Joint External Evaluation of IHR Core Capacities of the REPUBLIC of côte d’ivoire

Mission report: 5–9 December 2016

WHO/WHE/CPI/2017.20

Joint External Evaluation of IHR Core Capacities of the REPUBLIC of côte d’ivoire

Mission report: 5–9 December 2016 WHO/WHE/CPI/2017.20

© World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules). Suggested citation. Joint External Evaluation of IHR Core Capacities of the Republic of Côte d’Ivoire. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout by Jean-Claude Fattier Printed by the WHO Document Production Services, Geneva, Switzerland ACKNOWLEDGEMENTS

The WHO JEE Secretariat would like to acknowledge the following, whose support and commitment to the principles of the International Health Regulations (2005) have ensured a successful outcome to this joint external evaluation mission: • The Government and host country experts of Côte d’Ivoire for their support of, and work in, preparing and completing the evaluation mission. • The governments of France, Senegal and the United States of America, for providing technical experts for the peer review process. • The International Civil Aviation Organization (ICAO), The Food and Agriculture Organization of the United Nations (FAO), the United Nations Institute for Training and Research (UNITAR) and the World Organisation for Animal Health (OIE), for their contribution of experts and expertise. • The governments of Germany and Finland for their financial support to this mission. • The following WHO entities: the WHO Country Offices in Côte d’Ivoire, Gabon, Mauritania and Chad, the Regional Office for Africa, and the Department for Country Health Emergency Preparedness & IHR at WHO headquarters. • The Global Health Security Agenda for their collaboration and support.

Contents

Abbreviations------vi Executive Summary: conclusions of the joint external evaluation ------1 Côte d’Ivoire Scores------4 PREVENT—————————————————————————— 6 National legislation, policy and financing------6 IHR coordination, communication and advocacy------9 Antimicrobial resistance------11 Zoonotic diseases------15 Food safety------17 Biosafety and biosecurity------19 Immunization------21 DETECT————————————————————————— 24 National laboratory system------24 Real-time surveillance------28 Reporting------32 Workforce development------35 RESPOND ———————————————————————— 37 Preparedness------37 Emergency response operations------39 Linking public health and security authorities------42 Medical countermeasures and personnel deployment------44 Risk communication------47 OTHER IHR-RELATED HAZARDS AND POINTS OF ENTRY—————— 51 Points of entry ------51 Chemical events------54 Radiation Emergencies------57

Appendix 1: Joint External Evaluation Background------59 vi Joint External Evaluation WHO USCDC USAID TWG THIRA SOPs SNRA T RR PoE NFP NAMRU II mFETP MERS OIE JEE IMS IPC IHR (2005) IBS GHSA FA EVD EQA EOC EBS DHS CD CBRN CamLIS CamEWARN AMR AFRIMS APSED AET Abbreviations WHO WAHO USD USAID UNIT SOP PVS ORMICI OIE NFP LANAD JEE ISO INSSP INFOSAN ILO IHR IAEA GO GHSA GHS NFP FETP FA EPI EOC ECT CRESAC cMYP CIRAD CIAPOL CD CBRN CAPSCA AMR O O

ARN

AD A AR A World HealthOrganization West African HealthOrganization United StatesDepartmentof Agriculture United States Agency forInternationalDevelopment United NationsInstitutefor Training andResearch standard operating procedure performance ofveterinaryservices Ivorian Anti-infective-resistant MicroorganismsObservatory World Organisationfor Animal Health national IHRfocalpoint Ivorian National Agricultural DevelopmentLaboratory joint externalevaluation International OrganizationforStandardization Integrated NuclearSecuritySupportPlan International Food Safety Authorities Network International LabourOrganization International HealthRegulations Energy Agency International Atomic Global Outbreak Alert andResponseNetwork Global HealthSecurity Agenda Globally HarmonizedSystem National Focal Point field epidemiologytraining programme Food and Agriculture OrganizationoftheUnitedNations Expanded Programme onImmunization emergency operations centre Emergency Centrefor Transboundary Animal Disease Regional CentreforEducational, Environmentaland Accreditation Evaluations in Africa comprehensive multi-yearplan French Agricultural ResearchandInternationalCooperation Organization Ivorian AntipollutionAgency Centers forDiseaseControl chemical, biological, radioactive andnuclear Civil Aviation in Collaborative Arrangement forthePreventionandManagementofPublicHealthEvents antimicrobial resistance World HealthOrganization United StatesCentersforDisease ControlandPrevention United States Agency forInternationalDevelopment TechnicalGroup Working Threat andHazardIdentificationRisk Assessment Standard Operation Procedures Strategic NationalRisk Assessment Rapid Response Team Points ofEntry National IHRFocal Point Naval MedicalResearchUnitII modified FieldEpidemiology Training Middle Eastrespiratory syndrome World Organisationfor Animal Health Joint ExternalEvaluation Incident ManagementSystem Infection PreventionandControl International HealthRegulations(2005) Indicator-based Surveillance Global HealthSecurity Agenda Food and Agricultural OrganizationoftheUnitedNations Disease Ebola Virus External Quality Assurance Emergency Operations Centre Event-based Surveillance Department ofHospitalService Department ofCommunicableDiseasesControl, MinistryofHealth Combined JointChemical, Biological, Radiological, andNuclear Cambodia Laboratory InformationSystem Cambodia earlywarning surveillancesystem Antimicrobial Resistance Armed Forces ResearchInstituteofMedicalSciences Asia Pacific Strategy forEmergingDiseases Applied Epidemiology Training (Cambodia’s versionofmFETP) to facilitatingthe event-basedsurveillance systemsalreadyinplace. in allhealthdistrictsandregions, meaningthatnotifiablediseasescanbereported inrealtime, inaddition has establishedanationalepidemic controlcommittee. The electronicnotificationsystemisfullyfunctional The countryhasapublichealth emergencyoperations centre (EOC)thatactsasacoordinationcentre, and follows amultisectoral andmultidisciplinaryapproach. Health. The NFPcarriesout itsactivitiesincoordinationwithstakeholders fromotherinstitutionsandthus (2005). A nationalIHRfocal point(NFP)hasalsobeenidentifiedwithintheNationalInstituteofPublic Côte d’Ivoirehasanumberoflegaltextsthatarehelpful intermsofapplyingtheprovisionsIHR Main strengths (2005) planincorporating aOne Healthapproach. the mission. This reportcan thereforeserveasareferencedocumentfordrawing upthecountry’s IHR members fromdifferentinternationalinstitutionsandMember States, withthenecessaryskillstosupport allow theevaluation teamtovisit allsitesasplanned. The teamitselfwas multidisciplinary, composedof sectors testified to the national authorities’ full engagement in the process. Logistics were in place to level discussions. The presenceoftheIvorianDirector-General forHealthandseniorofficialsfromall key All nationalstakeholders, representingarange ofdisciplinesandsectors, participated activelyinhigh- Main findings are applied. multisectoral actionplanshouldbedrawn upfollowingtheJEE mission toensurethatitsrecommendations and rapidly respondtonatural, accidentalanddeliberately engineeredpublichealththreats. A national Joint external evaluations (JEEs) measure the ability of a State Party to the IHR (2005) to prevent, detect are: (i)annualreporting; (ii)jointexternalevaluations; (iii)after-action review; and(iv)simulationexercises. accountability betweenStatesParties. The fourcomponentsofthenewmonitoring andevaluation framework detailed reportingonthestatusofapplicationIHR(2005), therebypromotingdialogue, trustand capacities. The newframework focusesonincreasedaccountability andtransparency byrequiringregular, combines qualitativeandquantitativeapproachestomake anobjectiveassessmentofcountries’true WHO hasdevelopedanewIHR(2005)monitoringandevaluation framework forcorecapacitiesthat approaches fortheshorter- andlonger-term assessmentanddevelopmentofIHR(2005)corecapacities. In 2014, the IHR (2005) Review Committee recommended that the Director-General consider a variety of in theRegiondonotyethavenecessaryresources. minimum corepublichealthcapacitiesrequiredbytheIHR(2005). Progresshasbeenmade, butcountries completed byStatesParties toreportthe World Health Assembly onthestatusanddevelopmentof Since 2010, the IHR (2005) core capacity monitoring framework has used a self-assessment questionnaire international traffic andtrade. commensurate withandrestrictedtopublichealthrisks, andwhichavoidunnecessaryinterferencewith control andprovideapublichealthresponsetotheinternationalspreadofdiseaseinways thatare that havebeeninforcesince15June2007. Their purposeandscopearetoprevent, protectagainst, The InternationalHealthRegulations(2005)(IHR(2005))arealegallybindinginternationalinstrument Introduction ofevaluation joint the external Conclusions Executive summary:

1 of IHR Core Capacities of the Republic of Côte d’Ivoire 2 Joint External Evaluation plan. preparedness isessential, but thecountryhasnotyetdevelopedaunifiedmulti-risk, multisectoral national distributers toobtainmedical equipmentduringpublichealthemergencies. Robust publichealthemergency There arenoformalmechanisms forreachingagreementswithdomesticandinternational manufacturers/ documents oncareerprofiles, particularlyforcommunityhealthworkers. Risk communicationskillsandtheirapplicationsarequite limited. Inallsectorsthereisalackofpolicy must beincludedasastakeholder inthistechnicalarea. other levels of the health pyramid using a multisectoral approach, and the Ministry of Higher Education the surveillanceofantimicrobialresistance. Biosafety andbiosecuritycapacitiesmustbeextendedtothe all sectors. There isnoapproved planforimplementingthe World Health Assembly’s recommendationson The system for transporting specimens – vital to the prompt confirmation ofan outbreak– does not yet cover security threattakes placeonlyonanad-hocbasis. hospitals andprivate healthfacilities inthesurveillanceofdiseasesthatconstituteapublichealthand lacking incertainkey areasandcommunity-basedsurveillanceisnotrobustenough. The involvementof information-sharing sothatinformationcanbepassedtoallkey stakeholders. Veterinary capacitiesare The EOChasnottaken allnecessarystepstoimplementamultisectoral platform forcoordinationand between theepidemiologicalandenvironmentalsurveillancemechanisms. sharing informationbetweentheNFPandOIEfocalpoint. Inaddition, thereisinsufficientcollaboration Health approach. For example, thereareanumberofshortcomingswithregardtoformalproceduresfor the NFP. Despiteclearbuy-inin thecountry, thereisalsonoformalframework forimplementingaOne integrate thenecessaryprovisions. The lackofaformal coordinationframework limitsthefunctioningof Existing legalinstrumentsdonottake theIHR(2005)entirelyintoaccountandshouldberevisedtobetter invested significantlyincapacity-buildingformuchoftheIHR(2005). Côte d’IvoirereceivessupportundertheGlobalHealthSecurity Agenda (GHSA) initiative, whichhas response specifictocivilaviation. qualified personnelinplace, andthereisanationalplanforpublichealthemergencypreparedness Félix-Houphouêt-Boigny International Airport in Abidjan hasmedicalservices, specializedequipmentand also developedbytheEOCaspartofitsresponsetoEboladiseaseoutbreak. An effectivestandardoperating procedureforcommunicationsystemsinhealth-crisismanagementwas supplies incaseofapublichealthemergency. crisis. The proceduresoftheNewPublicHealthPharmacycontainaprovisionforstockpilingmedical provisions forsendingandreceivingmedicalequipmentdeployinghealthworkers duringahealth There isanationalplaninplacetoorganizereliefduringemergencies(theORSECPlan). Itcontains to responddifferenttypesofhumanandanimalhealthevents. Government providesincentivestomotivate theworkforce. Nationalandintermediarysectoral plansexist Generally speaking, humanresourcesaresupportedbyseveral universitiesandtechnicalschools, andthe waste intheenvironment, particularlythatproducedbyState-ownedcompanies. specimens. The MinistryoftheEnvironmenthasalaboratory formonitoringanddetectingradiological for quantifyingchemicalsubstancesandattheNationalPublicHealthLaboratory foridentifyingbiological There is also good analytical capacity at the central level - at the Ivorian Antipollution Agency (CIAPOL) reference centresfordetectingandconfirmingcasesofantimicrobialresistance. Reliable nationallaboratories areoperational inkey sectorsatthecentral levelandtherearenational Main challenges • • • for implementingallthepriorityactionsidentifiedineachtechnicalarea: After five daysof discussions withhostcountryexperts, the evaluation teamproposed thefollowingsteps Next steps radiological events–isstillnotoptimal. As in most countries in the region, preparedness for major public health incidents – especially chemical or points ofentry. of Abidjan. Ingeneral, thecountrydoesnothaveanationalmultisectoral publichealthemergencyplanat Félix-Houphouêt-Boigny International Airport hassuitablemedicalservices, butnotthe Autonomous Port review and simulation exercises). simulation and review continue to promote the implementation of the new IHR framework (annual reporting, JEE, after-action To strengthen health and implement security the IHR (2005) core capacities, the should country 2017. in finalized be should key sectors A national actionplan that takes into account the findings of the JEE and other recent evaluations of process. implementation IHR the accelerating when consideration Conference on One Health. It is also important to take other related frameworks such as the GHSA into West African States in the communiqué issued by the Ministerial Meeting of the West African Regional Côte d’Ivoire should continue to search for opportunities to materialize the commitments made by 3 of IHR Core Capacities of the Republic of Côte d’Ivoire 4 Joint External Evaluation Côte d’Ivoire scores 1

Capacities National legislation, policy andfinancing policy communication and communication National laboratory FETP: Fieldepidemiologytraining programme IHR coordination, Zoonotic diseases Immunization Biosafety and Antimicrobial development surveillance Food safety biosecurity Workforce Reporting resistance Real-time advocacy system relevant intheimplementation sectors ofIHR(2005) P.2.1 mechanismisestablishedforthecoordination Afunctional andintegration of ments D.4.1 Humanresources are available to implement IHR(2005)core require capacity P.3.1 Antimicrobial resistance (AMR) detection D.3.1 System forefficient to reporting WHO, FAO andOIE ernment instruments inplace are sufficient forimplementation ofIHR(2005) P.1.1 Legislation, laws, regulations, administrative requirements, policiesorothergov D.4.3 Workforcestrategy D.4.2 FETPorotherappliedepidemiologytraining programme isinplace D.3.2 network andprotocols Reporting inthecountry D.2.3 Syndromic systems surveillance D.2.3 data Analysisof surveillance D.2.2 Interoperable, interconnected, real-time electronic system reporting D.1.4 system quality Laboratory D.1.3 Effective, andlaboratory-based diagnostics modernpoint-of-care D.1.2 Specimenreferral system andtransport P.7.2 National vaccine access anddelivery P.6.2 training andpractices andbiosecurity Biosafety established andfunctional P.4.3 Mechanismsforresponding zoonoses to andpotential infection zoonoses are P.4.2 Veterinary oranimalhealthworkforce P.3.4 Antimicrobial stewardship activities P.3.3 prevention Health (HCAI) care-associated infection andcontrol programmes P.3.2 causedby AMR pathogens ofinfections Surveillance policies andadministrative arrangements to enablecompliance withtheIHR(2005) P.1.2 The State candemonstrate that ithasadjusted andaligneditsdomesticlegislation, borne diseaseandfoodcontamination P.5.1 andresponding fordetecting Mechanismsare to establishedandfunctioning food- P.7.1 Vaccine coverage ofthenational programme (measles)aspart P.4.1 systems are Surveillance zoonotic inplace forpriority diseases/pathogens D.1.1 diseases testing ofpriority Laboratory fordetection animal andagriculture facilities P.6.1 system isinplace andbiosecurity forhuman, biosafety Whole-of-government D.2.1 Indicator- andevent-based systems surveillance Indicators - - Score 2 3 3 1 1 1 1 2 2 2 2 3 2 2 3 3 3 3 3 3 3 2 4 3 3 2 2 2

