WHO Benchmarks for Strengthening Health Emergency Capacities

Support for the implementation of International Health Regulations (IHR) and health emergency prevention, preparedness, response and resilience (HEPR) capacities

Introduction

What is the Benchmark Tool?

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

Purpose of the Benchmark Tool

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

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, 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 is the audience?

The main audiences for this benchmark document are:

  • States Parties to the IHR, to suggest activities for IHR and HEPR implementation and any other strategic plans relevant to ensure prevention, preparedness, readiness and resilience for health emergencies.
  • Health agencies, civil society and specialized organizations at local, subnational, national, regional and global levels, to identify priorities for strengthening capacity and support the implementation of strategic plans.
  • Researchers and academics for the development and conduction of implementation and operational studies to generate scientific evidence for innovative solutions to address health emergency capacity gaps and to promote training and education programs.
  • Development partners, non-governmental organizations (NGOs) and other donors, who can use the benchmarks to guide funding and technical support for country assistance and ensure alignment with evolving needs, and to provide objective milestones to help guide and determine the effectiveness of assistance.
  • All national sectors and stakeholders who are involved in activities to strengthen health emergency prevention, preparedness, response and resilience.
  • WHO country and regional offices, to be able to prioritize assistance.
  • Other stakeholders with interest in national and global improvements in health security.
Definitions

For the propose of this document the following definitions are used:

BENCHMARK

Denotes a standard or point of reference for the capacity. Setting benchmarks facilitates the development of plans to increase capacity levels (limited, developed, demonstrated and sustainable) and the adoption of best practices with a target of reaching sustainable capacity for each benchmark.

ACTION

Denotes a set of activities in each capacity level of the benchmark. These actions define the steps that may be taken to progress up levels for the given benchmark.

STRUCTURE OF THE TOOL

The tool covers all IHR capacities and all HEPR capabilities/capacities. This includes the 15 IHR capacities covered in SPAR (2021), the 19 technical areas in the JEE (2022), and the HEPR five Cs. The actions provided in the tool reflect an amalgam of attributes of both JEE, SPAR indicators and HEPR capacities, with technical areas arranged to reflect the IHR MEF. The tool contains a total of 80 benchmarks, 62 strengthening both IHR and HEPR capacities with an additional 18 focusing on HEPR capacities beyond IHR. In the online portal, all benchmark actions have been mapped for health sector involvement (health/health and other sectors/other sectors), action type and readiness. In addition, the portal also offers disease-specific actions for respiratory pathogens7, cholera and Ebola which can be selected depending on country context and add actions across relevant benchmarks for each disease. These additional features further support country-level planning and the ability to review, edit and combine actions as grouped by type across technical areas.

WHEN TO USE THE BENCHMARK TOOL?

The tool should be used during a country's planning process (such as national health plans, strategies and policies (NHPSP), NAPHS, diseases specific plans, etc.) when a multisectoral and multidisciplinary planning team is identifying and prioritizing activities, when strengthening health systems for health security capacities at local, subnational, national or global levels, and when strengthening HEPR architecture.

Using the benchmark tool for country planning processes

NAPHS/HEPR

Benchmarks complement the NAPHS or HEPR planning process by looking at the current level of capacity (based on IHR MEF and other assessments) within the country and providing suggested actions to adapt according to capacity level and country context. These can then be used to update or develop plans.

NHPSPs

After performing a situational/gap analysis, the benchmarks provide suggested actions which can be adapted to the country's current capacities and expected targets. These can then be used to update or develop NHPSPs.

PRET

The benchmarks online portal provides key actions, which based on a country's hazard, vulnerability and capacity, can be used to update or develop a national pandemic preparedness plan7.

Disease specific plans

The benchmarks online portal provides suggested actions for specific diseases (e.g. cholera, Ebola, influenza, HIV, TB, malaria), which based on a country's hazards, vulnerabilities and capacities, can be used to update or develop disease specific plans.

HOW TO USE THE BENCHMARKS TOOL?

The benchmarks tool can be utilized through this document and through the Benchmarks online portal. Both versions of the tool present the same set of benchmarks and actions. The benchmarks tool facilitates State Party planning through the process of:

  1. Reviewing current situational analysis for priority actions for the selected technical area
  2. Reviewing the benchmarks tool and determining which capacity level a country would like to achieve utilizing actions in the tool
  3. Identify the actions that the country needs to establish to achieve the selected level
  4. Develop a list of activities for each action which the country needs to put in place to achieve the actions in the selected level.

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

SUGGESTED ACTIONS TO ACHIEVE THE CAPACITY LEVEL AND STRENGTHEN PREPAREDNESS

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

NO CAPACITY

  1. 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 development with activities conducted ad hoc.

