JOINT EXTERNAL EVALUATION OF IHR CORE CAPACITIES of the REPUBLIC OF ZIMBABWE

Mission report: 19-23 February 2018

JOINT EXTERNAL EVALUATION OF IHR CORE CAPACITIES of the REPUBLIC OF ZIMBABWE

Mission report: 19-23 February 2018 WHO/WHE/CPI/REP/2018.24

© World Health Organization 2018 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 Zimbabwe. Geneva: World Health Organization; 2018 (WHO/WHE/CPI/REP/2018.24). 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. Layout by Genève Design Risk communication------Medical countermeasuresandpersonneldeployment------Linking publichealthandsecurityauthorities------Emergency responseoperations------Preparedness------RESPOND Workforce development------Reporting------Real-time surveillance------National laboratory system------DETECT————————————————————————— Immunization------Biosafety andbiosecurity------Food safety------Zoonotic diseases------Antimicrobial resistance------IHR coordination, communicationandadvocacy------National legislation, policyandfinancing------PREVENT—————————————————————————— Zimbabwe scores------Executive summary------Abbreviations------Acknowledgements------Contents Appendix 1: JEE background————————————————— Radiation emergencies------Chemical events------Points ofentry------OTHER IHR-RELATED HAZARDS AND POINTSOFENTRY—————— ———————————————————————— 35 25 55 47 44 42 40 38 35 33 31 28 25 23 20 17 13 10 52 50 47 6 vi 8 6 4 1 v iii of IHR Core Capacities of the Republic of Zimbabwe

• • • • • • Regulations (2005)haveensuredasuccessfuloutcometothisJEEmission. acknowledge thefollowing, whosesupportandcommitmenttotheprinciples of theInternationalHealth The JointExternalEvaluation (JEE)Secretariatofthe World HealthOrganization(WHO)wouldlike to ACKNOWLEDGEMENTS this mission. this The governments of Germany, Finland, and the United States of America for their financial to support Agenda Initiative collaboration Global HealthThe for its Security and support. Regional for whoAfricasent experts. Office The following entities: WHO of CountryEthiopia, Offices South Sudan, Zimbabwe, andWHO the Animal Health (OIE) for their contribution and expertise. of experts andThe Food Agriculture Organization of the United Nations (FAO) and the World Organization for for the peer-review process. United States of America (Centers for Disease Control and Prevention), for providing technical experts The governments of Kenya, Nigeria, South Sudan, Sweden (Public Health Sweden), Tanzania, and the preparing JEE for the mission. The Government and national of the Republic experts of Zimbabwe for their of, support and work in, v of IHR Core Capacities of the Republic of Zimbabwe vi Joint External Evaluation ZRP ZINQAP ZIMRA ZDF VRAM SOPs SADC RRT RPAZ PoE PHEOC OIE NMRL NFP NBA NatPharm MPH MoU MOHCC MEWC MAMID IPC IHR IDSR IACCH IAEA HCAI FAO EVD EQA EPR EPI EOC EMA DLVS CVL AU-IBAR AMR Abbreviations Zimbabwe Republic Police Zimbabwe NationalQuality Assurance Programme Revenue Authority Zimbabwe Zimbabwe DefenceForces Vulnerability Risk Assessment andMapping Standard Operating Procedure Southern Africa Development Committee Response TeamRapid Radiation Protection Authority ofZimbabwe Point ofEntry Public HealthEmergencyOperation Centre World Organizationfor Animal Health National MicrobiologyReferenceLaboratory National Focal Point/Person Biotechnology Authority National National PharmaceuticalCompanyofZimbabwe Master ofPublicHealth Memorandum ofUnderstanding Ministry ofHealthandChildCare Ministry ofEnvironment, Water andClimate Ministry of Agriculture, Mechanization, andIrrigationDevelopment Infection preventionandcontrol International HealthRegulations(2005) Integrated DiseaseSurveillanceandResponse Inter-Agency CoordinationCommitteeonHealth Energy Agency International Atomic Health Care-AssociatedInfection Food and Agriculture OrganizationoftheUnitedNations Disease Ebola Virus Quality Assurance External Emergency PreparednessandResponse Expanded Program onImmunization Emergency Operations Centre Management Agency Environmental Department ofLivestockand Veterinary Services LaboratoryCentral Veterinary African UnionInter-African Bureaufor Animal Resources Antimicrobial resistance health threatsinZimbabwe will require: functions isalsoexpectedto beexpanded. The capacitytorespondmore effectivelyandrapidly topublic environmental domains. Lab capacitiesfordiagnosticandsusceptibilitytestingexist, andthescopeoftheir integrated systems are being planned to efficiently track antimicrobial resistance in the human, animal, and systems forprioritydiseases inthehuman, animal, andenvironmentalsectors. Furthermore, decentralized Zimbabwe hasexpressedanddemonstrated astrongcommitmenttobuildandmaintainrobustsurveillance 2. • • will needto: IHR (2005). Towards fosteringatrueOneHealthapproach intheimplementationofIHR(2005), Zimbabwe enacted intolawinthecomingmonths, incorporates provisionsthatwillfacilitatetheimplementation of the newPublicHealthBill(2017)ofZimbabwe, whichisexpectedtobeapprovedbytheParliament and of currentgoodpractices inmulti-sectoral coordinationand implementation inZimbabwe. Furthermore, (the entitymandatedtocoordinatetheresponseallemergenciesinZimbabwe), aresomeexamples Committee forHealth(IACCH), andthemulti-agencylinkagewithDepartment ofCivilProtection Coordination platformssuchasthedecentralized ZoonoticCommittees, theInter-Agency Coordination mechanisms, includingtheintegration ofanimal, human, andenvironmentalhealth surveillancesystems. Plan on Antimicrobial Resistance (AMR) calls for strong multi-sectoral coordination and implementation years torespondemergencies, aswellfordevelopmentprojects. The recentlylaunchedNational Action Zimbabwe hasbeensuccessfullyusingseveral informalandadhocmulti-sectoral mechanismsformany of IHR(2005). brings togetherthehuman, animal, andenvironmentalhealthsectors, andunderpinstheimplementation programmes andinterventions. These arealsothedefiningfeaturesofOneHealthapproach, which of-government’ anda ‘whole-of-society’ perspectiveinthedesignandimplementationof emergency sectoral, multi-disciplinary, andinvolvemultiplestakeholders. Strategically, thiscallsfortakinga ‘whole- Public healththreatstodayarecomplexanddemandariskmanagementapproachthatismulti- 1. areas, sixoverarching thematicareasemerged, whichrequirestronghigh-levelcommitment: Based onthefindingsofmissionandrecommendedpriorityactionsforeach19technical and deliveryoftheJEEmission. the self-assessment, aswelltheexternalevaluation. Their contributionsgreatlyenrichedthepreparation program managersandtechnicalexperts, fromavariety oforganizationsanddepartments, tocontribute The national team should also be congratulated for convening a large number of participants including key strong commitment, foresight, leadership, andconfidenceinthe process on thepartof the government. Zimbabwe istobecommendedforvolunteeringhostaJointExternalEvaluation (JEE). This demonstrates Executive summary

through appropriate memoranda (MoUs) understanding of and standard operating procedures (SOPs). arrangements formalizing mechanismsthe by implementation and coordination current the Empower Fast-track the updating of relevant legislation and policies, and develop new ones where needed. interoperability asthecore underlyingprinciples. Strengthen thesurveillancesystems, withintegration and advancing atrueOneHealthagenda. Consolidate andstrengthen multi-stakeholder engagementfor 1 of IHR Core Capacities of the Republic of Zimbabwe • Expansion, integration, and interoperability of electronic methods for data collection, transmission, analysis, and information sharing, across sectors and down to the grassroots level. • Generating and sharing real-time data and information to support decision-making, rapid response, monitoring, and evaluation.

3. Develop and implement innovative methodologies and make greater use of new technologies to enhance cost-effectiveness and the quality of interventions.

Substantial and additional financial resources are required in Zimbabwe to build a critical mass of trained public health professionals and frontline workers; and ensure the availability of supplies, consumables, hardware, and basic infrastructure. At the same time, the systems being built must continue to deliver timely and high-quality results over the foreseeable future. Towards ensuring this, Zimbabwe may wish to consider making some strategic investments in developing innovative methodologies and expanding the use of new technologies. This can bring about cost-efficiencies, as well as, substantial improvements in the timeliness and quality of information and interventions. Potential areas to consider for innovations include: • Methodologies to minimize dilution and enhancing the quality of large-scale training interventions for frontline workers. • The convergent use of geographical information systems (GIS), mobile telephony, and digital data capture tools for improving data quality, timeliness, and integration of surveillance systems. • Developing a sentinel system that links epidemiological and social data on a real-time basis, to understand better the socio-behavioral drivers and determinants of disease outbreaks.

4. Expand the network of stakeholders involved to include civil society and private sector actors.

Globally, there is ever more clearer evidence emerging that a ‘whole-of-society’ approach is an imperative for responding to large-scale and complex emergencies. Emergency preparedness and response activities including surveillance, outreach, risk mapping, monitoring, etc., would benefit substantially by the inclusive and concerted engagement of civil society and NGO actors, private industry, the business sector, and communities themselves, in these activities. Moving forward, Zimbabwe must ensure that these stakeholders are fully engaged in the IHR (2005) implementation process.

5. Build a programme of work that retains a strong focus on addressing the socio-behavioral determinants and drivers of disease emergence and spread.

Human behaviors and actions ultimately drive both, the emergence of disease, and its prevention and control. In the context of emergencies, behaviors and decision-making of populations are largely influenced by the perception of risk, deep-rooted socio-cultural norms, and the level of trust that communities have in the public health authorities. Enhanced understanding of the socio-behavioral dimensions of diseases prevention and control will also facilitate the quality of training of frontline workers and their engagement with communities. It is therefore crucial to balance investments between the ‘technical’ and the ‘social’ domains. Towards this, Zimbabwe may consider making specific and earmarked investments in: for developingacomprehensiveandtime-boundnationalactionplantheway forward. The JEEteamisconfidentthattheoutputsofmissionwillbeusedbyZimbabweasarobustbasis and seeksolutionstogetherwiththeJEEteamwas instrumentaltothemission’s success. The professionalism, transparency, andwillingnessoftheZimbabweteamtoreceiveconstructivecritique dedicated totheJEEprocess, includingboththeself-evaluation and theexternalevaluation. The JEEteamwouldlike toexpressitsappreciationfortheconsiderable work and effortZimbabwe path tofullimplementationoftheIHR(2005). of thissupportcanbemadeavailable atnocostandshouldbeproactivelyleveraged byZimbabweonits are available toZimbabwefrom WHO, OIE, FAO, CDC, andseveral otherkey internationalpartners. Much Resources andexpertisefortechnicalsupporttostrengthencapacitiesinalltheabovesixthematicareas response times. reviews andsimulationexercisesshouldbeplannedimplementedtosharpenoperational skillsand also helpintestingsystemsandprotocolsfordifferentscenarios. A strongprogramme ofafter-action coordination, riskmanagement, andtheemergencyresponse. Simulations, includingdesktopexercises, response toeachsucheventneedsbesystematicallyreviewedanddocumentedcontinuouslyimprove It alsocontinuestodealwithregularflare-upsofendemicinfectiousdiseases. The lessonsfromthe Zimbabwe has experienced several public health emergencies and natural disasters in the recent past. 6. • •