Emergency response Emergency Risk communication health and security health andsecurity countermeasures Chemical eventsChemical Points ofentry and personnel Linking public Preparedness emergencies deployment authorities operations Radiation Medical Medical R.2.1 Capacityto activate operations emergency chemical events oremergencies andresponding fordetecting CE.1 Mechanismsare to establishedandfunctioning developed andimplemented R.1.1 Multi-hazard national preparedness publichealthemergency andresponse planis RE.2 Enabling environment isinplace formanagement ofradiation emergencies CE.2 Enabling environment isinplace formanagement ofchemicalevents PoE.2 Effective publichealth response at points ofentry listening andrumourmanagementR.5.5 Dynamic R.5.4 Communication engagementcommunities withaffected R.5.3 Public communication communicationR.5.2 Internal andcoordination andpartner health emergency R.4.2 System isinplace forsendingandreceiving healthpersonnelduringapublic R.2.4 Case management procedures are implemented forIHR(2005)relevant hazards operationsR.2.3 Emergency programme operationsR.2.2 Emergency centre operating procedures andplans publichealthrisksandresourcesR.1.2 Priority are mappedandutilized public healthemergency R.4.1 System isinplace forsendingandreceiving medicalcountermeasures duringa radiological and nuclearemergencies andresponding fordetecting RE.1 Mechanismsare to establishedandfunctioning toms) are linked orconfirmed biologicalevent duringasuspected authorities,R.3.1 Public (e.g. healthandsecurity law enforcement, border control,- cus R.5.1 Risk communicationR.5.1 Risk systems (suchasplans, mechanisms) PoE.1 Routinecapacitiesare establishedat points ofentry 2 3 1 1 2 2 2 3 2 2 1 2 2 1 2 2 1 2 2 2 5 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT PREVENT 6 Joint External Evaluation States Parties should have an adequate legal framework to support and enable the implementation of of implementation the enable and support to framework legal adequate an have should Parties States highest importance. detail the country’s responsibilities and determine the distribution of sufficient funding are also of the http://www.who.int/ihr/legal_issues/ legislation/en/index.html.)Policies thatprovidefornationalfacilities, in theirimplementation. (SeedetailedguidanceonIHR(2005)implementationinnationallegislationat operations withintheStateParty. Itcanalsofacilitatecoordinationamongthedifferententitiesinvolved manner. ImplementinglegislationcouldservetoinstitutionalizeandstrengthentheroleofIHR(2005) in ordertofacilitateIHRimplementationandmaintenanceamoreeffective, efficientandbeneficial be specificallyrequired, States Parties maystillchoosetorevisesomeregulationsorotherinstruments of theIHR(2005)mayrequirenewormodifiedlegislation. Evenifneworrevisedlegislationmaynot The IHR(2005)provideobligationsandrightsforStatesParties. InsomeStatesParties, implementation Introduction andfinancing National legislation, policy PREVENT in thecountry. A draft textinthisregardhasbeendevelopedandisawaiting approval. For themoment, There isasyetnoformalframework forimplementingaOne Healthapproach, althoughthereisclearbuy- surveillance fortheperiod2016–2020. There isalsoanationalhealth developmentplaninplacethatincludeshealthmonitoring andepidemiological lack ofaformalcoordinationframework. carries outitsactivitiesincoordinationwithstakeholders withinotherbodies, butthisishamperedbythe In termsofinstitutions, anNFPhasbeenidentified within theNationalInstituteofPublicHealth. The NFP the necessaryprovisions. these instrumentsdonottake theIHR(2005)entirelyinto accountandshouldberevisedtobetterintegrate national epidemiccontrolcommitteeandestablishingits organization, remitandfunctioning. However, CAB of31December2007amendingOrderNo. 415/CAB/MEMSP of28November2005creatingthe organizational framework forthe preventionandcontrolofEbolavirusdisease; andOrderNo. 435-MSP/ is inchargeofepidemiologicalsurveillance; DecreeNo. 2014-486of3September2014establishingthe (CIAPOL); DecreeNo. 91-614of9October1991creatingtheNationalInstitutePublicHealth, which Among themare: DecreeNo. 91-662of9October1991creatingtheIvorian Antipollution Agency Côte d’IvoirehasaseriesoflegalinstrumentsaimedatimplementingtheprovisionsIHR(2005). Côte d’Ivoire levelofcapabilities T all of their obligations and rights to comply with and implement the IHR (2005). In some States Parties, Parties, States some In (2005). IHR the implement and with comply to rights and obligations their of all implementation of the IHR (2005) may require new or modified legislation. Even where new or revised revised or new where Even legislation. modified or new require may (2005) IHR the of implementation legislation may not be specifically required under the State Party’s legal system, States may still choose choose still may States system, legal Party’s State the under required specifically be not may legislation to revise some legislation, regulations or other instruments in order to facilitate their implementation and and implementation their facilitate to order in instruments other or regulations legislation, some revise to States Parties should ensure provision of adequate funding for IHR implementation through the national national the through implementation IHR for funding adequate of provision ensure should Parties States maintenance in a more efficient, effective or beneficial manner. beneficial or effective efficient, more a in maintenance budget or another mechanism. another or budget arget • • • practices Strengths/best implementing theIHR(2005) werereviewedandnecessaryadaptationsidentified. Legislation, regulations, administrative requirementsandothergovernmentinstrumentsrelatedto - Score 2 policies andadministrative arrangements toenablecompliancewiththeIHR(2005) P.1.2 • • • • strengthening/challenges need that Areas • • • • • • practices Strengths/best related toimplementingtheIHR(2005)werereviewed. Legislation, laws, regulations, administrative requirements, policiesandother governmentinstruments instruments inplaceare sufficientforimplementationofIHR(2005)-Score 2 P.1.1 Legislation, laws, regulations, administrative requirements, policiesorothergovernment Indicators andscores • • Recommendations forpriorityactions platform. however, stakeholders areincontactandworktogetherwithintheframework ofaninformalcoordination Develop aunified funding plan for actions related to the IHR (2005). Plan for strengthening surveillance capacities isavailable. capacities surveillance strengthening Plan for adaptationsNecessary to the legal framework have been identified. Clarificationstakeholders’ of roles and responsibilitieswithin collaboration the intersectoral framework. applicationEffective of existing legal instruments. networks. surveillance various Coordination between surveillance. epidemiological for framework Legal Annual simulation exercises are carried out at Félix-Houphouêt-Boigny International in Abidjan. Airport epidemicLocal monitoring are andin control place. committees coordinationIntersectoral out. is carried A cooperation protocol with Burkina Faso is in place. Procedural guidance, manuals and directives exist for each level of the health pyramid. surveillance. organize that epidemiological exist texts Regulatory evaluation. that on based recommendations Implement (2005). IHR legislation the related to Re-evaluate m m m m The Statecandemonstrate thatithasadjustedandaligneditsdomesticlegislation,

Produce and distribute regulations that formally institutionalize aOne Health approach. Provide regular training and outreach to focal points in the bodies that implement the IHR (2005). Promote wider knowledge of the IHR (2005) among decision-makers, stakeholders and the public. (2005). Produce complementary instruments (laws, degrees and regulations) for implementing the IHR 7 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT PREVENT 8 Joint External Evaluation • • • strengthening/challenges need that Areas • • Sufficient, predictable mobilization of resources for implementing the plan outside of times of crisis. Funding in the national budget earmarked for IHR-related activities outside of emergency situations. and allocationForecasting resources of for IHR-related activities. incidents. There is political will to strengthen surveillance and response for epidemics and other public health Partners and donors are fully committed to funding IHR-related activities. The NFP should be accessible at all times to communicate with the WHO IHR Regional Contact Points and and Points Contact Regional IHR WHO the with communicate to times all at accessible be should NFP The avian influenzaorEbolavirus disease). etc., whoparticipateasneeded). Unfortunately, thecommitteeisactive only incrises(e.g. outbreaksof from theMinistryofEnvironment, theMinistryofInteriorand of Water andForests, epidemic control committee, which includes stakeholders with the necessary competencies (representatives coordination, communicationandIHRadvocacymechanism thatoperates withinthecontextofnational The NFP is tasked with enhancing coordination and communication between ministries. It is a multisectoral • • • • all stakeholders: However, thecountryhasothercapacities thatfacilitatecommunication, coordinationandadvocacyamong • • • • However, thefollowinglimitingfactors remain: NFP’s communicationactivitiesarecarriedoutincoordinationwithstakeholders within otherinstitutions. has a national epidemic control committee and a national committee for Ebola virus disease control. The Côte d’IvoireestablishedanEOCinFebruary 2016thatactsasacoordinationcentre. The countryalso Côte d’Ivoire levelofcapabilities T requisite forIHRimplementation. including the designation of an IHR NFP, which is a national centre for IHR communications, is a key national partnershipsforeffectivealertandresponsesystems. Coordinationofnationwideresources, The effectiveimplementationoftheIHR(2005)requiresmultisectoral/multidisciplinary approachesthrough Introduction IHR andadvocacy coordination, communication with all relevant sectors and other stakeholders in the country. States Parties should provide WHO with with WHO provide should Parties States country. the in stakeholders other and sectors relevant all with contact details of NFPs, continuously update and annually confirm them. confirm annually and update continuously NFPs, of details contact arget organization of coordination meetings. coordination of organization involved;sectors standard operating procedures (SOPs) and guidelines for coordination the NFP between and other sharing with other of reports the institutions involved; intersectoral coordination mechanism that functions on an ad-hocbasis; Challenges to functioning of NFP (24-hour accessibility) in terms of: There is information-sharing no platform. There is no actionplan for multidisciplinary, multisectoral information-sharing mechanisms. coordination. and There is no unified multidisciplinary, multisectoral information-sharing mechanism for communication m m

qualified human resources. communications 9 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 10 PREVENT

Joint External Evaluation • • • • Recommendations forpriorityactions discuss thepresidentialdecreeanddevelopacoordinationcommunicationmechanism. of tasksintheinteresttechnicalcollaboration. Legaladvisersfromdifferentministriesshouldmeetto importance thatstakeholders agree uponamultisectoral coordinationframework andtheassignment on theOneHealthapproachiscurrentlybeingdrafted tosupporttheworkofNFP. Itisofparticular SOPs arecurrentlybeingapprovedandwillsoonbeavailable fordissemination. A presidentialdecree activities fallingwithinitsremit. of these situations are handled on a sectoral basis, with the appropriate ministry being responsible for There is currentlyno multisectoral coordinationmechanism for respondingto non-critical events. Most • strengthening/challenges need that Areas • • • • • • • practices Strengths/best • • sectors intheimplementationofIHR(2005)-Score 2 P.2.1 A functionalmechanismisestablishedforthecoordination andintegration ofrelevant Indicators andscores Evaluate of the the NFP effectiveness and implement the resulting recommendations. Strengthen the capacities of communication teams and the teams that manage the EOC. aspect. level that coordinates all actions related to the One Health approach, thus strengthening multisectoral its Fuse the various supra-ministerial coordination mechanisms into a single framework at the presidential Develop anational One Health plan. An information-sharingAn platform should put be in place that so information is accessible to all, by: Shared reporting on implementation of the IHR (2005). Epidemic holds coordination control committee meetings during health crises. Drafting of SOPs is in progress. A public health EOC is in place. Decree on Ebola virus disease control has been issued. Interministerial order on avian influenza control hasbeen issued. National and departmental epidemic control committees are in place. the NFPbetween and other involved. the sectors National SOPs, or their equivalent, are in the process of being approved and will allow for coordination Mechanism for interministerial coordination is in place. m m

mechanisms. developing multisectoral, a multidisciplinary plan coordination on action and communication multidisciplinary; establishing acoordination and communication mechanism that is multisectoral and Support work coordinated by FAO, OIE and WHO to develop an integrated global package of activities to to activities of package global integrated an develop to WHO and OIE FAO, by coordinated work Support • Recommendations for priorityactions • • Other resources inCôted’Ivoire: total numberofnationalreferencecentresto20(Order No. 393/MSHP/MESRSof21June2006). laboratories – in Yamoussoukro, Korhogo, Abengourou, Daloa, San Pedro and Man – bringing the country’s The President’s EmergencyPlanfor AIDS Reliefprojecthas strengthenedthecapacitiesofsixregional it. carried outonthetopic, particularlyacademicstudies, butthereisnonationalorganizationthatsupports Health andPublicHygienetheMinistryofHigherEducationwhensuchcasesarise. Work isregularly confirming casesof AMR, havenonethelessbeencreatedsince2006. The centresalerttheMinistryof not haveanapprovednationalplan. Several nationalreferencecentres, whichcontribute todetectingand Although Côted’Ivoirehasbeenworkingtodetect AMR inthelaboratory for23years, thecountrydoes Côte d’Ivoire levelofcapabilities T agriculture, economicsecurity, andnationalsecurity. of thwarting infectionsinhumans. This situationthreatenspatientcare, economicgrowth, publichealth, (AMR) isoccurringatanalarmingrate andisoutpacingthedevelopmentofnewcountermeasurescapable Over the past decade, however, thisproblem has becomea crisis. The evolutionof antimicrobial resistance as thegrowthofresistancewas slowandthepharmaceuticalindustrycontinuedtocreatenewantibiotics. mechanisms toresistbeingkilledbyantimicrobialagents. For manydecades, theproblemwas manageable Bacteria and othermicrobialspeciesevolvein responseto their environment and inevitably develop Introduction resistanceAntimicrobial combat antimicrobial resistance, spanning human, animal, agricultural, food and environmental aspects (i.e. (i.e. aspects environmental and food agricultural, animal, human, spanning resistance, antimicrobial combat a One Health approach). Each country has: (i) its own national comprehensive plan to combat antimicrobial antimicrobial combat to plan comprehensive national own its (i) has: country Each approach). Health One a resistance; (ii) strengthened surveillance and laboratory capacity at the national and international levels levels international and national the at capacity laboratory and surveillance strengthened (ii) resistance; following international standards developed as per the framework of the Global Action Plan and taking taking and Plan Action Global the of framework the per as developed standards international following into account existing laws; and (iii) improved conservation of existing treatments and collaboration to to collaboration and treatments existing of conservation improved (iii) and laws; existing account into support the sustainable development of new antibiotics, alternative treatments, preventive measures and and measures preventive treatments, alternative antibiotics, new of development sustainable the support rapid point-of-care diagnostics, including systems to preserve new antibiotics. new preserve to systems including diagnostics, point-of-care rapid arget establish set roles and responsibilities at all levels of the health pyramid in human and animal medicine. Develop anational institutional framework for the prevention and control of infections and and AMR (CIAPOL). Agency andIvorian the Antipollution National the reports), Agricultural (LANADA) Development Laboratory Animal health and environment: 19 public and 24 private veterinary clinics (source: 2015 DSV annual health facilities (source: 2015). RASS Among these facilities, there are atotal of 27 laboratories. AMR Human health: 4teaching hospitals, general 84 hospitals, 17 regional hospitals and 1964 first-contact 11 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 12 PREVENT

Joint External Evaluation in thesensethatlatterisnotasinvolvedcombatting AMR. that allcountriescanuseandadapt. There isalsosomedisparitybetweenthehuman andanimalsectors, involved intheglobal AMR surveillancesystemforhumanandanimalhealth. WHO hasproposedamodel network oflaboratories needstobedeveloped, andtheircapacitiesstrengthened, sothattheycanbe This potentialremainsgeographically limitedtoafewfacilitiesatthetopofhealth pyramid. A broader assurance. resistant pathogens; and(iii)verifiedlaboratory methodsandqualitycontrolcarriedoutbyexternal laboratories (for human and animal health, both public and private) able to detect and report antimicrobial- (i) anationallaboratory forantimicrobial-resistantpathogens(thePasteur InstituteofCôted’Ivoire); (ii)44 Although this capacity is non-existent, the country nonetheless has the potential to combat AMR through: No national plan has been approved fordetecting and reportingpriority antimicrobial-resistant pathogens. P.3.1 Antimicrobial resistance detection-Score 1 Indicators andscores • • • • • • • • • • strengthening/challenges need that Areas • • • • • • • • • • practices Strengths/best Implement the national plan for AMR surveillance capacity-building. surveillance AMR national plan for the Implement sectors. Increase and awareness-raising advocacy about in AMR the animal, agricultural, food and environmental Strengthen of theall capacity facilities with an important role to play under the new One Health policy. ground the on and accompaniedreality operational budgeted bya plan. Develop astrategic actionplan, technical based on WHO recommendations, that is adapted to the Participation in the global surveillance system put in place by WHO. Standardized detection AMR and surveillance techniques in laboratories in all three sectors. Management of data and (bio-collection, outputs archiving and waste). Management of input stocks. Creation of technical guidance for the veterinary and environmental sectors. Training for laboratory workers in toAMR human detect and animal health care and agriculture. Accreditation and certification process in place. control quality more of laboratories.External More laboratories identified in allsectors. 3 sectors. environmental and veterinary for developed practices Best laboratories. to provided guidelines surveillance AMR National qualityExternal control at 6regional laboratories. Anti-infective-resistant microorganisms (ORMICI) observatory established in 2002. 27 public and private laboratories identified. medication. tuberculosis to resistance of National surveys available. guidelines AMR National • • • • • practices Strengths/best roles andresponsibilitiesmustbedesignatedatthenational, intermediateandoperational levels. A nationwideprogramme, set withinawell-definedinstitutionalizedframework, mustbeputinplaceand programmes. No nationalplanhasbeenapprovedforhealth-care-associatedinfectionpreventionandcontrol P.3.3 Health-care-associated infectionprevention andcontrol programmes -Score 1 • • • • • • • strengthening/challenges need that Areas • • • • • practices Strengths/best medicine. must beputinplaceattheoperational levelforthesurveillanceofinfectionsinbothhumanandveterinary The samestrengtheningactionsareneeded. Collaborative partnershipsbetweenlaboratories andclinics pathogens. No nationalplanhasbeenapprovedforthesurveillanceofinfectionscausedbyantimicrobial-resistant P.3.2 Surveillanceofinfectionscausedbyantimicrobial-resistant pathogens-Score 1 Key documents exist (see above), to circulated be nationally. Cocody University Hospital at andTreichville 30 staff University Hospital. Training in health-care-associated infection prevention and control provided to people: 60 at 30 staff Policy on the prevention and control of health-care-associated infections is being drafted. committees, at Cocody, Yopougon and Treichville University Hospitals). Organizational structure for infection prevention and control (3 health-care-associated infection control infections). health-care-associated prevention of surveillance and the on national guidelines and documentation hygiene hospital (toolbox, approved National documentation multi-resistant microbes. operationalEffective collaboration clinics between and laboratories in detecting infections caused by Creation of adatabase of infections caused by antimicrobial-resistant pathogens. Mapping of infections caused by antimicrobial-resistant pathogens. the authorities, health workers, NGOs and the public). to pathogens antimicrobial-resistant about information providing pathogens, antimicrobial-resistant of infectionsOverview caused by antimicrobial-resistant pathogens (reporting of infections caused by Collection of data. AMR pathogens. antimicrobial-resistant Transport of pathogens. antimicrobial-resistant of Collection ORMICI has been made an official institution. Infections caused by pathogens are for reported surveillance. AMR strengthened. and identified have been environment Greater number of laboratories nationwide in the areas of public health, veterinary medicine and the Anti-infective-resistant microorganisms (ORMICI) observatory is in place. of 16A network public and 11 private laboratories has been identified. 13 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 14 PREVENT

