Development of a Costed National Action Plan for Health Security in Pakistan: Lessons Learned

Safi, Malik; Ijaz, Kashef; Samhouri, Dalia; Malik, Mamun; Sabih, Farah; Kandel, Nirmal; Salman, Mohammad; Suryantoro, Ludy; Liban, Ahmad; Jafari, Hamid; Hafeez, Assad

doi:10.1089/hs.2018.0072

Cited by 6 publications

(9 citation statements)

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“…49 Most had a single country and single area focus. 50,51 Other global level studies and investment cases, such as those focused on polio risk management, may also offer insights. 52,53 This review can inform future costing methods and the creation of country-specific cost estimates to inform planning and priority setting by policymakers and stakeholders.…”

Section: Discussionmentioning

confidence: 99%

The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

et al. 2022

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Background Investing in health emergency preparedness is critical to the safety, welfare and stability of communities and countries worldwide. Despite the global push to increase investments, questions remain around how much should be spent and what to focus on. We conducted a systematic review and analysis of studies that costed improvements to health emergency preparedness to help to answer these questions. MethodsWe searched for studies that estimated the costs of improving health emergency preparedness and that were published between 1 January 2000 and 14 May 2021, using PubMed, Web of Science, Google Scholar, EconLit, and National Health Service Economic Evaluation Databases (PROSPERO CRD42021254428). We also searched grey literature repositories and contacted subject experts. We included studies that estimated the costs of improving preparedness at the global level and/or at the national level across at least ten countries, covered two or more technical areas in the WHO Benchmarks for International Health Regulations (IHR) Capacities, and included activities focused on human health. We mapped costs across technical areas in the WHO Benchmarks for IHR Capacities.Findings Ten studies met our inclusion criteria. Costing methods varied substantially across included studies and cost estimates ranged from US$1¢6 billion per year to improve capacities across 139 low-and middle-income countries (LMICs) to US$43 billion per year to support national-level activities worldwide and implement global-level initiatives, such as research and development for health technologies (diagnostics, therapeutics, and vaccines). Two recent studies estimated costs by drawing on IHR Monitoring and Evaluation Framework country capacity data, with one study estimating costs across 67 LMICs of US$15¢4 billion per year (US$29¢1 billion including upfront capital costs) and the other calculating costs for the 196 States Parties to the IHR of US$24¢8 billion per year. Differences in included studies' methods, and the characteristics of countries considered, mean it is difficult to make like −for−like comparisons of the absolute costs or per-capita costs estimated by studies.Interpretation Improving health emergency preparedness worldwide will require substantial and sustained increases in investments. Further guidance on estimating the size of those investments can help to standardise methods, allowing greater interpretation and comparison across studies/countries. As well as greater transparency and detail in the reporting of methods by studies focused on this topic, this can help support estimates of global resource requirements and facilitate investments towards improving preparedness for future pandemics.

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Section: Discussionmentioning

confidence: 99%

The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

et al. 2022

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“…Building on the International Health Regulations [5], the Global Health Security Agenda, in collaboration with the World Health Organization (WHO), introduced the Joint External Evaluations (JEEs) as one mechanism to evaluate current capabilities [6]. This process establishes a checklist for change by evaluating national-level preparedness and vulnerabilities, highlighting and prioritizing important next steps for each country [7, 8]. The JEEs also task national governments with creating or revising “National Action Plans” to define and implement strategies to address gaps and strengthen relevant capacity [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Travel time to health facilities in areas of outbreak potential: maps for guiding local preparedness and response

