peers and relevant stakeholders to exchange best practices and
promote continued innovations in dual purpose manufacturing.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience.
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).  
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/

WHO benchmarks for strengthening health emergency capacities

publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).    
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).     
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
344
 Regulatory framework for manufacturing platforms
The implementation of a strengthened regulatory framework to oversee the set-up and scale-up of manufacturing platforms for medical countermeasures
is essential to effective health emergency preparedness and response. Recognizing the importance of efficient, reliable, and timely production while adhering
to good regulatory practices and upholding stringent regulatory standards, includes capacities in the areas of robust regulatory systems, global and regional
technical support, adaptable manufacturing regulatory requirements, emergency coordination mechanisms, accelerated access to medical countermeasures
and expedited evaluation and approval process.

IMPACT:
Local and regional manufacture of medical countermeasures enables equitable access to life-saving interventions before, during and after health
emergencies.

MONITORING AND EVALUATION:

(1) Robust regulatory frameworks are established and operational to effectively oversee the efficient and timely production of medical
countermeasure while upholding stringent standards.

WHO benchmarks for strengthening health emergency capacities

172
345

These systems provide oversight of licensing and compliance with good practice including good manufacturing practices, good storage and distribution practices, good clinical practices and
good pharmacovigilance practices, ensuring adherence to high-quality standards.
 BENCHMARK H4.5: National regulatory frameworks for manufacturing platforms are developed and implemented for health emergencies
OBJECTIVE: To establish robust national regulatory frameworks that effectively oversee the set-up and scale-up of manufacturing platforms for medical
countermeasure products during health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z National regulatory framework that effectively oversee the set-up and scale-up of manufacturing platforms for medical

01 countermeasure products during health emergencies is not in place or efforts are ad hoc.
NO CAPACITY

z Conduct a situational analysis of the existing regulatory framework for manufacturing platforms of medical countermeasures
02 for health emergencies, including: regulatory systems and oversight of licensing of good practice; level of adaptability in
LIMITED regulatory requirements during emergencies; coordination between regulators and manufacturers; level of technical support
CAPACITY received from regional and global entities; and ability for accelerated production during health emergencies.
z Conduct stakeholder analysis to identify key actors and their roles in the regulatory process and manufacturing for medical
countermeasures.
z Establish effective communication and coordination mechanisms among stakeholders to streamline regulatory operations
before, during and after health emergencies.
z Obtain technical guidance from global and regional entities to support national regulatory system strengthening.
z Explore opportunities for the accelerated production of medical countermeasures and how regulatory reliance, harmonization
and convergence can be increased during health emergencies.

z Develop comprehensive regulatory framework and strategies/guidelines to set-up and scale-up manufacturing platforms

WHO benchmarks for strengthening health emergency capacities

03 for medical countermeasure products during health emergencies.
DEVELOPED z Develop legal frameworks and procedures that align with international standards and best practices for manufacturing
CAPACITY medical countermeasures.
z Develop M&E mechanisms to assess manufacturing regulatory systems.
z Conduct capacity-building initiatives for relevant authorities to enhance capabilities in overseeing and regulating
manufacturing platforms.
346
 z Implement national regulatory framework and strategies, ensuring adherence to legal frameworks and procedures, to set-

04 up and scale-up manufacturing platforms for medical countermeasure products during health emergencies.
DEMONSTRATED z Assess the use of WHO emergency use authorization (EUA), emergency use listing (EUL) and licensing, as relevant to the
CAPACITY country.
z Conduct regular M&E of the regulatory system for manufacturing platforms, including adaptability of requirements during
health emergencies.
z Demonstrate coordination mechanism between regulators and manufactures for manufacture and access to medical
countermeasures during health emergencies.
z Establish regulatory oversight of licensing of Good Manufacturing Practice compliance.

z Adjust and update the regulatory systems based on M&E results.

05 z Secure long-term funding to sustain and support the regulatory oversight activities for medical countermeasure
SUSTAINABLE manufacturing platforms before, during and after health emergencies.
CAPACITY z Contribute to global regulatory technical support and offer guidance to other countries on national regulatory system
strengthening.
z Engage in knowledge sharing and collaboration with other regions to enhance regulatory practices and standards.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience.
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).  

WHO benchmarks for strengthening health emergency capacities

z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).    
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).     
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
347

handle/10665/333419)
 Coordinated demand aggregation for medical countermeasures
Coordinated demand aggregation is crucial in the efforts of building an agile and effective health emergency supply chain, and is essential for decision-
makers to anticipate and meet demand of medical countermeasures for emergency preparedness and response. This includes performing risk-based
demand analysis, demand forecasting, aggregating demand forecasts across countries and regions, and formulating robust methodologies for demand
forecasting.

IMPACT:
Decision-makers are able to effectively anticipate and meet demand for medical countermeasures during health emergencies.

MONITORING AND EVALUATION:

(1) Robust methods are developed and applied for forecasting demands and well aggregated to ensure accurate and equitable distribution of
medical counter measures and inform decision-making for procurement and distribution. (2) Risk-based analyses and rapid needs assessments
are applied to quantify medical countermeasures for initial supply push at the onset of a health emergency response.

WHO benchmarks for strengthening health emergency capacities

348
 BENCHMARK H4.6: Coordinated demand aggregation systems are established and operational
OBJECTIVE: To establish and operationalize coordinated demand aggregation systems that effectively anticipate and meet the demands for medical
countermeasures during health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z Coordinated demand aggregation systems that meet the needs for medication countermeasures during health

01 emergencies are not in place, or efforts are ad hoc.

NO CAPACITY

z Conduct a situational analysis to identify gaps and challenges in existing demand analysis and forecasting capabilities for
02 medical countermeasures during health emergencies.
LIMITED z Conduct a stakeholder analysis to identify key actors involved in the demand aggregation process, and establish effective
CAPACITY communication and coordination mechanisms.
z Develop a mechanism to perform risk-based demand analysis, including rapid risk-assessment of needs at the onset and
during a health emergency.

z Conduct a risk-based demand analysis, including rapid risk-assessment of needs at the onset and during a health

03 emergency.
DEVELOPED z Develop and implement tools and methodologies to conduct rapid assessments using data-driven approaches to facilitate
CAPACITY accurate and timely demand forecasts for medical countermeasures during health emergencies.
z Establish data integrity and privacy policies to support data-driven approaches to demand forecasting and aggregation,
including vulnerable populations.

WHO benchmarks for strengthening health emergency capacities

z Develop a mechanism to share demand forecasts across countries and region, including vulnerable populations.
z Implement capacity-building programs to enhance the capabilities of stakeholders in collecting, analyzing and effectively
forecasting demand.

z Develop and integrate advanced tools and methodologies, such as statistical modelling and scenario analysis, to facilitate

04 accurate and timely demand forecasts for medical countermeasures during health emergencies.
DEMONSTRATED z Develop and implement a M&E framework to assess mechanisms to effectively determine demand aggregation and
349

CAPACITY forecasting for medical countermeasures for health emergencies.

z Implement mechanism to share demand forecasts across countries and region, including vulnerable populations.
 z Update tools and methodologies used for demand forecasting based on M&E results.

05 z Secure long-term funding and resource allocation to sustain demand aggregation and forecasting practices.
SUSTAINABLE z Document and share country experiences in demand aggregation and forecasting and engage the country in peer-to-peer
CAPACITY learning programmes at the subnational, national and international levels.
z Conduct research and analysis to identify new tools and methods to further enhance the accuracy and effectiveness of
risk-based demand analysis and demand forecasting.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience.
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).  
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).    
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).     
z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)

WHO benchmarks for strengthening health emergency capacities

350
 Equitable and transparent needs-based allocation of medical countermeasures
The fair, equitable and efficient distribution of medical countermeasures during emergencies is central to global health security and involves: needs-based
allocation frameworks and principles that can be rapidly adapted; a global allocation process that manages conflicts of interest and ensures that allocation
decisions are transparent, driven by public health goals and based on an ethical framework; allocation decisions take account of commitment to use medical
countermeasures appropriately according to established guidance; and allocations are timely, efficient, transparent and underpinned by collective agreements,
international instruments and political commitment to equitable access to appropriate medical countermeasures during health emergencies.

IMPACT:
Fair, equitable and efficient distribution of medical countermeasures during health emergencies.

MONITORING AND EVALUATION:

(1) Needs-based allocation frameworks and principles are developed and implemented to guide the transparent allocation of medical counter-
measures during health emergencies.

WHO benchmarks for strengthening health emergency capacities

351
 BENCHMARK H4.7: Equitable and transparent needs-based allocation frameworks are in place for medical countermeasures during health emergencies
OBJECTIVE: To establish and implement needs-based allocation frameworks and principles for the fair, equitable and efficient distribution of medical
countermeasures during health emergencies

CAPACITY LEVEL BENCHMARK ACTIONS

z Needs-based allocation frameworks for distribution of medical countermeasures are not in place or efforts are ad hoc

01 during health emergencies.

NO CAPACITY

z Conduct a situational analysis of resource allocation frameworks or mechanisms and principles for equitable access to
02 medical countermeasures before, during and after emergencies.
LIMITED z Review collective agreements and international instruments that support equitable access to appropriate countermeasures.
CAPACITY z Conduct a stakeholder analysis and mapping to identify key actors involved in the allocation process, and provide guidance to
relevant stakeholders.

z Develop and implement needs-based allocation frameworks and principles to optimize equitable, effective and responsive

03 distribution of medical countermeasure during health emergencies.

DEVELOPED z Contribute to the development of collective agreements and international instruments that support and promote equitable
CAPACITY access to appropriate countermeasures.
z Develop training and capacity-building initiatives for stakeholders involved in the distribution of medical countermeasures,
including needs-based, equitable, transparent and efficient allocation principles.
z Establish mechanisms for M&E of needs-based allocation frameworks and decisions, considering transparency and

WHO benchmarks for strengthening health emergency capacities

responsibility.

z Expand implementation of the needs-based allocation frameworks and principles to all levels to optimize medical

04 countermeasure distribution during health emergencies.

DEMONSTRATED z Actively participate and contribute to the global allocation process, conflict management, transparency and collaboration in
CAPACITY resource allocation.
z Conduct capacity-building initiatives for stakeholders involved in the distribution of medical countermeasures, including
352

needs-based, equitable, transparent and efficient allocation principles.

 z Enhance compliance with collective agreements and international instruments for medical countermeasure allocation by
conducting regular in-country audits, publishing allocation processes and outcomes, and implementing robust governance
mechanisms for transparency.
z Conduct regular M&E of need based allocation frameworks and decisions, considering transparency and responsibility.

z Update frameworks and principles based on M&E results.