Joint External Evaluation by WHO, whichcountriescanuseandadaptasneeded. A nationalantimicrobialstewardship planneedstobedrafted andimplementedbasedonthetoolproposed No nationalplanhasbeenapprovedforantimicrobialstewardship activities. P.3.4 Antimicrobial stewardship activities-Score 1 • • • • strengthening/challenges need that Areas • • • • • • strengthening/challenges need that Areas • • • • • • practices Strengths/best Monitoring and evaluation. nationwide. infections health-care-associated levelsreduce to operational Organizational and administrative measures to put be in place at the national, intermediate and Health-care-associated infection control capacities for health facilities to strengthened. be infections. health-care-associated into nationalof prevalence Investigation nationally. disseminated and approved guidelines and documents Policy More health-care-associated infection control committees established. developed. plan training National Workforce development in support of programmes promoting the proper use of antibiotics. of use proper the promoting programmes of support in development Workforce sectors. three all in antimicrobials Awareness-raising among health professionals population and the regarding judicious the of use National actionplan to put be in place using the tool. WHO activities. stewardship AMR coordinates ORMICI regimens. treatment on held are Consensus conferences National programme of regular into surveys the use of antimicrobials in all is three in sectors place. surveillanceAMR carried out by the ORMICI. National on survey antimicrobial use is in development. National on survey cotrimoxazole has been carried out. Adopted measured behaviours, policies and/or practices that minimize the transmission of zoonotic zoonotic of transmission the minimize that practices and/or policies behaviours, measured Adopted • • • practices Strengths/best health threat. Surveillance systemsareinplacefor1-4zoonoticdiseases/pathogens posingthegreatestnationalpublic P.4.1 Surveillancesystemsare inplaceforpriorityzoonoticdiseases/pathogens-Score 3 Indicators andscores • • • Recommendations forpriorityactions integrated zoonoticdiseasecontrolmechanism. The countrydoesnothaveanofficialOneHealthpolicy, butinitiativesareunder way toestablishan in bothhumanandanimalhealth. Valley fever). There is also a small core group of trained professionalsand competent laboratories working influenza, bovine/humantuberculosis, Ebolafeverdisease, brucellosis, echinococcosis, cysticercosis andRift has alistofzoonoticdiseasesundersurveillance(anthrax, salmonella, rabies, highlypathogenicavian committee isestablishedtodevelopandimplementanintegrated epidemiccontrol plan. Côted’Ivoire which carriesoutsurveillanceactivitiesindependently. However, whenepidemicsoccur, aninterministerial and Fisheries, theMinistryof Water andForests andtheMinistryofHealth Public Hygiene), eachof Côte d’Ivoirehasbodiesresponsibleforzoonoticdiseasesurveillance(theMinistryof Animal Resources Côte d’Ivoire levelofcapabilities T zoonotic. infectious diseasesaffectinghumansareofanimalorigin; approximately 60%ofallhumanpathogensare or inanimatevectorsmaybeneededtotransfer themicrobe. Approximately 75%ofrecentlyemerging These diseasesarecausedbybacteria, viruses, parasites, andfungithatarecarriedbyanimalsinsect Zoonotic diseasesarecommunicableandmicrobesspreadingbetweenanimalshumans. Introduction Zoonotic diseases diseases from animals into human populations. human into animals from diseases arget At the time of writing, proactive prevention have kept efforts the free of country Ebola virus disease. control. Successful management of an avian influenza(A(H5N1)) epidemic in 2006; 2016 epidemic is under wildlife. Surveillance system for animal diseases (including zoonotic diseases) since 2001, for human health and Increase country-wide coverage in terms of the animal health workforce, including private veterinarians. above) public with health andlaboratories. veterinary Establish formal ties for information-sharing that link technical (the partners three ministries listed Establish unified a and integrated national plan preventingfor controllingand zoonotic diseases. priority 15 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 16 PREVENT

Joint External Evaluation than halfoflower-level systemswithinthecountry. Côte d’Ivoirehasananimalhealthworkforceaspartofitsnationalpublichealth-caresystembutinless P.4.2 • • • • • strengthening/challenges need that Areas • • • • strengthening/challenges need that Areas • • practices Strengths/best A zoonoticdiseaseresponsepolicy/strategy/national planisinplace. and functional-Score 2 P.4.3 Mechanismsforresponding toinfectiousandpotential zoonoticdiseasesare established • • • strengthening/challenges need that Areas • • practices Strengths/best Material, technical and financialcapacity-building forstakeholders. Zoonotic disease prevention and control plan to implemented. be Systematic information-sharing the animal, between human and wildlife sectors. Use of the risk-analysis tool. systems. surveillance wildlife animal, and of human Integration Intersectoral collaboration is weak. Response times are sometimes slow (seven days on average, including laboratory confirmation). population. mechanismNo effective for rapid information-sharing and communication sectors between with the Insufficient coordination (no joint missions)structures involvedbetween in response operations. pathogenic avian influenza or Ebolavirus disease. National committees and zoonotic disease control plans are in place in of case an epidemic of highly Ebola virus disease. Prevention and control plans are in place for rabies, anthrax, highly pathogenic avian influenza and Qualified workforce is too small to cover the entire country. Few veterinarians trained in field epidemiology. Insufficient workforce at the central and departmental levels. (FETP,programme training epidemiology field 2016)Joint veterinarians. and physicians for Public and private veterinarians and technical (engineers, staff support assistants and instructors). V eterinary oranimalhealthworkforce -Score 3 States Parties should have surveillance and response capacity for foodborne and waterborne diseases’ risk risk diseases’ waterborne and foodborne for capacity response and surveillance have should Parties States • • practices Strengths/best disease andfoodcontamination-Score 2 P.5.1 Mechanismsare establishedandfunctioningfordetectingresponding tofoodborne Indicators andscores • • • Recommendations forpriorityactions • • • • The followingstakeholders playspecificroles: they havebeencarriedout. between thevarious bodiesinvolvedinmanagingcrises, andresponseactivitiesare notevaluated after Network (INFOSAN)andCodex Alimentarius. Butthereisinsufficientcoordination (nojointmissions) Côte d’IvoirehasnationalfoodsafetystandardsandispartoftheInternationalFood Safety Authorities Côte d’Ivoire levelofcapabilities T the preventionofhumancases(orfurthercases)needtobeputinplace. food asthesourceofanevent, basedonariskassessment, suitableriskmanagementoptionsthatensure to control throughout the food chain continuum must be developed. If epidemiological analysis identifies source ofanoutbreakanditscontainmentiscriticalforcontrol. Riskmanagementcapacitywithregard the potentiallikelihood ofinternationalincidentsinvolvingcontaminatedfood. The identificationofthe particularly inlessdevelopedcountries. The rapid globalizationoffoodproductionandtrade hasincreased Foodborne andwaterborne diarrhoealdiseasesaretheprimarycauseofmorbidityandmortality, Introduction Food safety or events. This requires effective communication and collaboration among the sectors responsible for food food for responsible sectors the among collaboration and communication effective requires This events. or safety and safe water and sanitation. and water safe and safety arget Animal Health Code. Health Animal Membership in INFOSAN, Codex Alimentarius and the OIE Aquatic Animal Health Code and Terrestrial place. in are standards National Make funding available for joint missions and strengthen technical, logistical and financialcapacities. Strengthen the mechanism for information-sharing during foodborne illness outbreaks. Speed up finalization and approval of the multisectoral safety management food system. for agriculture. The Ministry of the Environment implements inspection policies for bodies of water and species used policies for animal or animal-origin foodstuffs. The Ministry of Animal Resources and Fisheries’ of Office Veterinary Services implements inspection Agriculture of policies Ministry implementsThe for inspection agricultural production. The Ministry of Health and Public Hygiene implements nutrition policies. 17 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 18 PREVENT

Joint External Evaluation • • • • • • • • • • • • • strengthening/challenges need that Areas • • • • Multisectoral management system inspections for food safety to put be in place. Responses to be evaluated. Stakeholders’ capacities to strengthened be (technical and financial). improved. be to stakeholders Communication between improved. be to collaboration Multisectoral No multisectoral management system inspections for food safety in the country. communicationNo mechanism for informing, and educating advising public. the communicationNo effective mechanism stakeholders. food safety between multisectoral collaborationNo risks. for evaluating safety food evaluated. not Responses during investigations of foodborne illness alerts/suspected outbreaks. rapidNo effective, mechanism for information-sharing all between stakeholders involved and sectors Insufficient coordination (no joint missions) thebodies between involved. Sectoral management of prevention and response during suspected outbreaks of foodborne illness. Specimens are taken from symptomatic for testing. and cases foodstuffs investigations. during used are questionnaires Standardized food. contaminated of incidents investigate to formed have been teams Response Members of foodborne illness outbreak response teams have been designated. A whole-of-government national biosafety and biosecurity system is in place, ensuring that especially especially that ensuring place, in is system biosecurity and biosafety national whole-of-government A • • • • • • • challenges remainintermsof: Much efforthasgoneintoproducingregulations, guidance anddirectivesintoworkforcetraining, but However, these capacities must be extended to other levels of the health pyramid and across sectors. potentially infectioussubstancesisalsoinplace. A P4-levellaboratory isunderconstruction. Evaluations in Africa (CRESAC) and WHO accreditationauditors. A WHO focalpointforthetransport of issuing laboratory accreditations: theRegionalCentreforEducational, Environmental and Accreditation handles foodsafety, andCIAPOLhandlesenvironmental pollution. There arealsobodiesresponsiblefor The Pasteur InstituteandtheNationalPublicHealthLaboratory handlehumanhealth matters, LANADA appropriately staffed and equipped, thereby allowing them to ensure proper biosafety and biosecurity. Côte d’Ivoireisfortunateinhavinghigh-levelnationallaboratories attheapexof healthpyramid, Côte d’Ivoire levelofcapabilities T the environment. infectious agentsagainstthosewhowoulddeliberately misusethemtoharmpeople, animals, plants, or and biosecuritytoprotectresearchersthecommunity. Biosecurityisimportantinordertosecure to workwithinfectiousagentshaveraised concernsregardingtheneedtoensureproperbiosafety natural anddeliberate origin. At thesametime, theexpansionofinfrastructure andresourcesdedicated tools thatareneededtodetect, diagnose, recognize, andrespondtooutbreaksofinfectiousdiseaseboth Research withinfectiousagentsiscriticalforthedevelopmentandavailability ofpublichealthandmedical diseases. set oftools–suchasdrugs, diagnostics, andvaccines –tocountertheeverevolvingthreatofinfectious Working withpathogensinthelaboratory isvitaltoensuringthattheglobalcommunitypossessesarobust Introduction biosecurity and Biosafety dangerous pathogens are identified, held, secured and monitored in a minimal number of facilities facilities of number minimal a in monitored and secured held, identified, are pathogens dangerous according to best practices; biological risk management training and educational outreach are conducted conducted are outreach educational and training management risk biological practices; best to according to promote a shared culture of responsibility, reduce dual-use risks, mitigate biological proliferation and and proliferation biological mitigate risks, dual-use reduce responsibility, of culture shared a promote to deliberate-use threats, and ensure safe transfer of biological agents; and country-specific biosafety and and biosafety country-specific and agents; biological of transfer safe ensure and threats, deliberate-use biosecurity legislation, laboratory licensing, and pathogen control measures are in place. in are measures control pathogen and licensing, laboratory legislation, biosecurity arget carrying out follow-upcarrying evaluations of all of the above activities. inputting place anational infection prevention and control plan and a strategic actionplan capacity-building for laboratories at lower levels of the health pyramid and in all sectors procedures operating national-level approving and developing developing and approving curricula at the national level regulations national in gaps in filling inputting place aframework to coordinate activities across sectors 19 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 20 PREVENT

Joint External Evaluation • • • • • Recommendations forpriorityactions • • • strengthening/challenges need that Areas • • • practices Strengths/best training andbestpractices acquisition. The externalevaluation teamsuggestedraising thescorefrom 1to2basedonprogressintheareasof P.6.2 Biosafetyandbiosecurity training andpractices -Score 2 • • • strengthening/challenges need that Areas • • • practices Strengths/best activities thathavebeencarriedout. The externalevaluation teamsuggestedraising thescore from 1to2basedonexistingcapacitiesand and agriculture facilities-Score 2 P.6.1 Whole-of-government biosafetyandbiosecuritysystemisinplaceforhuman, animal Indicators andscores Implement a plan for the transport of infectious substances (human, animal and environmental sectors). level. peripheral the at management Promote biosafety and biosecurity by using rapid testing methods rather than cultures, for waste better institutions. respective Provide biological risk management skills with the necessary experts to train others within their including those in research institutions and diagnostic and biotechnology laboratories. Establish aprogramme for national biosafety and biosecurity training and supervision at laboratories, in laboratories. pathogens of confinement and disposal Develop national biosafety and biosecurity regulations, particularly on the secure and safe use, storage, Capacity-building for laboratories at lower levels of the health pyramid and in all sectors. procedures. national operating of approval and Development curricula. national-level of approval and Development Biosecurity training needs have been evaluated. laboratoriesSome CRESAC or undergoing WHO accreditation processes. place. in directives and procedures operating National standard Monitoring of regulations, preparation of guidelines and directives, training. and staff Multisectoral collaboration to be established. stakeholder. technical a as Education Higher of Multisectoral capacity-building at lower levels of the health pyramid and incorporation of the Ministry Numerous biosecurity protocols already in place nationally, and used regularly in some facilities. Competent structures and personnel out accreditation for carrying procedures. capabilities. biosecurity haveLaboratories sufficient A functioning national vaccine delivery system – with nationwide reach, effective distribution, access for for access distribution, effective reach, nationwide with – system delivery vaccine national functioning A Upcoming activitiesaredescribed intheEPIComprehensiveMulti-yearPlan(cMYP) 2016–2020. coverage goals. Supervisionofimmunizationactivitieswould helptocorrectsuchirregularities. providers incertainareasimpose smallfeesforimmunizingchildren, whichhashindered theattainmentof not provideimmunizationserviceseveryday. Although vaccinations arecompletelyfreeofcharge, vaccine vaccine in2015, therewas ashortageofnationalyellowfevervaccine. Morethanhalfof healthcentresdo However, EPIhasencountereddifficultiesinrecentyears. Although there was nostockout ofmeasles developed. Immunizationcoverage fortargetdiseasesisalittleover80%. Immunization isfullyfunctionalinCôted’Ivoire. Much progresshasbeenmadeandcapacity • • • • • • • made, including: The routineEPItargetisyoungchildrenunder11monthsandpregnantwomen. Great progress hasbeen year plan). Haemophilus influenzaetype b, yellowfever, measlesandpneumococcaldiseases (comprehensivemulti- diseases: tuberculosis, tetanus, diphtheria, pertussis, poliomyelitis, hepatitisB, diseases causedby Côte d’IvoirehasanExpandedProgramme onImmunization(EPI)CoordinationOffice thatcovers10 Human health: Côte d’Ivoire levelofcapabilities T deaths ayearglobally. ways to save lives and prevent disease. Immunizations are estimated to prevent more than two million Immunization isoneofthemostsuccessfulglobalhealthinterventionsandcost-effective Introduction Immunization marginalized populations, an adequate cold chain, and ongoing quality control – that is able to respond respond to able is that – control quality ongoing and chain, cold adequate an populations, marginalized to new disease threats. disease new to arget EPI focal point team trained and deployed in each district. 2017; awareness campaigns on the poliomyelitis and measles vaccines will focus on children and parents in data); penta-3 vaccine coverage was 93% and measles vaccine coverage was 82% in 2015 (administrative measles; particularly diseases, targeted of outbreaks epidemic in reductions for PoliomyelitisCertification Committee November in 2015; national documentation that the is certifying country free of wild poliovirus, accepted by the Regional transmission of wild poliovirus halted as of July 2011; 2013; in validated tetanus, neonatal and maternal of elimination 21 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 22 PREVENT