02

LIMITED CAPACITY

ACTIONS TO ACHIEVE THIS LEVEL:

Core capacities at level 2 are in the development stage, with implementation started. While some elements of the capacity area may be in place, others are at the commencement stage. Example actions across technical areas at this level include:

  1. Conduct stakeholder mapping and form a national multisectoral committee/working group to perform subsequent actions
  2. Conduct analysis, including a review of existing plans and policies relevant to the area, to identify gaps and needs
  3. Map existing resources and required needs for IHR implementation in the area

03

DEVELOPED CAPACITY

ACTIONS TO ACHIEVE THIS LEVEL:

Core capacities at level 3 are in place at the national level but are not sustainable. Example actions across technical areas at this level include:

  1. Develop and implement procedures, processes and plans at national level to support capacity implementation for the area
  2. Develop and conduct training of relevant staff at the national level
  3. Establish systems relevant to the area, such as standards, data and information sharing, deployment mechanisms and networks

04

DEMONSTRATED CAPACITY

ACTIONS TO ACHIEVE THIS LEVEL:

Core capacities at level 4 are in place at the national and subnational level and are somewhat sustainable through being supported by funding and inclusion in national plans. Example actions across technical areas at this level include:

  1. Conduct SimEx/AAR/IAR or other M&E actions (if not already performed at earlier levels)
  2. Expansion and adaptation of national-level plans, training actions and systems to the subnational level
  3. Securing funding

05

SUSTAINABLE CAPACITY

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 technical areas at this level include:

  1. Regular, ongoing improvement of systems and functions based on updates and integration of results from SimEx/AAR/IAR and other M&E actions
  2. Achieve long-term sustainability of systems and capacities, including full funding
  3. Contributions to capacity development through peer-to-peer learning and sharing of best practices at subnational, national and international levels

How to apply the benchmarks

The benchmarks tool provides a list of suggested actions which can then be used at the country-level to inform the health emergency planning process. This includes determining the activities required to achieve each suggested action based on country context. All actions and activities are aimed at meeting a priority recommendation from previous assessments or to advance to a higher level in capacity implementation, focusing on progressing to sustainable capacity (level 5) in the future. For example, an action may be to develop guidelines and standard operating procedures (SOPs) relevant to the technical area; activities which contribute to this may include forming a working group to develop such guidelines and SOPs, identifying a focal point for drafting documents, finalizing the guidelines and SOPs, developing and implementing training packages to increase awareness and facilitate roll out.

While benchmark actions are primarily used to support the planning process for IHR and HEPR implementation, they may additionally be used to help develop priority recommendations during evaluations and reviews (such as a JEE) or to help track incremental progress made from one capacity level to the next.

BUILDING SYSTEMS USING THE BENCHMARKS

The collective and coordinated actions described in the benchmarks contribute to the country's health systems for health security. These benchmark actions support the strengthening of health system capacity for health emergency prevention, preparedness, response and resilience. These benchmark actions serve five purposes in strengthening the system:

  • Allow for a definition of desirable attributes — what actions are required for prevention, preparedness, response and resilience at each level of the benchmark.
  • Provide a way of defining health emergency priorities for countries, development partners and WHO.
  • Provide a useful way of clarifying essential actions that require a more integrated response and recognize the interdependence of each action of the benchmarks.
  • Suggest actions that require the support of multiple sectors.
  • Support the optimal implementation of activities based on whole-of-society, whole-of government and multilevel approaches to strengthen overall IHR and HEPR capacities at national and subnational levels.

WHAT IS THE TOOL ABOUT?

  • A list of benchmarks that are required to sustain capacities to support IHR implementation, effective prevention, preparedness, response and resilience, and overall management of health emergencies.
  • A list of suggested actions that can increase capacities for IHR implementation and prevention, preparedness, response and resilience at local, subnational, national and global levels.
  • Offering recommendations informed by technical experts.
  • A starting point for development of an evidence-based strategic plans/programs for health emergency prevention, preparedness, response and resilience.

WHAT IS THE TOOL NOT ABOUT?

  • A list of mandatory activities.
  • Completely applicable to every context.
  • An exhaustive list of actions/recommendations.
  • Comparing country capacity-levels.