05 z Sustain needs-based allocation frameworks and principles within subnational and national emergency response systems,
SUSTAINABLE ensuring integration into policies, legislation and SOPs.
CAPACITY z Secure sustainable funding to optimize needs-based allocation frameworks and systems at all levels for health
emergencies.
z Advocate for fair global allocation processes by actively contributing to the development of international standards,
guidelines and frameworks, ensuring that allocation decisions are driven by public health goals and ethical considerations.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience.
Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).  
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).    
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).     

WHO benchmarks for strengthening health emergency capacities

z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
353
 Emergency coordination
Operational support and logistics platforms
Robust operational support and logistics systems enable the transformation of strategies into practical actions. The achievement of tangible outcomes can
be attained through:

z Staff safety and security: Ensuring the protection of both personnel and affected communities involved in emergency response efforts. Staff safety
and security mainly includes suitable accommodation and provisions, equipment for safety and communications, adequate working environment,
and provision of safe transport. Safety and security also safeguards against threats such as sexual exploitation, abuse, and harassment, with a strong
emphasis on upholding the welfare of all individuals engaged in the emergency coordination and response process.
z Operational logistics: Medical and supply logistics involve the establishment and maintenance of vital infrastructure and processes that are indispensable
for effective coordination during emergencies.
z Operational support and management: A range of essential functions necessary for streamlined emergency coordination such as financial administration,
efficient allocation and utilization of resources, and effective management of human resources within the context of emergency response operations.

IMPACT:
Emergency coordination strategies are informed and supported by well established operational support and logistics platforms.

MONITORING AND EVALUATION:

(1) Systems for staff safety and security are established and operational for health emergencies. (2) Operational logistics platforms for medical

WHO benchmarks for strengthening health emergency capacities

and supply logistics are well coordinated before, during and after health emergencies. (3) Systems for operational support and management are
established and operational within the context of emergency response operations.
354
 BENCHMARK H5.1: Operational support and logistics platforms are established and functional for health emergencies
OBJECTIVE: To establish and maintain functional operational support and logistics platforms for effective emergency coordination including staff safety
and security, operational logistics and efficient operational support and management

CAPACITY LEVEL BENCHMARK ACTIONS

z Operational support and logistics platforms are not in place or are functional on an ad hoc basis during health

01 emergencies.
NO CAPACITY

z Conduct a situational analysis of existing capabilities for emergency coordination, including staff safety and security,
02 operational logistics and operational support and management, to identify strengths and gaps.
LIMITED z Conduct a review, as appropriate, to gather insights from previous health emergencies regarding staff safety and security,
CAPACITY operational logistics, and operational support and management aspects.
z Perform a stakeholder analysis to identify key actors involved in providing operational support and logistic platforms for
health emergencies.
z Designate a focal point or entity responsible to oversee and coordinate operational support and logistics required before,
during and after health emergencies.

z Develop a safety and security framework and protocols to ensure the protection of staff and communities they serve

03 during emergency response efforts.

DEVELOPED z Develop an integrated operational support and logistics plan that encompasses basic financial administration
CAPACITY procedures, clear guidelines for human resources management, contingency measures and enhanced coordination with

WHO benchmarks for strengthening health emergency capacities

accommodation providers, transportation agencies and suppliers.
z Establish dedicated logistics coordination teams to manage accommodation facilities, health emergency logistics and
procurement, ensuring essential resources and supplies are available during emergencies.
z Enhance the capacity for safety and security of personnel engaged in emergency coordination through targeted training
programs, workshops and establishing reporting mechanisms and collaboration with law enforcement agencies.
z Establish codes of conduct and ethics policies for staff involved in emergency response efforts.
355
 z Implement the safety and security framework and protocols at national and subnational levels.

04 z Implement the integrated operational support and logistics plan for effective coordination, resource management and
DEMONSTRATED response during health emergencies at national and subnational levels.
CAPACITY z Establish effective linkages between medical logistic and supply departments and PHEOCs to strengthen operational
logistic capacities and implement technology solutions.
z Enhance operational support and management by implementing relevant financial forecasting and risk management
systems, innovative resource allocation approaches and continuous capacity-building programs for relevant multisectoral
staff.
z Regularly monitor and evaluate and refine operational systems and processes based on performance metrics and
feedback.

z Sustain strategic stockpiles of essential resources and supplies, leverage advanced technology solutions and establish

05 long-term partnerships for optimized operational logistics.

SUSTAINABLE z Secure and sustain funding for staff safety, security, operational logistics and support, and management systems.
CAPACITY z Regularly assess and improve financial and operational systems through regular M&E, audits and participation in
knowledge-sharing initiatives.
z Share country experience in operational support and logistics platforms and engage the country in peer-to-peer learning
programmes at the subnational, national and international levels.

Tools:
z 10 proposals to build a safer world together – Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience.

WHO benchmarks for strengthening health emergency capacities

Geneva: World Health Organization; 2022 (https://www.who.int/publications/m/item/10-proposals-to-build-a-safer-world-together---strengthening-
the-global-architecture-for-health-emergency-preparedness--response-andresilience--white-paper-for-consultation--june-2022).  
z Strengthening health emergency prevention, preparedness, response and resilience. Geneva: World Health Organization; 2023 (https://www.who.int/
publications/m/item/strengthening-the-global-architecture-for-health-emergency-prevention--preparedness--response-and-resilience).    
z WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public
health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).     
356

z Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).

z Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/
handle/10665/333419)
 357

Annex 1: Glossary
Note: These terms and definitions have been provided for use within the context of this tool and may differ
from those used in other documents.

After action review. An AAR provides an opportunity to review the functional capacity of public health and
emergency response systems and to identify practical areas for continued improvement (Guidance for after
action review (AAR). Geneva, Switzerland: World Health Organization; 2019 (WHO/WHE/CPI/2019.4). Licence:
CC BY-NC-SA 3.0 IGO.)

Biological agents of high consequence. These are biological agents and toxins that have the potential to
pose a severe threat to both human and animal health. While some select agents are normally found in the
environment and don’t cause human disease, many of them – if manipulated or released in large quantities
– can cause serious health threats. The informal Australia Group provides a List of human and animal
pathogens and toxins for export control (http://www.australiagroup.net/en/human_animal_pathogens.html)

Biosafety. Laboratory biosafety describes the containment principles, technologies and practices that are
implemented to prevent unintentional exposure to pathogens and toxins, or their accidental release. (World
Health Organization. (2020). Laboratory biosafety manual, 4th ed. World Health Organization. https://iris.
who.int/handle/10665/337956. License: CC BY-NC-SA 3.0 IGO)

Biosecurity. Laboratory biosecurity describes the protection, control and accountability for valuable biological
materials within laboratories as well as information related to these materials and dual-use research, in
order to prevent their unauthorized access, loss, theft, misuse, diversion or intentional release. (World Health
Organization. (2022). Joint external evaluation tool: International Health Regulations (2005), 3rd ed. World
Health Organization. https://apps.who.int/iris/handle/10665/357087. License: CC BY-NC-SA 3.0 IGO)

Case. A person who has the particular disease, health disorder or condition that meets the case definitions
for surveillance and outbreak investigation purposes. The definition of a case for surveillance and outbreak
investigation purpose is not necessarily the same as an ordinary clinical definition. (adapted from Porta M,
editor. A dictionary of epidemiology, sixth edition. International Epidemiological Association, Inc. New York:
Oxford University Press; 2014).

Case definition. A set of diagnostic criteria that must be fulfilled for an individual to be regarded as a case of
a particular disease for surveillance and outbreak investigation purposes. Case definitions can be based on
clinical criteria, laboratory criteria or a combination of the two with the elements of time, place and person. (In
the IHR, case definitions are published on the WHO website1 for the four diseases for which all cases must
be notified by States Parties to WHO, regardless of circumstances, under the IHR as provided in Annex 2.)

Chemical event. A manifestation of a disease or an occurrence of an event which creates a potential for a
disease as a result of exposure to or contamination by a chemical agent.

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Communicable disease. A disease whose causal agent can be transmitted from successive hosts to healthy
subjects, from one individual to another. An illness due to a specific infectious agent or its toxic products
that arises through transmission of such agent or products from an infected person, animal, or reservoir to
a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or the
inanimate environment. All infections and infestations are communicable (transmissible) diseases. (adapted
from Porta M, editor. A dictionary of epidemiology, sixth edition. International Epidemiological Association,
Inc. New York: Oxford University Press; 2014).

Competent authority. An authority responsible for the implementation and application of health measures
under the IHR.

Contamination. The presence of an infectious or toxic agent or matter on the body surface of a human or
animal, in or on a product prepared for consumption or on other inanimate objects, including conveyances
that may constitute a public health risk.

Decontamination. A procedure whereby health measures are taken to eliminate an infectious or toxic agent
or matter on the body surface of a human or animal, in or on a product prepared for consumption, or on other
inanimate objects, including conveyances that may constitute a public health risk.

Designated laboratories. These are laboratories designated to perform specific laboratory services by
national, WHO or other authorities because of their proven capacities and capabilities, such as for AMR
testing.

Designated points of entry. These refer to a port, airport and potentially a ground crossing that is designated
by a State Party to strengthen, develop and maintain the capacities as per main IHR articles 19, 20 and 21,
and as described in Annex 1 of the IHR: the capacities at all times concerning access to medical services
for prompt assessment and care of ill travellers, a safe environment for travellers (e.g. water, food, waste),
personnel for inspection and vector control functions; and the capacities to respond specifically to events
that may constitute a public health emergency of international concern.

Disease. An illness or medical condition, irrespective of origin or source, that presents or could present
significant harm to humans.

Disinsection. The procedure whereby health measures are taken to control or kill insect vectors of human
diseases present in baggage, cargo, containers, conveyances, goods and postal parcels.

Early warning alert and response. The organized mechanism to rapidly detect and respond to signals that
might indicate potential acute public health events (Early Warning Alert and Response in Emergencies: an
operational guide. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO).