Joint External Evaluation availability ofvaccines orfundingfortheirpurchase. having areliabledistributionsystematalllevels, Côted’Ivoirecannotcurrentlyguarantee continuous both the operational and national levels which disrupts the regularity of immunization activities. Despite distribution systemforvaccines andinputsattheoperational level. However, therearestillstockouts at are properlydistributedinalldistrictsthroughoutthecountry, whichshowsthatthereisaneffective their animal-healthcounterparts, usingthesamecoldchainatoperational andterritoriallevels. Vaccines used tobettersteeranimalimmunizationactivities. Humanhealthorganizationsworkincollaboration with Veterinary servicesarewellorganizedandoperational. The surveillancesystemforhumandiseasesisoften Cold chainandsurveillance: travel (immunizationisprovidedbyprivate services). As fortherabies vaccine, thereisnospecificserologicalmonitoring, buttestingismandatoryfordogsthat was 90%amongthe80%ofinventoriedanimalpopulation. wholesalers attheoperational level, andnoshortageshavebeenreported. Immunizationcoverage in2016 Animal ResourcesandFisheries, thesolepurchasingauthority. All othervaccine stocksaremanagedby that there have been stockouts of the last two vaccines due to financial constraints within the Ministry of tuberculosis, rabies, sheepandgoatplaguecontagiousbovinepleuropneumonia. Itisworthnoting plan hasbeenimplementedundertheresponsibilityofOffice Veterinary Services. The plantargets animals (Côted’Ivoire Animal HealthEnforcement Agency Decreeof1963). An animalimmunization Immunization againstcontagiousbovinepleuropneumoniaismandatoryinCôted’Ivoireforat-riskdomestic Animal health: Strengths/best practices • practices Strengths/best P.7.1 Indicators andscores • • • • • Recommendations forpriorityactions A strategic plan is in place (cMYP 2016–2020) which aims to improve immunization coverage through: Increase demand for immunization among the public. Improve the quality of administrative data. Continue to provide funding for immunization particularly services, for advanced and mobile strategies. management. in cold-chain capacities Strengthen workforce Strengthen logistical resources and maintenance capacities for human and animal health. m m m m m m m V

accine coverage (measles)aspartofnationalprogramme -Score 3 measures for increasing demand for immunization. for demand increasing for measures all levels at system vaccine-management strengthened materials) transport and (cold-chain equipment and infrastructure improved consumables and vaccines of availability uninterrupted good, immunization community-based strengthened schedulemonitoring mechanisms improved supply of free vaccines administered in private facilities immunization services strengthened • at thecentral level, butthereareoccasionalshortagesinthedistricts. Needs forecastingandprocurementofvaccines arecarriedoutinsuchaway thattherearenostockouts P.7.2 Nationalvaccineaccessanddelivery-Score 3 • • strengthening/challenges need that Areas No strengthsrecorded. practices Strengths/best • • • strengthening/challenges need that Areas Continued strengthening of health districts’ capacities in terms of rolling stock. Continued strengthening of the EPI Coordination Office’s supply chain managementcapacities by: Vaccines and inputs to available be at all times. vaccines: new introduce to Continuing from civilorganizations society and community leaders. Strengthening immunization and uptake advocacy in the community by increasing demand with help populations. hard-to-reach among especially immunizationStrengthening strategies, m m m m

strengthening workforce capacities in cold-chain management. in cold-chain capacities workforce strengthening constructing regional cold-storage rooms rubella and meningitis Ain 2018 2017 in rotavirus 23 of IHR Core Capacities of the Republic of Côte d’Ivoire PREVENT 24 DETECT

Joint External Evaluation Real-time biosurveillance with a national laboratory system and effective, modern point-of-care and and point-of-care modern effective, and system laboratory national a with biosurveillance Real-time education; andpartnershipscommunication. and specializedtesting; laboratory oversight; emergencyresponse; publichealthresearch; training and safety, including: diseaseprevention, controlandsurveillance; integrated datamanagement; reference serve asafocalpointfornationalsystemthroughtheircorefunctionshuman, veterinaryandfood response, environmental monitoring and disease surveillance. Stateand local public healthlaboratories can Public healthlaboratories provideessentialservices, includingdiseaseandoutbreakdetection, emergency Introduction National system laboratory DETECT which hastwoaccreditations forqualitycontrolofmedicines). have aqualityassurance systeminplace(withtheexception oftheNationalPublicHealthLaboratory, While there is a national body – CRESAC - in charge of laboratory certification, in practice few laboratories equipment, consumablesandhumanresources. not actuallyfunctional). There isthereforeanurgentneedtocorrectthesedisparitiesthroughadditional animal health/agricultureandenvironment), andalso withineachsector(someregionallaboratories are terms of human resources and equipment, which are spread unevenly among the 3 sectors (human health, or informalpartnerships. The diagnosticlaboratory systeminCôted’Ivoireischaracterized bydisparitiesin National laboratories withvarying levelsofcapacityandareasspecializationcollaborate through formal laboratories andevaluate theirdiagnosticactivities. poliomyelitis. The National Public Health Laboratory and the Pasteur Institute provide support to regional recognized byitsstatusasa WHO regionalreferencelaboratory formeasles, gonococcalinfectionsand One notableassetisthePasteur InstituteofCôted’Ivoirewithitsmoleculardiagnosticcapacity, afact This systemiscapableofdiagnosingmostknownhumanandanimaldiseasespresentinthecountry. • • • Côte d’Ivoirehasanextensivelaboratory systemintheareasof: Côte d’Ivoire levelofcapabilities T laboratory-based diagnostics. laboratory-based arget environment: 1 laboratory. 1 environment: animal health and agriculture: laboratories; 5 laboratories and those located at university hospitals and specialized institutes); (209 laboratories at general and regional hospitals) (12 and tertiary laboratories, including national health centres, specialized urban health centres and urban health education facilities), secondary dividedbe into 3categories based on their level of capabilities: primary (within rural and urban human health: over 420 laboratories, 113 of which are in the private sector. These laboratories can Strengths/best practices • practices Strengths/best and environmentalsectors. specimen transport doesseemtobebetterorganizedinthe humanhealthsectorthanintheanimal (and thereforeinvolvesconsiderable risk). The systemdoesnotfunctionwellinmostdistricts. However, Although asystemfortransporting specimensisinplace, itismostoftenreliantonpublictransport D • • • • a setperiod. The newstrategy willhavetoaddressanumber ofchallenges. The countrymustassessits2012–2015strategic plananddraw lessonsfromittoprepareanewplanfor strengthening/challenges need that Areas • practices Strengths/best The nationallaboratory systemisabletocarryoutnineofthetenmaintests. D Indicators andscores • • • • and reliable. The followingpriorityactionswereidentifiedtomake thecountry’s diseasediagnosticsystemmoreeffective Recommendations forpriorityactions .1.2 Specimenreferral andtransport system - Score 2 .1.1 Laboratory testingfordetectionofprioritydiseases-Score 4 Transfer of specimens to their destination laboratory for diagnosis is well documented. specialists. in bringing for preparation in plans maintenance Overcoming it will not easy be and will require pooling resources and coordinating equipment in practicallyAs other every Sub-Saharan African country, maintaining equipment is also achallenge. environmental must promoted be sectors in order to implement aOne Health approach. Better coordination and collaboration laboratories between in the human health, animal health and To do the above, regional and district facilities must also strengthened be (this will amajor be challenge). response to the country’s diseases priority is made as rapidly as possible. Existing facilities must strengthened be thatso many carried can be tests out closer to patients and the diarrhoea, CD4 and serological HIV testing). other laboratories for anumber of diagnostic (e.g. tests tuberculosis, influenza, bacteria thatcause laboratory system is that the National Public Health carries Laboratory out external evaluations of (2012–2015), although the plan has not yet been assessed. One considerable strength of the Côte d’Ivoire has anational laboratories policy, published in 2012, and athree-year strategic plan Encourage laboratories out quality to assurance carry that so they canreceive accreditation. providecan better to support peripheral and regional laboratories out primary diagnosis. which carry andLaboratory quality control of laboratories by the Ministry of Health and Public Hygiene) that so they Strengthen national laboratories (particularly the organizational functions of the National Public Health diagnostic testing easier and increase access to testing in remote areas/districts from 50% to 80%. Put in place system afastfor transporting and effective specimens to national laboratories to make human resources. facilities closer to points of care) while providing peripheral laboratories with more equipment and diagnostic of human laboratoriesAdapt network the and animal for priority diseases diagnostic (bring 25 of IHR Core Capacities of the Republic of Côte d’Ivoire DETECT 26 DETECT

Joint External Evaluation strategies atseveral levels. The country uses point-of-care diagnostic tests for its prioritydiseases in accordance with diagnostictesting Pasteur Institute. Central Veterinary Laboratory iswell equippedformolecularbiology, butnottothesameextentas molecular characterization ofpathogens.) However, thisisnotthecaseforanimalhealth. The Bingerville techniques. (The Pasteur Institutehasanadvanced molecularbiologyplatformand isabletoconduct which thePasteur Instituteservesasthereferencelaboratory –whichevenincludes modernmolecular national specimentransport systemandconfirmatorytestingforanumberofdiseases – suchasthosefor Specific diagnostictestingstrategies havebeendocumentedandfullyappliedatseveral levels. There isa D • • • strengthening/challenges need that Areas • certifying laboratories. voluntary basisandnotrequired foralllaboratories). There isalsoanationalbody, CRESAC, incharge of Laboratory implementsitbycarryingoutexternalquality evaluations (theprocessis undergone ona There isalicensingsystem forlaboratories inthehuman healthsector, andtheNational PublicHealth D • • strengthening/challenges need that Areas • • • Côte d’Ivoire’s nationallaboratory systemhasanumberofimportant assets. practices Strengths/best .1.3 Effective, modernpoint-of-care andlaboratory-based diagnostics-Score 3 .1.4 Laboratory qualitysystem-Score 3 and across all sectors. Best practices for the transport of infectious substances should disseminated be throughout the country this problem. tackle to advised companies are also less and less likely to accept these substances. WHO, FAO and OIE would well be abroad, which poses an increasing challenge in transporting infectious substances. Air transport It is more and more difficult sendto dangerous substances UN (category 2814) to reference laboratories sectors. such or as the WHO CDC) for the human health but not sector for the animal health and environmental Transport have contracts been signed and are funded by the Ministry of Health (or external partners belong to international and regional networks. laboratory The Pasteur Institute (human health) and the Bingerville Central Veterinary (animal Laboratory health) peripheral laboratories’ diseases. forcountry’s the results priority Strengthening national laboratories in terms of equipment and qualifiedso that theystaff can confirm health. animal for particularly times, response Strengthening peripheral diseases laboratories and thus shorten diagnose that so theycan priority for the mainneeded diagnostic tests. Ministry of Health has procurement good procedures in place for purchasing media and reagents medicines, which could also be used to inspect foodstuffs. The National Public Health has well Laboratory avery equipped laboratory for quality control of including tests, most out molecular techniques. The Pasteur Institute has well avery equipped laboratory and awell trained workforce able to carry • strengthening/challenges need that Areas • • • • • • practices Strengths/best health. (No government in charge body animal of certifying health laboratories.) Adoption of quality-assurance procedures by agreater number of laboratories, particularly in animal specialization. technical of applications aspects from private laboratories and working services within area its of In the environmental sector, CIAPOL’s Central Environmental is Laboratory in charge of assessing the Laboratory, which accreditations. has two Some laboratories have begun the quality-assurance process, such as the National Public Health New Public Health Pharmacy. National Public Health Laboratory, of Infrastructure, the Office Equipment and Maintenance and the This authority is made up ofof membersPharmacies, of the Office Medicines Laboratories,and the A national regulatory authority is in charge of qualifying and registering devices for in-vitro diagnostics. of veterinary anetwork of RESOLAB, laboratories in western and central Africa). Some facilities take in inter-laboratory part testing for both human and animal is health part (LANADA of Pharmacies,The Office Medicines Laboratoriesand is in charge of licensing human health laboratories. CRESAC is in charge laboratories. of certifying 27 of IHR Core Capacities of the Republic of Côte d’Ivoire DETECT 28 DETECT

Joint External Evaluation Strengthened foundational indicator- and event-based surveillance systems that are able to detect detect to able are that systems surveillance event-based and indicator- foundational Strengthened T events. an integrated biosurveillanceeffortthatfacilitatesearlywarning andsituationalawareness ofbiological The purposeofreal-timesurveillanceistoadvance thecountry’s safety, security, andresiliencebyleading Introduction Real-time surveillance for reportingwarnings ofdiseasesundersurveillanceorunusual healthevents). in thehealthdistricts2016. There isalsosharedreporting toolforcommunity-basedsurveillance(form Event-based surveillanceisalsofunctionalinCôted’Ivoire. Community-basedsurveillancewas introduced northern Côted’Ivoire. The private sectoronlyparticipatesinsurveillanceonanad-hocbasis. Cross-border surveillanceisinplacefordiseaseswith epidemic potential, particularlyformeningitisin supervised inthehealthdistricts. Effortsmustnonetheless bemadetoimprovedataquality. Office, theNational Institute of Public Health, andthe Pasteur Institute of Côte d’Ivoire). Surveillance is also four entities(theOfficeofHealthInformation Forecasting, PlanningandEvaluation, theEPICoordination centralizing data. Qualitycontrol ofsurveillancedataiscarriedoutduringtheharmonizationmeetings website (MAGPI). However, thereisnoreal-timedatacollection withinlaboratories andnomechanismsfor Health Information Software (DHIS2) trackers and the Advanced Mobile Data Messaging and Visualization collection toolsavailable. Smartphonesareusedinallhealthdistrictsandregions, alongwithDistrict electronic reporting system that enables real-time reporting of notifiable diseases by making information- A well-runnetworkforcollectinginformation, dataandfeedbackisinplace. The countryhasafunctioning surveillance training. national fieldepidemiologytraining programme (FETP)isvery effectiveandincludesbasic andadvanced the topicwas consequentlyheldforstaffin40healthdistrictsandcommunity workers. The training/retraining programme isongoing forintegrated diseasesurveillanceandresponse. Training on and response. The listof notifiable diseases isavailable. Healthworkers wereretrained in 2012 anda Indicator-based diseasesurveillanceinCôted’Ivoire iscarriedoutthroughintegrated diseasesurveillance Human healthsurveillance: Côte d’Ivoire levelofcapabilities events of significance for public health, animal health and health security; improved communication and and communication improved security; health and health animal health, public for significance of events collaboration across sectors and between sub-national, national and international levels of authority authority of levels international and national sub-national, between and sectors across collaboration regarding surveillance of events of public health significance; improved country- and intermediate-level intermediate-level and country- improved significance; health public of events of surveillance regarding regional capacity to analyse and link data from and between strengthened, real-time surveillance systems, systems, surveillance real-time strengthened, between and from data link and analyse to capacity regional including interoperable, interconnected electronic reporting systems. This would include epidemiologic, epidemiologic, include would This systems. reporting electronic interconnected interoperable, including clinical, laboratory, environmental testing, product safety and quality and bioinformatics data; and and data; bioinformatics and quality and safety product testing, environmental laboratory, clinical, advancement in fulfilling the core capacity requirements for surveillance in accordance with the IHR (2005) (2005) IHR the with accordance in surveillance for requirements capacity core the fulfilling in advancement and OIE standards. OIE and arget • • • strengthening/challenges need that Areas • • • • • practices Strengths/best Indicator- orevent-basedsurveillancesystemsare inplacetodetectpublichealththreats. D Indicators andscores • • • • • Recommendations forpriorityactions Environmental surveillanceisbeingputinplace, alongwitharelatedelectronicreportingsystem. collaboration shouldbeformalized. inspected. The private andpublicsectorscollaborate perfectlywell, especiallyduringcrises. However, this In termsofcross-bordersurveillance, therearehealthpostsalongthecountry’s borderswhereanimalsare some difficultiesintheanimalhealthsector. Itsimplementationisinthepilotphasethreeregions. validation beforeitissharedwithtechnicalandfinancialpartners. Community-basedsurveillancefaces At thedepartmentallevel, informationissenttoregionaldirectorswhoforward ittothecentral levelfor in theFETP, inadditiontoensuringthelastingimpactoftraining. and riskassessment. The maindifficultyliesindistributingthesetraining toolstostakeholders notinvolved available. Front-line FETPtraining isinitsearlystages, andalsoincludespractical toolsforspecificdiseases at the operational level because the application is not very user friendly. The list of notifiable diseases is (WAHIS) and Animal ResourcesInformationSystem(ARIS2). However, thelatterhasencountered difficulties In the animal health sector, surveillance is carried out using the World Animal Health Information System Animal healthsurveillance: .2.1 Indicator- andevent-basedsurveillancesystems-Score 3 Mechanism for transferring laboratory results in real time to put be in place. Surveillance in the animal health and environmental is slow often sectors and incomplete. the environmentalfor definitions andneeded case events sector. priority of List takesThe country in epidemiological part investigations. Veterinarians and laboratory workers trained in field epidemiology. epidemiology. Health workforce has been trained in integrated disease surveillance and response and field National for network collecting data, information and feedback is in place. needs. country’s Guidance on integrated disease surveillance and response is available and has been adapted to the Strengthen the capacities of data managers at all levels. sectors. environmental Strengthen regular supervision of surveillance systems in the human health, animal health and Integrate hospitals and the private into sector the national surveillance system. surveillance. event-community-based and Strengthen laboratory aspect. Put in place an electronic surveillance of system aOne Health as part approach that includes a 29 of IHR Core Capacities of the Republic of Côte d’Ivoire DETECT 30 DETECT