improve the design and content of health protection messaging and communication strategies. Processes and systems for linkage better of social data and epidemiological data, to substantively communities. affected with dialogue/communication real-time Qualitative socio-behavioral research, after-action reviews, and building systems for continuous and every emergency response event. Establish processes thatfacilitateaculture ofcontinuouslearningfrom 3 of IHR Core Capacities of the Republic of Zimbabwe 4 Joint External Evaluation Zimbabwe scores 1 and advocacy communication IHR coordination, and financing legislation, policy National development Workforce Reporting surveillance Real-time system laboratory National Immunization biosecurity Biosafety and Food safety Zoonotic diseases resistance Antimicrobial areas Technical FETP: Field epidemiologytraining programme D.4.3 Workforcestrategy D.4.2 FETP D.3.2 network andprotocols Reporting incountry D.2.4 Syndromic systems surveillance D.2.3 Integration data andanalysisofsurveillance D.2.2 Interoperable, interconnected, real-time electronic system reporting D.1.4 system Laboratory quality D.1.3 andlaboratory-based diagnostics Effective modernpoint-of-care D.1.2 referral Specimen system andtransport P.7.2 National vaccine access anddelivery P.6.2 training andpractices andbiosecurity Biosafety and functional P.4.3 Mechanismsfor responding andpotential to infectious zoonotic diseasesare established 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 by caused antimicrobial-resistant ofinfections Surveillance pathogens cies andadministrative arrangements to enablecompliance withIHR(2005) P.1.2 The State demonstrate can that ithasadjusted andaligneditsdomesticlegislation, poli- sectors intheimplementationsectors ofIHR P.2.1 mechanismisestablishedfor thecoordination Afunctional andintegration ofrelevant instruments inplace are sufficient forimplementation ofIHR(2005) P.1.1 Legislation, laws, regulations, administrative requirements, policiesorothergovernment D.4.1 Humanresources available to implement IHRcore requirements capacity D.3.1 System for efficient to reporting FAO, OIEand WHO D.2.1 Indicator- andevent-based systems surveillance D.1.1 diseases Laboratory testing ofpriority for detection P.7.1 Vaccine coverage ofnational programme (measles)aspart and agriculture facilities P.6.1 system isinplace andbiosecurity for human,animal biosafety Whole-of-government emergenciesfood safety andoutbreaks offoodborne diseases P.5.1 Mechanismsfor collaboration multisectoral are establishedto ensure rapid response to P.4.1 systems zoonotic inplace Surveillance for priority diseases/pathogens P.3.1 Antimicrobial resistance detection Indicators 1 orotherappliedepidemiologytraining programme inplace Score 3 3 2 2 3 2 2 1 1 3 3 3 2 3 4 4 2 3 2 2 4 4 4 3 1 1 2 3 Scores: 1=Nocapacity; 2=Limitedcapacity; 3=Developedcapacity; 4=Demonstrated capacity; 5=Sustainablecapacity. emergencies Radiation eventsChemical Points ofentry communication Risk deployment and personnel countermeasures Medical authorities and security public health Linking operations response Emergency Preparedness areas Technical RE.2 EnablingRE.2 environment inplace for management ofradiation emergencies EnablingCE.2 environment inplace for management events ofchemical PoE.2 Effective publichealth response at points ofentry listening andrumourR.5.5 Dynamic management R.5.4 Communication engagement withaffected communities R.5.3 Public communication communicationR.5.2 Internal andcoordination andpartner gency R.4.2 System inplace for sending andreceiving healthpersonnelduringapublicemer- R.2.4 Case management procedures implemented for IHRrelevant hazards. operationsR.2.3 Emergency programme R.2.2 EOCoperating procedures andplans publichealthrisksandresourcesR.1.2 Priority are mappedand utilized and nuclearemergencies andresponding for detecting to Mechanismsestablishedandfunctioning RE.1 radiological events oremergencies andresponding for detecting to Mechanismsestablishedandfunctioning CE.1 chemical PoE.1 establishedat Routinecapacities points ofentry communicationR.5.1 Risk systems (plans, mechanisms, etc.) health emergency R.4.1 System inplace for sendingandreceiving countermeasures medical duringapublic are linked orconfirmed event biological duringasuspect authorities(e.g.R.3.1 Public healthandsecurity law enforcement, border control, customs) R.2.1 Capacity to activate operations emergency developed andimplemented R.1.1 National multi-hazard preparedness publichealthemergency andresponse planis Indicators Score 1 1 1 1 2 1 2 2 1 1 1 2 1 2 1 2 2 3 3 2 5 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 6 Joint External Evaluation Adequate legal framework for States Parties to support and enable the implementation of all their their all of implementation the enable and support to Parties States for framework legal Adequate structures andresponsibilitiesaswelltheallocationofadequatefinancialresourcesarealsoimportant. http://www.who.int/ihr/legal_issues/legislation/en/index.html. Inaddition, policiesthatidentifynational in theirimplementation. SeedetailedguidanceonIHR(2005)implementationinnationallegislationat operations withintheStateParty. Itcanalsofacilitatecoordinationamongthedifferententitiesinvolved manner. ImplementinglegislationcouldservetoinstitutionalizeandstrengthentheroleofIHR(2005) or otherinstrumentsinordertofacilitateIHRimplementationandmaintenanceamoreeffective or revisedlegislationmaynotbespecificallyrequired, statesmaystillchoosetorevisesomeregulations States Parties, implementationoftheIHR(2005)mayrequirenewormodifiedlegislation. Evenifanew The InternationalHealthRegulations(IHR)(2005)provideobligationsandrightsforStatesParties. Insome Introduction and financing National legislation, policy PREVENT the IHR(2005). a componentofIHR(2005). The National HealthSectorStrategy (2016-2020) ofZimbabweincorporates developed andsubmittedto the President’s officeforapproval. The current Port HealthRegulationsinclude and isawaiting parliamentapproval forenactmentintolaw. The newBillallows fornewregulationstobe (2005). In 2017, thegovernmentprepareda new Public Health Bill, which incorporates the IHR (2005), Zimbabwe stilluses its old Public Health Act [Ch. 15.09] of1924 which does not cover all aspectsofIHR Limpopo MalariaInitiative(TLMI). Malaria Cross-border Agreement; theBasel, Rotterdam, and Stockholm Conventions; andthe Trans- Botswana, andNamibia(ZAZIBONA) Collaborative Registration Process; theZambia-Zimbabwe (ZAMZIM) Zimbabwe onCommunicableDiseases; JointCholera InitiativeforSouthern Africa; theZambia, Zimbabwe, Mozambique andMalawi); JointCommuniqueofMinisters ofHealthMozambique, Malawiand Sanitary andPhytosanitary Agreement; SADCMinistersofHealthCommuniqueonEbola(Zimbabwe, Southern African Development Community (SADC) Protocols on Health , Communicable Diseases, and the The country does have cross border agreements regarding public health emergencies. These include the assessment hasnotbeencarriedouttodetermineiftheyfacilitatefullimplementationofIHR(2005). government instrumentsthatsupportsomeoftheIHR(2005)components. However, acomprehensive Zimbabwe has rules, legislation, laws, regulations, administrative requirements, policies, and other Zimbabwe levelofcapabilities Target obligations, and rights to comply with and implement the IHR (2005). New or modified legislation in in legislation modified or New (2005). IHR the implement and with comply to rights and obligations, some States Parties for implementation of the IHR (2005). Where new or revised legislation may not be be not may legislation revised or new Where (2005). IHR the of implementation for Parties States some specifically required under the State Party’s legal system, States may revise some legislation, regulations or or regulations legislation, some revise may States system, legal Party’s State the under required specifically other instruments in order to facilitate their implementation and maintenance in a more efficient, effective effective efficient, more a in maintenance and implementation their facilitate to order in instruments other or beneficial manner. States Parties ensure provision of adequate funding for IHR implementation through through implementation IHR for funding adequate of provision ensure Parties States manner. beneficial or the national budget or other mechanism. mechanism. other or budget national the • • strengthening/challenges need that Areas • • practices Strengths/best policies andadministrative arrangements toenablecompliancewiththeIHR(2005)–Score 1 P.1.2 The Statecandemonstrate thatithasadjustedandaligneditsdomesticlegislation, • • strengthening/challenges need that Areas • • practices Strengths/best instruments inplaceare sufficientforimplementationofIHR(2005)–Score 1 P.1.1 Legislation, laws, regulations, administrative requirements, policiesorothergovernment Indicators andscores • • • Recommendations forpriorityactions Disease Surveillancemeetingsandbulletins. Subcommittees theCivilProtectionCommittees(atalllevels), theHealthOfficers Forum, andthe Weekly also facilitatedthroughcollaborative meetings: atPoints ofEntry, theprovincialanddistrictZoonotic Inter Agency CoordinationCommitteeonHealth(IACCH). Coordinationandinformationexchangeis the BorderEfficiencyManagementSystem Technical Committee, theOneStopBorder Post Act, andthe (NRRTs), formalcross-borderagreementsandcollaborations, theSanitaryandPhytosanitaryCommittee, The countryensurescoordinationthroughstructuresthatincludetheNationalRapidResponse Teams across the various which do sectors not communicate with each other on aregular basis. The coordination for IHR (2005) implementation is fragmented as there are numerous committees Legislation needs to aligned be to IHR (2005). Teams Response Rapid (NRRTs), mechanisms. other and (SPS)Phytosanitary Committee, the Interagency Coordination Committee on Health (IACCH), National Coordination for IHR (2005) implementation is done through structures like the and Sanitary The New Public Health Bill of 2017 incorporates the IHR 2005. needsThe to country align laws its to IHR (2005). of IHR (2005). implementation full facilitate they if determine to instruments, governmental other and requirements, hasThe country not done acomprehensive assessment of legislation, regulations, administrative 2005. IHR of implementation Zimbabwe has some cross-border agreements, MoUs, and other instruments that promote (2005). hasThe country anew drafted Public Health Bill in 2017 that will facilitate implementation of IHR for facilitating full implementation of the IHR (2005) across all sectors. designation of the Inter-Agency Coordination Committee for Health (IACCH) as an empowered entity Review and identify options for the possibility of creating instrument astatutory that will enable includes provisions the to implementation support of IHR (2005). Facilitate and expedite Parliament approval and enactment of the new Public Health Bill (2017), which arrangements to enable compliance with, and the full implementation of, IHR (2005). arrangements, and regulations towards adjusting and aligning current laws, policies, and administrative Conduct asystematic and formal assessment of all relevant existing legislation, administrative 7 of IHR Core Capacities of the Republic of Zimbabwe PREVENT PREVENT 8 Joint External Evaluation Multisectoral/multidisciplinary approaches through national partnerships that allow efficient, alert and and alert efficient, allow that partnerships national through approaches Multisectoral/multidisciplinary Target is akey requisiteforIHRimplementation. including thedesignationofanationalIHRfocalpoint, whichisanationalcentreforIHRcommunications, national partnershipsforefficientandalertresponsesystems. Coordinationofnationwideresources, The effectiveimplementationoftheIHRrequiresmultisectoral/multidisciplinary approachesthrough Introduction IHR and advocacy coordination, communication IHR (2005), including training andthedevelopment ofstandardoperating proceduresandprotocolsfor strengthening oftheNFPto systematically addresstheissueofstrengtheningCore Capacitiesunderthe An assessmentoftheimplementation ofIHR(2005)was conductedin2016whichrecommended provides overall coordinationforrespondingtodiseaseoutbreaks inthecountry. The MinistryofHealthhas alsoestablishedaPublicHealthEmergencyOperations Centre(PHEOC)that national leveltoprovidescalablecapacityforresponding tooutbreaksandpublichealtheventsofconcern. One Healthissuesandzoonoticdiseaseoutbreaks. A RapidResponse Team hasbeenestablished atthe Other mechanismsincludetheZoonoticCommitteemeetings thatarethecoordinatingmechanismsfor IACCH foractionandresource allocation. local authorities. The deliberations andrecommendationof thetaskforcemeetingsaresharedwith regular meetingsofthe Task Force onEpidemic-Prone Diseases, involvingnational, provincial, district, and The IACCH meetsweeklyduring activeoutbreaksandquarterlyduringothertimes. Additionally, there are emergencies and was last activated in January 2018 to address the cholera outbreak in Chegutu area. coordinating resourcemobilizationandresponsetopublichealthevents. This is activated duringmajor Coordination CommitteeonHealth(IACCH), chairedbytheMinisterofHealth, has been establishedfor of informationacrossvarious sectorsandlevels. A multisectoral andmultidisciplinaryInter-Agency There is good implementation ofamultisectoral approach, with channels and platforms for dissemination Protection Authority ofZimbabwe(RPAZ). Civil Protection); Finance; Home Affairs; Information, Communication& Technology; andtheRadiation Livestock and Veterinary Services); Environment; Transport; Defence; LocalGovernment(Departmentof Disease Control, DepartmentofEnvironmentalHealth, Laboratory Services); Agriculture (Departmentof various sectoral Ministriesandtheirdepartmentsincluding: Health(DepartmentofEpidemiologyand the Environmentsector, andother key partnerorganizations. Coordinationinvolvesengagementwith IHR. The NFPiscomposedoffocalpersonsfrom various IHRstakeholders includingthe Veterinary Services, available allthetimeandsharesinformationwithlocalregionalcontactsasrecommended bythe Health astheIHRNationalFocal Point (NFP)tooverseetheimplementationofIHR(2005). The NFPis The MinistryofHealthandChildCare(MOHCC)hasdesignatedtheofficeDirectorEnvironmental Zimbabwe levelofcapabilities responsive systems for effective implementation of the IHR (2005). Coordinate nationwide resources, resources, nationwide Coordinate (2005). IHR the of implementation effective for systems responsive including sustainable functioning of a national IHR focal point – a national centre for IHR (2005) (2005) IHR for centre national a – point focal IHR national a of functioning sustainable including communications which is a key requisite for IHR (2005) implementation – that is accessible at all times. times. all at accessible is that – implementation (2005) IHR for requisite key a is which communications States Parties provide WHO with contact details of national IHR focal points, continuously update and and update continuously points, focal IHR national of details contact with WHO provide Parties States annually confirm them. confirm annually • • • • strengthening/challenges need that Areas • • • • practices Strengths/best sectors intheimplementationofIHR–Score 2 P.2.1 A functionalmechanismestablishedforthecoordination andintegration ofrelevant Indicators andscores • • • • Empower theIHRNFPofficeby: Recommendations forpriorityactions response topublichealthemergenciesofinternationalconcern(PHEICs)asrequiredundertheIHR(2005). collaboration hasnotbeensystematicandfullymainstreamedintotheplanningforpreparedness The NFPhasdemonstrated several mechanismsforcoordinatingIHRimplementation. However, multisectoral and reviewmeetingsonIHRimplementationatbothnationalprovinciallevels. implementation. MembersoftheNFPaddressingvarious CoreCapacitieshaveparticipatedinsensitization the highest government levels. government highest the There is need for increased advocacy, awareness and resource allocations for IHR implementation at sectors. health environmental There is need for systematic exchange of information especially sectors, between the animal and NFP to identify responsible agencies and persons for each IHR hazard. Develop clear terms of reference for the NFP and standard operating procedures that will the support IHR NFP as the central coordinating across body all the response platforms. There is a need to formalize multisectoral coordination in implementation of the IHR (2005) with the improvement. The functions of the IHR NFP have been assessed previously and recommendations made for There is exchange need-based of information relevant between involved sectors in IHR implementation. Numerous mechanisms for coordinating exist multisectoral collaboration through NFP. IHR the IHR National Focal Point(NFP) is designated and available. to draw on their as needed. expertise Develop acomprehensive from agencies roster of working experts on the various components of IHR, involved in the implementation of IHR (2005). Develop plan an advocacy to ensure the engagement active and collaboration of all key stakeholders of thethe IHR office National Focal Point (NFP). Develop acosted plan to ensure adequate government budget allocation to enable full functionality of and entities. sectors coordination, communication, and partnership-strengthening functions of the NFP with all relevant the guide and facilitate to procedures operating standard and reference of terms clear Developing 9 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 10 PREVENT

Joint External Evaluation 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 security andnationalsecurity. in humans. This situationthreatenspatientcare, economicgrowth, publichealth, agriculture, economic alarming rate andisoutpacingthedevelopmentofnewcountermeasurescapablethwarting infections Over the past decade, however, this problem has become a crisis. Antimicrobial resistance is evolving at an of resistancewas slowandthepharmaceuticalindustrycontinuedtocreatenewantibiotics. resist being killed by antimicrobial agents. For many decades, the problem was manageable as the growth Bacteria andothermicrobesevolveinresponsetotheirenvironmentinevitablydevelopmechanisms Introduction resistance Antimicrobial of AMR acrossallsections ofsociety, whether in the professional ornon-professional domain. There isalso The mainchallengeforestablishing arobust AMR surveillancesystemisthelackofadequate awareness the NAP. AMR program enjoyssomelevelofsupportfromgovernment partners, itisinsufficienttofullyimplement (IPC) policyforhealthcarefacilities, buttheprogramme isnotwelldevelopedinZimbabwe. Although the being putinplacetostartcollectingdataforthispurpose. There isaninfectionpreventionandcontrol or veterinaryoversight. There isnodataonantimicrobialuseinhumansandanimalsalthougheffortsare Antimicrobials arewidelyusedintheproductionoffood animalsandareavailable withoutprescription AMR pointprevalence surveys. operational inZimbabwe’s healthfacilities. However, someofthesefacilitieshadpreviouslyparticipatedin data. Antimicrobial stewardship and healthcare associatedinfection(HCAI)surveillanceprograms arenot Antimicrobial ResistanceSurveillanceSystem(GLASS)but isyettocommencesubmissionofsurveillance priority pathogens–Salmonellaspp. andEscherichia coli. The countryhasenrolledinthe WHO Global Currently, duetofundingconstraints, thesentinelsitesaremonitoringonlytwoofeight WHO and 2environmentlabs. surveillance networkof17sentinelsitescomprising9humanhealthlabs, 5veterinarylabs, 1foodlab, The NationalMicrobiologyReferencelaboratory servesastheNationalCoordinatingCentre forthe AMR Health approach, althoughonlyafewactivitiesarecurrentlybeingimplemented. National Action Plan(NAP)for AMR inSeptember2017. The NAPwas developedaccordingtotheOne Zimbabwe hasconductedarobustsituationanalysisonantimicrobialresistance(AMR), andlauncheda Zimbabwe levelofcapabilities Target 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 (iii) (iii) and Plan; Action Global the of framework the per as developed standards international following improved conservation of existing treatments and collaboration to support the sustainable development of of development sustainable the support to collaboration and treatments existing of conservation improved new antibiotics, alternative treatments, preventive measures and rapid point-of-care diagnostics, including including diagnostics, point-of-care rapid and measures preventive treatments, alternative antibiotics, new systems to preserve new antibiotics.. antibiotics.. new preserve to systems • • • • strengthening/challenges need that Areas • • • practices Strengths/best P.3.1 Antimicrobial resistance detection–Score 2 Indicators andscores • • • • • • Recommendations forpriorityactions needs substantialadditionalresourcestoimplementNAPactivities. resources; andlimitedparticipationinexternalqualityassurance programs. The coordination mechanism participation ofsomethelaboratories inthenetworkduetolackofreagents, equipment, and human inadequate funding to implement the NAP; lack of ongoing research to determine the drivers of AMR; non- need strong financial and technical support. To ensure data quality and compliance of all participating laboratories, EQA processes will continue to published. and reported, surveillanceAMR has not yet formally begun; data is yet to collected, be analysed, interpreted, Currently, only pathogens 2out priority of 8WHO are for being reporting to monitored. GLASS actions. national inform and GLASS into data surveillance AMR There is need to train and equip staff laboratories appropriately for Zimbabwe to commence reporting Centre of Excellence (RCE) in Quality Systems. Programme (ZINQAP) which as the Southern serves Africa Development Community (SADC) Regional QualityExternal Assurance (EQA) scheme administered by the Zimbabwe National Quality Assurance Some laboratories in have the network and access participate to software the in WHONET the coordinating centre for the surveillance AMR comprising network of 17 sentinel laboratories. The National Microbiology Reference (NMRL) Laboratory has been designated as the national approvedAn National Action Plan (NAP) based on on AMR the One Health approach is in place. programs/campaigns. stewardship antimicrobial and education, bound targets, and develop strategies implementation for effective of public awareness, professional Based on findingsfrom the ZimbabweAMR situation analysis, establish working baselines, time- laboratories. surveillance designated of all certification proficiency and assurance quality strengthening including system, surveillance and andIdentify barriers resolve to bottle-necks implementation of an integrated One Health recommended actions. the and the OIE Gap Analysis and associated Action Plan, with all key and actors proceed to implement Share the recommended actions priority identified by theOIE Performance of Veterinary Services (PVS), testing of food animals meant for domestic consumption. expanding the number and scope of pathogens and surveillance sites, including antimicrobial residue surveillance) as recommended through development by GLASS, of acosted plan for progressively under currently two the (beyond pathogens additional to surveillance AMR Consider expanding relevant required. national as Zimbabwe within entities sources/sites to theGlobal WHO Antimicrobial Resistance Surveillance System (GLASS), as well as to Initiate the process of formally reporting surveillance data from all nationally designated surveillance programs. prevention infection associated healthcare stewardship, and antimicrobial surveillance, Implement the Zimbabwe National Action Plan prioritizing on AMR awareness creation, AMR 11 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 12 PREVENT