Early Warning System. In disease surveillance, a specific procedure to detect as early as possible any departure
from usual or normally observed frequency of phenomena. (Porta M, editor. A dictionary of epidemiology,
sixth edition. International Epidemiological Association, Inc. New York: Oxford University Press; 2014)

Epidemic. The occurrence in a community or region of cases of an illness, specific health-related behaviours,
or other health-related events clearly in excess of normal expectancy. The community or region and the
period in which the cases occur are specified precisely. The number of cases indicating the presence of an
epidemic varies according to the agent, size and type of population exposed, previous experience or lack of

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exposure to the disease, and time and place of occurrence (adapted from Porta M, editor. A dictionary of
epidemiology, sixth edition. International Epidemiological Association, Inc. New York: Oxford University Press;
2014).

Event. A manifestation of disease or an occurrence that creates a potential for disease.

Event-based surveillance. The organized collection, monitoring, assessment and interpretation of mainly
unstructured ad hoc information regarding potential public health events or risks which may represent an
acute risk to human health. (Early Warning Alert and Response in Emergencies: an operational guide. Geneva:
World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO).

Field Epidemiology Training Program.

z FETP Basic Level Training is for local health staff and consists of limited classroom hours interspersed
throughout as a three-to-five month on-the-job field assignment to build capacity in conducting timely
outbreak detection, public health response and public health surveillance.
z FETP Intermediate Level Training is for district/region/state-level epidemiologists, and consists of
limited classroom hours interspersed throughout as a six-to-nine month on-the-job mentored field
assignment to build capacity in conducting outbreak investigations, planned epidemiologic studies, and
public health surveillance analyses and evaluations.
z FETP Advanced Level Training is for advanced epidemiologists and consists of limited classroom hours
interspersed throughout the 24 months of mentored field assignments to build capacity in outbreak
investigations, planned epidemiologic studies, public health surveillance analyses and evaluations,
scientific communication, and evidence-based decision making for development of effective public
health programming with a national focus. Animal health professionals can be engaged in these FETP
trainings.

Gender. refers to socially constructed characteristics of women and men – such as norms, roles
and relations of and between groups of women and men. (World Health Organization. (2011). Gender
mainstreaming for health managers: a practical approach. World Health Organization. https://apps.who.int/
iris/handle/10665/44516)

Gender action plan. Refers to a planning document that includes: (i) Activity(ies) that will be undertaken to
address identified and assessed gender gap(s) (ii) Indicators to assess progress in closing each gender gap;
(iii) Data and measures required to track shifts in each indicator; (iv) Training and (human and institutional)
capacity requirements and how these will be met; (v) An estimated line-item budget; (vi) A timeline.

Gender gaps. refers to differences between men, women and people of diverse gender identities in terms
of their levels of participation, access, rights, remuneration or benefits. These gaps may arise because of
biological, socioeconomic or sociocultural reasons. Gender high priority gaps refers to sex and gender gaps
that are assessed to (i) inhibit implementation effectiveness, (ii) potentially affect a large proportion of the
population of the disadvantaged sex (women and girls, or men and boys) and (iii) act as a constraint to
effective and full preparedness and response that the whole population can access. Based on the gender
analysis conducted, each country will determine which elements of gender inequalities are high priority, with
consideration given to the differences across countries in sociocultural contexts and gender norms

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Gender systematic assessment. refers to evidence-based identification of a gender gap to understand the
causes of that gender gap (sometimes referred to as gender analysis), without knowing the causes of a
gender inequality it is not possible to develop an action plan to address it. Assessments can be done using
secondary analysis of available data and research where possible, as well as with novel research.

Ground crossing. A point of land entry into a State Party, including those utilized by road vehicles and trains.

Hazard. The inherent capability of an agent or situation to have an adverse effect; a factor or exposure that
may adversely affect health (similar concept to risk factor).

Health worker. Any employee in a healthcare facility who has close contact with patients, patient-care areas
or patient-care items; also referred to as “health care worker, health worker, or health and care worker”.

Public health and social measures (PHSMs). Are a key strategies to reduce the transmission of pathogens
with epidemic or pandemic potential. PHSMs include non-pharmaceutical interventions that can be taken
by individuals, institutions, communities, local and national governments and international bodies to slow or
stop the spread of an infectious disease. (https://www.who.int/activities/measuring-the-effectiveness-and-
impact-of-public-health-and-social-measures)

Incidence. The number of instances of illness commencing, or of persons falling ill, during a given period in a
specified population (Porta M, editor. A dictionary of epidemiology, sixth edition. International Epidemiological
Association, Inc. New York: Oxford University Press; 2014).

Indicator-based surveillance. The systematic collection, monitoring, analysis and interpretation of structured
health-related data (indicators), produced by health facilities or other defined sources.

Reporting is based on standardized case definitions of selected priority diseases or conditions. (Early Warning
Alert and Response in Emergencies: an operational guide. Geneva: World Health Organization; 2022. Licence:
CC BY-NC-SA 3.0 IGO).

Infection. The entry and development or multiplication of an infectious agent in an organism, including the
body of humans and animals that may constitute a public health risk. Infection is non synonymous with
infectious disease; the result may be inapparent of manifest. (adapted from Porta M, editor. A dictionary of
epidemiology, sixth edition. International Epidemiological Association, Inc. New York: Oxford University Press;
2014).

Infectious agent. A microscopic element that is capable or causing a disease in a susceptible host. (Porta M,
editor. A dictionary of epidemiology, sixth edition. International Epidemiological Association, Inc. New York:
Oxford University Press; 2014).

Infectious disease. A disease due to an infectious agent. While some infectious diseases are contagious, others
are noncontagious (i.e. require a vector for transmission). All infectious and infestations are communicable
diseases (See also Communicable diseases) (adapted from Porta M, editor. A dictionary of epidemiology,
sixth edition. International Epidemiological Association, Inc. New York: Oxford University Press; 2014).

International Health Regulations (2005) (IHR). This is a legally-binding instrument of international law which
has its origin in the International Sanitary Conventions of 1851, concluded in response to increasing concern
about the links between international trade and spread of diseases (cross-border health risks).

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Intra-action review. a country-led, facilitated discussion that allows national and subnational stakeholders of
the COVID-19 response to (i) reflect on actions being undertaken to prepare for and respond to the COVID-19
outbreak at the country level in order to identify current best practices, gaps and lessons learned, and (ii)
propose corrective actions to improve and strengthen the continued response to COVID-19. Additionally, IAR
findings and recommendations may contribute to improving the management of concurrent emergencies
and to long-term health security. (Guidance for conducting a country COVID-19 intra-action review (IAR).
Geneva: World Health Organization; 2020 (WHO/2019-nCoV/Country_IAR//2020.1). Licence: CC BY-NC-SA
3.0 IGO.)

Isolation. Separation, for the period of communicability, of infected persons or animals from others under
such conditions as to prevent or limit the transmission of the infectious agent from those infected to those
who are susceptible or who may spread the agent to others. (Porta M, editor. A dictionary of epidemiology,
sixth edition. International Epidemiological Association, Inc. New York: Oxford University Press; 2014).

Legislation. The range of legal, administrative or other governmental instruments that may be available for
States Parties to implement the IHR. This includes legally binding instruments, such as state constitutions,
laws, acts, decrees, orders, regulations and ordinances; legally non-binding instruments, such as guidelines,
standards, operating rules, administrative procedures or rules; and other types of instruments, such as
protocols, resolutions and inter-sectoral or inter-ministerial agreements. This encompasses legislation in
all sectors, such as health, agriculture, transportation, environment, ports and airports, and at all applicable
governmental levels (national, intermediate, local and other).

Multisectoral. A holistic approach involving the efforts of multiple organizations, institutes and agencies. It
encourages interdisciplinary participation, collaboration and coordination of people of concern and resources
from these key organizations for promoting health security, to achieve a specific goal.

National legislation. see Legislation.

National IHR Focal Point. The national centre designated by each State Party, which shall be accessible at all
times for communications with WHO IHR contact points under the IHR.

Notifiable disease. A disease that, by statutory/legal requirements, must be reported to a public health or
other competent authority in the pertinent jurisdiction when the diagnosis is made (adapted from Porta M,
editor. A dictionary of epidemiology, sixth edition. International Epidemiological Association, Inc. New York:
Oxford University Press; 2014).

Notification. The processes by which cases or outbreaks are brought to the knowledge of the health
authorities. In the context of the IHR, notification is the official communication of a disease/health event to
WHO by the health administration of the Member State affected by the disease/health event.

One Health. Defined by WHO as an approach to designing and implementing programmes, policies,
legislation and research in which multiple sectors communicate and work together to achieve better public
health outcomes, In the context of the WHO IHR monitoring and evaluation framework, taking a One Health
approach means including, from all relevant sectors, national information, expertise, perspectives and
experience necessary to conduct assessments, evaluations and reporting for the implementation of the IHR.

Other governmental instruments. Agreements, protocols and resolutions of any government authority or
body.

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Outbreak. An epidemic limited to localized increase in the incidence of a disease, such as in a village, town
or closed institution (adapted from Porta M, editor. A dictionary of epidemiology, sixth edition. International
Epidemiological Association, Inc. New York: Oxford University Press; 2014).

Point of entry. A passage for international entry or exit of travellers, baggage, cargo, containers, conveyances,
goods and postal parcels, and the agencies and areas providing services to them upon entry or exit.

Port. A seaport or a port on an inland body of water where ships on an international voyage arrive or depart.

Public health emergency of international concern (PHEIC). An extraordinary event (as provided in the IHR)
that: (i) constitutes a public health risk to other states through the international spread of disease; and (ii)
potentially requires a coordinated international response.

Public health risk. The likelihood of an event that may adversely affect the health of human populations, with
an emphasis on whether it may spread internationally or present a serious and direct danger.

Rapid response team. A group of trained individuals that is ready to respond quickly to an event. The
composition and terms of reference are determined by the concerned country.

Readiness. It is the ability to quickly and appropriately respond when required to any emergencies.

Regulations or administrative requirements. All regulations, procedures, rules and standards.

Relevant/other sectors. Private and public sectors: such as all levels of the healthcare system (national,
subnational and community/primary public health); NGOs; ministries of agriculture (zoonosis, veterinary
laboratory), transport (transport policy, civil aviation, ports and maritime transport), trade and/or industry
(food safety and quality control), foreign trade (consumer protection, control of compulsory standard
enforcement), communication, defence, treasury or finance (customs), environment, interior, health, tourism;
the home office; media; and regulatory bodies.

Risk communication. For public health emergencies includes the range of communication capacities required
through the preparedness, response and recovery phases of a serious public health event to encourage
informed decision making, positive behaviour change and the maintenance of trust.