Joint External Evaluation real time. and animal health surveillance systems. However, the systemdoesnot have the capacity to share datain The countryhasputinplaceaninteroperable andinterconnectedelectronicreportingsystemforpublic D • • • • health emergencysituation. Syndromic surveillancesystems areinplacetodetectonetwomajorsyndromes indicativeofapublic D • • • • strengthening/challenges need that Areas • • • • practices Strengths/best the data. Data isrecordedinreportsthatareoftendrawn upaftersomedelay. Ad-hoc teamsareinplacetoanalyse D • • strengthening/challenges need that Areas • • • practices Strengths/best .2.2 Interoperable, interconnected, electronic real-time reporting system-Score 3 .2.4 Syndromic surveillancesystems-Score 3 .2.3 Analysis ofsurveillancedata-Score 3 surveillance and response and field epidemiology. field and response and surveillance Retention mechanism to put be in place for the health workforce trained in integrated disease Field epidemiology training for all workers in the field. epidemiology. field and response Continued training and supervision of health workers in terms of integrated disease surveillance and Surveillance system for animal health and the environment to strengthened. be Reporting forms to be integrated. environment). the and health animal health, human (for time real in forwarded be to data surveillance and results Laboratory Reporting forms issued by the various ministries to harmonized. be resultsLaboratory to forwardedto be relevant bodies in real time. Epidemiological bulletin (outbreak watch) and exists is distributed, but only during animal health crises. Cases of malaria by reported community health workers. are completeReports and issued promptly in the human health sector. events). health unusual or surveillance Shared reporting tool for community-based surveillance (form for reporting warnings of diseases under Sharing of key information about diseases with epidemic potential across sectors. Interoperable, interconnected, real-time reporting across sectors. software. MAPGI using reported diseases Notifiable sectors. Real-time electronic reporting systems in place for notifiable diseases in the human and animal health Smartphones made available in all health and districts regions. • • • • strengthening/challenges need that Areas • practices Strengths/best Data integration mechanism to put be in place. Continued training for community health workers to promoted be throughout the country. Community-based electronic surveillance to to extended be the environmental sector. and environmental the and two. between sectors Centralized mechanism integrating clinical and laboratory data to put be in place for the animal health Beginning stage of community-based electronic surveillance in the environmental sector. 31 of IHR Core Capacities of the Republic of Côte d’Ivoire DETECT 32 DETECT

Joint External Evaluation Timely and accurate disease reporting according to WHO requirements and consistent coordination with with coordination consistent and requirements WHO to according reporting disease accurate and Timely ecosystems reducestheriskofdiseasesatinterfacesbetweenthem. and animal health systems. Collaborative multidisciplinary reporting onthehealth of humans, animals and pathogens continuetoevolveandadaptnewhostsenvironments, imposingaburdenonhuman Health threats at the human–animal–ecosystem interface have increased over the past decades, as Introduction Reporting • • • • Recommendations forpriorityactions interconnected. between the NFP and the OIE delegate, and the two reporting systems are neither interoperable nor there arestillsomeissuesintermsofinformationsharing. There isnoprocedure for sharinginformation Important advances havebeenmadeoverall andanumberof initiatives havebeenimplemented. However, A regionalmeetingwas heldtodesignatetheNFP. animals, foodsafetyandwildlife, allofwhomhavebeenidentifiedandtrained. Union Inter African Bureaufor Animal Resources. There arealsoOIEfocalpointsforterrestrialandaquatic In termsofanimalhealth, reportsaremadetoOIE(viaitsdelegateinthecountry)and African priority diseases(Integrated DiseaseSurveillanceandResponse). is carriedoutusingthedecisioninstrumentcontainedin Annex 2oftheIHR(2005), basedonthelistof districts, which then relay the information to the next level. Internationally, reporting of public health events guidelines, whereasprimary-carefacilitiesreportsuspectedcasesorpublichealtheventstothe At thenationallevel, reportingofhumancasesisbasedonintegrated diseasesurveillance andresponse WHO asprovidedforin Article 8oftheIHR(2005). regular basis, notonlyduringemergencies. The NFPmakes useofinformalmechanisms forconsultingwith the IHR(2005)platform. Reportingtothe West African HealthOrganization(WAHO) iscarriedoutona Ministry ofHealthandPublicHygiene. Reportingto WHO duringemergencysituations iscarriedoutusing The directoroftheNationalInstitutePublicHealthservesasnationalIHRfocalpointwithin Côte d’Ivoire levelofcapabilities T FAO and OIE. and FAO arget Strengthen reporting capacities in all three particularly sectors, in the area of training. Draw up aprotocol for reporting threats. Set up amultisectoral committee to assess threats. environment). the and health animal Put in place amultisectoral that reporting network brings on board all (human three sectors health, • • • • • • practices Strengths/best D • • • • • strengthening/challenges need that Areas • • • • • • • • • • • • • • practices Strengths/best particularly lackinginremoteareas. The countryhasreportingcapacities, buttheyarelimited, coveringonlypartofthecountry, andare D Indicators andscores .4.2 Reportingnetworkandprotocols incountry-Score 2 .4.1 Systemforefficient reporting toF Collaboration promoted within network. the Legal assistance provided during drafting of SOPs. meetings for SOPs. Drafting potential. epidemic with diseases for place in network surveillance Epidemiological up. drawn laws and Regulations up. drawn procedures and Protocols Designation of IHR focal points in other sectors. mechanisms. surveillance environmental and epidemiological Collaboration between Collaboration the human between and animal health sectors. specimens. Transport of surveillance. Community-based Animal health threats to reported OIE. Simulation exercises carried out. All international public health events to (IHR reported WHO (2005) Annex 2). surveillance. epidemiological in trained workers Field International Airport. Boigny Immediate detection ofcases the first of pandemic influenza A(H1N1) in2009 at Félix-Houphouêt- Smartphones available in health for districts reporting individual cases. All health participate districts in reporting of diseases with epidemic potential. point. contact OIE Operational preparedness. emergency Health inNFP place. approved. guidance response and surveillance disease integrated New emergencies. health of reporting Immediate Electronic the and districts reporting the between National Institute of Public Health. Reporting system for diseases with epidemic and epizootic potential. A O , OIEand O -ScoreWH 3 33 of IHR Core Capacities of the Republic of Côte d’Ivoire DETECT 34 DETECT

Joint External Evaluation • • strengthening/challenges need that Areas Collaboration platform needed. Procedures for multisectoral collaboration to put be in place. States Parties should have a skilled and competent health workforce for sustainable and functional public public functional and sustainable for workforce health competent and skilled a have should Parties States and laboratory scientistsandtechnicians). The countryhasamultidisciplinary workforceatthenationallevel(epidemiologists, veterinarians, clinicians Score 2 D Indicators andscores • • • • • Recommendations forpriorityactions remain scarceandrequirestrengtheningatalllevels. environmental personnel. Effortstodevelopthehealthworkforcethroughcommunity-basedtraining although theyarespreadovertheentireterritory. Moreover, thereisaseverelackofanimalhealthand Despite all these assets, human resources for human health remain quantitatively and qualitatively limited, incentives aimedatmotivating andretainingtheworkforce. Government, theprivate sectorandlocalinternationalpartners. The governmenthasalsoputinplace a pharmacyschool, amedicalschoolandtheFETP). These programmes areorganizedbytheIvorian also hasseveral professional, appliedanduniversitytraining programmes (e.g. scientifichighereducation, professionals make upamultidisciplinaryworkforceactiveacrossthelevelsofsystem. The country health workers, biostatisticians, laboratory andanimalsciencespecialists, and fieldepidemiologists. These Côte d’Ivoire’s healthworkforceincludesphysicians, paramedics, pharmacists, veterinariansandanimal Côte d’Ivoire levelofcapabilities T scientific skillsandsubject-matterexpertise. developing and maintaining a highly qualified public health workforce with appropriate technical training, Workforce developmentisimportantinordertodevelopasustainablepublichealthsystemovertimeby Introduction Workforce development health surveillance and response at all levels of the health system and the effective implementation of the the of implementation effective the and system health the of levels all at response and surveillance health IHR (2005). This workforce includes physicians, animal health workers or veterinarians, biostatisticians, biostatisticians, veterinarians, or workers health animal physicians, includes workforce This (2005). IHR laboratory scientists and farming/livestock professionals, with an optimal target of one trained field field trained one of target optimal an with professionals, farming/livestock and scientists laboratory epidemiologist (or equivalent) per of 200,000 population, all of whom can systematically cooperate cooperate systematically can whom of all population, 200,000 of per equivalent) (or epidemiologist to meet the core competencies of the IHR (2005) and the OIE Tool for the Evaluation of Performance of of Performance of Evaluation the for Tool OIE the and (2005) IHR the of competencies core the meet to Veterinary Services (PVS Tool). (PVS Services Veterinary arget .5.1 Human resources are available to implement IHR (2005)core capacity requirements - Put in place intermediate and advanced levels of the FETP. development. workforce for plan strategic multisectoral the Approve Provide technical and financial capacity-buildingfor support for available human resources. Map human resources by specialization within the Human Resources Office. Draw up acareer profilepolicy document, particularly for community health workers. 35 of IHR Core Capacities of the Republic of Côte d’Ivoire DETECT 36 DETECT

Joint External Evaluation • • • • • • • practices Strengths/best plan forworkforcedevelopmentwhichincludesbothareassothatthecountrycanimproveinregard. there iszerocapacity(Score: 1). Itisthereforeimportanttodevelopandimplementabudgetednational Workforce developmentisstillneeded, particularlyin AMR andinfectionpreventioncontrol, forwhich • strengthening/challenges need that Areas • practices Strengths/best epidemiologists, veterinariansandlaboratory technicians. A healthworkforcestrategy exists, butitdoesnotincludepublic-health-relatedprofessionssuchas D • strengthening/challenges need that Areas • • practices Strengths/best Advanced training isprovidedinBurkinaFaso throughanagreement withtheUniversityofOuagadougou. Basic epidemiologytraining existsinCôted’Ivoire, buttheintermediateandadvanced levelsdonot. training isinplacethecountryorcountrieswithwhichithasanagreement. A certain level of field epidemiology training (basic, intermediateand advanced) or appliedepidemiology D • • • • • strengthening/challenges need that Areas .5.3 Workforce strategy -Score 2 .5.2 FETPorotherappliedepidemiologytraining programme isinplace-Score 3 software. Data managers share information through monthly reporting forms reports, and MAGPI and DHIS 2 (publicNursing workforce health and clinical care). training. health Community health. public in specialized nurses Training registered of health. international Specialized degrees in offered public health and Master’s degrees offeredin public health and (FETP). programme training epidemiology Field physicians. clinical and Training health public of infection prevention and control, and AMR chemical and radiological hazards. Special strategy to adopted be for areas in which human resources are rare or non-existent, such as Training facilities exist for arange of specializations. Intermediate and advanced to FETP put be in place. officers, EPI coordinators,social welfare andsolidarity centres, and the FETP. surveillance epidemiological of centralized supervision through monitored are capacities Epidemiological Human resources are available to provide the core capacities required under the IHR (2005). No intermediate or advanced field epidemiology training programme exists in the country. radiological hazards, and the scored country lowest on these indicators. Human resources are particularly lacking in certain technical areas, such asand AMR chemical and document. policy profile career No non-existent. are capacities Environment: epidemiological Human and animal health: epidemiological capacities exist but are insufficient. The effective implementation of the IHR (2005) requires multisectoral/multidisciplinary approaches through through approaches multisectoral/multidisciplinary requires (2005) IHR the of implementation effective The • • • • Recommendations forpriorityactions disbursement ofemergencyfunds, whichareheldsolely bytheMinistryofHealth. a nationwideorinternationalpublichealthemergency. Another barrierto rapid responseistheslow The countrydoeshavemechanismsformitigatingalack ofresources, buttheyareinsufficientfortackling in several areasofanimalhealthand the environment, andriskmapping is not complete for all regions. yellow fever, Ebolavirusdisease, avianinfluenzaandHIV/AIDS). However, mappinghasnotbeendone and response to events. Risks and resources have also been mapped for several diseases (e.g. meningitis, logistical, materialandfinancialresourcesavailable atthenationalandregionallevels forpreparedness emergency plan, anationalplanforEbolavirusdiseasecontrol, etc. These plans setforththehuman, ORSEC Planforrelieforganization, thePollumar Planforenvironmentalpollution, anintegrated airport exist forvarious eventsthatcouldimpacthumanoranimalhealththeenvironment. These includethe of apublichealthemergency. However, nationalandintermediarysectoral plansandmultisectoral analyses Côte d’Ivoirehasnotdrawn upanationalmulti-risk, multisectoral preparednessandresponseplanincase Côte d’Ivoire levelofcapabilities T emergency. to supportoperations attheintermediateandcommunity/primaryresponselevelsduringapublichealth identification andmaintenancesofavailable resources, includingnationalstockpiles, andthecapacity and nuclear hazards. Other components of preparedness include mapping of potentialhazards, the response levelpublichealthemergencyplansforrelevant biological, chemical, radiological Preparedness includesthedevelopmentandmaintenanceofnational, intermediateandcommunity/primary Introduction Preparedness RESPOND national partnerships for effective alert and response systems. Coordination of nationwide resources, resources, nationwide of Coordination systems. response and alert effective for partnerships national including the sustainable functioning of a national IHR focal point is a key requisite for IHR (2005) (2005) IHR for requisite key a is point focal IHR national a of functioning sustainable the including implementation. The NFP should be accessible at all times to communicate with the WHO IHR Regional Regional IHR WHO the with communicate to times all at accessible be should NFP The implementation. Contact Points and with all relevant sectors and other stakeholders in the country. States Parties Parties States country. the in stakeholders other and sectors relevant all with and Points Contact should provide WHO with contact details of NFPs, continuously update and annually confirm them. confirm annually and update continuously NFPs, of details contact with WHO provide should arget emergency funds. emergency Mobilize resources for human and animal health and the environment and make it easier to access health. to threats biological/zoonotic Strengthen human resources for preventing, detecting and controlling chemical, radiological and Map public health risks and resources for all levels. health of aOne Health as part approach. Draw up, consolidate and test anational, multisectoral preparedness and response plan for public 37 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 38 RESPOND

Joint External Evaluation • • • • practices Strengths/best required under Annex 1A, Article 2oftheIHR(2005)hasbeendeveloped. A nationalmulti-hazardpublicemergencypreparednessandresponseplanguaranteeing thecorecapacities developed andimplemented-Score 2 R.1.1 National multi-hazard public health emergency preparedness and response plan is Indicators andscores • • • strengthening/challenges need that Areas • practices Strengths/best Public healthrisksandresourceshavenotbeenmapped. R.1.2 Prioritypublichealthrisksandresources are mappedandutilized-Score 1 • • • • strengthening/challenges need that Areas collaboration with WHO, the CDC and the Ivorian National Institute of Public Health. Risk assessments for human health conducted at the national level in 2016 using the STAR tool, in Mechanism for mitigating resource shortages. action at thesupport local level. Plans available for mobilizing or re-allocating resources at the national and intermediate levels to Multi-risk plan (ORSEC Plan) in place. Technical and financial for preparedness.support resources. logistical Insufficient health. public and epidemiology intervention threats, chemical and radiation, biological nuclear in Too experts few health. public and epidemiology intervention threats, chemical and radiation, areas:biological nuclear available following the in Experts ofLack technical and financial support. Frequency of updates to risk profile and national resources be to determined. emergencies. health Human, logistical and financial resources insufficient for tackling nationwide or international public National multi-risk preparedness and response plan for public health emergencies to developed. be Countries will have a public health EOC functioning according to minimum common standards; maintaining maintaining standards; common minimum to according functioning EOC health public a have will Countries • • • • • • Coordination structure andfunctioning: • • Legal instrumentsandemergencymanagementprocedures: • • • Government bodiesandtheirresponsibilities inmanaginghealthemergences: Côte d’Ivoire levelofcapabilities T support decision-makingandimplementation, coordinationandcollaboration. during aresponsetoanemergencyorexercise. They alsoprovideotheressentialfunctionsto exercises. EOCsprovidecommunicationandinformationtoolsservicesamanagementsystem information andresourcesforstrategic managementofpublichealthemergenciesandemergency A publichealthemergencyoperations centre(EOC)isacentral locationforcoordinatingoperational Introduction operations response Emergency trained, functioning, multisectoral rapid response teams and “real-time” biosurveillance laboratory laboratory biosurveillance “real-time” and teams response rapid multisectoral functioning, trained, networks and information systems; and trained EOC staff capable of activating a coordinated emergency emergency coordinated a activating of capable staff EOC trained and systems; information and networks response within 120 minutes of the identification of a public health emergency. health public a of identification the of minutes 120 within response arget levels of the health system. health levels the of Case management guidelines are available for diseasespriority and IHR (2005) relevant hazards at all improvement. for plans and recommendations with 5 simulation exercises have been conducted to test response capacities, and have been followed up EOC procedures manual has been but drafted not yet approved. emergency. isno there when (GHSA) monthly held meetings coordination multidisciplinary Multisectoral, A plan is in place for recruiting staff. extra permanent of 4(1 staff specialist, IT 2data managers and 1secretary). information and communication technology (computers, telephones and multimedia devices) and a as an intersectoralThe EOC acts and multidisciplinary centre for managing emergencies, with Animal teams health comparable protection with information system. system for early human health warnings (surveillance call centre: (+225) 21253510). committees presided over (ORSEC by prefects Plan) communications with an effective and information Order creating and organizing anational epidemic control committee; departmental epidemic control EOCAn was created 2016 February as coordination to act centre and manage health threats. From 2014 to 2016, amultisectoral national committee for Ebola virus disease control was established. managed of by the Office VeterinaryServices. Public Health acting as atechnical secretariat. For animal health, zoonotic disease epidemics were epidemic response activities were overseen by the Minister of Health, with the National Institute of Until 2014, health emergencies were managed by the national epidemic control committee and 39 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 40 RESPOND