Joint External Evaluation P.3.3 Healthcare-associated infection(HCAI)prevention andcontrol programmes –Score 2 • • strengthening/challenges need that Areas • • practices Strengths/best P.3.2 Surveillanceofinfectionscausedbyantimicrobial-resistant pathogens–Score 3 • • • strengthening/challenges need that Areas • • • • • practices Strengths/best P.3.4 Antimicrobial stewardship activities–Score 2 • • • strengthening/challenges need that Areas • • • practices Strengths/best included in the AMR surveillance. AMR the in included Environmental surveillance of antibiotics is currently not being done, and food chain sources are not treatment guidelines and essential medicines list for human and animal health. Low human resource and limited capacity provision of quality assured antimicrobials, standard human and animal health laboratories for reporting which is to centrally be coordinated by the NMRL. of the most common human pathogens in is the country. available software WHONET at some of the situation AMR An analysis has been conducted which details the prevalence and resistance patterns pathogens, and Zimbabwe is enrolled surveillance in theGLASS WHO network. The National Action Plan includes on AMR surveillance for human infections caused by resistant stewardship programs are not being implemented in health facilities. health in implemented being not are programs stewardship Antimicrobial stewardship committees not yet established or empowered, hence antimicrobial effectively. The mandatory requirement of aprescription for sale/purchase of antimicrobials is not enforced animals. Data on antimicrobial use, including prescription patterns, are lacking -for both humans and food There is alegal requirement to have aprescription for most antimicrobials used in human medicine. Plan in place out antimicrobial to carry use using survey Defined DailyDoses for antimicrobials. district, and infectious diseases public hospitals, as well as, those in the private healthcare sector. point The first prevalence on antibioticsurvey prescribing included participation of central, provincial, which is reviewed and years. updated two every National guidance on antimicrobial use is provided through the Essential Medicines List of Zimbabwe The National Action Plan includes acomponent on antimicrobial stewardship. measures. evaluating HCAI for place programsHCAI not well executed in majority of the health facilities as there is no robust system in disease programmes with different IPC policies require harmonization. Harmonization of IPC policies required across different disease-specific programmes. Different specific Surveillance to cluster detect of health care associated infection within high risk groups is not yet in place. There is asystem to regularly evaluate of IPC measures the effectiveness and publish the results. professionals in all hospitals. tertiary Majority of health facilities have IPC committees and isolation units, and there are trained IPC isand years. reviewed HCAI two every There is an approved national IPC with policy SOPs for health facilities, and the existing plan for IPC Adopted measured behaviors, policies and/or practices that minimize the transmission of zoonotic diseases diseases zoonotic of transmission the minimize that practices and/or policies behaviors, measured Adopted Resources (AU-IBAR). development partnerssuch as WHO, OIE, FAO, andthe African UnionInter-African Bureau for Animal product waste), theZimbabweParks and Wildlife Management Authority (Zimparks), andinternational places and processors), Environmental Management Agency (EMA, for managing dip tanks andanimal Police (ZRP, forenforcementofmovementcontrol), Local Authorities (formanagementofslaughterhouses/ include theZimbabweRevenue Authority (ZIMRA, forimprovingbordercontrol), ZimbabweRepublic of veterinarypublichealthinterventions. Otherpartners involvedatthenationallevel, tonameafew, national, provincial, anddistrictlevels, thatmeet monthlytoshareinformationandcoordinatethedelivery zoonotic diseases using the One Health approach. This is done through the Zoonotic Committees at The ministriesof Agriculture, Health, andEnvironmentarejointlyresponsibleforthemanagementof such asarobustcompensationmechanismtoencourage earlynotificationofprioritydiseases. lack ofstrongepidemiologicalsurveillanceandfinancial resourcestoapplyadequatecontrolstrategies emerging orareatincreasedriskofre-emerging. Zoonoticdiseaseshavealsobeenincreasingduetothe under-resourced andhavestruggledtomaintain their momentum. Previouslycontrolleddiseasesarere- implementation ofcontrolactivities. Inrecenttimeshowever, diseasecontrolprogrammes havebeen by theveterinaryservices, goodcoordinationwiththeprivate sector, clearstrategic planning, andefficient Zimbabwe hasahistoryofmountingeffectiveanimaldiseasecontrolprogrammes with strongleadership contingency planwas updatedin2017followingtheH5N8outbreak. successfully controlledthroughdepopulationoftheflocksataffectedproperty. The avianinfluenza an outbreakofhighlypathogenicavianinfluenza(H5N8)forthefirsttimeinMay2017. Theoutbreak was funded mandatoryanimalvaccination program forbothrabies andanthrax. Zimbabwealsoexperienced by thetsetsefly. Specialcontrolprograms areimplementedissuchareas. The countryhasagovernment- brucellosis occursporadically, whiletrypanosomiasisislimitedtospecificgeographical locationsinfested The countryhasexperiencedrabies andanthrax outbreaks intherecentpast. Riftvalley feverand for example, prioritydiseasessuchasrabies oranthrax appear tobeentrenched. mandatory. The Animal Health Act alsoprovidesforthegazettingofidentifiedgeographical areaswhere, under the Animal Health Act. The reportingofallsuspectedandconfirmedcasesforsuchdiseasesis occur sporadically. All theimportant zoonoticdiseaseshavebeenidentifiedandlistedasnotifiable Zimbabwe experiencesseveral zoonoticdiseaseeventsannually, someofwhichareendemicwhileothers Zimbabwe levelofcapabilities Target is ofanimalorigin; andapproximately 60%ofallhumanpathogensarezoonotic. that aidinitstransmission. Approximately 75%ofrecentlyemerginginfectious diseases affectinghumans diseases are caused by viruses, bacteria, parasites and fungi carried by animals, insects or inanimate vectors Zoonotic diseasesarecommunicablethatcanspreadbetweenanimalsandhumans. These Introduction Zoonotic diseases from animals into human populations. human into animals from 13 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 14 PREVENT

Joint External Evaluation • • work plantoimproveandstrengthentheveterinaryservicesinlinewithnationalpriorities. Notably, Zimbabwehasperformedallthesteps within theOIEPVSPathway anddevelopedabudgeted or planinplaceforrespondingtozoonoticevents. need tomake itmoresystematicandimprovetimeliness. There isalsonoformalnationalpolicy, strategy, institutionalized andalthoughthereisregularexchangeofinformationbetweenDLVS andMoHCCthereis The country has a mechanism in place for a coordinated response to zoonoses. However, it is not farming communitiesatthesub-districtlevels. the governmentuptodistrictlevel, whilediplomaandcertificateholdersaregenerally deployedwithin institutions ismandatoryforallanimalhealth-training courses. Degree-holdingveterinariansareposted by and Bulawyo polytechnics for extension staff and meat hygiene inspectors. Attachment to public health Zimbabwe undergraduate andpost-graduate students, aswellfordiploma studentsattheMazowe Public healthtraining foranimalhealthandveterinarystaffispartofthecurriculum forUniversityof Health Officers(EHOs)includingpassivesurveillanceattheslaughterhouses(antemorteminspection). under DLVS andMoHCCundervarious activitiesincludingMCAZandthefieldoperations oftheEnvironmental farmers. InZimbabwethemanagementofveterinarypublichealthisdividedbetweenservices represent a key part of the surveillance network, as they are the ones in closest contact with the animals and vaccinations, branding, and supervise the work done atthe dip tanks. With morethan800 such centres, they At thesub-districtlevel, Animal HealthMedicalCentres(AHMCs)provideconsultationservices, perform Quality controlassurance isbeingprovidedbytheSouth Africa National Accreditation System(SANAS). other provinciallabs. There arealsoeightotherprivate and/orassociatedlabsprovidingveterinarylabservices. rabies sectionthatoperates sevendaysaweek. Plansareunderway todecentralize rabies testingtothree Laboratory functionsareprovidedbytheCentral Veterinary Laboratory (CVL)atHarare whichhasadedicated to incorporate datafromtheveterinaryservicesintonationalhealthinformationsystem. Disease (FMD), anthrax andrabies. Furthermore, theMinistryofHealthandChildCare(MoHCC)isplanning and adequateequipment. The departmentisapplyingGISinmappingrisksrelatedtoFoot andMouth disasters relatedtolivestock. The system isnotrobustenoughandcallsforinvestmentinskillsdevelopment and IrrigationDevelopment(MAMID)hasalivestockdiseasesurveillancesystemfortracking imminent The DepartmentofLivestockand Veterinary Services(DLVS) oftheMinistry Agriculture, Mechanization, • Recommendations forpriorityactions ❍ ❍ ❍ One Health approach, especially veterinarians at the district level. Establish recruitment attractive and retention schemes for personnel trained and experienced in the and exchange all between relevant sectors. Establish an integrated information management system for systematic and timely information sharing Institutionalization of multisectoral collaboration to address zoonotic diseases by: by: zoonotic diseases collaboration address to Institutionalization multisectoral of ❍ ❍ ❍ ‘concept of operations’ to actions promote necessary and specify the One Health approach. Develop the an ministries MoU between of health, agriculture and environment that document a RRTs. joint through response funding that so they function efficiently in supporting surveillance, lab activities, and a coordinated Strengthening zoonotic committees at the various levels, and securing adequate and sustainable of the IHR includingaspects zoonotic diseases, food safety, and AMR. Establishing the “One Health” approach as formal in policy the to country cover all relevant • • • practices Strengths/best P.4.2 Veterinary oranimalhealth workforce –Score 3 • • • • • • • strengthening/challenges need that Areas • • • • practices Strengths/best P.4.1 Surveillancesystemsinplaceforpriorityzoonoticdiseases/pathogens–Score 3 Indicators andscores district, and levels. sub-district The animal health is workforce capable of conducting One Health activities at national, provincial, and medicines. and enforcement of public health regulations, as well as the regulations on quality and usage of drugs There is professional collaboration key between ministries partner particularly in the implementation exist. Established training institutions with reputable training curricula that meet the needs of the country allocations. resource greater for advocacy underpin to conducted in collaboration with MoHCC, the cost-benefit analyses of preventing zoonotic outbreaks shouldbe More textured data and granular analysis should incorporated be into the animal health database; and should staff trainedSelected be as risk analysis specialists. (BSE). encephalopathy spongiform promptly, for example, neurological which in cases cattle requires adifferential diagnosis for bovine “Syndromic” surveillance should developed be for key diseases of concern that so they are reported private. and government both veterinarians, field the and para-professionals veterinary the support The current list of notifiable diseases shouldbe reviewed and updatedwith clearcase definitions to control. and surveillance disease improving and husbandry, and animal breeding promoting A system for animal identification and traceability is lacking,which is critical for managing livestock, inspectionmortem (passive surveillance). slaughter and sale of animals and animal are products, needed to improve comprehensive use of ante Registration of all premises used for livestock slaughter, and an awareness programme to reduce illegal centralized funding mechanism to cover the activities of the zoonotic committees. Although there to is respond capacity to zoonotic disease outbreaks within 24 hours, there is no While coordination structures exist there is no documentation on formal institutional arrangements. testing. brucellosis (CVL),Laboratory district laboratories, and some private labs. also The CVL produces antigens for There is functional laboratory testing for diseases priority by supported the Central Veterinary at the grassroots are agreat resource for disease surveillance and control. salmonellosis, avian influenza, and brucellosis.The largecadre extensionof workers and dip attendants Surveillance systems are in place for zoonoses priority such as rabies, anthrax, trypanosomiasis, finalization. under is Act Health Animal updated The creation, outbreak control, and safe disposal of infectious materials. responsibilities, sharing of data and information on zoonotic events, and actions related to awareness committees are aligned with their respective mandates and well-defined in terms of surveillance Roles and responsibilities of key ministries partner (Health, Agriculture, and Environment) in the zoonotic 15 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 16 PREVENT

Joint External Evaluation and functional–Score 3 P.4.3 Mechanismsforresponding toinfectiousandpotentialzoonoticdiseasesestablished • • • • • strengthening/challenges need that Areas • • • • • • strengthening/challenges need that Areas • • • • practices Strengths/best implemented to encourage reporting of priority diseases. diseases. priority of reporting encourage to implemented control programmes, greater public awareness and astrong compensation mechanism needs to be To promote understanding better and compliance of farmers with the requirements of relevant zoonotic receive training to allow them to assess and register slaughter premises. of veterinary para-professionals undertaking this role need to defined; better be shouldand thesestaff allows inappropriate and untrained people to undertake this work. The qualifications knowledgeand Current legislation on the required competencies for ante and inspection mortem post at slaughterhouses Private participation sector in disease surveillance and reporting needs to substantially be enhanced. current freeze on recruitment, particularly for those with high on impact public health delivery. schemes need to urgently be established to retain and experienced lobby staff; for the reversal of the To address the high worryingly rate vacancy of veterinarians at the district level, retention attractive disease of control programmes delivery for the (including zoonoses). and supervision priority support A high number of veterinary positions remain vacant at the district level (> 40%), negatively impacting strategy to guide actions. Consider establishing a“One Health Centre” and develop acomprehensive One Health and policy Strengthen of the Rapid capacity Response Teams (RRTs) for responding to zoonotic diseases outbreaks diseases such as brucellosis and should TB also considered be as zoonotic priority diseases. and capabilities. This requires from across support the array of government agencies. Other important procedures management disease emergency generic with developed be plans should Contingency surveillance and lab diagnosis with of the both, support the government and private sectors. The DLVS should lobby to gain increased funding for the control of these diseases including field Greater commitment is required to control major zoonoses, such as rabies and anthrax, at source. systematic exchange of information DLVS between and MoHCC. Develop SOPs for information sharing and outbreak investigations to ensure regular, timely, and responsibility. of areas specific cover There is aneed for increased formal meetings and across aMemorandum sectors of Understanding to timeliness. improve and systematic (DLVS)Services and the Ministry of Health and Child Care (MoHCC), there is need to make this more Although there is regular exchange of information the Department of Livestock between and Veterinary to zoonotic outbreaks are in place. Established institutions for field surveillance, lab diagnosis, and mechanisms for a coordinated response zoonotic diseases exist. priority of control and surveillance for programmes government-funded and guidelines; WHO and OIE with hasThe country alist of notifiable animal diseases that includes important zoonotic diseases in line regularly. held being Informal committees for zoonoses at national, provincial, and district levels, and monthly meetings are Surveillance and response capacity among States Parties for food- and water-borne disease risks or events events or risks disease water-borne and food- for Parties States among capacity response and Surveillance and E. coli, respectively. estimated thatabout80%and 53%ofthecooked vendedfoodsarehighlycontaminated withS. aureus of concernforfoodcontrolofficers asstreet-vendedfoodsareoftenassociatedwith foodpoisoning. Itis and peopleonlowincomes. However, thehygieneaspects ofthevendingoperations are amajorsource towns. Streetfoodvendors provideanessentialservicetoworkers, shoppers, travellers, schoolchildren, consumption ofready-to-eatfoods, whichareoften soldasstreetfoodsinmanyplaces, particularlyin In recentyears, therehasbeenagrowingshiftin Zimbabwe, fromeatinghome-preparedfoodto that anthrax, whichisafoodborne diseasefrommeat, iscommoninthecountry. much as1perhundredthousandpopulationin1999and 2perhundredthousandin2002. This indicates adhered to. Available statisticsshowthattheprevalence ofsuspectedanthrax casesinZimbabwewas as meat, canbecontaminatedduringslaughteringifgood slaughteringpractices orproceduresarenot between various departmentsand ministriesandalackofpropertraining ofpersonnel. Food, especially Food inspectioninZimbabweisgenerally weakpartlyduetothefactthatinspectionservicesaresplit aspects offoodsafetyexisttheyneedinternationalaccreditationinlinewithIHR(2005)requirements. and currentlythereisnonationalfood safety policy and strategy in place. Although labs covering most are covered inthe legislation there is poor coordinationamong the agenciesresponsible for foodsafety, to inspectandcollectsamplesfromwherefoodissoldorprepared. Although manyelements offoodsafety (MoHCC) areempoweredbythePublicHealth Act [15:09]andtheFood andFood Standards Act [15:04] The EnvironmentalHealth Technicians fromlocalauthoritiesandtheMinistryofHealthChildCare likely sourceoffoodcontamination. deaths. CampylobacterinfectionsinhumanshavebeenwidelyreportedZimbabweandpoultrywerethe inadequate. A majorcholera epidemicoccurredinZimbabwe2008with98585reportedcasesand4287 Food safetyrelatedeventsoccurquitefrequentlyinZimbabweyetsurveillanceandreportingremain such ascholera andtyphoid, includingguidelinesforspecimencollectionandtesting. for respondingtoallpublichealthemergencies. Setprotocolsareavailable forspecificfoodborneillnesses Food safetyemergenciesinZimbabwearedealtwithbyRapidResponse Teams (RRTs) whoareresponsible Zimbabwe levelofcapabilities Target prevention ofhumancases(orfurthercases)needtobeputinplace. the sourceofanevent, basedonariskassessment, suitableriskmanagementoptionsthatensurethe throughout thefoodchaincontinuummustbedeveloped. Ifepidemiologicalanalysisidentifiesfoodas outbreak anditscontainmentiscriticalforcontrol. Riskmanagementcapacitywithregardtocontrol likelihood ofinternationalincidentsinvolvingcontaminatedfood. The identificationofthesourcean developed countries. The rapid globalizationoffoodproductionandtrade hasincreasedthepotential Food- and water-borne diarrhoeal diseases are leading causes of illness anddeath, particularlyin less Introduction Food safety by strengthening effective communication and collaboration among the sectors responsible for food safety, safety, food for responsible sectors the among collaboration and communication effective strengthening by and safe water and sanitation. and water safe and 17 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 18 PREVENT

Joint External Evaluation • • Recommendations for priority actions Recommendations forpriorityactions formalized collaboration onmanyaspectsoffoodsafety. have beenestablished, butthecollaborations areonlyactiveduringemergencies; andthereisalack between healthandthefoodproduction/agriculturesectors. Someoperational linksbetweenagencies safety systemscoveringtheentirefoodchain. These systemsmustbedevelopedinclosecollaboration A key recommendationistoaspireameliorate thesefactorsbybuildingefficientandintegrated food weak communicationandinformationsystemsalsocompoundtheproblem. health, andinadequatediseasesurveillance. The lackofanationalfoodsafetypolicyandstrategy, and rural-urban migration, poor environmental hygiene andsanitation, inadequate investments inpublic Like inmanyotherdevelopingcountries, thedriversoffoodbornediseasesinZimbabweincludepoverty, • • • • • • practices Strengths/best food safetyemergencies andoutbreaks offoodbornediseases–Score 2 P.5.1 Mechanismsformultisectoral collaboration establishedtoensure rapid response to Indicators andscores • • ❍ ❍ ❍ ❍ agencies dealing safety. food with Develop appropriate terms of reference and an MoU to facilitate and enhance coordination among to the actions promote necessary ofspecify animal of food products safety origin. Develop and implement operational frameworks based on the existing Gap OIE PVS Analysis that the Government Analyst (GAL), Laboratory and the Central Veterinary (CVL). Lab Health, City Health, Environmental include surveillance safety food conduct that institutions Existing outbreaks. and Phytosanitary Committee meetings), during investigation of suspected foodborne disease Mechanisms exist for information exchange, among entities represented in the RRTs (e.g. the Sanitary Legislation, policies, and regulations covering exist, but are outdated. aspects food safety cholera and salmonellosis. There are well-established protocols for responding to some specific foodborne diseases such as emergencies. health public hasThe country mechanisms for detection and response to foodborne illnesses, using the RRTs for diseases are being implemented and promoted along the value chains. International standards and practices good for production of safer food and the prevention of foodborne Enhance of relevant capacity dealing sectors by: with food safety and strategy on food safety. Review and update food legislation and food safety which is outdated; and develop anational policy ❍ ❍ ❍ ❍ accreditation of laboratories responsible for food safety. international ensuring and system management information integrated an of Development emergencies. safety food to responding and Provision of logistic and operational to enhance support for surveillance, capacity lab diagnostics Participation of key stakeholders in international fora. food safety Timely recruitment, training, and retention of skilled personnel. • • • • • • strengthening/challenges need that Areas Currently, inspections are carried out by and medical not the staff veterinary services. Meat inspection in slaughterhouses is not being according performed to international standards. competencies. safety food on knowledge amatter of priority,As vacant need to filled be posts andexisting re-trainedstaff to refresh their Coordination among agencies responsible needs for to food strengthened. be safety International accreditation is lacking for laboratories responsible for food safety. through technical assistance, adequate equipment, and asecured supply of lab consumables. Capacity for surveillance, diagnosis, and responding emergencies to food safety needs to strengthened be formulated. legislationFood needs to updated, be and a national and policy strategy needs for to food safety be 19 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 20 PREVENT

