KEY ACHIEVEMENTS  |  BACKGROUND  |  PRACTICE DEVELOPMENT  |  RESULTS  |  KEY LEARNING

Background

The COVID-19 outbreak offers a stark reminder about the importance of national efforts to access, analyse and act on data for global health security preparedness strengthening. Although a wealth of data is being collected at the national level across a range of indicators, frameworks and programmes, existing data is not always readily available or effectively used in national decision-making by National Public Health Institutes (NPHIs). Working with the International Association for National Public Health Institutes (IANPHI), in March 2018, as part of the IHR Strengthening Project, PHE commissioned Chatham House to identify barriers to assess the capacity and capability of NPHIs to access data, and initiate action on global health security preparedness. The aim was to identify barriers to action on preparedness using the ‘Strengthening National Accountability and Preparedness – Global Health Security (SNAP- GHS) Toolkit’ then, disseminate findings and share recommendations. Three key IHR Project national partners, the NCDC, EPHI and NIH, Pakistan participated in this research.

Practice development

This work was undertaken in 3 phases, the pre-assessment phase, the assess analyse and act phase and finally the dissemination phase. The pre-assessment phase focused on identifying core priority gap areas for national preparedness for the development of the SNAP-GHS assessment tool kit. Indicators complementary to the identified data gaps were developed and systematic literature reviews, and modified Delphi rounds, global and national level frameworks were identified to prioritise and validate gap indicators. Although two gap areas were fixed (WHO priority gaps), individual NPHIs were invited to select one priority area suitable for their contexts. As part of the ‘assess, analyse and act phase’, key informant interviews with stakeholders from EPHI, NCDC, NIH Pakistan were conducted to determine specific barriers to accessing data, capacity to manage relevant data and existing mechanisms to report and communicate data, findings on the identified limitations were compiled and a set of recommendations for each country created. This lead to the dissemination phase, (between August and December 2019), which was marked by a series of international dissemination events to review and discuss findings with NPHIs and disseminate the SNAP GHS toolkit and examine key findings (including limitations and lessons learned).

Results

The findings from the project were in 3 main areas, indicator gaps, data sharing challenges and NPHI human resource capacity.

• Indicator gaps- the project found indicator gaps existed at national level as the 3 NPHIs assessed, lacked the networks and relationships to   access indicators outside of the health sector making preparedness data inaccessible. In relation to the regional level indicators, the study highlighted, while there is a need to assess regional preparation for health security, few indicators can be compared in a way that acknowledges or controls for country differences, making some regional indicators were less useful than others. The study also highlighted, at a global level, there may be a mandated requirement for NPHIs to have access to data collected by other health and non-health entities that may have preparedness-relevant data collected for different global health initiatives.
• Data sharing challenges- although strong and committed leadership at senior level was recognised within all partner NPHIs, common areas for improvement included, the need to define data sharing roles and responsibilities at subnational level and to collaborate more widely with external stakeholders through the establishment of formal collaborations and agreements.
• NPHI human resource capacity- there were some issues surrounding NPHI human resource capacity, particularly in the case of the EPHI. This was evidenced by the access challenges experienced by NPHI staff during the data collection exercise which formed part of the assessment, where effective mechanisms enabling data requesting and engagement between institutions were very limited.
• Key recommendations: NPHIs which had been accepted as an authority for public health preparedness, were more successful in collecting data indicating preparedness, highlighting the importance of establishing a well-defined legal mandate for the role of NPHIs. Establishments of MoUs for data sharing from non-health and private sector organisations, is also highly recommended. 
• Following the conclusion of the SNAP GHS project and successful dissemination of its recommendations, IANPHI has adapted the principles of the project in its approach for joint working with the WHO head office, under the theme of strengthening preparedness and response. 

Key Learning

A key learning point was that sometimes, the desire of multilateral institutions to prioritise forming a common set of indicators can conflict with the reality of each country having very particular needs and priorities for preparedness, this is a potential further area for future research. It is also suggested, indicators that stakeholders in the country have prioritised to conduct a self-assessment of preparedness gaps would be more effective than using a standardised set of indicators to compare across countries, therefore another potential future area of research could include the re-development of regional preparedness indicators that have been considered with wider local consultation.

KEY ACHIEVEMENTS  |  BACKGROUND  |  PRACTICE DEVELOPMENT  |  RESULTS  |  KEY LEARNING