Joint External Evaluation • • • • Recommendations forpriorityaction • • • • • • • • • • • • • • • • Various servicescarryoutmostfunctionsduringemergencyresponseoperations. Inparticular: practices Strengths/best R.2.1 Capacitytoactivateemergency operations -Score 2 Indicators andscores Strengthen workforce emergency response capacities at all levels. at capacities response emergency workforce Strengthen fund. emergency unified the strengthen and funds of disbursement emergency for mechanism a Establish mechanisms. coordination response emergency multisectoral Strengthen Approve the EOC SOPs and increase involvement its in surveillance and response activities. No stakeholders have been trained in public communication. Under the ORSEC Plan, health of emergencies aspects are managed by the public health authorities. Trained available staff to manage during cases health emergencies covered by the IHR (2005). SOPs). and ambulances (dedicated Mechanism for referral and transport of patients has been established and has sufficient resources guidelines). international (national and points SOPs are available for the management and transport of potentially infected patients from local entry emergencies who leads regularmeetings. leads who emergencies There is collaboration good stakeholders, between with acoordinator for health threats and ORSEC Plan for relief organization is in place. place. in is framework management emergency and risk multidisciplinary Multisectoral, of the armed conflict in Bouna. simulation, management of the meningitis epidemic in Kouibly and management of the health aspects operations. It carried out several hands-on operations in 2016, including an Ebola virus disease case EOC is in place as apoint and with of aphone acts contact, hotline to provide guidance and direct investigations. for support and The Pasteur Institute and the Bingerville Central Veterinary provide Laboratory confirmation testing emergencies. of aspects health The National Institute of Public Health provides in support investigating, responding and managing the threats, including zoonoses. of The Office Veterinary providesServices in support investigating and responding to animal health The National Civil manages Protection Office emergencies. threats. environmental to responds and investigates CIAPOL investigate and respondto epidemics (including for zoonoses). The health and districts departmental of the offices MinistryAnimal of Resources and Fisheries First-contact health facilities out epidemic carry response activities. • • • strengthening/challenges need that Areas • • practices Strengths/best - Score 2 R.2.4 Casemanagementprocedures are implementedforIHR(2005)relevant hazards • • strengthening/challenges need that Areas • practices Strengths/best R.2.3 Emergency operations programme -Score 3 • strengthening/challenges need that Areas • practices Strengths/best approving theEOC’s SOPs. A consensus was reached on a score of 2, but withstronginsistence on the necessity of finalizing and R.2.2 Emergency operations centre operating procedures andplans-Score 2 • • strengthening/challenges need that Areas Workforce development and resource availability remain availability challenges. major resource and development Workforce by the IHR (2005). covered emergencies health managing for resources sufficient and workforce of deployment Effective guidelines and/or SOPs. Case management, referral and transport of potentially infected patients to carried be out in line with managementCase (2005) to conforms IHR recommendations. infected patients within communities and at points of entry. potentially of transport procedures; operating and guidelines management (2005) case IHR relevant emergency. health public a declared Activating acoordinated emergency response operation or simulation within 120 minutes of having Making the EOC more operational. EOC is functional and was out an able exercise to carry to test operational its capacities. To make the EOC more operational, SOPs must its approved be and legal provisions put in place. There is an operational plan, and the levels at which the EOC is activated are well understood. Putting in place aformalized collaboration GHSA–EOC platform. efforts. surveillance environmental Collaboration the human between and animal health epidemiological and between sectors and 41 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 42 RESPOND

Joint External Evaluation Country conducts a rapid, multisectoral response in case of a biological event of suspected or confirmed confirmed or suspected of event biological a of case in response multisectoral rapid, a conducts Country T officials. emergency, lawenforcementwillneedtoquicklycoordinateitsresponsewithpublichealthandmedical occurring (e.g. influenzapandemics)orman-made(e.g. theanthrax terroristattacks). Inapublichealth Public healthemergenciesposespecialchallengesforlawenforcement, whetherthethreatisnaturally Introduction authorities security and health public Linking • • practices Strengths/best the publichealth, animalhealthandsecuritysectors. Contact pointsandtriggersforreportingsharinginformation havebeenidentifiedandsharedbetween customs) are linked duringasuspectedorconfirmedbiologicalevent-Score 2 R.3.1 Publichealthandsecurityauthorities(e.g. lawenforcement, border control and Indicators andscores • • • • Recommendations forpriorityactions country mightface, althoughamemorandum ofunderstandinghasnotyetbeensigned. All theseinstrumentshavebeenbroughtintolinewithIHR(2005)andthenewchallengesthat Ministry oftheInterior, thefirst action ofthistypebeingtheresponsetoEbolavirusdisease. At thecentral level, responsecoordinationiscentralized within theMinistryofHealthrather thanatthe At theperipheral level, prefectsensurecoordinationbetweencivilprotectionservices and healthdirectors. services hasbeenenacted, alongsidemeasurestoprovidepersonalprotectiveequipmentresponders. regular contacts maintainedright up tothe level ofthePresident. A decree creating emergency medical different territorial units. The relationship betweenthetwoadministrative structuresiswell developed, with Since 1993, interministerialregulations have formallylinked the public health and security authorities in Côte d’Ivoire levelofcapabilities deliberate origin, including the capacity to link public health and law enforcement, and to provide and/or and/or provide to and enforcement, law and health public link to capacity the including origin, deliberate request effective and timely international assistance, such as to investigate alleged use events. use alleged investigate to as such assistance, international timely and effective request arget National Security Council. National Security Legal coordination framework. Institute periodic simulation exercises to familiarize those involved with their respective roles. mobilizeemergencies. in rapidly to financial resources procedures place in Put national ORSEC Plan for risks and disasters. Develop sector-specific plans in different areas so of thataction canthesebe incorporated into the authorities. security Speed up approval procedures for a memorandum of understanding the public between health and • • • • • • strengthening/challenges need that Areas • • • • Making financing available quickly in emergencies. in available financing Making quickly progress. in emergency Maintaining the coordination framework during non-crisis periods when there is no major public health Improving post-crisis the phase (debriefing and feedback). management. crisis for Financing central level (the situation in the prefectures is fine). Inventory-taking and coordination of resources (workforce, material, financing, etc.) especially at the period. observation the Coordination during representatives. departmental Monthly conferences of directors and heads presided of services over by the of prefect each region and Meetings departmental between epidemic control committees. events. health Government Information and Communications Centre is involved in sharing information on public committee. response and control epidemic National 43 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 44 RESPOND

Joint External Evaluation National framework for transferring (sending and receiving) medical countermeasures and public health health public and countermeasures medical receiving) and (sending transferring for framework National health emergency. public health. Inaddition, itisimportanttohavetrained personnelwhocandeployinresponsetoapublic infectious diseasethreats. Investmentsinmedicalcountermeasurescreateopportunitiestoimproveoverall Medical countermeasuresarevitaltonationalsecurityandprotectnationsfrompotentiallycatastrophic Introduction deployment countermeasuresMedical andpersonnel health emergency -Score 2 R.4.1 Systemisinplacefor sendingandreceiving medical countermeasures duringapublic Indicators andscores • • • • Recommendations forpriorityactions response actionplan. countries in1996. This protocolshouldbeputintopractice throughanationalepidemicpreparednessand Côte d’Ivoire signed a cooperation protocol with Algeria and Chad on epidemic control in West African were deployedtoheavilyaffectedcountries(LiberiaandGuinea)withsupportfrom WAHO. for avianinfluenzaandEbolavirusdisease. DuringtheEbolaoutbreakin West Africa, Ivorianpersonnel Ministry ofHealthhasalsoorganizedsimulationexercisestoprepareforepidemicsorpandemics, including Several disastersimulationexerciseshavebeencarriedoutaspartoftheORSECPlan since1979. The responsibilities offoreignmedicalpersonnelhavenotbeenclarifiedbylaw. Community of West African States (ECOWAS) havemuchfundingfordisasterresponse, andthestatus are noavailable plansfordeployingmedicalandsecuritypersonnel. Neitherthecountry northeEconomic the NewPublicHealthPharmacyprovideforsecuritymedicalstockpilingemergencyresponse, butthere receiving medicalcountermeasuresanddeployingpersonnelduringahealthdisaster. The proceduresof Ministry ofHealth. A nationalplanisinplace(theORSECPlan)thatsetsforthasystem forsendingand In Côted’Ivoire, emergencyreliefisorganizedbytheMinistryofInteriorincollaboration withthe Côte d’Ivoire levelofcapabilities T and medical personnel from international partners during public health emergencies. health public during partners international from personnel medical and arget personnel. out simulationCarry exercises for sending/receiving medical countermeasures and deploying/receiving emergencies. health public during workers health receiving and deploying for procedures up Draw emergencies. health public during country the in procurement ensure rapid to countermeasures medical of distributors and manufacturers with Formalize agreements emergencies. health public other and pandemics Develop apreparedness plan for sending and receiving medical countermeasures during epidemics,

• • • strengthening/challenges need that Areas • • practices Strengths/best No nationalplanfordeployingpersonnelhasbeendeveloped. emergency -Score 1 R.4.2 Systemisinplaceforsendingandreceiving healthpersonnel duringapublichealth • • • • • • • strengthening/challenges need that Areas • • • • • practices Strengths/best public healthemergency. Plans arereadyforputtinginplaceasystemsendingandreceivingmedicalcountermeasuresduring Development that regulate of texts the foreign personnel’s authorization to work in the country. ofSetting training standards and criteria for personnel that are sent or received. emergency. health public a during personnel health receiving and sending for procedures Strengthening disease outbreak (October 2014 to March 2015). healthFifteen workers (8 physicians, 4nurses and 3technicians) sent to Guinea during the Ebola virus and Response (GOARN), Network are applied. Regional and international agreements for workforce deployment, such as the Global Outbreak Alert (PHEIC). international of concern emergency health public a during countermeasures medical of receiving sending/ ensure rapid to distributors and manufacturers with agreements framework of Development emergencies. health public manage animal to health National stockpiling of antibiotics, vaccines and laboratory material and supplies for both human and animals. and humans for countermeasures medical receiving and sending incorporates Development of a national epidemic/pandemic control plan (including for zoonotic diseases) that laboratories. Production of antibiotics, vaccines and laboratory material and supplies by local businesses and emergency. health public a during ensure supply to countermeasures medical of distributors and manufacturers with agreements of Formalization countermeasures. Development of a pandemic preparedness plan that incorporates sending and receiving medical of antibiotics,Domestic production vaccines, material laboratory and supplies, etc. place. in health animal Procedures and legal provisions for the procurement and distribution of medical countermeasures for place. in countermeasures Regional and international agreements for the procurement, sharing and distribution of medical outbreak. Ebola the during acquired countermeasures medical of Stockpile Pharmacy. Health Public New the by held emergencies health public for countermeasures medical of stockpiles Security national level. the at equipment ORSEC Plan covers of legalreceiving aspects medicines, medical devices, and logistical and security 45 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 46 RESPOND

Joint External Evaluation • • • Addressing financial aspects of international deployment of personnel. of internationaldeployment of financialaspects Addressing personnel. of international of deployment aspects security Addressing Specifying responsibilities related to the use of medical personnel deployed internationally. States Parties should have risk communication capacity which is multi-level and multi-faced real-time real-time multi-faced and multi-level is which capacity communication risk have should Parties States synergy intermsofstrategy andplannedactions. is alsoworthstrengthening throughmoreformalcollaboration betweenkey sectors, toachievebetter Anthropologists playedadecisive roleinprovidingpsychosocialcareduringtheEbola crisis. This practice rumours. This systemshouldbestrengthenedandformalized. free hotlineisavailable to receive comments from thepublic in reactiontoannouncements, andto track and actively involved in the country’s public health system, which should be encouraged and continued. A Field visits made bythe evaluation team revealed that communityhealthrepresentatives are highlyvisible private sectorforsocialmobilization activities. It isalsoworthnotingthatfinancingavailable forhealthemergenciesandthereisgoodbuy-infromthe in thisarea. existing textsinlinewiththeIHR(2005)wouldhelpto promote thedevelopmentofaformalframework crisis managementwas drawn upaspartoftheEOC’s proceduresduringtheEbolacrisis. Adaptations to plan (theORSECPlan)anda2016–2020nationalactionforriskdisasterreduction. An SOPfor However, Côte d’Ivoire does havecommunication services at someministries. It has a relieforganization emergencies. plan. The workforceisthereforenotyetspecializedortrained inriskcommunicationandpublichealth Côte d’Ivoire has insufficient risk communication capacity overall, and lacks a specific national multisectoral Côte d’Ivoire levelofcapabilities T communications plansneedtobetestedandupdatedasneeded. decision makingareessentialforbuildingtrustbetweenauthorities, populationsandpartners. Emergency mechanisms shouldbeestablished. Inaddition, thetimelyreleaseofinformationandtransparency in and stakeholders inthecountryneedtobeidentified, andfunctionalcoordinationcommunication levels. Disseminatingtheinformationthroughappropriatechannelsisessential. Communicationpartners prevention andcontrolactionthroughcommunity-basedinterventionsatindividual, familyandcommunity voice oftheaffectedpopulation. Communicationsofthiskindpromotetheestablishmentappropriate political andeconomicaspectsassociatedwiththeeventshouldbetaken intoaccount, aswellthe For any communication about risk caused by a specificeventto be effective, thesocial, religious, cultural, the disseminationofinformationtopublicabouthealthrisksandevents, suchasoutbreaksofdiseases. the capacitytocopewithanunfoldingpublichealthemergency. An essentialpartofriskcommunicationis define risks, identifyhazards, assessvulnerabilities andpromotecommunityresilience, therebypromoting Risk communicationsshouldbeamulti-levelandmulti-facetedprocesswhichaimsathelpingstakeholders Introduction Risk communication exchange of information, advice and opinion between experts and officials or people who face a threat or or threat a face who people or officials and experts between opinion and advice information, of exchange hazard to their survival, health or economic or social well-being so that they can take informed decisions to to decisions informed take can they that so well-being social or economic or health survival, their to hazard mitigate the effects of the threat or hazard and take protective and preventive action. It includes a mix of of mix a includes It action. preventive and protective take and hazard or threat the of effects the mitigate communication and engagement strategies like media and social media communication, mass awareness awareness mass communication, media social and media like strategies engagement and communication campaigns, health promotion, social mobilization, stakeholder engagement and community engagement. community and engagement stakeholder mobilization, social promotion, health campaigns, arget 47 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 48 RESPOND

Joint External Evaluation • • • • • Recommendations forpriorityactions • • • strengthening/challenges need that Areas • • practices Strengths/best collaboration includingwithhealth workers, civilsociety, theprivate sectorandothernon-Stateactors. Coordination ofcommunicationexistsonanad-hoc basis, butwithlimitedpartnerandstakeholder R.5.2 Internalandpartnercommunicationcoordination -Score 3 • • • • • strengthening/challenges need that Areas • • • • • practices Strengths/best There arenoformalgovernmentarrangements forriskcommunication. R.5.1 Riskcommunicationsystems(suchasplans, mechanisms)-Score 1 Indicators andscores Promote wider knowledge of the media’s role and responsibilities in implementing the IHR (2005). emergency). is no Create apermanent framework for community dialogue (which should remain even active when there (technical,partners financial andsocial and partners community organizations). Formalize mechanisms for collaboration and communication governmental between bodies and capacities.strengthen its Establish ateam for risk communication during public health emergencies within the EOC and Develop and test anational multisectoral risk communication plan. Mobilizing financial resources. partners. between communication and evaluating coordination for system the Strengthening Formalizing the framework to guide internal coordination with all stakeholders and partners. communicationEffective with partners. A culture of internal communication with stakeholders. risk communication. for financialIncreasing resources Maintaining communities’ trust in the authorities. Strengthening monitoring and evaluation plans. sectoral of Strengthening to maintain capacity and develop communication activities. communication. emergency of charge in personnel responsibilitiesof and roles Strengthening Centre. Ebola Government the by steered communications Information and Communications sub-committee disease).virus Ebola of case first the declaring for (system announcements emergency disseminating for Procedures communications. Financing available emergency for Existence of multisectoral crisis management committees. emergencies. in communication with tasked services Government not fullyutilizedindirecting operations. Ad-hoc systemsforlistening andrumourmanagement, includingthroughhealthworkers, areinplacebut R.5.5 Dynamiclisteningandrumour management-Score 2 • • • strengthening/challenges need that Areas leaders participateinthecentre’s decision-makingandstrategies. communication activities, includingsurveillance, awareness-raising andcommunitydialogue. Community Marcory revealedthatthecommunityintermediarieswerewellintegrated intoandguided thecentre’s A fieldvisittotheurbancommunityhealthcentreat Arras 3housingdevelopmentin Treichville- practices Strengths/best identified atthenationalandintermediate(provincial/regional)levels. promoting involvementinriskcommunicationstrategies. Somestakeholders inthis domainhavebeen and permanentfootingwithintheadministration, withafocusonlisteningtocommunities’ concernsand partners andstakeholders arebeingmapped. However, thesekey resourcesneedtobeputonanofficial A system for community-level engagement is in the process of development; existing processes, programmes, R.5.4 Communicationengagementwithaffectedcommunities-Score 2 • • • • • • strengthening/challenges need that Areas • • • • • • practices Strengths/best Centre andwithinministries. There isapubliccommunicationteam/unitwithintheGovernmentInformationandCommunications R.5.3 Publiccommunication-Score 2 Financial and human resource mobilization to strengthen leadership skills. leadership strengthen to mobilization Financial human resource and audiences. target Community members to trained be in risk communication and development of messages tailored to System for promoting collaboration community formalized to be in. and bedded Mobilization of financial resources. systems. health environmental Harmonization of procedures to develop and adapt key messages within the human, animal and Low mobilization and understanding by the media of the One Health approach under the IHR (2005). Awareness-raising among the media as to their roles and responsibilities under the IHR (2005). informed. audiences keeping in target media the of Evaluation role of Formal spokesperson (personor entity) to formally be identified and trained. Well-known religious leaders have made information videos. Involvement and of partners civilin disseminating society information to the public. developed. strategies Relevant communication Available workforce. Authorities show clear willingness to engage in public communication. A range of media platforms. 49 of IHR Core Capacities of the Republic of Côte d’Ivoire RESPOND 50 RESPOND