Joint External Evaluation A whole-of-government national biosafety and biosecurity system with especially dangerous pathogens pathogens dangerous especially with system biosecurity and biosafety national whole-of-government A plants ortheenvironment. secure infectious agents against those who would deliberately misuse them to harm people, animals, biosafety andbiosecuritytoprotectresearchersthecommunity. Biosecurityisimportantinorderto dedicated toworkwithinfectiousagentshaveraised concernsregardingtheneedtoensureproper of bothnatural anddeliberate origin. At thesametime, theexpansionofinfrastructure andresources tools thatareneededtodetect, diagnose, recognizeandrespondtooutbreaksofinfectiousdiseases Research withinfectiousagentsiscriticalforthedevelopmentandavailability ofpublichealthandmedical diseases. set oftools–suchasdrugs, diagnostics, andvaccines –tocountertheever-evolving threatofinfectious It isvitaltoworkwithpathogensinthelaboratory toensurethattheglobalcommunitypossessesarobust Introduction biosecurity and Biosafety to checkforcompliance intermsofavailability ofpersonalprotective equipment (PPE); environmental a systeminplacetoensurethat alllaboratories arelicensed. Newlyconstructedlaboratories areinspected For biosafetycabinets, servicecontracts areinplaceto monitorwhethertheyarefunctioningwell. There is with theZimbabweCouncil of Veterinary Surgeons, and biannuallybytheNBA. annual assessments are being conducted by the office of the Directorof Veterinary Services in collaboration A Third-Party Assessment hasbeendone for the Tuberculosis (TB)laboratory. For theanimalhealthlab, in place. Informationdisseminationisdonethrough periodicworkshopsandthroughtheNBAwebsite. Inspections, spot-checks, andauditsareusedto monitor biosecurityandbiosafetyactivities, andtheseare exists, butZimbabwedoesnothaveadedicatedagency todealwithbiosafetyandbiosecurity. regulates onlyproductsandnotdangerouspathogens. A nationalpolicyonbiotechnology andbiosafety a bidtominimizeimpactofnewandemergingtechnologies onnationalsecurity. However, the Authority assesses safetyaspectsofimportsandexportsbiologically-derived materialsandresearchactivitiesin the NationalBiosafetyFramework andLabSafety Manuals. The NationalBiotechnology Authority (NBA) National Biotechnology Authority Act [Chap. 14.31]of2006; theNationalBiotechnologyPolicy of2005; The legalandadministrative frameworks thatgoverntheissues ofbiosafetyandbiosecurityincludethe mandated toregisterallfacilitiesusedforbiologicalandmolecularwork. the veterinarylaboratory needstobemadefullyfunctional. The NationalBiotechnology Authority (NBA)is salmonella typhiarecontainedattheNMRL. The humanhealthlaboratories needtoberefurbishedand Microbiology ReferenceLaboratory (NMRL), andoneforanimalhealth. The isolatesforcholera and Zimbabwe hasthreeBiosafetyLevel3(BSL3)laboratories -twoforhumanhealth, based attheNational Zimbabwe levelofcapabilities Target identified, held, secured and monitored in a minimal number of facilities according to best practices; practices; best to according facilities of number minimal a in monitored and secured held, identified, biological risk management training and educational outreach conducted to promote a shared culture of of culture shared a promote to conducted outreach educational and training management risk biological responsibility, reduce dual-use risks, mitigate biological proliferation and deliberate use threats, and ensure ensure and threats, use deliberate and proliferation biological mitigate risks, dual-use reduce responsibility, safe transfer of biological agents; and country-specific biosafety and biosecurity legislation, laboratory laboratory legislation, biosecurity and biosafety country-specific and agents; biological of transfer safe licensing and pathogen control measures in place as appropriate. as place in measures control pathogen and licensing • • • • strengthening/challenges need that Areas Best Practice: Free-of-charge provisionofHIVprophylaxisforlaboratory functionaries. • • • • • • • practices Strengths/best agriculture facilities–Score 1 P.6.1 Whole-of-government biosafetyandbiosecuritysysteminplaceforhuman, animaland Indicators andscores • • • • • Recommendations forpriorityactions security information. Moreover, thereisasysteminplacetoconductinternalandexternalaudits. availability ofwater andpower. The countryhasanOfficialSecrets Actthatmanagestherelease ofsensitive fitness; controlofaccess; presenceoffireextinguishers, skilledpersonnel, andregisteredpersonnel; and, Central, provincial, and district labs are not yet ISO-accredited. adopted and currently there is no specific planaction for biosecurity and controlbiosafety measures. been yet not plan has response emergency draft The enforcement. and oversight their including At the Ministry-level there is inadequate funding biosafety to and support biosecurity programs, Institute of Communicable Diseases (NICD) in Johannesburg, South Africa. that require Level 4biosafety are referred to the Regional reference laboratory based at the National does notThe country have a Biosecurity Level 4 (BSL4) lab for either human or animal health. Pathogens There is no specific national regulation(s) for biosafety and biosecurity in Zimbabwe. rapid diagnostic test (influenza), gramstain (anthrax),(TB). and Xpert Gene utilizesThe country diagnostic that tests eliminate the need for culturing dangerous pathogens e.g. identify biohazards and are fully cognizant measures of the safety required. There are qualifiedpersonnel who have basic competencies in biosafety and theycanbiosecurity; guidelines. contaminated materials have been established, and follow IATA regulations and Manual the Safety Lab Procedures for the safe and secure transportation of cultures, specimens, samples, and other Staff working at the animal health labs receive pre-exposure vaccination for rabies. All labs in the are country licensed. biannually by the National Biotechnology (NBA). Authority Assessment of the animal health lab is done annually by the Council of Veterinary Surgeons and There are biosafety cabinets to protect users from dangerous pathogens, and these are locally. serviced dealing with dangerous pathogen (e.g. Hepatitis B, among others). Develop options and anational for policy the vaccination of laboratory health workers especially those Finalize national the draft for policy the management of waste, including dangerous pathogens. includes development of curricula and aplan for the training of trainers. Conduct atraining needs assessment and develop atraining program on biosafety and biosecurity that biosecurity. Finalize Emergency the draft Response Plan for responding to incidents concerning biosafety and health. environmental and animal, human, encompassing biosecurity, Develop comprehensive legislation and the associated set of regulations for managing biosafety and 21 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 22 PREVENT

Joint External Evaluation • • • • • practices Strengths/best P.6.2 Biosafetyandbiosecuritytraining andpractices –Score 1 • • • • strengthening/challenges need that Areas Lab scientistsLab were trained andfor certified handling dangerous pathogensWHO. by reporting, investigating, and addressing any incidents and accidents at the facility. There is an accidents logbook in the human health and veterinary labs for systematically documenting, staff. laboratory of competency assessments conducts The country and performance reviews to monitor the competencies budget set aside for maintenance and equipment used in these facilities. There is astrong commitment for the provision of resources for all laboratory facilities and there is a curricula. training Relevant training institutions have included modules on the issue of biosafety and biosecurity in their The waste management for policy the handling of dangerous pathogens is still in form. draft run out. maintenance of facilities and equipment, including the stock and availability of PPEs which tend to Insufficient allocation of resources (financial and human)negatively proper andimpacts timely free. lack of aclear vaccination for policy lab staff, only pre-exposure vaccination for rabies is available for Post-exposure prophylaxis treatment is not provided to laboratory workers in all facilities. Also, due to and aprogramme for training of trainers needs to developed. be housing or working with dangerous pathogens. Atraining needs assessment has not been conducted, There is no comprehensive training programme specifically on biosecurity and biosafety for facilities A national vaccine delivery system – with nationwide reach, effective distributions, access for marginalized marginalized for access distributions, effective reach, nationwide with – system delivery vaccine national A • • Recommendations forpriorityactions and technicalsupport, fromgovernmentandpartners. program delivery system there is dedicated transport, staff, cold rooms, communication, continued financial temperatures inthefridgesare monitoredusingthermometersanddataloggers. To ensureasustainable where theystorevaccines and every clinichasasolar-powered fridgewherethey canstorevaccines. The outs atcentral levelandonly rarely atthedistrictlevel. Inaddition, everyprovincehasacoldroom trucks fortransportation. Zimbabwe reachesalldistrictswithvaccine delivery, anditnolongerhasstock- The nationalvaccine deliverysystemensurescontinuouscoldchainsforvaccine deliveryusingrefrigerated resulting inrecommendationsonwhattoimprove. due toproblemswithfinancingoftheprogram. InJuly2016there was acomprehensivereviewoftheEPI There was a measles outbreak in 2009-2010 associated with a lower overall coverage of measles vaccination in 2017was 89%. Almost allprovincesachievedthestandards forpolio-freecertification. Agency (ZIMSTAT), andtheMaternalChildHealthIntegrated Program (MCHIP). Coverage formeasles surveys. The program receivessupportfrom WHO, UNICEF, World Vision, ZimbabweNationalStatistics coverage istracked throughPentavalent andMeaslesvaccination throughroutinedatacollectionand free vaccination; national immunisation days; school immunisation programs and media support. Vaccine mobilisation; free treatment of children who are illwith other conditionswhenthey come for immunisation; programs (toreducewalking distances); mobilisationcampaigns; useofvillagehealthworkers forsocial In Zimbabwe, immunizationisvoluntaryandincentivestoencourage routinevaccination include: outreach was includedintheEPIfouryearsagoandthereareplanstostartcholera andtyphoidvaccination. on Immunization(EPI)attheprovinceanddistrictlevelsbutnotallpostsarefilled. Rotavirus vaccination but post-exposureprophylaxisforrabies isavailable. There arefocalpersonsfortheExpandedProgramme target for coverage is 95% for all of them. Zimbabwe’s immunization plan does not include any zoonoses on Polio, Rubella, Measles, Diphtheria, Rotavirus, Tetanus, HepatitisB, TB, PneumococcusandPertussis. The Zimbabwe hasanexpandedimmunizationprogram targetingchildrenunder5yearsofage, andfocusing Zimbabwe levelofcapabilities Target of themostsuccessfulglobalhealthinterventionsandcost-effectiveways tosavelivesandpreventdisease. Immunizations areestimatedtopreventmorethantwomilliondeathsayearglobally. Immunizationisone Introduction Immunization populations, adequate cold chain and ongoing quality control – that is able to respond to new disease threats. disease new to respond to able is that – control quality ongoing and chain cold adequate populations, coverage in all districts. Investigate reasons for children not being immunized and address these obstacles to reach the target dueouts to forecasting. poor Establish local better population estimates to calculate a more accurate coverage and reduce stock- 23 of IHR Core Capacities of the Republic of Zimbabwe PREVENT 24 PREVENT

Joint External Evaluation • • • • practices Strengths/best P.7.1 Vaccine coverage (measles)aspartofnationalprogramme –Score 3 Indicators andscores • • • • • • • strengthening/challenges need that Areas • • practices Strengths/best P.7.2 Nationalvaccineaccess anddelivery–Score 4 • • • strengthening/challenges need that Areas Program receives support from various partners. various from support receives Program Vaccine coverage is regularly monitored, and results are shared. vaccination. available are encourage to incentives Several National immunization program and plan in place and in use. cold-chain. of maintenance for funding Assure awards). performance work, Reduce turnover staff by, for example, motivation packages (timely promotions, recognition of good sources. funding Review existing funding streams and create contingency plans to deal with the potential loss of external trucks) is lacking. Financing for maintenance (refrigerators, cold-chain of temperature-monitoring, and refrigerated Not all vaccine storage facilities have an appointed manager. Financing of vaccination is largely donor-funded which makes the program vulnerable. Better data analysis and forecasting at district level to avoid any stock-outs. Dedicated human and financial resourcesfrom the government and partners. Efficient vaccinestorage and deliverysystem. Staff turnover not and filled, posts especially at the health-post level improve. to needs and optimum not is Vaccination coverage asreported >100 %. Population figures are not reliable. Population censusfrom 2012 and coverage somein areassometimes 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 and laboratory-based diagnostics. available. The coretestshavenationalalgorithms. There isaguidelinefor rollingoutmodernpointofcare PPE use, biosafety, andbiosecurityisdonebythesafety officersandstandardoperating proceduresare laboratory staffandtracked using astockcardinventorysystemoranelectronicdatabase. Trainings for data aresharedusingtheweeklysurveillancereports. Personal ProtectiveEquipment(PPE)isavailable for register andmake theirreportsavailable tothecentral veterinaryreferencelab. Zoonoticdiseaselaboratory There isanestablishedveterinarylaboratory networkandallveterinarylabsarenowmandatedbylawto Diseases (NICD)inSouth Africa, andothers. by ZimbabweNationalQuality Assurance Program (ZINQAP), The NationalInstituteofCommunicable Laboratories also participate in External Quality Assurance (EQA) through proficiency testing as provided for qualitymanagementsystemareenforcedandinuse byallhumanandanimalhealthlaboratories. certified, respectively. The National Polio Laboratory (NPL)is WHOcertified. Guidelinesandprotocols Reference Laboratory (NMRL)andtheCentral Veterinary Laboratory (CVL)areISO15189and17025 Some national labs are accreditedor internationally certified. For example, the National Microbiology laboratories. Resultsaredeliveredusingcourierservicesfromthenationallevel. guide clinicians on specimen collection and transportation has been developed and is being used in some core testscanbedoneatnationallevel, andfouratthesub-nationallevel. A laboratory handbookto The laboratory servicesinZimbabwecanconductsixcoretests(ofthe10listed under theIHR). All six each tierarewell-definedinapolicydocument. than 1500otherlaboratories areattachedtoclinicsalloverthecountry. Responsibilitiesoflaboratories at includes threereference, fivecentral, eightprovincial, and64district/mission/private/city-health labs. More expertise and skills are available where and when they are needed most. The tiered laboratory system resources forrapid identification, confirmation, andresponsetooutbreaksevents. Therighttechnical Zimbabwe enjoysastrongpublichealthlaboratory networksystemwhichpoolshuman andtechnical Zimbabwe levelofcapabilities Target education; andpartnershipscommunication. and specializedtesting; laboratory oversight; emergencyresponse; publichealthresearch; training and food safetyincludingdiseaseprevention, controlandsurveillance; integrated datamanagement; reference can serveasafocalpointfornationalsystem, throughtheircorefunctionsforhuman, veterinaryand response, environmentalmonitoringanddiseasesurveillance. Stateandlocalpublichealthlaboratories Public healthlaboratories provideessentialservicesincludingdiseaseandoutbreakdetection, emergency Introduction National system laboratory DETECT laboratory-based diagnostics. laboratory-based 25 of IHR Core Capacities of the Republic of Zimbabwe DETECT 26 DETECT