Simulation exercise. An exercise is a form of practice, training, monitoring or evaluation of capabilities,

involving the description or simulation of an emergency to which a described or simulated response is made.
There are two categories of exercises: discussion-based (table top exercises) and operations-based (drills,
functional exercises, field exercises and full-scale exercises) (WHO Simulation Exercise Manual http://apps.
who.int/iris/bitstream/10665/254741/1/)).

Subnational level. Refers to all administrative levels under the national level, including regional, provincial or
state, and can also include municipality level.

Surveillance. The systematic ongoing collection, collation and analysis of data for public health purposes
and the timely dissemination of public health information for assessment and public health response, as
necessary.

Syndrome. A complex of signs and symptoms that tend to occur together, often characterizing a disease, in
which the symptoms and/or signs coexist more frequently than would be expected by chance independently
(adapted from Porta M, editor. A dictionary of epidemiology, sixth edition. International Epidemiological
Association, Inc. New York: Oxford University Press; 2014).

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Trained staff. Individuals that have educational credentials and/or received specific instruction that is
applicable to a task or situation.

Vector. An insect or other invertebrate that transmits an infectious agent or parasite from one animal
(including humans) or plant to another.

Verification. The provision of information by a State Party to WHO confirming the status of an event within
the territory or territories of that State Party.

WHO IHR contact point. The unit within WHO that is accessible at all times for communications with the
National IHR Focal Point.

Zoonotic diseases (or zoonoses). Any infection or infectious disease that is naturally transmissible from
vertebrate animals to humans.

Zoonotic event. A manifestation of a disease in animals that creates a potential for a disease in humans as
a result of human exposure to the animal source.

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Benchmarks to JEE/SPAR and HEPR

Annex 2: Mapping of

WHO benchmarks for strengthening health emergency capacities

 Table 1. Mapping of Benchmarks to JEE and SPAR.
JEE Indicators SPAR Indicators WHO Benchmarks
(3rd edition, 2022) (2nd edition, 2021) (2023)
PREVENT
P1 Legal Instruments C1. Policy, legal and normative instruments to 1. Legal Instruments
implement IHR
P1.1. Legal instruments C1.1. Policy, legal and normative instruments 1.1 Legal instruments are in place across relevant sectors to
support and enable International Health Regulations (2005) (IHR)
implementation and compliance
P1.2. Gender equity and equality C1.2. Gender equality in health emergencies 1.2 Gender equity and equality principles are applied throughout
in health emergencies IHR capacities
P2. Financing C.3. Financing 2. Financing
P2.1. Financial resources for IHR C3.1. Financing for IHR implementation 2.1 Financing is available and disbursed for the implementation of
implementation IHR capacities
P2.2. Financial resources C3.2. Financing for public health emergency 2.2 Financing available for timely response to health emergencies
for public health emergency response
response
P3. IHR Coordination, National C2. IHR coordination and National IHR Focal 3. IHR Coordination, National IHR Focal Point Functions and
IHR Focal Point Functions and Point Advocacy
Advocacy
P3.1. National IHR Focal Point C2.1. National IHR Focal Point functions 3.1 The IHR national focal point (NFP) is fully functional
functions

WHO benchmarks for strengthening health emergency capacities

P3.2. Multisectoral coordination C2.2. Multisectoral coordination mechanisms 3.2 Multisectoral IHR coordination mechanism effectively supports
mechanisms the implementation of prevention, detection and response activities
P3.3. Strategic planning for IHR, C2.3. Advocacy for IHR implementation 3.3 Strategic planning for IHR, preparedness or health security are
preparedness or health security in place and supported by functional advocacy mechanisms for
IHR implementation
365
 P4. Anti-Microbial Resistance 4. Antimicrobial Resistance
(AMR)
P4.1. Multisectoral coordination 4.1 Effective multisectoral coordination for antimicrobial resistance
on AMR (AMR)
P4.2. Surveillance of AMR 4.2 A surveillance system for AMR is in place
P4.3. Prevention of multidrug 4.3 Effective mechanisms are in place to prevent multidrug
resistant organism (MDRO) resistant organisms (MDRO)
P4.4. Optimal use of 4.4 Optimize use of antimicrobial medicines in human health
antimicrobial medicines in
human health
P4.5 Optimal use of antimicrobial 4.5 Optimize use of antimicrobial medicines in animal health and
medicine in animal health and agriculture
agriculture
P5. Zoonotic Diseases C12. Zoonotic diseases 5. Zoonotic Diseases
P5.1. Surveillance of zoonotic C12.1. One Health collaborative efforts across 5.1 A multisectoral surveillance system is in place for priority
diseases sectors on activities to address zoonoses zoonotic diseases/pathogens
P5.2. Response to zoonotic 5.2 A functional mechanism to respond to priority zoonotic
diseases diseases is in place
P5.3. Sanitary animal production 5.3 Safe practices in animal breeding and animal product systems
practices limit the risk of zoonotic diseases
P6. Food Safety C13. Food safety 6. Food Safety
P6.1. Surveillance of foodborne C13.1. Multisectoral collaboration mechanism 6.1 Surveillance systems are in place for the detection and

WHO benchmarks for strengthening health emergency capacities

diseases and contamination for food safety events monitoring of foodborne diseases and food contamination
P6.2. Response and 6.2 A functional mechanism is in place for the response and
management of food safety management of food safety emergencies
emergencies
366
 P8. Immunization 7. Immunization
P8.1. Vaccine’s coverage 7.1 Optimum vaccine coverage (measles) as part of a national
(measles) as part of national programme
programme
P8.2. National vaccine access 7.2 Provision of national vaccine access and delivery
and delivery
P8.3. Mass vaccination for 7.3 An effective mechanism for mass vaccination of epidemics of
epidemics of VPDs vaccine preventable diseases (VPD) is in place
P7. Biosafety and Biosecurity 4. Laboratory 8. Biosafety and Biosecurity
P7.1. Whole-of-government C4.2. Implementation of a laboratory biosafety 8.1 Whole-of-government biosafety and biosecurity system is
biosafety and biosecurity system and biosecurity regime in place for relevant sectors including human, animal (domestic
is in place for human, animal and animals and wildlife) and agricultural facilities
agriculture facilities
P7.2. Biosafety and biosecurity 8.2 Biosafety and biosecurity training and practices in relevant
training and practices in all sectors including human health, animal health (domestic animals
relevant sectors (including and wildlife) and agriculture are in place
human, animal and agriculture)
DETECT
D1. National Laboratory System C4. Laboratory 9. National Laboratory System
D1.1. Specimen referral and C4.1. Specimen referral and transport system 9.1 Specimen referral and transport system is in place for relevant
transport system sectors
D1.2. Laboratory quality system C4.3. Laboratory quality system 9.2 Laboratory quality system is in place

WHO benchmarks for strengthening health emergency capacities

D1.3. Laboratory testing capacity C4.4. Laboratory testing capacity modalities 9.3 Laboratory testing for detection of priority diseases is in place
modalities
D1.4. Effective national C4.5. Effective national diagnostic network 9.4 An effective national diagnostic network is in place
diagnostic network
367
 D2. Surveillance C5. Surveillance 10. Surveillance
D2.1. Early warning surveillance C5.1. Early warning surveillance function 10.1 Early warning surveillance systems are well established and
function functional
D2.2. Event verification and C5.2. Event management 10.2 Well functioning event verification and investigation systems
investigation are in place
D2.3. Analysis and information 10.3 Surveillance data and information are systematically analysed
sharing and shared to inform decision making for action
D3. Human Resources C6. Human resources 11. Human Resources
D3.1. Multisectoral workforce 11.1 An up-to-date multisectoral workforce strategy is in place
strategy
D3.2. Human resources for C6.1. Human resources for implementation of 11.2 Human resources are available to effectively implement IHR
implementation of IHR IHR
D3.4. Workforce surge during a C6.2. Workforce surge during a public health 11.4 Multisectoral workforce surge strategy for health emergencies
public health event event is well established and functional
D3.3. Workforce training 11.3 Fit for purpose, competency-based education programmes
are available for multisectoral workforce
RESPONSE
R1 Health Emergency C7. Health emergency management Health Emergency Management
Management
R1.1. Emergency risk C7.1. Planning for health emergencies 12A.1 Effective risk profiling, readiness assessment and rapid risk
assessment and readiness assessment (RRA) processes are in place and strongly linked to
health emergency and disaster management plans and structures

WHO benchmarks for strengthening health emergency capacities

R1.2. Public health emergency 12A.2 Public health emergency operations centre (PHEOC)
operations centre (PHEOC) capacities, procedures and plans are in place
R1.3. Management of health C7.2. Management of health emergency 12A.3 A functional multisectoral all hazard health emergency
emergency response response response management system is in place
R1.4. Activation and coordination 12A.4 A system is in place for timely and effectively providing surge
of health personnel and teams in health personnel and teams during a health emergency
a public health emergency
368
 R1.5. Emergency logistic and C7.3. Emergency logistic and supply chain 12A.5 A system is in place for emergency logistics and supply
supply chain management management chain management during a health emergency
R1.6. Research, development and 12A.6 Research, development and innovation (RD&I) capacity for
innovation emergency management is in place
Health Emergency Management Additional Benchmarks
12B.1 All hazard health emergency and disaster risk management
(EDRM) are mainstreamed across IHR capacities
12B.2 Safe and resilient hospitals and health facilities are in place
to rapidly respond to emergencies
12B.3 Emergency resources, needs and gaps are identified
and mapped, and information shared with decision-makers
and partners based on country risk profiles to inform resource
strategies and activities
12B.4 Multisectoral planning for health emergency preparedness
and response is in place
R2 Linking Public Health and 13. Linking Public Health and Security Authorities
Security Authorities
R2.1. Public health and 13.1 Public health and security authorities (law enforcement, border
security authorities, (e.g. law control, customs) are linked during a suspected or confirmed
enforcement, border control, biological, chemical or radiological event
customs) are involved during a
suspect or confirmed biological

WHO benchmarks for strengthening health emergency capacities

event
R3 Health Service Provision C8 Health services provision 14. Health Services Provision
R3.1. Case management C8.1 Case management 14.1 Case management procedures are implemented for relevant
IHR hazards
R3.2. Utilization of health C8.2 Utilization of health services 14.3 Mechanism is in place to ensure effective utilization of health
services services before, during and after health emergencies at all levels of
health service delivery
369