Joint External Evaluation • • • • • • • strengthening/challenges need that Areas • • • • practices Strengths/best Mobilization of financial resources. Buy-in from the private sector, particularly mobile telephone providers. service Identification of pointsfocal in charge of press relations. population. dissemination informationthe to Prompt of Updating websites with proactive postings. Accessibility of free call centres. areas. Listening and rumour management systems to formalized be and coordinated with other technical Communications Centre. and Information Existence of atechnical ministry with public channels broadcast nationwide and aGovernment Specific websites for each ministry. Free telephone hotlines: 101, 143 and 106 information). (AIDS Communication exist services within administrative services. States Parties should designate and maintain core capacities at international airports and ports (and where where (and ports and airports international at capacities core maintain and designate should Parties States • Recommendations for priorityactions database withrecordsofall activities since2013. dockings attheport. The workforcehasbeentrained andallproceduresareinplace. There isalsoa CIAPOL managestheinspectionofships’residuesandbilge. The centretakes samplesbeforeauthorizing The Ministryof Water and Forests inspectsimportedandexportedwildflora andfaunaatpointsofentry. carried outattheairportandportin Abidjan butonlypartiallyatgroundcrossings. for publichealthemergenciesatpointsofentry, andambulancesarenotavailable. Healthinspectionsare crossings, whereservicesandequipmentarenotascomprehensive. There isnonationalcontingencyplan The airportandportof Abidjan havemuchbettermedicalservicesandequipmentthantheground collaboration thatexistsbetween thehealthandcivilaviationauthorities. Management ofPublicHealthEventsinCivil Aviation (CAPSCA)hasgreatlycontributed totheexcellent police andgendarmes, customsservice, etc.). The Collaborative Arrangement forthePreventionand included intheseplansatkey pointsofentry(MinistrytheEnvironment, vectorcontrolservice, national emergency airportplanandintersectoral emergencyplanarealsoavailable. Ingeneral, mostministriesare simulation exerciseshavebeencarriedout. The arrangements hereareinlinewiththeIHR(2005). An Response capacitiesatFélix-Houphouêt-Boigny International Airport areknownto be functional, asseveral and groundcrossings. Ouangolodougou, andNoé). An NFPhasbeendesignatedtomanagethesepoints ofentryatports, airports Airport), sea(autonomousportsin Abidjan andSanPedro) andland(atLaleraba andPogo, near Côte d’Ivoirehasdesignatedcertainpointsofentryfortravel byair(Félix-Houphouêt-Boigny International Côte d’Ivoire levelofcapabilities T manage avariety ofpublichealthrisks. Party maydesignategroundcrossings)whichwillimplementspecificpublichealthmeasuresrequiredto core capacities at international airports and ports (and where justified for public health reasons, a State of healthmeasurestopreventtheinternationalspreaddiseases. StatesParties arerequiredtomaintain All core capacities and potential hazards apply to points of entry and thus enable the effective application Introduction Points of entry ENTRY OF POINTS AND HAZARDS IHR-RELATED OTHER justified for public health reasons, a State Party may designate ground crossings) which implement specific specific implement which crossings) ground designate may Party State a reasons, health public for justified public health measures required to manage a variety of public health risks. health public of variety a manage to required measures health public arget at pointswhich of entry integrates all other actionplans, particularly those at Abidjan airport. emergencies health public plan for contingency national multisectoral a test disseminateDevelop, and 51 of IHR Core Capacities of the Republic of Côte d’Ivoire OTHER 52 OTHER

Joint External Evaluation bring otherpointsofentryuptothesamelevel. IHR (2005)recommendationshavebeenimplementedat Abidjan airport, andeffortsshouldbemadeto PoE.1 Routinecapacitiesare established atpointsofentry-Score 2 Indicators andscores • • • • • • • • strengthening/challenges need that Areas • • • • • • • practices Strengths/best PoE.2 Effectivepublichealthresponse atpointsofentry-Score 1 • • • strengthening/challenges need that Areas • • • • • practices Strengths/best Conduct regular simulation exercises to maintain ahigh level of preparedness at points of entry. entry. of points at operations Evaluate emergency health public Establish information-sharing mechanisms and agreements at points of entry. and ground crossings. for ports Develop SOPs ports. and crossings ground at materials personnel and equipment, additional providing by services medical Strengthen No agreements, SOPs or information-sharing at points of entry. entry. of points at operations emergency health public evaluation of No plan). emergency airport isan there plan (though contingency emergencies health public nationwide No 18–19Assistance visit from CAPSCA, December 2014. Health inspections carried out at the National Institute of Public Health checkpoint. Good collaboration the civil between aviation and public health authorities. Abidjan adopted airport, on 23 June 2015. Surveillance protocol and communicable diseases control measures developed for air passengers at Secure transport of ill passengers to medical centres. Health inspections at the Sitarail railway station in Ouangolodougou. port. and airport Abidjan at inspections Health No ambulances at points of entry. Suitable medical and services equipment only partially in place at ground crossings. only at groundPartial crossings. inspections Knowledge sharing with other countries in the region via simulation exercises. NFP in with contact senior management at through points of entry the main health checkpoints. Health inspections carried out in presence of medical (airport). services in place. service control Vector Suitable medical and services equipment at some (airport points of entry and port). • • • • Mechanisms to put be in place at (information-sharing points of entry and agreements). written. to be SOPs evaluated. be to operations emergency Public health disseminated. and developed be plan to contingency emergencies health public Nationwide 53 of IHR Core Capacities of the Republic of Côte d’Ivoire OTHER 54 OTHER

Joint External Evaluation States Parties with surveillance and response capacity for chemical risks or events. This requires effective effective requires This events. or risks chemical for capacity response and surveillance with Parties States T transportation andsafedisposal. effective communication and collaboration among the sectors responsible for chemical safety, industries, States Parties shouldhavesurveillanceandresponsecapacityforchemicalriskorevents. This requires Introduction eventsChemical In reality, communication andsystematicdatacollectionexchangebetween allstakeholders must Coordination mechanismswith otherkey IHRsectorsareinplacemostlyforresponding tomajoremergencies. strengthened, andbettercollaboration betweenclinicaland laboratory personnelshould beencouraged. for chronicexposurebedeveloped. Toxicology training forphysiciansand otherhealthworkers mustbe particularly insituationsofconcern. Itisimperative thatbiomarkers ofexposureandsurveillancecapacities testing. These capacitiesare necessaryforidentifyingcasesofpoisoningandmonitoringchemicalrisks, There isnopoisoncontrolcentrewiththerequired capacitiesforanalytical, clinicalandtoxicological exist inthecountryarenotalways implementedorappliedinsmallandmedium-sizedcompanies. or intheimmediateareaoffacility. These plansshouldbetestedannually. However, thefewplansthat Every majorindustrialfacilityisrequiredtohaveanemergency planincaseofchemicalaccidentswithin Koala in2006andpesticidepoisoningsledtodeaths Yamoussoukro in2016. contamination identificationinfood. There was anincidentofillegaltoxic waste dumpingbytheshipProbo in thecountry. For thisreason, itisessentialtostrengthenatmosphericpollutionsurveillanceandchemical the peripheral level. Environmentalsurveillancecapacityforwater, airandsoilexists, butnoteverywhere the NationalPublicHealthLaboratory foridentifyingspecimens. However, thesecapacitiesarelackingat There is good analysis capacity at the central level: at CIAPOL for quantifying chemical substances and at been ratified, andimplementationoftheGloballyHarmonizedSystem(GHS)isinprogress. for implementingtheStockholmConventionhasalsobeendeveloped. ILOConventions170and174have (amended) BaselConventionsandisintheprocessofratifying theMinimataConvention. A nationalplan Management (SAICM) are in progress. Côte d’Ivoire has ratified the Paris, Stockholm, Rotterdam and chemical productsandanimplementationstrategy fortheStrategic Approach toInternationalChemicals for themanagementofchemicalproductsandshouldbeupdatedregularly. A nationalsecuritypolicyfor The countryhasanationalchemicalsmanagementprofile, whichprovidesanadministrative structure (by theMinistryofHealth). Waste managementcapacityisweak, especiallyinlarge cities. Department ofSanitation), hazardous/industrialwaste (byCIAPOL), medicalwaste andradioactive waste pesticides and pharmaceutical products, and fourtypes of waste are regulated: household waste (by the and funding. Mostlegislationdoesnotcoverproducts’entirelifecycles. Specificregulationsexistfor of chemicals is oftenmanagedpoorly or only on an ad-hocbasisdue to a lack of trained human resources other industriesaswellhouseholduseandhealthcare. Although regulatorylegislation exists, theuse Chemical productsarewidelyusedinCôted’Ivoire, particularlyinagriculture, oilproduction, miningand Côte d’Ivoire levelofcapabilities communication and collaboration among the sectors responsible for chemical safety, industries, industries, safety, chemical for responsible sectors the among collaboration and communication transportation and safe disposal. safe and transportation arget • • • practices Strengths/best for coordinationandnopoisoncontrolcentre, thecountry was givenascoreof2forthisindicator. coordination body/committeeforchemicalsecurityalsoexists. However, asthereisno regulatoryframework A strategic planforchemical security (nationalchemicalsmanagementstructure) isinplaceandanational laboratories capableofcarrying outsystematicanalysis, andenvironmentalcontrolsforchemicalhazards. Côte d’Ivoirehasanorganizationresponsibleforthesurveillance andinspectionofchemicalproducts, and poisoningsareavailable. Guidelines ormanualsonthesurveillance, assessmentandmanagementofchemicalevents, intoxications events oremergencies -Score 2 CE.1 Mechanismsare established and functioningfordetectingresponding tochemical Indicators andscores • • • • • Recommendations forpriorityactions laboratories forchemicalsecurity, referencehealthfacilitiesforchemicalsecurity, etc. private sector/industry, thepoisoncontrolcentre, nationalchemicalsurveillanceinstitutes, reference airports andbordercheckpoints(especiallythosedesignatedundertheIHR(2005)), transport services, the local, intermediateandnationallevels, hazardoussites, meteorologicalservices, pointsofentryatports, ambulance workers andphysicians), theconsumersafetyauthorities, administrative/political authoritiesat public health services at the local, intermediateand national levels, emergency services(firefighters, police, be involvedinimplementingpriorityoperations: thehealth, environmentalandagricultural sectors, theNFP, Because surveillanceandresponseforchemicalrisksoreventscanbecomplex, thefollowingentitiesshould by procuringprotectiveequipmentandtraining theworkforce. sector hasnotyetdevelopeditsownplanforchemicalevents. Responsecapacitiesneedtobeimproved chemical events preparedness and response within the framework of the ORSEC Plan. However, the health The healthsectorcooperates withemergencyservicescoordinatedbytheMinistryofInteriorfor strengthened. pyramid in remote areas. Chemical risk evaluation and communication capacities must therefore also be decision-making difficultwhenrespondingtochemicalemergencies, especiallyatthebottomofhealth be strengthened. Knowledgeofpotentialchemicalrisksislimitedamongthepopulation, whichmakes country. Laboratories are capable of systematic analysis (with laboratories), partner but do not cover the entire products. chemical Operational organization is in place with primary responsibility for the surveillance and inspection of available. are poisonings and intoxications Guidelines or manuals on the surveillance, assessment and management of chemical events, CIAPOL’sStrengthen capacities. surveillance Establish aGHS for classifying and labelling chemical products. security needs. Strengthen current capacities (human, financial, technical and material resources) to meet chemical the poison control centre once it is created). Centralize all information on chemical exposure (first at the National Institute of Public Health, then at patients (diagnostics, treatment and monitoring) that is operational 24/7. Create apoison control centre capable of conducting toxicological analysis and caring for poisoned 55 of IHR Core Capacities of the Republic of Côte d’Ivoire OTHER 56 OTHER

Joint External Evaluation received ascoreof2. coordination andnosystematicdatacollection. Responsecapacityislacking, whichiswhythisindicator in case of emergency collaborate with each other. However, there is no regulatory framework for this Côte d’Ivoirehasapublichealthplanforchemicalevents/emergenciesandcrisiscommitteescreated National policies, plansorlegislationforchemicaleventsurveillancealertandresponseareinplace. CE.2 Enablingenvironment isinplaceformanagementofchemicalevents-Score 2 • • • • • • strengthening/challenges need that Areas • • • • • strengthening/challenges need that Areas • • • • • • • practices Strengths/best poisoned patients (diagnosis, treatment and monitoring) which is operational 24/7. No operational poison control centre capable of conducting toxicological analysis and caring for (ISO 17025) certification and accreditation needed. Training on laboratory practices best according to ISO standards and in support achieving laboratory Insufficient funding to meet chemical needs. security Insufficient workforce to meet chemical needs. security Legislation on chemical does not cover products everything. informationIneffective sharing in the area of surveillance/control of chemical products. air. extent Environmental controls for chemical hazards are carried out for water, soil, sediment and to some Health sector’s for caring capacity for poisoned patients must strengthened. be Medical workforce must trained be in the care and monitoring of poisoned patients. emergency. chemical a to respond to insufficient resources Human plans for this to coordinated be by the GHSA. framework regulatingNo crisis multisectoral collaboration although there are committees, between available products. of chemical Database (UNEP). Programme Environment UN and (IAEA) International Agency Atomic the Energy networks: international in chemical/toxicology Participation carried each out after Assessments exercise or operation. emergency. health public chemical a of by operations related to environmental protection and pollution control for air, water and soil in case Under the Pollumar Plan, the National Fund for the Environment covers all of expenses orincurred part events/emergencies. chemical plan for Public health National coordination body/committee for chemical security. for chemical, biological, radioactive and nuclear (CBRN) substances and their illicit trafficking. Strategic plan for chemical (national security chemicals management structure), national control plan States Parties should have surveillance and response capacity for radionuclear hazards/events/emergencies. hazards/events/emergencies. radionuclear for capacity response and surveillance have should Parties States emergencies. There arenonationalpolicies, strategies orplansforthe detection, assessmentandresponsetoradiation and nuclearemergencies -Score 1 RE.1 Mechanismsare establishedandfunctioningfordetecting andresponding toradiological Indicators andscores • • • • Recommendations forpriorityactions emergency management)isstillweak. are alsoinsufficientforemergencyresponse. Insum, responsecapacity(coordination, communicationand response planforradiation emergencies. Coordinationmechanismsandhuman materialresources and gooddetectionevaluation systems, Côted’Ivoiredoesnotyethaveanational preparednessand Despite strongpoliticalengagement, afunctioningsurveillancesystemwithwell-developedmethodologies, monitor radionuclear issues. especially forproductsusedbyState-ownedcompanies. An officialfocalpoint has beendesignatedto The MinistryoftheEnvironmenthasalaboratory forradiological waste surveillanceanddetection, has signed international conventions on radionuclear safety and assistance during radiation emergencies. A nationalauthorizationandregistrysystemforradioactive sourceshasbeendeveloped, andthecountry Since 1991, thecountryhasaregulatorybodyinplaceforuseandmanagementofradioactive sources. There arenonuclearpowerstationsorreactorsinCôted’Ivoire, norareradioactive substancesproduced. of obsoleteequipmentandradioactive materialonthecoast, suchaswaste beingexpelledintothesea. minor risks. Butconsiderable riskscanarisefromimproperhandling, criminaluse, oruncontrolleddisposal amounts ofradioactive materialinsomeindustries. When usedcorrectly, theseprocessespresentonly The mainradiation risksinCôted’Ivoireareassociatedwithmedicalequipmentandtheuseofsmall Côte d’Ivoire levelofcapabilities T management. This requireseffectivecommunicationandcollaboration amongthesectorsresponsibleforradionuclear States Parties should have surveillance and response capacity for radionuclear hazards/events/emergencies. Introduction Radiation emergencies This requires effective communication and collaboration among the sectors responsible for radionuclear radionuclear for responsible sectors the among collaboration and communication effective requires This management. arget Draw up SOPs and conduct simulation exercises for radiation emergency response. radiationemergency simulation for exercises conduct and SOPs up Draw human, material of financial terms in and resources. emergencies Strengthen the coordination mechanism for detection, assessment and response to radiation security. nuclear including emergencies, radionuclear plan for response and national a preparedness implement and Develop Strengthen the national regulatory framework and coordination mechanism. 57 of IHR Core Capacities of the Republic of Côte d’Ivoire OTHER 58 OTHER