Joint External Evaluation supply ofreagentsandconsumablesisnotsecuredrequiresattention. laboratory network. The veterinarylabhasalotofobsoleteequipmentwhichneedstobereplaced. The surveillance program. Clinicians in private practice have not been making use of the national public health body forlaboratory accreditation. The laboratory dataisnotwell integrated intothenationaldisease There isnoadequateequipment, media, reagents, andconsumablesforisolation. There isalsononational country isalsoyettodecideontheotherfourcorepriorityteststhatitmaywishbeableconduct. maintenance agreements. Humanandanimaldiseasesurveillancesystemsarenotinter-operable. The for laboratory workers isnolongerimplemented. There isinadequateworkspaceandlackofequipment is not appropriately managed. The available biosafetycabinetsarenot installed. A vaccination scheme not known and the national bacteriology reference laboratory has not been accredited. Generated wasted and policyisyettobeimplemented. The populationthathasaccesstodiagnosisofprioritypathogensis posts lyingvacant. Staff, whereavailable, requireadditionaltraining. The nationallaboratory strategic plan The country’s humanresourcecapacityforthelaboratory servicesisverylow, withmorethan50%ofthe Despite impressiveprogress, several challengesstillconfrontthelaboratory servicesnetworkinZimbabwe. recipient labsbyphoneandthecouriersystem. transportation oflabsamplesincaseoutbreaksusingambulances. Laboratory resultsaresentto A couriersystemforspecimentransportation isavailable, howevertherearemechanismsforquicker Veterinary SurgeonsofZimbabwemonitorslabqualityforanimalhealth. and theHealthProfessionals Authority (HPA) ofZimbabwe, forhumanhealth; whiletheCouncilof The laboratory qualitysystemsaremonitoredbyMedicalLaboratory andClinicalScientistCouncil(MLCSC) • • • • • • • practices Strengths/best D.1.1 Laboratory testing fordetectionofprioritydiseases–Score 4 Indicators andscores • • • • • • • Recommendations forpriorityactions standards. National are aligned diagnostic international tests with core of algorithms laboratory for performance available. EQA is including system inspection Laboratory SOPs for all core have tests been prepared. systems. management quality implementing are Laboratories system. referral Tiered Establishment of public health laboratory for human network and animal health. Availability of national laboratory strategic plan and policy. external labs. Develop and establish material transfer agreements for the movement of biological materials to Advocate for the establishment of anational lab accreditation body. Establish asustainable funding mechanism for specimen transport. pathogens for surveillance four on Agree core priority testing. supply. consumables and equipment reagents, national a plan for implement and Develop Develop and implement aplan for use of point of care diagnostic testing. Implement the national laboratory strategic plan and policy. • • • strengthening/challenges need that Areas • • • practices Strengths/best D.1.4 Laboratory qualitysystem–Score 2 • • strengthening/challenges need that Areas • • practices Strengths/best D.1.3 Effectivemodernpoint-of-care andlaboratory-based diagnostics–Score 2 • strengthening/challenges need that Areas • • practices Strengths/best D.1.2 Specimenreferral andtransport system–Score 4 • • • • • strengthening/challenges need that Areas • Need for mandatory licensing for mandatory Need all of laboratories. Absence of specific national document on registration procedure for vitroin diagnostic medical devices. No national in charge body of laboratory certification and accreditation. Legislative animal by registration for mandatory backing and reporting health laboratories. bodies. regulatory by inspection laboratory Annual Enforcement of quality management by professional regulatory bodies in human and animal health. Capacity building on point of care technologies. network. laboratory to scale up theAdvocacy use of point of care diagnostics technology in the tiered public health Some laboratories already deploying point of care technology for testing. Plan in place to improve the availability of point of care diagnostics at clinical sites in the country. No national or policy guidelines on specimen archiving and bio-banking. Ambulances available for transporting specimens especially during outbreaks. Courier contracted, service funded, and paid by the government through adedicated account. Integrated data management labs between and the national surveillance network. accredited. is not laboratory reference national bacteriology The lab equipment. other and consumables, media, reagents, for funding Inadequate More than 50% rate vacancy for laboratory personnel. Implementation of the national laboratory strategic plan and policy. agreementsOfficial with labs outside the for country specialized testing not available in country. 27 of IHR Core Capacities of the Republic of Zimbabwe 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 Target biological events. leading anintegrated biosurveillanceeffortthatfacilitatesearlywarning andsituationalawareness of The purposeofreal-timesurveillanceistoadvance the safety, securityandresilienceofthenationby Introduction Real-time surveillance based veterinarysurveillance istobepilotedbyFAO in thenearfuture. investigate rumoursormedia reportspicked upatcentral level. A mobilephoneapplicationforevent- lead toinvestigationofpossible threatstopublichealth. Districtauthoritiesare contacted andasked to There isnospecificevent-based surveillancebutrumoursandmediareports, forexample, sometimes reporting electronically. are includedintheweeklyepidemiologicalbulletin. Plans areatanadvanced stagetoalsodocase-based paper formwiththreecopies(fordistrict, province, andnationallevel)notviaDHIS2, butthedata is asuspectedorconfirmedcase, orifthereis aclusterofcases. Case-basedreportingisdoneona and actionthresholdsforwhentodefinitelyact. The alertandactionthresholds dependonwhetherit as cholera issuspected. There arealertthresholds for whentoreportthenextadministrative level, reporting, followedbydistrict-levelinvestigation, is mandatory ifanylistedoutbreak-pronediseasesuch level whereitisfedintotheDHIS2anddataaggregated. Routinereportingisdoneweekly. Immediate Reporting fromthelowestlevelisdonebyShortMessage Service(SMS, i.e. textmessaging)tothedistrict event-based systemisinplaceyet, whichwouldhavemadethesurveillancesystemmoresensitive. flaccid paralysis (AFP), influenzaetc., areincludedasreportableinthesurveillance system. However, no Syndromic surveillance for more than three coresyndromessuchas watery diarrhea, bloody diarrhea, acute all levels. Consideringthelimitedresources, thesurveillancesystemseemstoworkwell. monthly andannualanalysesbyaspecialteamatMoHCC. These reportsaresharedwithstakeholders at outbreaks. The weeklyepidemiologicalreportsareproducedat thecentral level, whichissupplementedby which areusedtogenerate weeklyepidemiologicalreports, healthprofiles, and situationreportsduring and syndromes. The systemhasthecapacitytoshareinformationthroughpivottables, chartsandmaps e.g. TB, HIV, andmalaria, includingtheweeklyreportofaggregateddataonothernotifiablediseases Information Software version2(DHIS2). The systemintegrates allreportsfromdifferentprogrammes Zimbabwe hasdevelopedanindicator-based human diseasesurveillancesystemusingtheDistrictHealth Zimbabwe 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 level intermediate 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 and and IHR the with accordance in surveillance for requirements capacity core the fulfilling in advancement OIE standards. OIE • • • practices Strengths/best D.2.3 Integration and analysisofsurveillancedata–Score 4 • • strengthening/challenges need that Areas • • practices Strengths/best D.2.2 Interoperable, interconnected, electronic real-time reporting system–Score 2 • • strengthening/challenges need that Areas • • • practices Strengths/best D.2.1 Indicator- andevent-basedsurveillancesystems–Score 3 Indicators andscores • • • Recommendations forpriorityactions animal andhumanhealthsurveillancesystems. veterinary surveillancesystemisnotelectronicandtherenolinkageorinteroperability betweenthe The human disease surveillance system is only partly electronic and not real-time for the most part. The e-mail or on paper. National weekly disease surveillance on epidemic-prone report diseases shared among all levels, by subnational meetings. taskforce Coordination and feedback mechanisms in the form of national taskforce meetings, as well as, trends. disease of DHIS2 has an built-in program that cangenerate tables and reports, graphs which are used for analysis Unreliable and network internet across the is country connectivity hampering real-time reporting. ofLack trained at health staff facility level and turnover. high staff There is amechanism for feedback from the national to subnational level. AFRO,WHO and it is being applied in the training of all health workers in disease surveillance. Zimbabwe adopted and adapted the Integrated Disease Surveillance and Response (IDSR) strategy of diseases. labsbetween and patient care are needed for quicker reporting of confirmedcases of notifiable Data collected from the health facilities is mostly aggregated and not patient-level data. Better links as quickly as they should. There is need for training. further Data transmission from the health facilities to the district level could improve do not always as staff act are used in all health facilities transmit data to the district level using Frontline SMS software. There is mobile good phone coverage network across the country. Standard data collection tools which There is adisease surveillance on epidemic-prone report diseases, which is produced weekly. a built-in data validation and verificationsystem. There is adistrict health information system which the is country using surveillance to report data, with Train and orient at regional staff and local levels when and how to interpret on data. and act health. human for Organize electronic surveillance system for animal health and make this interoperable with the system system. surveillance event-based an organizing Integrate reporting from other sources like media, rumours, from traditional and reports healers by 29 of IHR Core Capacities of the Republic of Zimbabwe DETECT 30 DETECT

Joint External Evaluation • • practices Strengths/best D.2.4 Syndromic surveillancesystems–Score 4 • • strengthening/challenges need that Areas • • • strengthening/challenges need that Areas dog bites,dog and anthrax, snake bites. when needed with animal health counterparts and the zoonotic committees, for example in relation to Joint surveillance and exchange of information, to facilitate coordination and collaboration, takes place as dysentery, cholera, acute flaccid paralysis(AFP) etc. Availability of guidelines for syndromic surveillance of patients with suspected health conditions such down to the health facility level. Feedback from the provincial and district levels to the level sub-district should improved be all the way the link data analysis between and the response. Analysis of data and use is its limited at the district and levels. sub-district There is need to strengthen Better feedback and training from district level to health facilities is required. with defined thresholds for and alert action. Surveillance data should linked be to at action the local level according to the guidelines that exist, There is need to strengthen information exchange on the syndromic approach. 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 • • • Recommendations forpriorityactions mechanism betweenthetwoformoreefficientreporting to WHO, OIE, and FAO. are working collaboratively to fully implement IHR (2005), there is need to strengthen the data sharing reported theavianinfluenza(H5N8)outbreaktoOIEin 2017. AlthoughtheIHRNFPandOIEdelegate The notificationpromptedamultisectoral responsetotheoutbreak. The OIEdelegateinZimbabwealso area within48hoursoftheoccurrenceoutbreak, asprescribedin Annex 2oftheIHRdocument. January 2018, theIHRNFPnotified WHOIHRcontactpointaboutacholera outbreakinChegutu The implementationofIHRinZimbabwewas testedbyamajorcholera outbreakin2008-2009. In NFP andthefoodsafetyauthorities. The twodelegatesshareinformationatanad hoclevel. Person. The OIEdelegateisbasedattheMinistryof Agriculture andworksincollaboration withtheIHR Health, andothersectorssuchasnon-governmentalorganizationsareassistingtheIHRNationalFocal effective andefficientmanner. Intheeventofan emergency, individualsfromCivilProtectionUnits, Animal the departmentlacksqualifiedstafftoaidIHRNational Focal Person incarryingouthisdutiesan National Focal Point (NFP). The NationalFocal Person is the DirectorofEnvironmentalHealth. However, The MinistryofHealthandChildCarehasdesignatedtheDirectorate ofEnvironmental HealthastheIHR Case-based Surveillance. completeness (morethan90%)ofreports, asprescribedby WHO. The dataasclassifiedRoutineand The useofDHIS2hasfacilitatedreal-timereportingandimprovedthetimeliness(morethan80%) in turnconsolidatethedataandenterthemintoDHIS2submittonationallevelelectronically. facilities arestillusingpaper-based reporting(e.g. T3, T5, and T6 forms)toreportthedistrictlevel, who system wheredataiselectronicallytransmitted fromhealthfacilitiesdirectlyintoDHIS2. Someofthehealth Reporting withinZimbabweisdonethroughtheDistrictHealthInformationSoftware version2(DHIS2) Zimbabwe levelofcapabilities Target ecosystems reducestheriskofdiseasesatinterfacesbetweenthem. and animal health systems. Collaborative multidisciplinary reporting on the health of humans, animals and pathogens continuetoevolveandadaptnewhostsenvironments, imposingaburdenonhuman Health threats at the human–animal–ecosystem interface have increased over the past decades, as Introduction Reporting FAO and OIE. and FAO concern and zoonotic events. zoonotic and concern to continuously improve reporting of potential public health emergencies of national/international Conduct regular training and simulation exercises for national IHR focal persons and the OIE delegates, to and WHO OIE. Fast track the development and dissemination of guidelines and SOPs for reporting events of concern security. for point focal designated the events; Point (NFP) and, the OIE delegate; the focal points for food safety, radiation emergencies, and chemical Establish amechanism for systematic information sharing/exchange the IHR National between Focal 31 of IHR Core Capacities of the Republic of Zimbabwe DETECT 32 DETECT

Joint External Evaluation • • practices Strengths/best D.3.1 Systemforefficient reporting to FAO, OIEand WHO–Score 3 Indicators andscores • • • • • strengthening/challenges need that Areas • • • • practices Strengths/best D.3.2 Reportingnetworkandprotocols incountry–Score 2 • • strengthening/challenges need that Areas Protection Sub-committee meetings). Sub-committee Protection Existence of coordination and response forums (e.g., the Zoonotic Sub-committee and the Civil exchange the Ministry between of Health and WHO, the and Ministry between of Agriculture and OIE. The IHR National Focal Point (NFP) for the is country established and there is aplatform for information health. human in counterparts Institutionalize and facilitate closer working arrangements the zoonotic between disease unit and their outbreaks. toNeed strengthen capacities to analyze data at the local level to facilitate early detection of possible system. surveillance There is need to include the private healthcare into sector the national health information and Limited resources available at the national level to fulfil the IHR corecapacity requirements. review, incorporates and thus these aspects presents an opportunity. (PHEICs) or the IHR (2005). However, the new Public Health Bill of 2017, which is currently under internationalof concern emergencies health public articulate specifically not Current legislation does (OSDVs). Data quality assurance through conduct of assessments, reviews, and periodic on-site data verifications Existence of coordination and response forums (Zoonotic and Civil Protection sub-committees). From the district level upwards all reporting is electronic, and paper-based system has been eliminated. Existence of surveillance systems for both animal and human health, and communication around it. are beingNo reports received from private institutions. sector absence of IHR implementation guidelines that are specific to the Zimbabwean context. There is a need to strengthen further coordination for IHR implementation, which is hampered by the States Parties with skilled and competent health personnel for sustainable and functional public health health public functional and sustainable for personnel health competent and skilled with Parties States • practices Strengths/best D.4.1 Humanresources available toimplementIHRcore capacityrequirements –Score 3 Indicators andscores • • • Recommendations forpriorityactions health professionals. does notaddresstheentireworkforcenecessaryforeffectiveimplementationofIHR, mostnotably, animal for Health (HRH) strategy that was updated in 2017 that includes human public health professions, but it skills and providing motivation for health workers at the sub-national level. There is a Human Resources to lackoffunds. Revivingthistraining wouldbeusefulforimprovingepidemiology andmanagement A short-coursetraining fordistrict-levelMinistryofficialsusedtobeoffered, butit was discontinued due ministries, includingtheMinistryofHealthandChildcare, Ministryof Agriculture, andMinistryofDefence. accredited advanced FieldEpidemiology Training Programme (FETP)enrolsparticipantsfrommultiple national levelwherethereisa critical shortageofstaffneededto effectively implementIHR(2005). An all sectors, whichcannotbefilledduetothegovernment’s hiringfreeze. This ismostevidentatthesub- results invarying levelsofskillandcapabilityamonggraduates. There arecurrentlymanyvacancies across degree programs, thereiscurrentlynostandardizationofcompetenciesorcurricula across programs. This Promotion; MScinNursing; andMaster’s inMedicalMicrobiology. While itisanadvantage tohavemultiple Environmental Health; MScinEpidemiologyandBiostatistics; MScinClinicalEpidemiology; MPHHealth local institutions. These degreeprograms spanmultiple disciplines: MPHinFieldEpidemiology; MScin Zimbabwe hasastrongpublichealthworkforce, educatedthoughseveral differentdegreeprograms in Zimbabwe levelofcapabilities Target scientific skillsandsubject-matterexpertise. developing and maintaining a highly qualified public health workforce with appropriate technical training, Workforce developmentisimportantinordertodevelopasustainablepublichealthsystemovertimeby Introduction developmentWorkforce surveillance and response at all levels of the health system and the effective implementation of the IHR IHR the of implementation effective the and system health the of levels all at response and surveillance (2005). (2005). laboratory specialists,laboratory etc.). Workforce includes multiple disciplines (veterinarians, environmental health specialists, epidemiologists, training at the district level. Revive the basic Field Epidemiology Training Programme (FETP) or short-course field epidemiology curricula. Develop core competencies that all public health training institutions agree to achieve through their Advocate the to hiring lift freeze and fill critical unfilled positions, especially at district/provincial levels. 33 of IHR Core Capacities of the Republic of Zimbabwe DETECT 34 DETECT

Joint External Evaluation • practices Strengths/best D.4.2 FETPorotherappliedepidemiology training programme inplace–Score 3 • • • strengthening/challenges need that Areas • • • • strengthening/challenges need that Areas • practices Strengths/best D.4.3 Workforce strategy –Score 3 • strengthening/challenges need that Areas (TEPHINET). accredited by the Training Programs in Epidemiology and Public Health Interventions Network Advanced trains FETP workers from multiple Ministries (e.g. Health, Agriculture, Defence) and is times. non-emergency during evident not workforce multidisciplinary of Systematic collaboration competencies curricula or across institutions. Master’s in Public Health (MPH) training programs are all independent and do not have common High rates vacancy throughout the system; cannot posts filled be due to the hiringfreeze. Poor incentives and low motivation of the workforce encourage attrition. staff There is aneed for organized, regulated, and continuous professional development training. approved –it is still in form. draft The strategy was updated in 2017 for implementation from 2017-2020, but it has not been officially strategy exists. The workforce strategy includes only human health professions and no animal health workforce Workforce strategy that exists includes key public health professions (e.g. laboratorians, epidemiologists). retention of workers at the sub-national level. to lack of funding. It would helpful be to revive this program to help with continuing education and course epidemiologyA short and management training used to take place but was discontinued due Development and maintenance of national, intermediate (district) and local/primary level public health health public level local/primary and (district) intermediate national, of maintenance and Development commodities fromNatPharm areprepositionedatthedistrictlevel. distributes medicalsupplies, whichcanbeusedinemergencies. Quarterly suppliesofmedicinesand In termsofmedicalstockpiles, theNationalPharmaceuticalCompany(NatPharm) procures, stores, and manages theresourcemobilization mechanismforemergencyresponse. place, operationalized throughtheDepartmentofCivilProtection. The Department ofCivilProtectionalso In termsofgovernance, therearestrongmultisectoral andmulti-disciplinarycoordinationmechanismsin (IDSR), andrapid responseteam (RRT) operations. Health workers havebeentrained oncasemanagement, integrated diseasesurveillanceandresponse (e.g. thereisonedocumentedforthecityofHarare). provinces havetheirownemergencypreparednessandresponse plans, butnotalways indocumentedform National Emergency Operations Centre (EOC) andaPublicHealthEmergency Operational Guide. Cities and Influenza, andasimulationexerciseforEbolahasbeen conducted. The countryalsohasguidelinesforthe Preparedness andresponseplanswerealsopreparedforEbola Virus Disease(EVD)andPandemic Zimbabwe has developed disease-specific guidelinesfortyphoid, yellow fever, cholera, rabies, and anthrax. requirements underIHR(2005)intoconsideration. diagnostics, andpublichealthmeasures. However, theplanwas developedwithouttakingmanyofthe structure, surveillance, casemanagement, logisticsduringemergencies, communicationstrategy, laboratory carried outduringemergencies. Areas ofworkdescribedintheplaninclude: anoperational response departments, withtechnicalsupportfromthe WHO CountyOffice. The planoutlinestheactivitiestobe by theMinistryofHealthandChildCare(MoHCC), Local Authorities, key partners, andothergovernment Zimbabwe hasamulti-hazardpublichealthemergencypreparednessandresponseplandevelopedin2012 Zimbabwe levelofcapabilities Target emergency. support operations attheintermediateandcommunity/primaryresponselevelsduringapublichealth identification andmaintenancesofavailable resources, includingnationalstockpilesandthecapacityto and nuclear hazards. Other components of preparedness include mapping of potentialhazards, the response levelpublichealthemergencyplansforrelevant biological, chemical, radiological Preparedness includesthedevelopmentandmaintenanceofnational, intermediateandcommunity/primary Introduction Preparedness RESPOND emergency response plans for relevant biological, chemical, radiological and nuclear hazards. This covers covers This hazards. nuclear and radiological chemical, biological, relevant for plans response emergency mapping of potential hazards, identification and maintenance of available resources, including national national including resources, available of maintenance and identification hazards, potential of mapping stockpiles and the capacity to support operations at the intermediate and local/primary levels during a a during levels local/primary and intermediate the at operations support to capacity the and stockpiles public health emergency. health public 35 of IHR Core Capacities of the Republic of Zimbabwe RESPOND 36 RESPOND

