Joint external evaluation process: bringing multiple sectors together for global health security
Authors: Nirmal Kandel, Rajesh Sreedharan, Stella Chungong, Karen Sliter, Simo Nikkari, Kashef Ijaz, Guenael RM Rodier
Journal: The Lancet Global Health (2017)

The International Health Regulations (2005; IHR) is a legally binding instrument with a purpose of "preventing, protecting against, controlling and providing a public health response to the international spread of diseases in ways that are commensurate with and restricted to public health risks.1WHOInternational Health Regulations (2005). 3rd Edn. World Health Organization, Geneva2016http://apps.who.int/iris/bitstream/10665/246107/1/9789241580496-eng.pdf?ua=1Google Scholar The IHR Review Committee on Second Extension recommended to transition from self-evaluations to approaches that combine self-evaluation, peer review, and voluntary external evaluation, thus the IHR Monitoring and Evaluation Framework was developed, with the Joint External Evaluation (JEE) being one of its components.2WHOImplementation of the International Health Regulations (2005): report of the Review Committee on Second Extensions for establishing national Public Health Capacities and on IHR implementation. EB136/22 Add.1. World Health Organization, Geneva2015http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_22Add1-en.pdfGoogle Scholar, 3WHODevelopment, monitoring and evaluation of functional core capacity for implementing the International Health Regulations (2005): concept note. World Health Organization, Geneva2015http://www.who.int/ihr/publications/concept_note_201507/en/Google Scholar, 4WHOIHR (2005) Monitoring and Evaluation Framework. Joint External Evaluation tool. World Health Organization, Geneva2016http://apps.who.int/iris/bitstream/10665/204368/1/9789241510172_eng.pdf?ua=1Google Scholar A key aspect of this approach is the recognition that effective management of IHR (2005) capacities for health security requires the involvement of several key sectors, including human, animal, and environmental health, wildlife, security, law enforcement, finance, and others.4WHOIHR (2005) Monitoring and Evaluation Framework. Joint External Evaluation tool. World Health Organization, Geneva2016http://apps.who.int/iris/bitstream/10665/204368/1/9789241510172_eng.pdf?ua=1Google Scholar The aim of JEE is to support countries' capacities to prevent public health events, detect signals of unusual health events early, rapidly mount an effective multisectoral response, and, when appropriate, request international mobilisation.4WHOIHR (2005) Monitoring and Evaluation Framework. Joint External Evaluation tool. World Health Organization, Geneva2016http://apps.who.int/iris/bitstream/10665/204368/1/9789241510172_eng.pdf?ua=1Google Scholar It begins with an internal, whole-of-government self-evaluation using other relevant assessments (such as the animal health Performance of Veterinary Services [PVS]) with the involvement of multisectoral stakeholders. During the JEE mission phase, a multisectoral group of internationally recognised experts works "peer to peer" with the multisectoral group of host country experts to jointly evaluate the host country's capacities. The voluntary, peer to peer, fully collaborative, and multisectoral approach to external evaluation has led to strong country ownership of the final report and its recommendations. The priority actions across 19 technical areas easily translate into an integrated national action plan.5WHOIHR Joint external evaluation–Country Implementation Guide. World Health Organization, Geneva2016Google Scholar Since the launch of JEE, as of May, 2017, 43 countries have already completed the JEE, and at least 30 are in the pipeline for 2016–17. Furthermore, three countries have developed and 19 countries are developing National Action Plans to implement the priority actions of the JEE. There is a tendency for each government sector to work in silos. Feedback from countries that have undergone the voluntary JEE process is that it has helped to establish and strengthen cooperation, coordination, and collaboration between different sectors and agencies. A key requirement of the JEE is the inclusion of multiple sectors during both the self-evaluation and the external evaluation.5WHOIHR Joint external evaluation–Country Implementation Guide. World Health Organization, Geneva2016Google Scholar Indicators, attributes, and questions have been developed in such a way that it is impossible to determine the baseline capacities and develop priority actions without the involvement of other sectors that are relevant to technical areas. The JEE has succeeded in bringing together national representatives from key sectors, including human and animal health, agriculture, wildlife, finance, defence, security, environment, communication, disaster management board, transportation, customs, civil aviation, universities or institutes, and political leadership.5WHOIHR Joint external evaluation–Country Implementation Guide. World Health Organization, Geneva2016Google Scholar Many international agencies, stakeholders, and partners have also combined their efforts to coordinate and collaborate for the common goal of implementation of IHR (2005) capacities in support of global health security. Many national institutes and agencies, international organisations, and donors are key partners, including many governments, the World Organization for Animal Health, the Food and Agriculture Organization of the United Unions, the International Atomic Energy Agency, the World Bank, the Bill & Melinda Gates Foundation, and other public and private partners. Paradigm shifts have been observed during JEE missions in regard to how sectors relate to each other. For example, a Provincial Animal Health Officer of Pakistan noted: "This is the first time we are meeting together, and we realised the concept of working for the people of Baluchistan and we commit to support and work together with the provincial health office". During the mission briefing, he committed to immediately provide veterinary staff to a provincial health office. In another instance, during the US mission, one of the representatives from outside of health sector mentioned: "We thought that we had an excellent coordination and collaboration mechanism in place between sectors but while going through self-evaluation process and discussion, we realised that we need to collaborate and coordinate with other sectors on many other things and this has provided a platform to initiate". A WHO Regional Office representative noted that "With strong emphasis on multisectoral coordination and cooperation in line with all-hazard, whole-of-government approach of the IHR, Joint External Evaluations have proven to be able to foster multisectoral dialogue, raise awareness among non-health sectors on respective roles and responsibilities within IHR, and jointly discuss existing weaknesses within national multisectoral response and ways to jointly address them". The JEE tool and process have achieved broad international support. As a result, the JEE country evaluation process is catalysing dialogue between sectors and helping shift the paradigm from an approach primarily oriented towards human health to a more holistic and integrated, multisectoral, One Health or Whole-of-government approach.6Karesh WB Cook RA One world-one health.Clin Med. 2009; 9: 259-260Crossref PubMed Scopus (18) Google Scholar Plans alone without implementation serve little purpose and developing National Action Plans is crucial. Planning is everything and an essential element is to involve all relevant stakeholders in the planning process, identify their roles and responsibilities, and ensure a truly collaborative approach with joint prioritisation for national funding.7Kandel N Is there a business continuity plan for emergencies like an Ebola outbreak or other pandemics.J Bus Contin Emer Plan. 2015; 8: 295-298PubMed Google Scholar We declare no competing interests. We thank all countries who have volunteered for a JEE and partners and organisations whose support have been instrumental to the success of the external evaluations.