Hulland

Wiens

Shirude

et al. 2019

BMC Med

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BackgroundRepeated outbreaks of emerging pathogens underscore the need for preparedness plans to prevent, detect, and respond. As countries develop and improve National Action Plans for Health Security, addressing subnational variation in preparedness is increasingly important. One facet of preparedness and mitigating disease transmission is health facility accessibility, linking infected persons with health systems and vice versa. Where potential patients can access care, local facilities must ensure they can appropriately diagnose, treat, and contain disease spread to prevent secondary transmission; where patients cannot readily access facilities, alternate plans must be developed. Here, we use travel time to link facilities and populations at risk of viral hemorrhagic fevers (VHFs) and identify spatial variation in these respective preparedness demands.Methods and findingsWe used geospatial resources of travel friction, pathogen environmental suitability, and health facilities to determine facility accessibility of any at-risk location within a country. We considered in-country and cross-border movements of exposed populations and highlighted vulnerable populations where current facilities are inaccessible and new infrastructure would reduce travel times. We developed profiles for 43 African countries. Resulting maps demonstrate gaps in health facility accessibility and highlight facilities closest to areas at risk for VHF spillover. For instance, in the Central African Republic, we identified travel times of over 24 h to access a health facility. Some countries had more uniformly short travel times, such as Nigeria, although regional disparities exist. For some populations, including many in Botswana, access to areas at risk for VHF nationally was low but proximity to suitable spillover areas in bordering countries was high. Additional analyses provide insights for considering future resource allocation. We provide a contemporary use case for these analyses for the ongoing Ebola outbreak.ConclusionsThese maps demonstrate the use of geospatial analytics for subnational preparedness, identifying facilities close to at-risk populations for prioritizing readiness to detect, treat, and respond to cases and highlighting where gaps in health facility accessibility exist. We identified cross-border threats for VHF exposure and demonstrate an opportunity to improve preparedness activities through the use of precision public health methods and data-driven insights for resource allocation as part of a country’s preparedness plans.

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“…9 In addition to providing a score that indicates the level of country capacity, the JEE report also provides ''priority actions''recommendations by the external evaluation team-to the host country to accelerate the development of capacity, which can form the basis for the prioritization and development of national strategies to increase capacities in 19 technical areas. [10][11][12] National Action Planning for Health Security (NAPHS) is a process developed by WHO to create capacity-building plans based on recommendations from the IHRMEF, country risk assessments, and other assessments. The resulting NAPHS plan includes activities that are developed to address gaps identified by the IHRMEF, as well as activities from other national plans, including those for antimicrobial resistance and influenza pandemic preparedness.…”

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“…16 To address the costing bottleneck, different costing approaches have been described. 10,11,17 WHO has developed an NAPHS costing tool to facilitate planning and costing of the NAPHS. The WHO NAPHS costing tool uses a detailed approach that aggregates the individual components of country-defined activities (eg, cost of workshop materials, meals, per diem, individual procurement items) to generate an overall cost estimate.…”

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Action-Based Costing for National Action Plans for Health Security: Accelerating Progress Toward the International Health Regulations (2005)

et al. 2020

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Multiple costing tools have been developed to understand the resources required to build and sustain implementation of the International Health Regulations (IHR), including a detailed costing tool developed by WHO (''WHO Costing Tool'') and 2 action-based costing tools, Georgetown University's IHR Costing Tool and CDC's Priority Actions Costing Tool (PACT). The relative performance of these tools is unknown. Nigeria costed its National Action Plan for Health Security (NAPHS) using the WHO Costing Tool. We conducted a desktop review, using the other tools to compare the cost estimates generated using different costing approaches. Technical working groups developed activity plans and estimated component costs using the WHO Costing Tool during a weeklong workshop with approximately 60 participants from various ministries, departments, and federal agencies. We retrospectively applied the IHR Costing Tool and PACT to generate rapid cost estimates required to achieve a Joint External Evaluation (JEE) score of ''demonstrated capacity'' (level 4). The tools generated similar activities for implementation. Cost estimates varied based on the anticipated procurement and human resources requirements and by the level of implementation (eg, health facility-level versus local government area-level procurement). The desktop IHR Costing Tool and PACT tools required approximately 2 and 8 person-hours to complete, respectively. A strategic costing approach, wherein governments select from a menu of recommended and costed actions following the JEE to develop a NAPHS, could accelerate implementation of plans. Major cost drivers, including procurement and human resources, should be prioritized based on anticipated resource availability and countries' priorities.

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Development of a Costed National Action Plan for Health Security in Pakistan: Lessons Learned

Cited by 6 publications

References 3 publications

The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

The costs of improving health emergency preparedness: A systematic review and analysis of multi-country studies

Travel time to health facilities in areas of outbreak potential: maps for guiding local preparedness and response

Action-Based Costing for National Action Plans for Health Security: Accelerating Progress Toward the International Health Regulations (2005)

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