Joint External Evaluation resources available fordeployment. the IHR(2005). Furthermore, thecountryhasyettoundertake amappingofhealthrisksandstrategic preparedness andresponseplanthatmeetsthecorecapacityrequirementsunder Annex 1A, Article of In summary, Zimbabwedoesnotyethaveadocumented andapprovednationalpublichealthemergency inform decision-makingandpreparednessplanning. such as the Index forRisk Management (INFORM) includes risk profilingfor Zimbabwe thatcan beusedto be leveraged toincludebiologicalhazards. Furthermore, global, open-sourceriskassessmentdatabases The ResilienceBuildingFundestablishedinZimbabwe2015providesmappingforhazardsthatcanalso agriculture, andlivestockthatneedtobeintegrated intoemergencypreparednessandresponseplanning. recommendations forreinforcementofcapacities. The assessmentincludedimportantelementsonhealth, a snapshot of risk and early warning information available across government and partners; and, a set of provided acomprehensivemulti-sectoral analysisofexistingcapacities, needsandgapsoftheDRMsystem; of theDepartmentCivilProtection, focusedonnationalandsub-nationalcapacities. The assessment assessment oftheDisasterRiskManagement(DRM)systeminZimbabwe, conductedundertheleadership the impactofthesenatural hazardsonfoodsecurityandnutritionofthepopulation. The 2017capacity Mapping (VRAM)ortheStrategic Risk Analysis exercise, the Vulnerability Assessment doeshoweverinclude Child Caredidnotreceivetechnicalorfinancialsupporttoconductthe Vulnerability Risk Assessment hazard mapping of risks, which mostly focused on floods and droughts. While the Ministry of Health and domain. The inter-agency grouponDisasterRiskManagementinZimbabwerecentlydevelopedamulti- leveraging theoutputsofseveral recentexercisesandinitiativesfromthewiderDisasterRiskManagement Public healthemergencypreparednessandresponseplanninginZimbabwecouldbenefittremendouslyby • • • practices Strengths/best developed andimplemented–Score 1 R.1.1 Nationalmulti-hazard publichealthemergency preparedness andresponse plan Indicators andscores • • • • Recommendations forpriorityactions all key stakeholder in the response activities. There is acoordinated multi-sectoral response to outbreaks and epidemics, and strong involvement of (IACCH), and the Ministry of Finance. place through the Department of Civil Protection, the Inter-Agency Coordination Committee for Health There are multisectoral and multi-disciplinary coordination and resource mobilization mechanisms in as, at the sub-national levels, although these are not yet fully aligned with IHR (2005). hasThe country anational, multi-hazard emergency preparedness and response plan in place, as well for use), and how to allocate resources and replenish used funds. Put in place adedicated EPR contingency fund with SOPs for decision-making about usage (i.e. triggers of hazardstypes as per Annex 1A of IHR (2005). Conduct simulation exercises/drills to test the plan. Update the EPR plan considering the results of the risk profilingexercise and align the plan to cover all response. and preparedness available emergency for Conduct a national strategic resource mapping exercise which includes stockpiles, and funding staffing, emergencies. health comprehensive a Conduct multi-hazard and multisectoral national risk profilingexercise publicfor • strengthening/challenges need that Areas • • • • practices Strengths/best R.1.2 Prioritypublichealthrisksandresources mappedandutilized–Score 1 • • • strengthening/challenges need that Areas programme of work on emergency preparedness and response. and preparedness emergency on work of programme aligned to the IHR (2005) and using the One Health approach, needs to undertaken be to inform the A comprehensive, systematic, and up-to-date analysis and mapping of public health threats and risks, all levels. at response emergency for workforce dedicated is a There occur. The various are aware sectors of sectoral risks, and where and when an emergency event is likely to Funding for preparedness and response activities are made available rapidly when the need arises hazards. various for developed have been plans Contingency managed by the Department of Civil Protection. is emergencies, health public including all to emergencies, responding for fund contingency The centre. operations (DRM) authorities under the Department of Civil Protection, which also oversees the national emergency There is aneed for more systematic and stronger collaboration with the Disaster Risk Management many natural hazards, but not prioritized for health issues. haveDonors not been forthcoming preparedness to support activities. Funding has been received for 37 of IHR Core Capacities of the Republic of Zimbabwe RESPOND 38 RESPOND

Joint External Evaluation Country with public health emergency operations centre (EOC) functioning according to minimum common common minimum to according functioning (EOC) centre operations emergency health public with Country support decision-makingandimplementation, coordinationandcollaboration. during aresponsetoanemergencyorexercise. They alsoprovideotheressentialfunctionsto operations centresprovidecommunicationandinformationtoolsservices, andamanagementsystem and resourcesforstrategic managementofpublichealthemergenciesandemergencyexercises. Emergency A public health emergency operations centre is a central location for coordinating operational information Introduction operations response Emergency • practices Strengths/best R.2.1 Capacitytoactivate emergency operations –Score 2 Indicators andscores • • • Recommendations forpriorityactions Response Teams andrelatestothewidernationalCivilDefence EOC. and involvespeoplefromotherMinistriesonanadhocbasis. The EOCorganizesandempowersRapid but notformalizedinroles, practices, andadministrative tools. ItconvenespersonnelwithintheMoHCC practice, theEOCtodateisusedasameetingspaceonly, witharoutineoffunctionality, whichisoperative EOC, and a senior MoHCC staff member who activates and presides over most of the EOC activities. In guide itsactivitiesandfunctions. There isanindividualmainlyresponsiblefororganizingmeetingsinthe a dozenpeople, andhasadocument(developedin2011, andavailable onlyon-line), whichisexpectedto The countryhasestablishedaphysicalspaceforanEmergencyOperations Centre(EOC) capableofseating Zimbabwe levelofcapabilities Target standards; maintaining trained, functioning, multisectoral rapid response teams and “real-time” biosurveillance biosurveillance “real-time” and teams response rapid multisectoral functioning, trained, maintaining standards; laboratory networks and information systems; as well as trained EOC staff capable of activating a coordinated coordinated a activating of capable staff EOC trained as well as systems; information and networks laboratory emergency response within 120 minutes of the identification of a public health emergency. health public a of identification the of minutes 120 within response emergency the different personnel involved are not well developed, informal, and spontaneous. often established. and Who what groups take in a mobilization part are determined only informally. Roles of Zimbabwe can mobilize rapidly, within often 24 hours, but the procedures to do are so not well opportunities to improve the function of the EOC. It is the systematic review of these After-Action Reviews and Simulation Exercises that are the ongoing events that do not occur in the country, conduct at least one multi-agency simulation exercise annually. It will critical be to develop aroutine out practice After-Action of carrying and, Reviews for (AARs) incident. Additional payments salary as an incentive may for this. necessary be of key personnel from various relevant to departments deploy and fill critical EOC roles during an The EOC canrapidly become more operational by nominating and appropriately training asmall group Guide, as well as to train during staff an incident and organize an After-Action exercise. Review (AAR) recommended to come from an experienced international consultant to recommend revisions to the The National Emergency Operations Guide needs to updated be urgently, with technical support • strengthening/challenges need that Areas • • practices Strengths/best R.2.4 Casemanagementprocedures implementedforIHRrelevant hazards –Score 2 • • practices Strengths/best R.2.3 Emergency operations programme –Score 1 • • strengthening/challenges need that Areas • practices Strengths/best R.2.2 EOCoperating procedures andplans–Score 2 • • strengthening/challenges need that Areas involved in EOC mobilizations EOC in involved nomination, and training of Rapid Response Team members, required roles, and organizations to be Procedures should developed be more generally for the functions of the EOC, including rotation, staff No table-top or functional exercises have been completed to test operational capacities. Case management procedures exist only for cholera and Ebola. Simulation exercises. These should guided be by the updated operations manual recommended earlier. important componentAn of the system will conducting be and reviewing After-Action Reviews and MoHCC. The EOC has been used repeatedly as ameeting space to coordinate emergency responses for the salaries. or staffing for this necessary be to occur, but the basic roles and procedures instituted canbe without further deploy and fill critical EOC roles during an incident. Additionalsalary payments as an incentive may Other key personnel from various relevant should departments also receive training in-service to international consultant is used to update the procedures and book train staff. trained, use the procedures that book is currently available, and the be prime trainee if an experienced who has the main responsibility to organize the EOC, record minutes, etc. That should person be time role; the ‘on canbe person call’ with other routine responsibilities. In practice, there is aperson nominated. Triggers for activation of the EOC should made be explicit. This does not need to afull- be To make the Emergency Operations Centre (EOC) more operational, a director of the EOC should be spontaneous. largely are the past years, but these mobilizations are not well assessed, and the roles and activities engaged in over mobilizations various in have worked They spontaneous. and informal largely are procedures The EOC’s functions and the designation of responsibilities and roles will impose the reliability and repeatability of the The IHR focal appears person to only partially be involved in the activities of the EOC. Greater structure EOC and activities. its Creation of major roles and functions in amore formalized manner will improve the reliability of the 39 of IHR Core Capacities of the Republic of Zimbabwe RESPOND 40 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 Target law enforcementwillneedtoquicklycoordinateitsresponsewithpublichealthandmedicalofficials. (e.g. theanthrax terroristattacks)ornaturally occurring(e.g. flupandemics). Inapublichealthemergency, Public healthemergenciesposespecialchallengesforlawenforcement, whetherthethreatismanmade Introduction authorities security and health public Linking documented, throughwritten agreementsorprotocols. different sectors, andthe triggersfornotificationsandrelatedactions, need to bediscussed, agreed, and agreements, betweenhumanhealth, animal health, andthesecurityauthorities. Points of contactsinthe Overall, duetolackofastronglegislativebasis, thereis apaucityofwrittenprotocols, MoUs, orother geographical informationsystems formappingandrespondingtopublichealthemergencies. Security agencies also foresee greater use of newtechnologiesinthe future including dronesand officers fromZimbabwearesecondedfortraining andliaison. international security, includingemergencies. There are Interpolofficesinthecountrytowhichsecurity Through theMinistryofHome Affairs, Zimbabwe linksandcoordinateswithInterpolonmattersof intentional oraccidentalreleaseofdangerouspathogens. during natural disasters. However, therehavebeennospecific training orjointsimulationexercisesonthe The armyandairforcealsoprovidelogisticssupport helicoptersfortransport andrescueoperations and supportcityauthoritiesinimplementingdiseasecontrolmeasuresduringpublichealthemergencies. Protection Committeemeetings. The securityandmilitaryservicesprovidesurgepersonnelduringoutbreaks national EmergencyOperations Centre(EOC), andduringemergenciesparticipateinEOC, IACCH, andCivil Health (IACCH). Defense, police, andborderpatrolpersonnelwereinvolved in theestablishmentof The militaryandtheprisonsauthoritiesparticipateinInter-Agency CoordinationCommitteefor (IDSR). in jointinvestigationsandtrainings withMoHCCstaffonintegrated disease surveillance andresponse have beentrained intheFieldEpidemiology Training Programme (FETP). Securitypersonnelalsoparticipate surveillance reportsfromtheMinistry. The securityforceshavecompetent publichealthpersonnelwho related datatotheMinistryofHealththroughDHIS2system, andinturnreceiveweeklydisease Services (ZPCS), andtheZimbabweRepublicPolice (ZRP)reportdiseasesurveillanceandotherincident- The ZimbabweNational Army (ZNA), the Airforce ofZimbabwe (AFZ), ZimbabwePrisonsandCorrectional responding toeventsinvolvingbiologicalweaponsandtoxins. coordination and written agreements, as well as the conduct of joint exercises and simulations for written agreements of cooperation andcollaboration between the sectors. There is a need forimproved especially in relation to border control and public health events. However, at present there are no formal Zimbabwe hasplatformswherethesecurityandpublichealthsectorsmeettodiscusspertinentissues, Zimbabwe 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 • • • strengthening/challenges need that Areas • • • • practices Strengths/best linked duringasuspectorconfirmedbiologicalevent–Score 1 R.3.1 Publichealthand security authorities(e.g. lawenforcement, border control, customs) Indicators andscores • • • • • Recommendations forpriorityactions involve biological threats. threats. biological involve There is aneed to conductAfter-Action Reviews of suspected events and simulation exercises that levels. formal MOUs or agreements public between health and other at the national sectors and sub-national Current coordination various is between informal sectors and based on personal relationships, with no There is no specific plan in place for coordination and responding potentialto biological threats. international an nature. of matters emergency The national government liaises with Interpol through the Ministry and of Home on Affairs security public health risk. Legislation is in place that allows the government to detain/quarantine an individual who presents a entry. of point the at emergencies to responses joint of coordination Emergency OperationalThe Airport Plan for the international at Harare airport is in place for the Report. Surveillance Disease areservices fed into the national health information system and consolidated regularly into the Weekly Public health specialists in and the military serve security Data services. and information from these authorities. publicboth health and security Conduct periodic exercises and simulations for response to deliberate that involve acts leadership from inventory of dangerous pathogens stored in the country. Involve authorities security of biosecurity and biosafety, in aspects including development of an Develop SOPs for joint risk assessments that include triggers for notification. threats. potential biological for biological incidents of deliberate origin into the overall EPR strategy, and then develop specific plans coordination and responding public of to suspected for identifying health and security Integrate aspects significance to issues security.of and other for joint sectors risk assessments, investigations, and responding to public health events of Develop MoUs and agreements at national and intermediate levels security, between public health, 41 of IHR Core Capacities of the Republic of Zimbabwe RESPOND 42 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 emergencyforresponse. public health. Inaddition, itisimportanttohavetrained personnelwhocanbedeployedincaseofapublic infectious diseasethreats. Investmentsinmedicalcountermeasurescreateopportunitiestoimproveoverall Medical countermeasuresarevitaltonationalsecurityandprotectnationsfrompotentiallycatastrophic Introduction deployment countermeasuresMedical and personnel • • Recommendations forpriorityactions to assistwiththe2014Ebolaoutbreak. Response Network(GOARN); nevertheless, somehealth personnelfromZimbabwedeployedto West Africa part ofanyregional/internationalpersonneldeployment agreement suchas the Global Outbreak and Alert there arenoformalproceduresinplaceforacceptance andorientationofthesestaff. The countryisnot typhoid. Zimbabwehasreceivedinternationalmedical personnelinemergencysituationspreviously, but needed torespondemergencies, whichhasbeenutilizedtorespondrecentoutbreaksofcholera and between differentlevelsofgovernmentandrequestedfromlocalinternationalorganizationswhen during apublichealthemergency. There isageneral understandingthathealthpersonnel canbemoved standards, oraddressregulatoryandlicensureconcernsrelatedtosendingreceivinghealth personnel The country does not have a formal plan to identify procedures for decision-making, training criteria and use foranoutbreakofcholera only. limited resourcesavailable. There iscurrently astockpileofmedicalcountermeasuresavailable fornational facilities andstafffortracking anddistributionofbothhumananimalhealthcountermeasures, but and distributingcountermeasuresduringpublichealthemergencies. Domestically, therearededicated to procuremedicalcountermeasuresandnoregional/internationalagreementsforprocurement, sharing, into thecountryduringanemergency. There arenostandingagreementswithmanufacturesordistributors produce antibiotics, vaccines, and other countermeasures, so there would likely be a delay in getting them vaccines andpersonalprotectiveequipmentduringemergencies. Within thecountry, thereisnocapacityto formal plans are absent, Zimbabwe does have experience receiving medical countermeasures such as procedures forsendingandreceivingmedicalcountermeasuresduringapublichealthemergency. Although Zimbabwe’s medicalcountermeasurescapacitiesarelimited, primarilyduetothelack offormalplansand Zimbabwe levelofcapabilities Target and medical personnel from international partners during public health emergencies. health public during partners international from personnel medical and countermeasures and personnel during emergencies. during personnel and countermeasures Based on the legal review, develop plans that outline systems for sending and receiving medical emergencies. determine what legislation may facilitate of medicines or export or restrict import and personnel during to deployment personnel and countermeasures medical relevant regulations governing Review • • • strengthening/challenges need that Areas • • practices Strengths/best emergency –Score 1 R.4.2 Systeminplaceforsendingandreceiving healthpersonnel duringapublichealth • • strengthening/challenges need that Areas • practices Strengths/best health emergency –Score 1 R.4.1 Systeminplaceforsendingandreceiving medicalcountermeasures duringapublic Indicators andscores • emergency. There is aneed for aformal agreement for surge for local deployment staffing during a public health emergencies. health No standing agreements with international to send partners or receive surge personnel during public but no plans. Limited procedures exist for sending and receiving medical personnel during apublic health emergency emergencies. to respond to needed organizations when different movedStaff canbe between levels of government and requested from local and international Rapid Response Teams (RRTs) are available at all levels as first line of response. emergencies. health public during countermeasures medical distribute No standing agreements with manufactures/distributors or international to procure, partners share, or plans place. in no are there and emergency Limited procedures exist for sending and receiving medical countermeasures during apublic health animal). There are dedicated facilities for tracking and staff and distribution of countermeasures (human and Response -GOARN).Alert Network (e.g. and emergencies during Outbreak Global the personnel sharing of and countermeasures medical Develop or join regional and international partnerships for procurement, sharing and distribution of 43 of IHR Core Capacities of the Republic of Zimbabwe RESPOND 44 RESPOND