R3.3. Continuity of essential C8.3 Continuity of essential health services 14.2 Mechanism for continuity of essential health services (EHS)
health services (EHS) (EHS) during a health emergency is well established
 R4. Infection Prevention and C9. Infection prevention and control 15. Infection Prevention and Control
Control
R4.1. IPC programmes C9.1. Infection prevention and control 15.1 National and health facility level infection prevention and
programmes control (IPC) programmes are in place
R4.2. HCAI surveillance C9.2 Health care-associated infections (HCAI) 15.2 A functioning health care acquired infection (HCAI)
surveillance surveillance system is in place for public health decision-making
R4.3. Safe environment in health C9.3 Safe environment in health facilities 15.3 Provide a safe environment in all healthcare facilities
facilities
R5. Risk communication and C10. Risk communication and community 16. Risk Communication, Community Engagement & Infodemic
Community Engagement engagement (RCCE) Management
Risk Communication
R5.1. RCCE system for C10.1. RCCE system for emergencies 16A.1 Risk communication and community engagement (RCCE)
emergencies systems with mechanisms for functions and resources are in place
and integrated within broader health emergency programmes  
R5.2. Risk communication C10.2. Risk communication 16A.2 Mechanisms to deliver quality, timely, impactful risk
communication are operational
Community Engagement
R5.3. Community engagement C10.3. Community engagement 16B.1 Community engagement is integrated and prioritized within
the management of health emergencies and unusual events  
Risk Communication, Community Engagement & Infodemic
Management Additional Benchmarks
Community Engagement

WHO benchmarks for strengthening health emergency capacities

16B.2 I Inclusive community centred governance and management
of health emergencies is in place
16B.3 Capacity-building mechanisms for multisectoral community
health workforce and community engagement in the management
of health emergencies and resilience building are well established
Infodemic Management
16C.1 An infodemic management system for health emergencies
370

and unusual events is in place

 IHR RELATED HAZARDS AND POINTS OF ENTRY AND BORDER HEALTH
PoE: Points of Entry and Border C11. Points of entry (PoEs) and border health 17. Points of Entry and Border Health
Health Section 1. Information by type of PoE Section 2.
Core capacities at PoEs and international travel-
related measures
PoE1. Core capacity C11.1. Core capacity requirements at all times 17.1 Routine core capacities at points of entry (PoEs) are in place
requirements at all times for for PoEs (airports, ports and ground crossings)
PoEs (airports, ports and ground
crossings)
PoE2. Public health response at C11.2. Public health response at PoEs 17.2 Public health responses at PoEs are in place
PoEs
PoE3. Risk-based approach C11.3. Risk-based approach to international 17.3 An effective multisectoral mechanism for risk-based approach
to international travel-related travel-related measures to international travel related measures is in place
measures
CE. Chemical Events C14. Chemical events 18. Chemical Events
CE1. Mechanisms established C14.1. Resources for detection and alert 18.1 Mechanisms are in place for surveillance, alert and response
and functioning for detecting and to chemical events or emergencies, supported by an enabling
responding to chemical events or environment
emergencies
CE2. Enabling environment
in place for management of
chemical events

WHO benchmarks for strengthening health emergency capacities

RE: Radiation Emergencies C15 Radiation emergencies 19. Radiation Emergencies
RE1. Mechanisms established C15.1 Capacity and resources 19.1 Mechanisms are in place for detecting and responding to
and functioning for detecting and radiological and nuclear emergencies, supported by an enabling
responding to radiological and environment
nuclear emergencies
RE2. Enabling environment
in place for management
371

of radiological and nuclear

emergencies
 Additional Technical Areas
20. Public Health and Social Measures
20.1 Leadership and governance dedicated to public health and
social measures (PHSM) is in place in relevant sectors, at all levels
and between levels
21. Additional benchmarks for health emergency capacities
beyond IHR
H1.1 A resilient monitoring system is established and fully
functional to routinely monitor the key metrics of health service
availability, capacity, access and usage
H1.2 Genomic surveillance systems are in place and functional
H1.3 Integrated, interoperable and standardized data systems and
data sharing platforms are established and functional
H1.4 Integrated networks are created and functional to support
surveillance information sharing and collaboration
H2.1 Integrated vector control management systems are in place
H2.2 Community-driven water, sanitation and hygiene (WASH)
interventions are in place and effective
H2.3 Social welfare and protection systems are expanded and
health emergency specific mechanisms are implemented
H2.4 Resilient food production and distribution systems are
functional to ensure food security during health emergencies

WHO benchmarks for strengthening health emergency capacities

H2.5 The protection of livelihoods, business continuity and
continuity of education and learning systems is in place for health
emergencies
H2.6 Strategic scaling of community health services and mental
health and psychosocial support (MHPSS) are in place before and
implemented during health emergencies
H4.1 Standardized platforms for conducting equitable and scalable
372

clinical trials are created and functional

 H4.2 Regulatory and legal frameworks are developed and
functional for timely trials, product review and approval
H4.3 Adaptable manufacturing platforms are established and
functional, and supported by prenegotiated agreements
H4.4 Manufacturing capabilities are enhanced through ever-ready
capabilities for rapid mobilization of medical countermeasure
production during health emergencies
H4.5 National regulatory frameworks for manufacturing platforms
are developed and implemented for health emergencies
H4.6 Coordinated demand aggregation systems are established
and operational
H4.7 Equitable and transparent needs-based allocation
frameworks are in place for medical countermeasures during
health emergencies
H5.1 Operational support and logistics platforms are established
and functional for health emergencies

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373
 Table 2. Mapping of Benchmarks to HEPR
HEPR Objective (L2) HEPR Capabilities (L3) Benchmark Mapping
C.1 Collaborative Surveillance
C.1.1 Strong national C.1.1.1 Strong public health surveillance 10.1 Early warning surveillance systems are well established and
Integrated disease, threat & functional
vulnerability surveillance 10.2 Well functioning event verification and investigation systems are in
place
10.3 Surveillance data and information are systematically analysed and
shared to inform decision making for action
C.1.1 Integrated disease, threat C.1.1.2 Health service capacity, access, and H1.1 A resilient monitoring system is established and fully functional to
& vulnerability surveillance usage monitoring routinely monitor the key metrics of health service availability, capacity,
access and usage
C.1.1 Integrated disease, threat C.1.1.3 Contextual, Community and One 4.2 A surveillance system for AMR is in place
& vulnerability surveillance Health insights 5.1 A multisectoral surveillance system is in place for priority zoonotic
diseases/pathogens
6.1 Surveillance systems are in place for the detection and monitoring of
foodborne diseases and food contamination
10.1 Early warning surveillance systems are well established and
functional
15.2 A functioning healthcare acquired infection (HCAI) surveillance

WHO benchmarks for strengthening health emergency capacities

system is in place for public health decision-making
C.1.1 Integrated disease, threat C.1.1.4 Collaboration: governance, 10.3 Surveillance data and information are systematically analysed and
& vulnerability surveillance innovation and integration shared to inform decision making for action
C.1.2 Effective diagnostics C.1.2.1 Decentralized testing capabilities at 9.4 An effective national diagnostic network is in place
and laboratory capacity or near the point of care
for pathogen and genomic
surveillance
374
 C.1.2.2 Expanded laboratory capacity and 9.1 Specimen referral and transport system is in place for relevant
collaboration, including genomics sectors
9.2 Laboratory quality system is in place
9.3 Laboratory testing for detection of priority diseases is in place
9.4 An effective national diagnostic network is in place
H1.2 Genomic surveillance systems are in place and functional
C.1.2.3 Risk-based biosafety and biosecurity 8.1 Whole-of-government biosafety and biosecurity system is in place
practices to manage biorisk for relevant sectors including human, animal (domestic animals and
wildlife) and agricultural facilities
8.2 Biosafety and biosecurity training and practices in relevant sectors
including human health, animal health (domestic animals and wildlife)
and agriculture are in place
C.1.2.4 Integrated laboratory networks, 9.1 Specimen referral and transport system is in place for relevant
including data and sample sharing sectors
9.4 An effective national diagnostic network is in place
C.1.3 Collaborative approaches C.1.3.1 Scalable architecture for integration H1.3 Integrated, interoperable and standardized data systems and data
for event detection, risk sharing platforms are established and functional
assessment, and response H1.4 Integrated networks are created and functional to support
monitoring surveillance information sharing and collaboration
C.1.3.2 Tools for data collection, analysis,
and sharing

WHO benchmarks for strengthening health emergency capacities

C.1.3.3 Information and data visualization
for interpretation
C.1.3.4 Networks for enhanced information
sharing and collaboration
375
 C.2 Community Protection
C.2.1 Community engagement, C.2.1.1 Listening to and understanding 16A.1 Risk communication and community engagement (RCCE) systems
risk communication and communities, and synthesizing insights with mechanisms for functions and resources are in place and integrated
infodemic management within broader health emergency programmes  
16A.2 Mechanisms to deliver quality, timely, impactful risk
communication are operational
16B.1 Community engagement is integrated and prioritized within the
management of health emergencies and unusual events  
16B.2 Inclusive community centred governance and management of
health emergencies is in place
C.2.1 Community engagement, C.2.1.2 Risk communication & community
risk communication and engagement 16B.3 Capacity-building mechanisms for multisectoral community health
infodemic management workforce and community engagement in the management of health
emergencies and resilience building are well established
16C.1 An infodemic management system for health emergencies and
unusual events is in place

C.2.1 Community engagement, C.2.1.3 Community capacities, services &

risk communication and coordination
infodemic management
C.2.1 Community engagement, C.2.1.4 Multisectoral community 16B.1 Community engagement is integrated and prioritized within the
risk communication and engagement management of health emergencies and unusual events  

