Simulation exercises and after action reviews – analysis of outputs during 2016–2019 to strengthen global health emergency preparedness and response

Abstract

Background Under the International Health Regulations (2005) [IHR (2005)] Monitoring and Evaluation Framework, after action reviews (AAR) and simulation exercises (SimEx) are two critical components which measure the functionality of a country’s health emergency preparedness and response under a “real-life” event or simulated situation. The objective of this study was to describe the AAR and SimEx supported by the World Health Organization (WHO) globally in 2016–2019. Methods In 2016–2019, WHO supported 63 AAR and 117 SimEx, of which 42 (66.7%) AAR reports and 56 (47.9%) SimEx reports were available. We extracted key information from these reports and created two central databases for AAR and SimEx, respectively. We conducted descriptive analysis and linked the findings according to the 13 IHR (2005) core capacities. Results Among the 42 AAR and 56 SimEx available reports, AAR and SimEx were most commonly conducted in the WHO African Region (AAR: n = 32, 76.2%; SimEx: n = 32, 52.5%). The most common public health events reviewed or tested in AAR and SimEx, respectively, were epidemics and pandemics (AAR: n = 38, 90.5%; SimEx: n = 46, 82.1%). For AAR, 10 (76.9%) of the 13 IHR core capacities were reviewed at least once, with no AAR conducted for food safety, chemical events, and radiation emergencies, among the reports available. For SimEx, all 13 (100.0%) IHR capacities were tested at least once. For AAR, the most commonly reviewed IHR core capacities were health services provision (n = 41, 97.6%), risk communication (n = 39, 92.9%), national health emergency framework (n = 39, 92.9%), surveillance (n = 37, 88.1%) and laboratory (n = 35, 83.3%). For SimEx, the most commonly tested IHR core capacity were national health emergency framework (n = 56, 91.1%), followed by risk communication (n = 48, 85.7%), IHR coordination and national IHR focal point functions (n = 45, 80.4%), surveillance (n = 31, 55.4%), and health service provision (n = 29, 51.8%). For AAR, the median timeframe between the end of the event and AAR was 125 days (range = 25–399 days). Conclusions WHO has recently published guidance for the planning, execution, and follow-up of AAR and SimEx. Through the guidance and the simplified reporting format provided, we hope to see more countries conduct AAR and SimEx and standardization in their methodology, practice, reporting and follow-up.

After Action Reviews of COVID‐19 response: Case study of a large tertiary care hospital in Italy

“…2 Among the six WHO regions, the majority of AARs were conducted in the African region and focused on outbreaks of infectious disease (Cholera, Ebola, Dengue, Lassa Fever). 2 Reports are available on the dedicated platform. 33 Despite both the WHO and the ECDC having promoted the use of AARs of the public health response to COVID-19 and provided technical guidelines, 6 little evidence is available as for now in the literature.…”

“…The guidance includes, among others, a concept note template, a facilitator’s manual, a generic presentation, a database with more than 300 COVID‐19 trigger questions and a final report template. The WHO has already supported the use of AARs concerning the responses to emerging and re‐emerging infectious disease outbreaks, environmental and natural disasters, and societal crises 2 . Among the six WHO regions, the majority of AARs were conducted in the African region and focused on outbreaks of infectious disease (Cholera, Ebola, Dengue, Lassa Fever) 2 .…”

“…The WHO has already supported the use of AARs concerning the responses to emerging and re‐emerging infectious disease outbreaks, environmental and natural disasters, and societal crises 2 . Among the six WHO regions, the majority of AARs were conducted in the African region and focused on outbreaks of infectious disease (Cholera, Ebola, Dengue, Lassa Fever) 2 . Reports are available on the dedicated platform 33 .…”

“…After‐Action Reviews (AARs, BOX I) are structured, qualitative reviews of the actions taken to respond to public health emergencies 1 and have been identified as one of the most useful tools to assess how preparedness systems perform, 2 so as to achieve collective learning and continuous operational improvement in healthcare delivery 3 . National and international health authorities, including the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) have recently suggested to apply AARs to assess public health responses to COVID‐19 in different settings 4 ,.…”

Effect of after action review on safety culture and second victim experience and its implementation in an Irish hospital: A mixed methods study protocol

“…AAR is included in the World Health Organisation (WHO) International Health Regulations as a methodology for learning and identifying follow-up actions after a national level public health response [ 23 ]. Between 2016 and 2019, over 60 AARs were conducted in WHO regions, primarily to support learning from epidemics and pandemics [ 24 ]. Therefore AAR is an important and relevant global tool for learning from the current COVID-19 pandemic [ 23 ].…”