Joint External Evaluation State Parties use multilevel and multifaceted risk communication capacity. Real-time exchange of of exchange Real-time capacity. communication risk multifaceted and multilevel use Parties State be testedandupdatedasneeded. for buildingtrustbetweenauthorities, populationsandpartners. Emergencycommunicationsplansshould established. Inaddition, thetimelyreleaseofinformationandtransparency indecision-makingareessential country needtobeidentified, andfunctionalcoordinationcommunicationmechanismsshouldbe information throughappropriatechannelsisessential. Communicationpartnersandstakeholders inthe through community-basedinterventionsatindividual, familyandcommunitylevels. Disseminatingthe Communications ofthiskindpromotetheestablishmentappropriatepreventionandcontrolaction of theaffectedpopulation. political andeconomicaspectsassociatedwiththeeventshouldbetaken intoaccount, includingthevoice For any communication about risk caused by a specific eventto be effective, the social, religious, cultural, is thedisseminationofinformationtopublicabouthealthrisksandevents, suchasdiseaseoutbreaks. the capacity to cope with an unfolding public health emergency. An essential part of risk communication define risks, identifyhazards, assessvulnerabilities andpromotecommunityresilience, therebypromoting Risk communicationsshouldbeamultilevelandmultifacetedprocesswhichaimsathelpingstakeholders Introduction Risk communication no after-action reports haveexaminedriskcommunicationsspecifically. created onan ‘as-needed’ basis. Noplanshavebeentestedasnosimulations havebeencarriedout, and communications personnel, materials, andactivities foremergenciesarenotroutine, theyareinstead several conditions, includingtyphoidandEbola, butnogeneral nationalorientationexists. Budgetfor staff havetargetedtraining in sucharole. Responseplans, includingcommunicationplans, existfor There arenopermanentorsurgestaffdedicatedto riskcommunicationduringemergencies, andno and healthsystemrelevant information. generates itsownmessagingfor emergencies; andaHealthInformationUnitwhichsummarizesdisease which isdesignedtofocusonpopulationhealthpractices; aCivilProtectionUnitoutsidetheMoHCCwhich department, whichgenerates messagingofrelevance totheMinister’s office; aHealthPromotionUnit, and Child Care (MoHCC) that lead elements of risk communication. These include a Public Relations There is no national plan for risk communication but there are multiple entities in the Ministry of Health Zimbabwe levelofcapabilities Target information, advice and opinions between experts and officials or people who face a threat or hazard hazard or threat a face who people or officials and experts between opinions and advice information, (health or economic or social wellbeing) to their survival, so that informed decisions can be made to to made be can decisions informed that so survival, their to wellbeing) social or economic or (health mitigate the effects of the threat or hazard and protective and preventive action can be taken. This includes includes This taken. be can action preventive and protective and hazard or threat the of effects the mitigate a mix of communication and engagement strategies, such as media and social media communications, mass mass communications, media social and media as such strategies, engagement and communication of mix a awareness campaigns, health promotion, social mobilization, stakeholder engagement and community community and engagement stakeholder mobilization, social promotion, health campaigns, awareness engagement. • strengthening/challenges need that Areas • practices Strengths/best R.5.3 Publiccommunication–Score 3 • strengthening/challenges need that Areas • • practices Strengths/best R.5.2 Internalandpartnercommunicationcoordination –Score 2 • strengthening/challenges need that Areas • practices Strengths/best R.5.1 Riskcommunicationsystems(plans, mechanisms, etc.) –Score 1 Indicators andscores • • • • Recommendations forpriorityactions already employed of anational as part plan will assist in answering these questions. intended audiences, is not well known. More formal mechanisms of communication using the media Whether messages are timely and appropriate, and whether they are well understood and reach the agency. of communications forwas adisease-specificidentified activity (forTyphoid), carried out bya partner Health. Assessment of the or impact even reach of these communications is rare; only one evaluation Public communications primarily consist of statements to the press and social media by the Minister of coordination to with improve partners it. Training and planning will needed to be improve both the content of risk communication and the to change. communities by an emergency to and provide affected serves ad hoc feedback when messages need community volunteers beyond the healthcare system. This system reaches into many or most messages from the national level to regional of the and national local staff health system, and to The strongest of risk aspect communication to date is the ability and practice of sending out key NGOs and inter-ministerial actions occur on an ad hoc basis. No systematic communication partner and coordination at the national level was identified. Partner need to be developed. Communication, coordination, training, risk of and planning communication various for the aspects not recognize their to tasks in be this field as such. The various units of the MoHCC have involved staff in risk communications, though many of them may stakeholders. relevant all of inclusion and reference Establish anational Technical Working Group on risk communication, with appropriate terms of plan. communication risk the and surveillance Establish aformal mechanism for rumour tracking/assessment and integrate it into an event-based approach. Map, assess, and build national for risk capacity communication at all levels under the One Health Emergency Operations Centre (EOC) and the other units dealing with communications in the MoHCC. Develop an ‘all-hazards’ risk communication strategy and plan to operationalized be through the 45 of IHR Core Capacities of the Republic of Zimbabwe RESPOND 46 RESPOND

Joint External Evaluation R.5.5 Dynamiclisteningandrumourmanagement–Score 2 • • • strengthening/challenges need that Areas • practices Strengths/best R.5.4 Communicationengagementwithaffectedcommunities–Score 3 • strengthening/challenges need that Areas • practices Strengths/best these systems. systems. these to emergencies of various need to developed be and types tested to more fully use the capabilities of Messages are prepared for several conditions, but more wider skills and preparation for responding in the country. It appears that the combination of radio messages and cell phone messaging can reach nearly everyone informal and ad hoc. Even this utilizing strongest aspect, both traditional and modern communication methods, remains care units to reach into communities using health volunteers of various types. The strongest of risk aspect communication in the health system appears to the be ability of primary and using established technologies. surveillance at the national level, these systems instituted canbe rapidly at little or no additional cost management and listening via telephone and SMS hotline components systems. of event-based As Together with event-based surveillance, there is an excellent to systematize opportunity rumour health facilities and volunteers in communities provide if ad systems hoc, effective, of listening. Only an informal system for listening and rumour management exist. of primary The level network States Parties designate and maintain core capacities at international airports and ports (and where where (and ports and airports international at capacities core maintain and designate Parties States facilities andhealthdeskwere observedattheNyamapande borderpost. kits) werenotavailable, and therewas noprovisionforyellowfevervaccinations. A lackofisolation staff lacked training andupdates ontheIHRrequirements. Basicequipment(e.g. water andfoodsampling border ofZimbabweandMozambique. These entrypointswerefoundtobeunder-staffed, andexisting mission visitedRobertGabrielMugabeInternational Airport andtheNyamapande groundcrossingatthe monitoring andevaluation oftheabilitytorespond topublichealtheventsatthePoEs. ExpertsoftheJEE coordination betweenallrelevant stakeholders, developavectorcontrolprogram, andconductperiodic Health Events of International Concern (PHEICs) occurring at points of entry. There is need to strengthen Capacity Assessment Tool norestablishedtheanypublichealthemergencyplansforrespondingtoPublic Despite theseestablishedcapacitiesallthedesignatedPoEs haveneitherbeenassessedusingtheIHRCore animal products, andhumanremainsaremonitoredsubjecttoinspections. well positioned health desks. Import and export of various products including food, chemicals, animals and infrared thermalscannersareusedforentryscreeningoftravellers. All threeinternationalairportshave the inspectionofPoE facilities. There aretrained personnelfortheinspectionofconveyances, andhandheld environments for travellers. These include programs for monitoring food safety, water quality control, and The majorityof PoEs, especiallythose identified for designation, haveprograms inplace toensure safe other sectorsatpointsofentry, includingImmigration, Security, Environment, Chemical, and Animal Health. three internationalairportsand11ground-crossings. There isstrongcollaboration between theHealthand further developmenttowards fulfillingcorecapacityrequirementsundertheIHR(2005). These include Zimbabwe hasidentified14outof17pointsentry(PoE) intothecountrytobeformallydesignatedfor Zimbabwelevelofcapabilities Target required tomanageavariety ofpublichealthrisks. a StateParty maydesignategroundcrossings), whichwillimplementspecificpublichealthmeasures capacities atdesignatedinternationalairportsandports(andwherejustifiedforpublichealthreasons, of healthmeasurestopreventinternationalspreaddiseases. StatesParties arerequiredtomaintaincore All corecapacitiesandpotentialhazardsapplyto “points ofentry” andthusenabletheeffectiveapplication Introduction Points of entry ENTRY OF POINTS AND HAZARDS IHR-RELATED OTHER justified for public health reasons, a State Party may designate ground crossings) that implement specific specific implement that 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 47 of IHR Core Capacities of the Republic of Zimbabwe OTHER 48 OTHER

Joint External Evaluation • • • • • Recommendations forpriorityactions • • • • • • • strengthening/challenges need that Areas • • • • practices Strengths/best PoE.1 Routinecapacitiesestablishedatpointsofentry–Score 2 Indicators andscores simulations, and audits. Periodically monitor and evaluate emergency response at PoEs through desk and after-action reviews, points of entry. at response emergency and screening conduct to personnel qualified and trained adequately Deploy Crossings. Ground and Airports Ports, at Control and Surveillance Vector Develop and implement control avector programme at the PoEs in line with theguidelines WHO on points of entry. Develop emergency preparedness and response plans with associated SOPs specific to the designated using the tool. WHO and ground-crossings ports, designation for assessment the airports, of core an IHR capacity Conduct (2005) at the PoEs are lacking. Relevant health and SoPs port operational guidelines implementation to support activities of IHR All screening, PoEs conductentry but there is no exit screening of travellers. awaiting transfer to isolation facilities, is severely constrained. Availability of holding areas, for humans and animals suspected of harbouring infectious diseases and airports. international There is need to establish standby transport arrangements for transfer of ill travellers at the larger about public health measures under the IHR that among the are staff available. The at critical PoEs is of compounded shortage staff further by alack of training and updated knowledge Vaccination for services yellow fever and aprogramme for control vector at PoEs is currently lacking. travellers. Ground crossings do not have aprovision for Health at immigration Desks control for screening project. (CAPSCA) Aviation the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil The Civil Aviation and Health the of Authority Port Zimbabwe authorities (CAAZ) both participate in available. are conveyances and parcels, protective equipment (PPEs) and chlorine for disinfection of contaminated baggage, cargo, postal There are trained personnel at all designated PoEs for the inspection of conveyances; and personal the PoEs are functioning. Programs for the inspection of facilities, food establishments, waste management, and rest rooms at monitoring of human remains at the PoEs. international have airports well-positioned health assessments. to desks perform There is aregister for Infrared thermometers are available at all designated PoEs for the assessment of travellers. All • • • • strengthening/challenges need that Areas • • • practices Strengths/best PoE.2 Effectivepublichealthresponse atpointsofentry–Score 1 facilities near PoEs need to strengthened be to manage ill travellers. Capacities, in termsequipment, of staffing, and ambulance at services designated referral health toAbility to respond apublic effectively health emergency at PoEs needs to evaluated. be conveyances. affected need toSoPs developed be for the assessment and referral of ill travellers and decontamination of developed. be to needs emergency, an to responding for stakeholders A specific public health emergency plan for withPoEs, defined roles and responsibilities of various decontamination. and There are available SoPs for formulation of chlorine solutions of concentration varying for disinfection also discussed. Each PoE has multisectoral committees and security and meetings where health related matters are vicinity. Designated PoEs have access to areferral system linked to local government health facilities in the 49 of IHR Core Capacities of the Republic of Zimbabwe OTHER 50 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 Target effective communicationandcollaboration amongthesectorsresponsibleforsafety. that StateParties needtohavesurveillanceandresponsecapacitymanagechemicalriskorevents other sectorsresponsibleforchemicalsafety, industries, transportation andsafedisposal. This wouldentail Timely detectionandeffectiveresponseofpotentialchemicalrisksand/oreventsrequirecollaboration with Introduction eventsChemical • • • • Recommendations forpriorityactions known toresultintheunintentionaldeathsoflivestock. practices whichincludeinappropriatestorage ofchemicals, lackofaccesscontrol, anddambreaches Agency. Affected sites such assaltlicks were decontaminatedtoobviateany residual risk. Poor mining Department of Veterinary Service, theParks and Wildlife Authority, andtheEnvironmentalManagement the illegaluseofchemicals, havebeenrecorded. Sucheventshavebeenpromptlyattendedtobythe activities wherecyanide isusedtokillelephantsandrhinos. Hundredsofanimal deaths, attributedto transportation, themajorchemicalsafetyeventsincountryhavebeenlargelyrestricted topoaching as wellas, actualandprojecteddemand. Although scores of localisedchemicaleventsoccurduring in goldextraction. These assessmentsincludetakinginventoryofimportation, useanddisposalcapacities, been undertaken throughthisenablinglegislationforprioritychemicalssuchascyanide, akey raw material Although nobaselinepublichealthassessmentshavebeenundertaken, chemicalsafetyassessmentshave Act -eachwithitsownancillarylegislation. enactments suchastheEnvironmentalManagement Act, theFactories and Works Act, andthe Agriculture Convention onMercury. These conventionshavebeenincorporated intodomesticlawthroughvarious Depleting Substances. The countryhasalsosignedandisintheprocessofratifying theMinamata (ILO) Conventions 170 and 174. Inaddition, the countryisaparty to the MontrealProtocolon Ozone Rotterdam, Stockholm, Vienna, andBamako Conventions, aswellas, theInternationalLabourOrganization Zimbabwe ispartytoseveral multilateral agreementsrelating tochemicaleventsincludingtheBasel, Zimbabwelevelofcapabilities 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. disposal. safe and transportation Strengthen for chemical capacity screening as points-of-entry. approach. Develop relevant guidelines and manual on chemical management safety in the spirit of the One Health safety. Develop and operationalize amultisectoral national strategy and emergency response plan on chemical Conduct baseline public health assessments regarding chemical safety. • • • strengthening/challenges need that Areas • • practices Strengths/best CE.2 Enablingenvironment inplaceformanagementofchemicalevents–Score 1 • • • • • • strengthening/challenges need that Areas • • • • • • practices Strengths/best events oremergencies –Score 2 CE.1 Mechanismsestablishedandfunctioningfordetectingresponding tochemical Indicators andscores relation to chemical safety. chemical to relation There is need for anational coordinating and body asentinel chemical event monitoring system, in Absence of anational strategy on chemical that safety is based on the One Health approach. undertaken for chemical events in safety the past five years. No baseline public health assessment, that considers morbidity, mortality, and biomarkers, has been improvement. continuous Presence of regular cross-sectoral Border Efficiency Management System (BEMS) meetings for protection. environmental and health, occupational is by supported awell-developed institutional framework. Key covered sectors include public and Presence of a comprehensive of legislation body covering the monitoring of chemical events, which human resources at the grassroots trained in the management of chemical spills. Absence of relevant guidelines, manual, and SOPs for chemical in the safety chemical sector. Inadequate ambient of Lack air monitoring quality system. forNeed decentralization of laboratory analytical to services provincial and district levels. equipment. maintenance of and Inadequate financial resources for the purchase equipmentof (e.g.HAZCHEM units) and calibrationthe manned. are Expansion of chemicals control at designated (PoEs), points of entry as only six out of seventeen PoEs resources. Limited in the capacity established Poison Centers in terms of equipment, infrastructure, and human by the Ministry of Health and Local Authorities. Presence of afunctional system for monitoring consumer such samples as products foodstuff collected Transportation. Availability of Emergency Response Guidelines which have been adapted from the US Department of Guidelines and procedures are in place for the monitoring of chemicals at six major points of entry. basis. monthly a parameters physicochemical most urban centres. additional An 385 monitoring points have been established which monitor 27 environmentalAn monitoring programme is in place which includes drinking water surveillance in mines; program for monitoring inspection vehicle emissions. Presence of soil quality monitoring mechanisms in high risk areas such as the environs of chromium Agency, and the Government Analyst) for testing and confirmation of chemical hazards. Presence of three laboratories (attached to the Veterinary the Services, Environmental Management 51 of IHR Core Capacities of the Republic of Zimbabwe OTHER 52 OTHER