WHO benchmarks for strengthening health emergency capacities

infodemic management 16B.2 Inclusive community centred governance and management of
health emergencies is in place
16B.3 Capacity-building mechanisms for multisectoral community health
workforce and community engagement in the management of health
emergencies and resilience building are well established
376
 C.2.2 Population & C.2.2.1 Prevent, detect and contain zoonotic 5.1 A multisectoral surveillance system is in place for priority zoonotic
environmental public health spillover diseases/pathogens
interventions 5.2 A functional mechanism to respond to priority zoonotic diseases is in
place
5.3 Safe practices in animal breeding and animal product systems limit
the risk of zoonotic diseases
C.2.2 Population & C.2.2.2 Vector control H2.1 Integrated vector control management systems are in place
environmental public health
interventions
C.2.2 Population & C.2.2.3 Community access to water, H2.2 Community-driven water, sanitation and hygiene (WASH)
environmental public health sanitation, and hygiene interventions are in place and effective
interventions
C.2.2 Population & C.2.2.4 Public health & social measures 17.1 Routine core capacities at points of entry (PoEs) are in place
environmental public health 17.2 Public health responses at PoEs are in place
interventions
17.3 An effective multisectoral mechanism for risk-based approach to
international travel related measures is in place
20.1 Leadership and governance dedicated to public health and social
measures (PHSM) is in place in relevant sectors, at all levels and between
levels
C.2.2 Population & C.2.2.5 Vaccination 7.1 Optimum vaccine coverage (measles) as part of a national
environmental public health programme

WHO benchmarks for strengthening health emergency capacities

interventions 7.2 Provision of national vaccine access and delivery
7.3 An effective mechanism for mass vaccination of epidemics of
vaccine preventable diseases (VPD) is in place
C.2.3 Multisectoral action C.2.3.1 Strengthening social welfare and H2.3 Social welfare and protection systems are expanded and health
for social and economic protection emergency specific mechanisms are implemented
protection C.2.3.4 Ensuring food security H2.4 Resilient food production and distribution systems are functional to
377

ensure food security during health emergencies

 C.2.3 Multisectoral action C.2.3.2 Protection of livelihoods and H2.5 The protection of livelihoods, business continuity and continuity of
for social and economic business continuity education and learning systems is in place and functional during health
protection emergencies
C.2.3 Multisectoral action C.2.3.3 Continuity of education and learning
for social and economic
protection
C.2.3 Multisectoral action C.2.3.5 Addressing indirect health and H2.6 Strategic scaling of community health services and mental health
for social and economic mental health impacts and psychosocial support (MHPSS) are in place for health emergencies
protection
C.3 Safe and Scalable Care
C.3.1 Scalable clinical care C.3.1.1 Scalable clinical care pathways 14.1 Case management procedures are implemented for relevant IHR
during emergencies hazards
14.2 Mechanism for continuity of essential health services (EHS) during a
health emergency is well established
C.3.1 Scalable clinical care C.3.1.2 Scalable infrastructure for safe 11.4 Multisectoral workforce surge strategy for health emergencies is
during emergencies clinical surge well established and functional
12A.4 A system is in place for timely and effectively providing surge
health personnel and teams during a health emergency
12B.2 Safe and resilient hospitals and health facilities are in place to
rapidly respond to emergencies
C.3.1 Scalable clinical care C.3.1.3 Stockpiles and supply chain for 12A.5 A system is in place for emergency logistics and supply chain

WHO benchmarks for strengthening health emergency capacities

during emergencies clinical care during emergencies management during a health emergency
C.3.2 Protection of health C.3.2.1 Water, sanitation, and hygiene 15.1 National and health facility level infection prevention and control
workers and patients (WASH) services (IPC) programmes are in place
15.3 Provide a safe environment in all healthcare facilities
C.3.2 Protection of health C.3.2.2 Infection Prevention and Control 15.1 National and health facility level infection prevention and control
workers and patients (IPC) in the context of health emergencies (IPC) programmes are in place
15.2 A functioning healthcare acquired infection (HCAI) surveillance
378

system is in place for public health decision-making

15.3 Provide a safe environment in all healthcare facilities
 C.3.3 Maintenance of essential C. 3.2.3 Patient and workforce safety during 11.3 Fit for purpose, competency-based education programmes are
health services health emergencies available for multisectoral workforce
12B.2 Safe and resilient hospitals and health facilities are in place to
rapidly respond to emergencies
15.1 National and health facility level infection prevention and control
(IPC) programmes are in place
15.3 Provide a safe environment in all healthcare facilities
C.3.3 Maintenance of essential C.3.3.1 Assessment of essential health 14.2 Mechanism for continuity of essential health services (EHS) during a
health services service needs, capacities and gaps health emergency is well established
14.3 Mechanism is in place to ensure effective utilization of health
services before, during and after health emergencies at all levels of health
service delivery
C.3.3 Maintenance of essential C.3.3.2 Adaptation and augmentation of 14.2 Mechanism for continuity of essential health services (EHS) during a
health services resources to deliver essential health services health emergency is well established
C.3.3 Maintenance of essential C.3.3.3 Resilient infrastructure and 11.1 An up-to-date multisectoral workforce strategy is in place
health services workforce for health service delivery 11.2 Human resources are available to effectively implement IHR
11.3 Fit for purpose, competency-based education programmes are
available for multisectoral workforce
12B.2 Safe and resilient hospitals and health facilities are in place to
rapidly respond to emergencies
C.4 Access to Countermeasures

WHO benchmarks for strengthening health emergency capacities

C.4.1 Fast-tracked research & C.4.1.1 Coordinated research built on a 12A.6 Research, development and innovation (RD&I) capacity for
development shared global R&D agenda emergency management is in place
C.4.1 Fast-tracked research & C.4.1.2 Enabling environment for research 12A.6 Research, development and innovation (RD&I) capacity for
development and discovery emergency management is in place
C.4.1 Fast-tracked research & C.4.1.3 Standardized platforms for equitable H4.1 Standardized platforms for conducting equitable and scalable
development and scalable clinical trials clinical trials are created and functional
379
 C.4.1 Fast-tracked research & C.4.1.4 Adapted regulatory and legal H4.2 Regulatory and legal frameworks are developed and functional for
development frameworks to enable timely trials, product timely trials, product review and approval
review and approval
C.4.2 Scalable manufacturing C.4.2.1 Adaptable manufacturing platforms H4.3 Adaptable manufacturing platforms are established and functional,
platforms and supported by prenegotiated agreements
C.4.2 Scalable manufacturing C.4.2.2 Distributed manufacturing supported H4.4 Manufacturing capabilities are enhanced through ever-ready
platforms by pre-negotiated agreements capabilities for rapid mobilization of medical countermeasure production
C.4.2 Scalable manufacturing C.4.2.3 Ever-ready capability for rapid during health emergencies
platforms mobilization
C.4.2 Scalable manufacturing C.4.2.4 Strengthened regulatory framework H4.5 National regulatory frameworks for manufacturing platforms are
platforms to oversee set-up and scale-up of developed and implemented for health emergencies
manufacturing platforms
C.4.3 End-to-end health C.4.3.1 Essential medical countermeasures 12A.5 A system is in place for emergency logistics and supply chain
emergency supply chains and their associated standards, policies and management during a health emergency
enablers are established for priority hazards
C.4.3.2 Coordinated demand aggregation H4.6 Coordinated demand aggregation systems are established and
operational
C.4.3.3 Coordinated supply and procurement 2.2 Financing available for timely response to health emergencies
12A.5 A system is in place for emergency logistics and supply chain
management during a health emergency

C.4.3.4 Equitable and transparent needs- H4.7 Equitable and transparent needs-based allocation frameworks are

WHO benchmarks for strengthening health emergency capacities

based allocations in place for medical countermeasures during health emergencies
C.4.3.5 Resilient logistics and distribution 12A.5 A system is in place for emergency logistics and supply chain
management during a health emergency
380
 C.5 Emergency Coordination
C.5.1 Strengthened C.5.1.1 Public Health and emergency 11.1 An up-to-date multisectoral workforce strategy is in place
workforce capacity for health workforce 11.2 Human resources are available to effectively implement IHR
emergencies
11.3 Fit for purpose, competency-based education programmes are
available for multisectoral workforce
11.4 Multisectoral workforce surge strategy for health emergencies is
well established and functional
12A.4 A system is in place for timely and effectively providing surge
health personnel and teams during a health emergency
C.5.1 Strengthened C.5.1.2 Health emergency corps 12A.2 Public health emergency operations centre (PHEOC) capacities,
workforce capacity for health procedures and plans are in place
emergencies 12A.3 A functional multisectoral all hazard health emergency response
management system is in place
12A.4 A system is in place for timely and effectively providing surge
health personnel and teams during a health emergency
C.5.1 Strengthened C.5.1.3 Interoperable surge deployment 11.4 Multisectoral workforce surge strategy for health emergencies is
workforce capacity for health well established and functional
emergencies 12A.4 A system is in place for timely and effectively providing surge
health personnel and teams during a health emergency
C.5.1 Strengthened 5.1.4 Connected health emergency 12A.2 Public health emergency operations centre (PHEOC) capacities,
workforce capacity for health leadership procedures and plans are in place

WHO benchmarks for strengthening health emergency capacities

emergencies 12A.3 A functional multisectoral all hazard health emergency response
management system is in place
3.1 The IHR national focal point (NFP) is fully functional
3.2 Multisectoral IHR coordination mechanism effectively supports the
implementation of prevention, detection and response activities
381
 C.5.2 Health emergency C.5.2.1 Capacity, risk and vulnerability 12A.1 Effective risk profiling, readiness assessment and rapid risk
preparedness, readiness and assessment assessment (RRA) processes are in place and strongly linked to health
resilience emergency and disaster management plans and structures
12B.1 All hazard health emergency and disaster risk management
(EDRM) are mainstreamed across IHR capacities
C.5.2.2 Prioritized and costed plans 3.3 Strategic planning for IHR, preparedness or health security are
in place and supported by functional advocacy mechanisms for IHR
implementation
12A.1 Effective risk profiling, readiness assessment and rapid risk
assessment (RRA) processes are in place and strongly linked to health
emergency and disaster management plans and structures
12B.4 Multisectoral planning for health emergency preparedness and
response is in place
C.5.2.3 Resource mapping and mobilization 12B.3 Emergency resources, needs and gaps are identified and mapped,
and information shared with decision-makers and partners based on
country risk profiles to inform resource strategies and activities
2.1 Financing is available and disbursed for the implementation of IHR
capacities
C.5.2.4 Implementation, monitoring and Included in all Benchmarks
review

