One hundred twenty-four indicators were identified that measured 16 elements that defined 7 domains of country-specific opportunities and challenges: political will, stakeholder involvement, culture, public health functionality, healthcare, laboratory and communication infrastructure. Thirty (24%) of the 124 indicators were chosen from the reporting requirements of the 2005 International Health Regulations. In the pilot, we found various positive and negative implementation characteristics in Uganda, Kenya, Tanzania, Afghanistan, Iraq and Pakistan.