Joint External Evaluation States Parties with surveillance and response capacity for radiological and nuclear hazards/events/ nuclear and radiological for capacity response and surveillance with Parties States Target responsible forradiation emergencymanagement. potential radiological and nuclear hazards/events/emergencies are required in collaboration with sectors To counterradiological andnuclearemergencies, timelydetectionandaneffectiveresponsetowards Introduction Radiation emergencies management facilityintheoutskirts ofHarare City. radiation sources and radiation waste management. To this end, the country is building a radiation waste IAEA. This event provided an opportunity to strengthen the existing capacity, including better storage of storage facilities and was handled successfullywithinthreemonths, withtechnical assistancefromthe simulations. In2016, aradiological emergencyoccurredinHarare involvingtheMinistryof Transport There isadraft EmergencyPreparedness andResponse(EPR)planthatprovidesforperiodicdrills assessment ofanapplicationforauthorizationtouseradiation sources. the radiation risks. These measuresaresubjecttoapproval bytheregulatoraspartofreviewand to document and regularly review emergency preparedness and response measures commensurate with All regulatedfacilitiesareobligedbyregulatoryrequirements underStatutoryInstrument62of2011 use ofradiation sources, complianceassurance inspections, aswellas, enforcementagainst violations. emergency preparednessandresponse. This isbeingdoneintheframework ofauthorization forthe There isanon-goingsurveillanceprogramme fortheuseofradiation technologieswhichencompasses installation byendof2018atmajorpointsentry. and radioactive materialsinandoutofthecounty. Portable detectionequipmenthasbeenprocuredfor the Integrated NuclearSecuritySupportPlan. The planwas developedtodetectthemovementofnuclear Nuclear SecurityDetection Architecture Strategy targetingkey portsofentryandstrategic locationsunder With supportfromInternational Atomic Energy Agency (IAEA), thecountryiscurrentlyimplementinga safety standards. Radiation protectionregulationsarecurrentlybeingrevisedtoincorporate provisions ofinternational on safetyandsecurityofradiation sourceswhichprovidesacoordinationmechanismfor allstakeholders. strategic plan(2014-2018)whichisuptodateandbeingimplemented. There isalsoanationalcommittee preparedness andresponsetoradiological emergencies. The operations areguidedbyaradiation safety Its functionsincludeauthorizationandinspectionofradiation practices andfacilities, aswellas, emergency Office inBulawayo. from theharmfuleffectsofradiation. The Authority isheadquarteredinHarare withasouthernRegional Radiation Protection Act [Chapter15:15]of2004--withamission to protectpeopleandtheenvironment oversees allaspectsofradiation control. The RPAZ was establishedthroughan Act ofParliament –the The RadiationProtection Authority ofZimbabwe(RPAZ) isanindependentandcompetentregulator that Zimbabwelevelofcapabilities emergencies. This requires effective communication and collaboration among the sectors responsible for for responsible sectors the among collaboration and communication effective requires This emergencies. radiological and nuclear emergency management. management. emergency nuclear and radiological • • • • • • practices Strengths/best and nuclearemergencies –Score 2 RE.1 Mechanismsestablishedandfunctioningfordetectingresponding toradiological Indicators andscores • • • • • Recommendations forpriorityactions national andinternationalstandards. (IAEA and International Air Transport Association guidelines) has enabled RPAZ to conform to acceptable Adoption anduseofinternationalguidelinesfortransport ofradioactive materialandwaste management for potentialradiation hazards. for RPAZ tomobilisequicklyincaseofemergenciesandthe Authority doesnotmonitorconsumergoods lack ofin-countrylaboratory capacityforsystematicanalyses. There arealsonodedicatedemergencyfunds challenges suchasinadequatehumanresourcecapacity(only30%ofapprovedpostsestablished)anda While RPAZ hasdevelopedsignificantcapacityfor radiation safetyregulation, itsuffersfromseveral daunting IHR focalpoint. exist forinterestedparties, thereisneedforformalagreementsbetweenstrategic stakeholders andthe referral, transport, andtreatmentofaffectedindividuals. Thus, althoughsomecoordinationmechanisms engagement isstillinformal. There isnodocumentedarrangement withhealthfacilitiesorhospitalsfor and ZimbabweRepublicPolice. There iscollaboration betweenRPAZ andtheMinistryofHealth, butthe To strengthencoordination, RPAZ hassignedMoUswithagencieslike theZimbabweRevenue Authority The country has The country adopted the International Atomic guidelines Energy (IAEA) Agency for EPR. risks. radiation the with commensurate measures response and preparedness emergency All regulated facilities are obliged by regulatory requirements to document and regularly review EPR arrangements. encompasses RPAZ has an on-going surveillance programme for the use of radiation technologies which also manage the risk of illicit trafficking of radioactive materials. isThe country implementing acomprehensive nuclear detection architecture security strategy to established. has been parties EPRA draft plan has been development and amechanism for coordination among various interested EPR. hasThe country the legal and regulatory framework for radiation in place, safety which encompasses Implement monitoring consumer of for radiation goods safety. Plan and conductsimulation exercises and drills on radiation safety. for testing training. and staff RPAZbetween and regional and international bodies/centres for sharing capacities e.g. laboratories cooperation, and understanding of memoranda including arrangements, document Formalize and stakeholders. relevant local other and agencies, government facilities, healthcare referral with understanding of memoranda including Formalize arrangements RPAZ between and key stakeholders in radiation and IHR safety (2005), Finalize and fast-track approval of the national Epidemic Preparedness and Response Plan. 53 of IHR Core Capacities of the Republic of Zimbabwe OTHER 54 OTHER

Joint External Evaluation RE.2 Enablingenvironment inplaceformanagementofradiation emergencies –Score 1 • • • • strengthening/challenges need that Areas • • • • • strengthening/challenges need that Areas • • • • • • • practices Strengths/best which can avail of such funds in the event of an emergency. No emergency fund has been established to deal with radiation emergencies, nor do structures exist documented arrangements for the provision of such with facilities aservice in neighboring countries. does notThe country have laboratory for testing capacity radio-nuclide materials and there are no consumers. There is no monitoring at present in of foodstuffs radioactivity thereby presenting aradiation risk to to address the gap in required and available staff. radiological monitoring equipment at critical sites like and POEs hiring of competent for the RPAZ staff Inadequate funding for the regulatory to body conduct training of early responders, to procure department, poisons centres, and the IHR focal point EPR for arrangements. effective forNeed strengthening collaborations the radiation between authority and meteorology safety before a response. Arrangements for financing emergency activities shouldbe clearly spelt out to reduce the time lag emergencies. radiation for designated be to need facilities healthcare There is need for the training of medical specialists to deal with radiation emergencies and referral laboratories for use when needed. needsThe country to build reference laboratory and /or capacity sign agreements with regional implementation. The National Emergency Prepared and Response Plan is yet to finalized be and approved for established. is being facility management waste radiation A Zimbabwe Police, with existing from the support Department of Civil Protection . Memoranda of understanding the regulatory exist between body, Zimbabwe Revenue and Authority RadiationSources. of Security A coordination mechanism for all stakeholder through exists the National Committee and on the Safety arePortable detectors available for distribution around in all the country. ports to illicit detect capacity flows of nuclear and radioactive materials throughstrategic ports. hasThe country developed aNuclear Detection Architecture Security which is aimed at building National surveillance of radioactive sources is covered by the regulatory framework and is ongoing. The regulatory body, RPAZ has acurrent strategic plan (2015-2018) to guide operations. its instability inthe country. workshop plannedforNovember 2017was howeverrescheduled toFebruary 2018duetopolitical assessment workbookwas submittedto WHO attheendofOctober2017. The externalevaluation The IHR/JEEself-assessment forZimbabwewas conducted inSeptember-October2017, andtheself- Preparation andimplementation ofthemission outcome; thiswillbenotedinthefinalreportalongwith thejustificationforeachparty’s position. country experts, oramongtheexternal, oramongthe hostcountryexperts, theJEEteamleadwilldecide Should therebesignificantandirreconcilabledisagreement betweentheexternalteammembersandhost aspects ofthefinalreportfindingsandrecommendations. should becollaborative, withJEEteammembersandhostcountryexpertsseekingfullagreementonall scores, thestrengths, theareasthatneedstrengthening, bestpractices, challengesandthepriorityactions The JEEprocessisapeer-to-peer review. The entireexternalevaluation, includingdiscussionsaroundthe The JEEprocess providing baselinedatatosupportZimbabwe’s effortstoreformandimprovetheirpublic healthsecurity. To assess Zimbabwe’s capacities and capabilities relevant to the 19 technical areas of the JEE tool for Objective • • • • • • • • • • • • • • Mission team members: Harare, Zimbabwe; 19–23February 2018. Mission placeanddates 1:Appendix JEE background Chadia Wannous, Sweden, Towards aSafer World Network Roland Wango, Senegal, WHO RegionalOfficefor Africa Mattew Kol Tut, SouthSudan, MinistryofHealth Satyajit Sarkar, India, WHO Headquarters(consultant) Abiodun Ogunniyi, Nigeria, NigeriaCentreforDiseaseControl Alice Ladu, SouthSudan, WHO CountryOffice Fredrick Kivaria, Kenya, Food and Agriculture OrganizationoftheUnitedNations(FAO) Remidius Kakulu, Tanzania, MinistryofHealth Jerker Jonsson, Sweden, PublicHealth Agency ofSweden Richard GarfieldRichard, USA, UnitedStatesCentersforDiseaseControlandPrevention Hichem Bouzghaia, Tunisia, World Organizationfor Animal Health(OIE) Maureen Bartee, USA, UnitedStatesCentersforDiseaseControlandPrevention Sofonias Getachew Asrat, Ethiopia, WHO CountryOffice(teamco-lead) Athman Mwatondo, Kenya, MinistryofHealth(teamlead) 55 of IHR Core Capacities of the Republic of Zimbabwe 56

Joint External Evaluation • • • • • • Limitations andassumptions evaluation mission. Country OfficeforZimbabwe, and WHOHeadquartersallcollaborated closelytoensurethesuccessof for theweekofmission. The nationalfocalpoints, the WHO RegionalOfficefor Africa, the WHO discussions withnationalfocalpointsandthe WHO CountryOfficetofinalizelogisticalarrangements arrival, theagendaandfurtherdetailsofJEEmissionwererefined. Roland Wango alsohelddetailed on themultipleteleconferencesheldbetweenRoland Wango andthe WHO Country Officepriortohis JEE mission. Duringthediscussions, allnationalstakeholders werebriefedontheIHRandJEEs. Building visited Zimbabweshortlypriorthearrival oftheevaluation teaminFebruary 2018, fordiscussionsonthe Roland Wango fromtheDakarHubof WHO EmergenciesProgram, WHO RegionalOfficefor Africa, • Participating institutions: Zimbabwe. Dr. IsaacPhiri, DeputyDirector, EpidemiologyandDiseaseControl, MinistryofHealthandChildCare, Zimbabwe leadrepresentative: andinstitutions participants Key hostcountry » Ministry of Tourism andHospitalityIndustry » » » Ministry of Agriculture, Mechanization andIrrigationDevelopment » » Ministry ofEnvironment, Water andClimate the evaluation team. This isapeer-to-peer review. verified butwillbediscussedandtheevaluation rating mutuallyagreedtobythehostcountryand The evaluation isnotjustanaudit. InformationprovidedbyZimbabwewillnotbeindependently It isassumedthattheresultsofthisevaluation willbepublicallyavailable. could bemanaged. The evaluation was limitedtooneweek, whichlimitedtheamountanddepthofinformationthat » » » » » » » Ministry ofHealthandChildCare » » » » » » » » » » » » » Zimbabwe Tourism Authority Zimbabwe Central Veterinary Laboratory Division of Veterinary FieldServices Department of Veterinary and LivestockServices Zimbabwe Parks and Wildlife Management Authority Management Agency Environmental Health Information Food Safety Health PromotionUnit Laboratory Government Analyst National MicrobiologyReferenceLaboratory Department ofEnvironmentalHealth Department ofEpidemiologyandDiseaseControl • • • • • • • • • • • • • • • IHR coordination, communicationandadvocacy • • • • • • • • National legislation, policyandfinancing during theevaluation. of thehealthsysteminZimbabweandoneach19technicalareasweremadebyteam The documentslistedbelowinformedthe Zimbabwe JEE process. Additionally, presentationsonan overview provided documentation by hostcountry Supporting • WHO CountryOffice, Zimbabwe The President’s Department City HealthHarare Radiation Protection Authority ofZimbabwe Zimbabwe of Civil AviationAuthority Ministry ofPrimaryandSecondaryEducation Ministry of Transport andInfrastructure Development » » Points ofEntry » Zimbabwe National Action Committeeon Water, Sanitation, andHygiene(WASH) Minutes ofIACCH meetings IHR NationalFocal Point Assessment Report, 2016 Highly Pathogenic Avian Influenza(HPAI H5N8)ResponseReportandPlan Guidelines andplansforyellow fever, typhoidfever, andcholera control(drafts) IHR reportstothe World Health Assembly. OIE Reports(World Animal HealthInformationSystem- WAHIS) Dairy Act Food andFood Standards Act Port Healthregulations The Zimbabwenationalsanitationandhygienepolicy Strategy toaccelerate accesstosanitationandhygiene National water policy Public HealthBill(underreview), 2017 Public Health Act (Ch. 15:09), 1924 » » Ministry ofDefence » » » » » Nyamapande BorderControlPost International Airport Harare WASH NationalCoordinationUnit– WASH Zimbabwe UniformedServices Zimbabwe DefenceServices 57 of IHR Core Capacities of the Republic of Zimbabwe 58

Joint External Evaluation • • • • • Zoonotic diseases • • Antimicrobial resistance • National laboratory system • • • • • • immunization • • • • • • • • • Biosafety andbiosecurity • Food safety Zimbabwe Anthrax ControlGuidelinesinHumansand Animals, 2ndEdition-May2012 Animal Health Act [Chapter19:01]. OIE PVS Veterinary LegislationIdentificationMissionReport, 2015 OIE PVSGap Analysis report, 2014 OIE PVSassessmentreport, 2009 Situation Analysis of Antimicrobial UseandResistanceinHumans Animals inZimbabwe(2017) Zimbabwe OneHealth Antimicrobial ResistanceNational Action Plan(2017-2021) N/A up CampaignCombinedwith Assessment ofRoutineImmunization, 2015 Report onEvaluation ofCoverage Achieved duringZimbabweMeasles/Rubellaand Vitamin A Catch- WHO immunizationcoverage data forZimbabwe2005to2016 Zimbabwe Demographic andHealth Survey(ZDHS), 2015 WHO (March2010) A proposaltorespondandcontroltheongoingmeasles outbreakinZimbabwebyUNICEFand Zimbabwe ExpandedProgramme onImmunization, comprehensivemulti-yearplan2015-2019 Zimbabwe ComprehensiveImmunizationProgram Review2016 Lab SafetyManual National BiosafetyFramework National BiotechnologyPolicy, 2005 Biotechnology AuthorityAct National Accident Book Lab Registerfordangerouspathogenshousedinthecountry. Cartagena ProtocolonBiosafety. OIE PVSGap Analysis report, 2014 OIE PVSassessmentreport, 2009 Food andFood Standards Act

• • Linking publichealth andsecurityauthorities • • Emergency response operations • • • • • • • • • • • • Preparedness • • Workforce development • Reporting • • • • Real-time surveillance Zimbabwe EmergencyPreparedness andResponse(EPR)Plan, 2011 Zimbabwe CivilProtection Act 1989andCivilProtectionBill 2011 Minutes ofmeetingsfromEOCmobilizationsforCholera. Public HealthEmergencyOperational Guide, 2011. https://www.un.org/disarmament/wmd/secretary-general-mechanism/ Secretary-General’s MechanismforInvestigationof Alleged UseofChemicalandBiological Weapons text (Biological) and Toxin Weapons andontheirDestructionhttp://disarmament.un.org/treaties/t/bwc/ Convention ontheProhibitionofDevelopment, ProductionandStockpilingofBacteriological Zimbabwe CustomsandExcise Act Zimbabwe Importationand Transit ofHazardousSubstances and Waste (SI77/2009) Zimbabwe Hazardous Waste ManagementRegulations(SI10/2007) Zimbabwe HazardousSubstances, Pesticides andother Toxic Substances Regulations(SI12/2007) Zimbabwe CivilProtection Act 1989andCivilProtectionBill2011 Zimbabwe INFORMriskindex: http://www.inform-index.org/Countries/Country-profiles/iso3/ZWE Cholera ControlGuidelines Typhoid ControlGuidelines Ebola Viral DiseasePreparednessPlan Zimbabwe EmergencyPreparednessandResponse(EPR)Plan, 2011 Human ResourcesforHealthStrategy 2017-2020 Human ResourcesforHealthPolicy N/A Zimbabwe’s E-HealthStrategy 2012-2017(draft) Zimbabwe NationalHealthInformationSystemStrategy 2009-2014(anewplanisinprocessnow) action Examples oftheweeklyreportincludingcasedefinitionsforreportingandthresholdsalert Integrated DiseaseSurveillanceandResponse(IDSR) Technical Guidelines, WHO, 2010 59 of IHR Core Capacities of the Republic of Zimbabwe 60

Joint External Evaluation • • • • • • • • Points ofentry • • • Risk communication • Medical countermeasures andpersonnel deployment • • • • • Radiation emergencies • • • • • • • • • Chemical events Crossings, 2009. IHR-Assessment Tool forCoreCapacityRequirementsatDesignated Airports, Ports andGround WHO guidelineson Vector ControlatPorts, Airport and GroundCrossings, 2016 Port HealthRegulationsSI200of1996 Public Health Act (15:09) Zimbabwe disease-specificguidelines(EVD, H1N1, Cholera, Typhoid,) Zimbabwe EmergencyPreparednessandResponse(EPR)Plan, 2011 Port HealthStandardOperating Procedures Harare Airport EmergencyPreparednessandResponsePlan Knowledge, Attitude, andPractice SurveyRelatedto Typhoid Fever, UNICEFZimbabwe Bi-Weekly MediaReports Zimbabwe CommunicationsStrategy forEbola, 2015 N/A http://rpaz.co.zw/ Radiation Protection Authority ofZimbabweStrategic Plan(2015-2018). Draft NationalEmergencyandPreparedness Plan. Radiation Protection(SafetyandSecurityofSources)Regulations (SI62/2011). Radiation Protection Act [Chapter 15:15]. Pesticides controlregulations Fertilizers, Farm Feeds, andRemedies Act Factories and Works Regulation(RGN263/1976; SI286/1982) and WorksFactories Act National SocialSecurity Act Customs andExcise Act Revenue AuthorityAct Zimbabwe Food andFood Standards Act Environmental Management Act (SI10/2007; SI12/2007; SI72/2009; SI6/2007) 61 of IHR Core Capacities of the Republic of Zimbabwe WHO/WHE/CPI/REP/2018.24