WHO benchmarks for strengthening health emergency capacities

382
 C.5.3 Health emergency alert C.5.3.1 Standardized triggers and rapid 6.2 A functional mechanism is in place for the response and
and response coordination resources for immediate response management of food safety emergencies
10.1 Early warning surveillance systems are well established and
functional
10.3 Surveillance data and information are systematically analysed and
shared to inform decision making for action
12A.1 Effective risk profiling, readiness assessment and rapid risk
assessment (RRA) processes are in place and strongly linked to health
emergency and disaster management plans and structures
18.1 Mechanisms are in place for surveillance, alert and response to
chemical events or emergencies, supported by an enabling environment
19.1 Mechanisms are in place for detecting and responding to
radiological and nuclear emergencies, supported by an enabling
environment
The IHR national focal point (NFP) is fully functional
3.2 Multisectoral IHR coordination mechanism effectively supports the
implementation of prevention, detection and response activities
3.3 Strategic planning for IHR, preparedness or health security are
in place and supported by functional advocacy mechanisms for IHR
implementation

WHO benchmarks for strengthening health emergency capacities

12B.4 Multisectoral planning for health emergency preparedness and
response is in place
383
 C.5.3 Health emergency alert C.5.3.2 Timely, evidence-based and 5.2 A functional mechanism to respond to priority zoonotic diseases is in
and response coordination resourced response strategies place
10.3 Surveillance data and information are systematically analysed and
shared to inform decision making for action
12A.1 Effective risk profiling, readiness assessment and rapid risk
assessment (RRA) processes are in place and strongly linked to health
emergency and disaster management plans and structures
12A.2 Public health emergency operations centre (PHEOC) capacities,
procedures and plans are in place
12A.3 A functional multisectoral all hazard health emergency response
management system is in place
13.1 Public health and security authorities (law enforcement, border
control, customs) are linked during a suspected or confirmed biological,
chemical or radiological event
C.5.3 Health emergency alert C.5.3.3 Operational support and logistics H5.1 Operational support and logistics platforms are established and
and response coordination platform functional for health emergencies
C.5.3 Health emergency alert C.5.3.4 Monitoring, review, and adjustments Included in all Benchmarks
and response coordination to response

Mapping is based on HEPR L1-L3 as of 23.05.2023, based on Strengthening health emergency prevention, preparedness, response and resilience. Geneva:

WHO benchmarks for strengthening health emergency capacities

World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.
384
 Annex 3: Summary of changes
from WHO Benchmarks for
International Health Regulations (IHR)

WHO benchmarks for strengthening health emergency capacities

Capacities (2019)
385
 WHO Benchmarks 2019 WHO Benchmarks 2023 Changes
Title WHO benchmarks for IHR capacities WHO benchmarks for strengthening Expanded to include both IHR and
health emergency capacities: To support HEPR capacities
implementation of IHR and HEPR
capacities
Number of technical areas 18 21 Expanded to reflect lessons learned
from recent health emergencies and
current IHR MEF structure
Number of benchmarks 44 80 62 BMs strengthening both IHR and
HEPR capacities with additional 18
BMs focusing on HEPR capacities
beyond IHR
Sectoral engagement All actions proposed as IHR benchmark Actions are identified based on expected Expected sectoral engagement for the
actions sectoral engagement as health/health actions are specified
and other sectors/other sectors

Technical areas and benchmarks

WHO Benchmarks 2019 WHO Benchmarks 2023 Changes
NATIONAL LEGISLATION POLICY AND Count Legal Instruments Count Legal instruments placed as a separate
FINANCING technical area aligning with JEE 3rd ed. and
SPAR 2nd ed.
Benchmark 1.1: Domestic legislation, 1 Benchmark 1.1: Legal instruments 1 Content updated

WHO benchmarks for strengthening health emergency capacities

laws, regulations, policy and administrative are in place across relevant sectors to
requirements are available in all relevant support and enable International Health
sectors and effectively enable compliance Regulations (2005) (IHR) implementation
with the IHR and compliance
Benchmark 1.2: Gender equity and equality 2 New benchmark added aligning with JEE
principles are applied throughout IHR 3rd ed. and SPAR 2nd ed.
386

capacities
 Financing Financing placed as a separate technical
area aligning with JEE 3rd ed. and SPAR
2nd ed.
Benchmark 1.2: Financing is available for 2 Benchmark 2.1: Financing is available and 3 Content updated
the implementation of IHR capacities disbursed for the implementation of IHR
capacities
Benchmark 1.3: Financing available 3 Benchmark 2.2: Financing available for 4 Content updated
for timely response to public health timely response to health emergencies
emergencies
IHR COORDINATION, COMMUNICATION IHR Coordination, National IHR Focal
AND ADVOCACY AND REPORTING Point Functions and Advocacy
Benchmark 2.1: The IHR NFP is fully 4 Benchmark 3.1: The IHR national focal 5 Content updated
functional point (NFP) is fully functional
Benchmark 2.2: Multisectoral IHR 5 Benchmark 3.2: Multisectoral IHR 6 Content updated
coordination mechanism effectively coordination mechanism effectively
supports the implementation of supports the implementation of prevention,
prevention, detection and response detection and response activities
activities
Benchmark 3.3: Strategic planning for IHR, 7 New benchmark added aligning with JEE
preparedness or health security are in place 3rd ed and SPAR 2nd ed.
and supported by functional advocacy
mechanisms for IHR implementation

WHO benchmarks for strengthening health emergency capacities

ANTIMICROBIAL RESISTANCE Antimicrobial Resistance
Benchmark 3.1: Effective multisectoral 6 Benchmark 4.1: Effective multisectoral 8 Content updated
coordination on AMR coordination for antimicrobial resistance
(AMR)
Benchmark 3.2: Surveillance system of 7 Benchmark 4.2: A surveillance system for 9 Content updated
AMR is in place AMR is in place
387
 Benchmark 3.3: Infection prevention and 8 Infection prevention and control developed
control is in place into new technical area Infection Prevention
and Control (please see benchmarks 15.1-
15.3 below).
Benchmark 4.3: Effective mechanisms 10 New benchmark for aligning with JEE 3rd
are in place to prevent multidrug resistant ed.
organisms (MDRO)
Benchmark 3.4: Optimize use of 9 Benchmark 4.4: Optimize use of 11 Split into two benchmarks differentiating
antimicrobial medicines in human and antimicrobial medicines in human health between human health and animal health
animal health and agriculture and agriculture, aligning with JEE 3rd ed.
Benchmark 4.5: Optimize use of 12
antimicrobial medicines in animal health
and agriculture
ZOONOTIC DISEASE Zoonotic Diseases
Benchmark 4.1: Coordinated surveillance 10 Benchmark 5.1: A multisectoral 13 Content updated
system is in place for priority zoonotic surveillance system is in place for priority
diseases/pathogens zoonotic diseases/pathogens
Benchmark 4.2: Functional mechanism 11 Benchmark 5.2: A functional mechanism 14 Content updated
to respond to priority zoonotic diseases in to respond to priority zoonotic diseases is
place in place
Benchmark 5.3: Safe practices in animal 15 New benchmark aligning with JEE 3rd ed.
breeding and animal product systems limit

WHO benchmarks for strengthening health emergency capacities

the risk of zoonotic diseases
FOOD SAFETY Food safety
Benchmark 5.1: Surveillance systems in 12 Benchmark 6.1: Surveillance systems 16 Content updated
place for the detection and monitoring are in place for the detection and
of foodborne diseases and food monitoring of foodborne diseases and food
contamination contamination
388
 Benchmark 5.2: A functional mechanism 13 Benchmark 6.2: A functional mechanism is 17 Content updated
is in place for the response and in place for the response and management
management of food safety emergencies of food safety emergencies
IMMUNIZATION Immunization
Benchmark 6.1: Optimum vaccine 14 Benchmark 7.1: Optimum vaccine 18 Content updated
coverage (measles) as part of a national coverage (measles) as part of a national
programme programme
Benchmark 6.2: Provision of national 15 Benchmark 7.2: Provision of national 19 Content updated
vaccine access and delivery vaccine access and delivery
Benchmark 7.3: An effective mechanism 20 New benchmark aligning with JEE 3rd ed.
for mass vaccination of epidemics of
vaccine preventable diseases (VPD) is in
place
NATIONAL LABORATORY SYSTEM National Laboratory System
Benchmark 7.1: Laboratory testing for 16 Benchmark 9.3: Laboratory testing for 21 Sequence changed aligning with JEE 3rd ed.
detection of priority diseases is in place detection of priority diseases is in place Content updated
Benchmark 7.2: Specimen referral and 17 Benchmark 9.1: Specimen referral and 22 Sequence changed aligning with JEE 3rd ed.
transport system are in place for all transport system is in place for relevant and SPAR 2nd ed.
relevant sectors sectors Content updated
Benchmark 7.3: Effective national 18 Benchmark 9.4: An effective national 23 Sequence changed aligning with JEE 3rd ed.
diagnostic network is in place diagnostic network is in place Content updated

WHO benchmarks for strengthening health emergency capacities

Benchmark 7.4: Laboratory quality system 19 Benchmark 9.2: Laboratory quality system 24 Sequence changed aligning with JEE 3rd ed.
is in place is in place Content updated
BIOSAFETY AND BIOSECURITY Biosafety and Biosecurity
Benchmark 8.1: Whole-of-government 20 Benchmark 8.1: Whole-of-government 25 Title and content updated
biosafety and biosecurity system is in biosafety and biosecurity system is in
place for all sectors (including human, place for relevant sectors including human,
animal (domestic animals and wildlife) and animal (domestic animals and wildlife) and
389

environment facilities) agricultural facilities

 Benchmark 8.2: Biosafety and biosecurity 21 Benchmark 8.2: Biosafety and biosecurity 26 Title and content updated
training and practices in all relevant training and practices in relevant sectors
sectors (including human, animal including human health, animal health
(domestic animals and wildlife) and (domestic animals and wildlife) and
environment) agriculture are in place
SURVEILLANCE Surveillance
Benchmark 9.1: Functional surveillance 22 Benchmark 10.1: Early warning 27 Updated to focus on early warning
system to identify potential events of surveillance systems are well established surveillance aligning with JEE 3rd ed. and
concern for public health and health and functional SPAR 2nd ed.
security is in place
Benchmark 9.2: Surveillance system is 23 Benchmark 10.2: Well functioning event 28 Updated to focus on event verification
supported by electronic tools verification and investigation systems are aligning with JEE 3rd ed. and SPAR 2nd ed.
in place
Benchmark 9.3: Systematic analysis of 24 Benchmark 10.3: Surveillance data and 29 Updated to include information sharing
surveillance data for action is in place information are systematically analysed aligning with JEE 3rd ed.
and shared to inform decision making for
action
HUMAN RESOURCES Human Resources
Benchmark 10.1: An up-to-date, 25 Benchmark 11.1: An up-to-date 30 Content updated
multisectoral workforce strategy is in multisectoral workforce strategy is in place
place
Benchmark 10.2: Human resources are 26 Benchmark 11.2: Human resources are 31 Content updated