UPDATING PROCESS OF THE BENCHMARK TOOL

Updating the benchmarks tool took place between August 2020 and June 2023, through multiple rounds of expert consultation from States Parties, WHO Regional and Country Offices, WHO Headquarters, partner agencies and technical experts with experience using the first edition of the benchmarks. The process followed four phases:

CONTENT UPDATES

  • All benchmarks and all actions were updated to incorporate lessons learned from recent health emergencies.
  • New benchmarks were added to this edition, based upon alignment with current health security frameworks, IHR capacities as per the third edition of the JEE (2022) and the second edition of the SPAR (2021), and HEPR. While the HEPR five Cs encompass all core capacities required by the IHR, the framework provides 18 additional benchmarks which cover HEPR capacities beyond IHR.
Technical area New benchmark
Alignment with JEE/SPAR
Legal instruments

1.2 Gender equity and equality principles are applied throughout IHR capacities
IHR coordination, national IHR focal point functions and advocacy

3.3 Strategic planning for IHR, preparedness or health security are in place and supported by functional advocacy mechanisms for IHR implementation
Antimicrobial resistance

4.3 Effective mechanisms are in place to prevent multidrug resistant organisms

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 Effective mechanism for mass vaccination for epidemics of vaccine preventable disease is in place
Surveillance

10.2 Well functioning event verification and investigation system is in place
Human resources

11.4 Multisectoral workforce surge strategy for health emergencies is well established and functional
Health emergency management

12A.1 Effective risk profiling, readiness assessment and rapid risk assessment processes are in place and strongly linked to health emergency and disaster management plans and structures

12A.6 Research, development and innovation capacity for emergency management is in place
Health services provision

14.2 Mechanisms for continuity of essential health services 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 and control

15.1 National and health facility level IPC programmes are in place

15.2 A functional healthcare-associated infection surveillance system is in place for public health decision making

15.3 Safe environment in all health care facilities
Risk communication, community engagement and infodemic management

16B.1 Community engagement is integrated and prioritized within management of health emergencies and unusual events
Points of entry and border health

17.3 Effective management system for health emergencies and unusual events is in place
New technical areas
Public health and social measures

20.1 Leadership and governance dedicated to public health and social measures is in place in relevant sectors, at all levels and between levels.
Additional benchmarks
Health emergency management

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
Risk communication, community engagement and 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

16C.1 An infodemic management system for health emergencies and unusual events is in place
Alignment with HEPR
Collaborative Surveillance

H1.1 A resilient monitoring system is established and fully functional to routinely monitor the key metrics of health service capacity, access, and usage.

H1.2 Genomic surveillance systems are in place and functional.


H2.1 Integrated, interoperable, and standardized data systems and data sharing platforms are established and functional.

H2.2 Integrated stakeholders' platforms/networks are created and functional for enhanced collaboration, understanding and evidence-based decision making.
Community Protection

H3.1 Integrated vector control management system is in place with full community participation and multisectoral engagement

H3.2 Community-driven WASH interventions are in place and effective


H4.1 Social welfare and protection systems are developed and effectively implemented.

H4.2 Resilient food production, procurement and distribution systems are developed and functional.

H4.3 The protection of livelihoods, business continuity and continuity of education and learning systems are in place and functional.

H4.4 Pre-response strategic scaling of health and mental health services are in place and implemented
Access to Countermeasures

H5.1 Standardized platforms for equitable and scalable clinical trials are created and functional

H5.2 Regulatory and legal frameworks are developed and executed for trails, product review and approval


H6.1 Adaptable manufacturing platforms are established and functional, enabling manufacturing efforts to align with specific requirements, optimize regional production capacities and meet the diverse demands 

H6.2 The integrated dual-purpose manufacturing systems with ever-ready capabilities are created for rapid mobilization of medical countermeasure products to enable swift and effective response during emergencies

H6.3 National regulatory frameworks for manufacturing platforms are developed, implemented and adapted


H7.1 Coordinated demand aggregation systems are established and operational

H7.2 The needs-based allocation frameworks are developed and implemented
Emergency Coordination H8.1 The operational support and logistics platform are established and functional.
  • Actions for foundational health system elements and other sector contributions were added for each benchmark.

CONTINUOUS UPDATING AND IMPROVEMENT OF THE TOOL

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

Please note that some of the changes noted here are not yet built in to the online portal, a new version which includes all updates will be launched soon.

Footnotes:

1 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. (PDF link) World Health Organization. 2019.

2 Strengthening the global architecture for health emergency prevention, preparedness, response and resilience World Health Organization. 2023.

3 Preparedness and resilience for emerging threats (PRET). World Health Organization.

4 International Health Regulations (2005) Joint External Evaluation Tool third edition. World Health Organization. 2022.

5 International Health Regulations (2005): State Party Self-assessment annual reporting tool, second edition. World Health Organization. 2021.

6 Dynamic Preparedness Metric. World Health Organization. 2023.

7 WHO, Member States, and partners have launched the Preparedness and Resilience for Emerging Threats (PRET) initiative - PRET uses a mode of transmission approach to epidemic and pandemic preparedness planning. PRET Module 1 and the associated checklist provide Member States with a template for national PRET plans and key actions to support respiratory pathogen preparedness. Key respiratory actions have been included in the Benchmark platform for countries that indicate through the platform their interest in respiratory pathogen preparedness planning.