Joint External Evaluation • • • • • • • • • practices Strengths/best plans inthisarea. Following lengthydiscussions, theinitialscoreof2forthisindicatorwas loweredto1. creation oftheNuclearSafetyandSecurity Authority. However, therearenotechnicalpolicies, strategies or There isclearpoliticalwillandgoodpractical arrangements atthenationallevel, asevidencedbythe • • • • • strengthening/challenges need that Areas • • • • • practices Strengths/best The countryhasacertainlevelofcapacitybuttheemergencyresponsesituationmustbeimproved. coordination andcommunicationwiththeministryofhealthand/orNFP. National authoritiesresponsibleforradiological andnucleareventshaveadesignated focalpointfor RE.2 Enablingenvironment isinplaceformanagementofradiation emergencies -Score 2 • • • • • strengthening/challenges need that Areas Investigation, detection and dosimetry of radioactive sources available. capacity Controls and inspections of nuclear radiation protection, are and security implemented. safety National of registry radioactive sources. Authorizations issued for transport, possession, the import, usage and stocking of radioactive sources. ionizing from protection on radiation.Decree ionizing from and protection radiation. and security nuclear on Law safety laboratories. dosimetry and spectrometry Gamma-ray Portable detection and measuring equipment for alpha, and beta gamma radiation is available. established. newly Authority and Security Nuclear Safety Health sector’s for caring capacity for patients exposed to strengthened. be Integrated Nuclear Plan Support Security (INSSP) to developed. be controlsEffective on and the import domestic transport of radioactive sources needed. regulations. security nuclear Functioning coordination mechanism to established be for national authorities with responsibility for put in place. Strategies on the domestic transport of radioactive material and radioactive waste management to be formalized. National CBRN technical committee, which meetings hosts on CBRN issues, is in place but not yet Controls and inspections of nuclear radiation protection, have and security safety been implemented Registry of sites of radioactive with stocks sources. Decree creating anational platform for risk reduction and disaster management. emergencies. radiation during assistance and security radionuclear internationalSigning on of conventions Risk assessments and investigation of exposures to ionizing radiation to carried be out. developed. be to radiationemergencies plan for response and National preparedness strengthened. be to framework Regulatory needed. radiation exposure testing Equipment for strengthened. be to personnel response radiationemergency for Capacities Mission teammembers Abidjan, Côted’Ivoire, 5–9December, 2016 Mission placeanddates 1:Appendix evaluation Joint background external • Preparation andimplementationofthe mission this willbenotedinthefinal report, alongwiththejustificationforeachparty’s position. members andthehostcountry experts, theexternalevaluation teamleaderwilldecideonthescoreand Should therebesignificantand/orirreconcilabledisagreement betweenoramongtheexternalteam the finalreportfindingsandrecommendations. collaborative, withJEEteam members andhostcountryexpertsseekingfullagreementonallaspectsof strengths, theareasthatneedstrengthening, bestpractices, challengesandthepriorityactionsshouldbe and JEEteammembers. The entireexternalevaluation, includingdiscussionsaroundthescores, the The JEEprocessisapeer-to-peer review. As such, itisacollaborative effortbetweenhostcountry experts The JEEprocess security. order toprovidebaselinedatasupportthecountry’s effortstoreformandimprove itspublichealth To assessCôted’Ivoire’s capacitiesandcapabilitiesrelevant forthe19technicalareasofJEEtoolin Objective 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 No . Côte d’Ivoire committed out internal to carrying and external evaluations IHR of capacities. its Youssouf Kabore Soatiana C.Rajatonirina Niang Saïdou Roland Wango Lubambo Demba Merawi Aragaw Margherita Ghiselli Mady Ba John A.Haines Honore D. Djimrassengar Ebba Kalondo Cheikh S.Fall Cecile Henri NdoyeBabacar Adama Diallo Stella Chungong Ahmed YahayaAli Name Senegal Congo Mauritania Congo Gabon Ethiopia USA Switzerland Switzerland Chad Congo Senegal France Senegal Senegal Switzerland Congo Country FAO WHO WHO WHO WHO Africa CDC US CDC WHO UNITAR,consultant WHO WHO WHO USDA ofHealthFrench Ministry WHO consultant CIRAD WHO (team co-lead) WHO (team lead) Organization 59 of IHR Core Capacities of the Republic of Côte d’Ivoire 60

Joint External Evaluation • • • National legislation, policyandfinancing • • listed below, bytechnicalarea. This listincludesonlythemainreferencedocumentsused duringtheJEE. Otherrelevant documentationis Supporting documentationprovided byhostcountry • • • Limitations andassumptions • • • • • • • Interministerial Order No. 011/MIPARH/MSHP of 10 May on avian 2006 influenza control and control of Ebola virus disease Decree No. 2014-486 of 3September 2014 establishing the organizational framework for prevention functioning 2005 creating the national epidemic-control committee and establishing organization, its remit and Order No. 435-MSP/CAB of 31 December 2007 amending Order No. 415/CAB/MEMSP of 28 November system; and (ii) the 19 technical areas PowerPoint presentations on: (i) the national health system, public health and services health security Self-report on JEE assessment tool, Côte d’Ivoire, November 2016 team will mutually agree on an assessment rating. This is apeer-to-peer review. verified. Information provided by Côted’Ivoire will be discussed and the host and country assessment The assessment is not an audit and information provided by Côte d’Ivoire will not independently be It is assumed that the results of this assessment will made be publically available. managed.could be The assessment was limited to one whichweek, limited the amount and depth of information that JEE was carried December out in Abidjan,2016: 5–9 JEE team members held atechnical meeting to prepare the workshop on 4December 2016. 23–24 2016. evaluation November Grand-Bassam, in held was external the for meeting Preparatory Internal evaluation was approved report during ameeting in Abidjan, 16–17 November 2016. Africa. Technical via support teleconference and e-mail was coordinated by the Regional WHO for Office Model technical documents were sent by the Regional WHO for Africa. Office Africa through in the office WHO Côted’Ivoire in August 2016. National authorities submitted arequest for ajoint external evaluation to the Regional WHO for Office m m m m m m

opening ceremony and remarks (CDC, and WHO Ministry of Health); closing ceremony and final remarks (CDC,WHO and Ministry of Health). findings by the JEE team lead; presentation of site visit and actions priority by JEE reports team members, summary of mission review of scores in each area; Abidjan; National Institute of Public Health, university hospital in Treichville and urban health centre in ground Noé crossingAirport, (Ghanaian border), EOC, epidemiological surveillance at the service Autonomous CIAPOL, ofLaboratory, Abidjan, Port LANADA, Félix-Houphouët-Boigny International fieldvisits to: Pasteur Institute facilities in Cocody and Adiopodoume, National Public Health presentation and discussion of each technical area; • Biosafety andbiosecurity • • • F • • • • • • • • • Zoonotic diseases • Antimicrobial resistance • • • • IHR coordination, communication andadvocacy ood safety National Public Health Laboratory Health Public National National technical guidance on integrated disease surveillance and response on theReport investigation into massive in the fish Jacquevilledie-off and Dabou lagoons on theReport investigation into the foodborne illness outbreak in San Pedro, 2016 national avian influenza control committee Interministerial Order No. 598/MIRAH/MSHP/MINEF/MPMEF/MPMBPEI of 10 November 2015 on the Interministerial Order No. 011/MIPARH/MSHP of 10 May on avian 2006 influenza control ofReport the Ministry of WaterWildlife andof Forests’ Office and Game, 2015 and control of Ebola virus disease Decree No. 2014-486 of 3September 2014 establishing the organizational framework for prevention functioning 2005 creating the national epidemic control committee and establishing organization, its remit and Order No. 435-MSP/CAB of 31 December 2007 amending Order No. 415/CAB/MEMSP of 28 November on the qualityOIE reports of Côte d’Ivoire’s veterinary (PVS Tool services and Gap PVS Analysis) Description of existing surveillance systems for animal diseases zoonotic pathogens for public priority of List health Law 63-323 of 25 July 1963 and implementing its decree on the animal health enforcement agency 2015 Health Situation Annual Report Standard operating procedures for coordination the NFP between and involved sectors Interministerial Order No. 011/MIPARH/MSHP of 10 May on avian 2006 influenza control and control of Ebola virus disease Decree No. 2014-486 of 3September 2014 establishing the organizational framework for prevention functioning 2005 creating the national epidemic control committee and establishing organization, its remit and Order No. 435-MSP/CAB of 31 December 2007 amending Order No. 415/CAB/MEMSP of 28 November m m m m m

Quality management actionplan, 30 August–1 September 2016 the of Microbiology Laboratory and Industrial and Microbiology Food Memorandum No. 20 dated 13 September 2016 creating the Technical Quality Committee within d’Ivoire Decree No. 91-654 1991 of 9October creating the National Public Health of Laboratory Côte health personnel working in establishments that provide HIV/AIDS treatment, September 2016 on Report the training workshop on biosecurity and secure transport of biological specimens for Bafing-Folon, Cavally-Guemon, HautSassandra Abidjan, and April 2016 Tonkpi, Kabadougou- Gbokle-Nawa-Sanpedro, of regions health the in specimens biological on theReport training of 150 health workers in hospital hygiene, biosecurity and transporting 61 of IHR Core Capacities of the Republic of Côte d’Ivoire 62

Joint External Evaluation • • • • National laboratory system • • • Immunization • • • CRESAC Annual National Report, Reference Centre, Pasteur Institute of Côte d’Ivoire, 2012 2015 Annual of Report the National Public Health Laboratory Regional for Africa regionalWHO/WHO Office on healthsurvey systems,laboratory 2016 on theReport anthrax immunization campaigns in the Bounkani region on theReport measles immunization campaign, 2014 2016–2020 cMYP EPI Other of Services Veterinary Office Pasteur Institute of Côte d’Ivoire m m m m m m m m m m m m m m m m m m

National guidance on external quality assessment for biology laboratories biology for assessment quality external National guidanceon and Packaging Unit of the Pasteur Institute of Côte d’Ivoire Decision No. 015 of 30 July 2012/IPCI on the appointment of the head of the Transport, Dispatch Pasteur Institute of Côte d’Ivoire Decision No. 014 of 30 July 2012/IPCI creating the Transport, Dispatch and Packaging Unit of the substances infectious potentially of transport the on guidance National guidance biosafety and biosecurity National laboratory 2015 Annual of Report the Training and Capacity-building Department Biosecurity training activities, 2016 Standards and directives on safe injections and waste management in Côte d’Ivoire, March 2009 Formalities regional formembera inbecomingof a progress international or association biosecurity of asigned declaration that is reviewed annually Document describing afacility’s biological risk management and biosecurity policies in the form pathogens Certified in biological staff on all officers safety laboratories that might handle dangerous promulgationDrafting, and application national of legislation and biosecurity biosafety on Documentation on the country’s existing collections of dangerous pathogens on theOIE report mission of the country’s veterinary laboratories on theOIE report gaps in the country’s veterinary (PVS Gap services Analysis) on theOIE report quality of the country’s veterinary (PVS Tool) services laboratories Order No. 184/MSHP/CAB of 26 2010 October on the accreditation procedures for medical Africa in Evaluations Accreditation Preliminary convention draft creating the Regional Centre for Educational, Environmental and • Risk communication • • Medical countermeasures andpersonnel deployment • • • Linking publichealthandsecurityauthorities • Emergency response operations • • • • • • Preparedness • • • • Workforce development • Reporting • Real-time surveillance • • ORSEC Plan ORSEC Procedures guidance on managing regional of antiretroviral stocks security medicines Cooperation protocol with Algeria and Chad on epidemic control in West Africa and nationwide relief following amajor disaster Interministerial Directive No. 437/INT/PC of 8 December 1993 on the organization of department-level ofDecree No.8August 79-643 1979 on the organization of nationwide disaster relief efforts Decree No. 74-265 of 19 June 1974 delegating ministerial powers to prefects on theReport simulation exercise for Ebola virus disease response operations in Côte d’Ivoire functioning 2005 creating the national epidemic control committee and establishing organization, its remit and Order No. 435-MSP/CAB of 31 December 2007 amending Order No. 415/CAB/MEMSP of 28 November and control of Ebola virus disease Decree No. 2014-486 of 3September 2014 establishing the organizational framework for prevention International Airport Boigny Civil aviation procedures manual for preventing and managing public health events at Félix-Houphouêt- sea, lagoons and coastal areas Decree No. 98-42 of 28 January 1998 on the emergency plan for controlling accidental pollution in the Decree creating the ORSEC Plan Plan ORSEC Department of Human Resources units Document by the health worker training institute (INFAS) and health science education and research 2015 Health Situation Annual pages 12 Report, and 117 report programme training epidemiology Field National technical guidance on integrated disease surveillance and response National technical guidance on integrated disease surveillance and response Decree No. 96-876 of 25 1996 October classifying public health facilities functioning of public medical laboratories within the health pyramid Order No. 59/MSHP/CAB of 28 February 2008 on the scope, classification, organization, remit and 63 of IHR Core Capacities of the Republic of Côte d’Ivoire 64

Joint External Evaluation • • • • • • Radiation emergencies • • • Chemical events • • • Points ofentry • • • national platform for risk reduction and disaster management disaster and risk reduction for national platform Decree No. 2012-988 of 10 2012 October on the creation, remit, organization and functioning of the Decree No. 2014-362 of 12 June 2014 implementing LawNo. 2013-701 of 10 2013 October Authority Security Decree No. 2014-361 of 12 June 2014 on the organization and functioning of the Nuclear and Safety Decree No. 91-654 1991 of 9October creating the National Public Health of Laboratory Côte d’Ivoire radiation Law No. 2013-701 of 10 2013 October on nuclear and and protection security safety from ionizing International conventions IAEA with plan CBRNaction National Decree No. 91-662 1991 of 9October creating the Ivorian Antipollution (CIAPOL) Agency Scientific of the report Central EnvironmentalLaboratory (2014 and 2015) documentOfficial designatingpoints deskof (see entry review report) Airport International Félix-Houphouêt-Boigny protocol, control and surveillance diseases Communicable on theReport assistance visit from CAPSCA National Ebola virus disease preparedness and response plan procedures EOC National actionplan for risk and disaster reduction 2016–2020 JEE workshopparticipants 10 13 12 11 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 9 8 7 6 5 1 4 3 2 Roger Dia Li Wei NdiayeSerigne Ramatou Toure-Adechoubou Christophe N’guessan G. LaissaOuedraogo Simplice Dagnan N’cho Kouamé Poquelin Assi Kouakou Yao Ahoulou Marie Sophie Guillaume Mwamba BranchiSaran Guy MichelBadia N. E.M’bouanéeNezzi Haida KalyDiarassoubaFadiga Adjo DannielleGnandji Moussa Diabate Bella Djézia Bouo Nicole Nkai Mehoua Sekongo Tiepordan Agathe Dotia Konan YaoSimplice Mireille Dosso Nathalie Guessennd Youssouf Traore Kone SitaSavane Joseph Vroh Bi Benie Anderson N’gattia Mayet Georges Koutouan Florence Kadjo Jocelyne Nebre Alfred Douba Ama Kounangui MarieNoëlle Ano Daouda Coulibaly Banakani ChristianAkani Banakani Monique N’guessan Dadie Nogbou Valery Rachel Duncan Rachel Yapo BlaiseAcho Alexis Bie Seka Name Office ofOffice ofAnimalResources and Ministry Fisheries Services, Veterinary ofOffice ofAnimalResources and Ministry Fisheries Services, Veterinary Office ofOffice HealthInformation Forecasting, Planningand Evaluation Office ofOffice WildlifeandHunting, of Ministry Water and Forests Ministry oftheEnvironmentMinistry Development andSustainable National Civil Aviation Agency, of Ministry Transport Department ofNeighbourhood Hospital Medicine Department Office ofPharmacies,Office MedicinesandLaboratories Office ofPharmacies,Office Medicines&Laboratories Ministry ofAnimalResources andFisheriesMinistry Preventive (AMP) MedicineAgency National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Institute ofPublic Health National Public Health Laboratory National Public Health Laboratory Department ofHospital Medicine Department International Committee Rescue Pasteur Institute ofCôte d’Ivoire Pasteur Institute ofCôte d’Ivoire General Directorate ofHealth FAO ECTAD Côte d’Ivoire EPI Coordination Office General Health Office French Embassy ABT Associates Institution MdH CDC CDC CDC CDC CDC 65 of IHR Core Capacities of the Republic of Côte d’Ivoire 66

Joint External Evaluation 49 48 47 46 45 44 43 42 41 Djibril Cherif Aristide Dionkounda Soumare Baba Regina Konan Koko Zandra Andre Gouzan Bernard GuessanBi Raymond Taha Tano-BianAka FolefackGervais National Institute ofPublic Health USAID Preparedness &Response USAID Preparedness &Response USAID PREDICT project USAID PREDICT UNICEF USAID USAID WHO WHO Joint External Evaluation of IHR Core Capacities of the REPUBLIC of côte d’ivoire

Mission report: 5–9 December 2016

WHO/WHE/CPI/2017.20