WHO benchmarks for strengthening health emergency capacities

available to effectively implement IHR available to effectively implement IHR
Benchmark 10.3: In-service trainings are 27 Benchmark 11.3: Fit for purpose, 32 Amalgamated into one benchmark to align
available competency-based education programmes with JEE 3rd ed. and reduce number of
Benchmark 10.4: Field epidemiology 28 are available for multisectoral workforce benchmarks.
training programme or other applied
epidemiology training programme is in
place
390
 Benchmark 11.4: Multisectoral workforce 33 New benchmark aligning with JEE 3rd ed.
surge strategy for health emergencies is and SPAR 2nd ed.
well established and functional
EMERGENCY PREPAREDNESS Health Emergency Management New technical area which merges three
technical areas from the 1st ed. aligning
with JEE 3rd ed. and SPAR 2nd ed.
12A Health Emergency Management Health Emergency Management presented
12B Additional Benchmarks in two subareas:
Subarea 12A includes benchmarks that
align with JEE 3rd ed. and SPAR 2nd ed.
Subarea 12B includes benchmarks beyond
JEE and SPAR.
Benchmark 11.1: Strategic emergency risk 29 Benchmark 12A.1: Effective risk profiling, 34 Title and content updated and benchmark
assessments conducted, and emergency readiness assessment and rapid risk split into two. 12A.1 aligns with JEE 3rd ed.
resources identified, mapped and utilized assessment (RRA) processes are in place and SPAR 2nd ed. and 12B.3 is beyond JEE
and strongly linked to health emergency and SPAR.
and disaster management plans and
structures
Benchmark 12B.3: Emergency resources, 35
needs and gaps are identified and mapped,
and information shared with decision-

WHO benchmarks for strengthening health emergency capacities

makers and partners based on country risk
profiles to inform resource strategies and
activities
Benchmark 11.2: Multisectoral planning 30 Benchmark 12B.4: Multisectoral planning 36 Content updated
for health emergency preparedness and for health emergency preparedness and
response is in place response is in place
391
 EMERGENCY RESPONSE OPERATIONS Health Emergency Management
Benchmark 12.1: Functional emergency 31 Benchmark 12A.3: A functional 37 Title and content updated
response coordination is in place multisectoral all hazard health emergency
response management system is in place
Benchmark 12.2: Emergency operations 32 Benchmark 12A.2: Public health 38 Title and content updated
centre (EOC) capacities, procedures and emergency operations centre (PHEOC)
plans are in place capacities, procedures and plans are in
place
Benchmark 12.3: Emergency exercise 33 Content from 1st edition has been included
management programme is in place across all benchmarks (all technical areas)
as an essential component to achieve all
capacities
MEDICAL COUNTERMEASURES AND Health Emergency Management
PERSONNEL DEPLOYMENT
Benchmark 14.2: System is in place 34 Benchmark 12A.4: A system is in place 39 Title and content updated
for activating and coordinating health for timely and effectively providing surge
personnel during a public health health personnel and teams during a health
emergency emergency
Benchmark 14.1: System is in place 35 Benchmark 12A.5: A system is in place 40 Title and content updated, focus on
for activating and coordinating medical for emergency logistics and supply chain emergency logistic and supply chain
countermeasures during a public health management during a health emergency management
emergency

WHO benchmarks for strengthening health emergency capacities

Benchmark 14.3: Case management 36 Moved to the new technical area Health
procedures implemented for relevant IHR Service Provision, please see benchmark
hazards 14.1 below
392
 Health Emergency Management
Benchmark 12A.6: Research, development 41 New benchmark aligning with JEE 3rd ed.
and innovation (RD&I) capacity for
emergency management is in place
Benchmark 12B.1: All hazard health 42 New benchmark to reflect on lessons
emergency and disaster risk management learned from recent health emergencies
(EDRM) are mainstreamed across IHR
capacities
Benchmark 12B.2: Safe and resilient 43 New benchmark to reflect on lessons
hospitals and health facilities are in place to learned from recent health emergencies
rapidly respond to emergencies
LINKING PUBLIC HEALTH AND SECURITY Linking Public Health and Security
AUTHORITIES Authorities
Benchmark 13.1: Public health and 37 Benchmark 13.1: Public health and 44 Content updated
security authorities (law enforcement, security authorities (law enforcement,
border control, customs) linked during a border control, customs) are linked during
suspect or confirmed biological, chemical a suspected or confirmed biological,
or radiological event chemical or radiological event
Health Service Provision New technical area aligning with JEE 3rd ed.
and SPAR 2nd ed.
Benchmark 14.1: Case management 45 Content updated, from 1st edition
procedures are implemented for relevant benchmark 14.3

WHO benchmarks for strengthening health emergency capacities

IHR hazards
Benchmark 14.2: Mechanism for continuity 46 New benchmark aligning with JEE 3rd ed.
of essential health services (EHS) during a and SPAR 2nd ed.
health emergency is well established
Benchmark 14.3: Mechanism is in place 47 New benchmark aligning with JEE 3rd ed.
to ensure effective utilization of health and SPAR 2nd ed.
services before, during and after health
393

emergencies at all levels of health service

delivery
 Infection Prevention and Control New technical area aligning with JEE 3rd ed.
and SPAR 2nd ed.
Benchmark 15.1: National and health 48 Title and content updated, expanded from
facility level infection prevention and 1st edition benchmark 3.3.
control (IPC) programmes are in place
Benchmark 15.2: A functioning healthcare 49 New benchmark aligning with JEE 3rd ed.
acquired infection (HCAI) surveillance and SPAR 2nd ed.
system is in place for public health
decision-making
Benchmark 15.3: Provide a safe 50 New benchmark aligning with JEE 3rd ed.
environment in all healthcare facilities and SPAR 2nd ed.
RISK COMMUNICATION Risk Communication, Community Technical area title changed to reflect
Engagement & Infodemic Management broader scope
Risk Communication, Community Risk Communication, Community
Engagement & Infodemic Management Engagement & Infodemic Management is
presented in two subareas:
Risk Communication, Community
Engagement & Infodemic Management Subarea Risk Communication, Community
Additional Benchmarks Engagement & Infodemic Management
includes benchmarks that align with JEE
3rd ed. and SPAR 2nd ed.
Subarea Additional Benchmarks includes
benchmarks beyond JEE and SPAR.

WHO benchmarks for strengthening health emergency capacities

Benchmark 15.1: Risk communication 38 Benchmark 16A.1: Risk communication 51 Title and content updated to include
systems for unusual events and and community engagement (RCCE) risk communication and community
emergencies is in place systems with mechanisms for functions engagement aligning with JEE 3rd ed. and
and resources are in place and integrated SPAR 2nd ed.
within broader health emergency
programmes  
394
 Benchmark 15.2: Coordination of risk 39 Benchmark 16A.2: Mechanisms to 52 Title and content updated to include
communication is effective deliver quality, timely, impactful risk risk communication and community
communication are operational engagement aligning with JEE 3rd ed. and
SPAR 2nd ed.
Benchmark 15.3: Effective 40
communication with communities
Benchmark 16B.1: Community 53 Title and content updated to include
engagement is integrated and prioritized risk communication and community
within the management of health engagement aligning with JEE 3rd ed. and
emergencies and unusual events   SPAR 2nd ed.
Benchmark 16B.2: Inclusive community 54 New benchmark, beyond JEE and SPAR
centred governance and management of
health emergencies is in place
Benchmark 16B.3: Capacity-building 55 New benchmark, beyond JEE and SPAR
mechanisms for multisectoral community
health workforce and community
engagement in the management of health
emergencies and resilience building are
well established
Benchmark 16C.1: An infodemic 56 New benchmark to reflect on lessons
management system for health learned from recent health emergencies
emergencies and unusual events is in place

WHO benchmarks for strengthening health emergency capacities

POINTS OF ENTRY Points of Entry and Border Health Technical area title changed to reflect
broader scope aligning with JEE 3rd ed. and
SPAR 2nd ed.
Benchmark 16.1: Routine capacities at 41 Benchmark 17.1: Routine core capacities 57 Title and content updated
points of entry are in place at points of entry (PoEs) are in place
Benchmark 16.2: Effective public health 42 Benchmark 17.2: Public health responses 58 Title and content updated
response at points of entry at PoEs are in place
395
 Benchmark 17.3: An effective multisectoral 59 New benchmark aligning with JEE 3rd ed.
mechanism for risk-based approach to and SPAR 2nd ed.
international travel related measures is in
place
CHEMICAL EVENTS Chemical Events
Benchmark 17.1: Mechanisms are in 43 Benchmark 18.1: Mechanisms are in place 60 Title and content updated
place for surveillance, alert and response for surveillance, alert and response to
to chemical events or emergencies chemical events or emergencies, supported
by an enabling environment
RADIATION EMERGENCIES Radiation Emergencies
Benchmark 18.1: Mechanism is in 44 Benchmark 19.1: Mechanisms are in place 61 Title and content updated
place for detecting and responding to for detecting and responding to radiological
radiological and nuclear emergencies and nuclear emergencies, supported by an
enabling environment
Public Health and Social Measures New technical area to reflect on lessons
learned from recent health emergencies
Benchmark 20.1: Leadership and 62 New benchmark to reflect on lessons
governance dedicated to public health learned from recent health emergencies
and social measures (PHSM) is in place in
relevant sectors, at all levels and between
levels
Additional benchmarks for health +18 New benchmarks to include HEPR

WHO benchmarks for strengthening health emergency capacities

emergency capacities beyond IHR capacities beyond IHR
Total count of benchmarks 44 Total count of benchmarks 80 36 new benchmarks
396
 397

Annex 4: Declaration
of Interests from WHO
Experts at the global
consultative meeting,
March 13-15 2023
All external experts submitted to WHO a declaration of interest disclosing potential conflicts of interest that
might affect, or might reasonably be perceived to affect, their objectivity and independence in relation to the
subject matter of the meeting. WHO reviewed each of those and had concluded that none could give rise to a
potential or reasonably perceived conflict of interest related to the subjects discussed at the meeting.

WHO benchmarks for strengthening health emergency capacities

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WHO benchmarks for strengthening health emergency capacities