How can we strengthen the Joint External Evaluation?

To date more than 100 countries have carried out a Joint External Evaluation (JEE) as part of their Global Health Security programme. The JEE is a detailed effort to assess a country’s capacity to prevent, detect and respond to population health threats in 19 programmatic areas. To date no attempt has been made to determine the validity of these measures. We compare scores and commentary from the JEE in three countries to the strengths and weaknesses identified in the response to a subsequent large-scale outbreak in each of those countries. Relevant indicators were compared qualitatively, and scored as low, medium or in a high level of agreement between the JEE and the outbreak review in each of these three countries. Three reviewers independently reviewed each of the three countries. A high level of correspondence existed between score and text in the JEE and strengths and weaknesses identified in the review of an outbreak. In general, countries responded somewhat better than JEE scores indicated, but this appears to be due in part to JEE-related identification of weaknesses in that area. The improved response in large measure was due to more rapid requests for international assistance in these areas. It thus appears that even before systematic improvements are made in public health infrastructure that the JEE process may assist in improving outcomes in response to major outbreaks.

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PUBLIC HEALTH ENGLAND—CENTRE FOR RADIATION, CHEMICAL AND ENVIRONMENTAL HAZARDS (PHE-CRCE) EXTERNAL EXPERT EXPERIENCE IN THE JOINT EXTERNAL EVALUATION (JEE) MISSION FOR THE RADIATION EMERGENCIES TECHNICAL AREA

Radiation Protection Dosimetry ◽

10.1093/rpd/ncy142 ◽

2018 ◽

Vol 182 (1) ◽

pp. 3-8

Author(s):

Alexandre de Ruvo ◽

Duncan Cox

Keyword(s):

Public Health ◽

Environmental Hazards ◽

External Evaluation ◽

Radiation Chemical ◽

External Expert ◽

Joint External Evaluation ◽

Technical Area

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Military participation in health security: analysis of Joint External Evaluation mission reports and National Action Plans for Health Security

10.1101/2020.04.21.20073270 ◽

2020 ◽

Author(s):

Brett M. Forshey ◽

Alexandra K. Woodward ◽

Jose L. Sanchez ◽

Stephanie R. Petzing

Keyword(s):

Global Health ◽

Evaluation Process ◽

Core Area ◽

Action Plans ◽

External Evaluation ◽

Global Health Security ◽

Health Security ◽

Military Involvement ◽

Core Areas ◽

Joint External Evaluation

AbstractMilitaries across the world play an important but at times poorly defined and underappreciated role in global health security. For example, they are often called upon to support civilian authorities in humanitarian crises and to provide routine healthcare for civilians. Furthermore, military personnel are a unique population in a health security context, as they are highly mobile and often deploy to austere settings domestically and internationally, which may increase exposure to infectious diseases. Despite the role of militaries, few studies have systematically evaluated the involvement of militaries in global health security activities, including the Global Health Security Agenda (GHSA). To address this shortcoming, we analyzed Joint External Evaluation (JEE) mission reports (n=91) and National Action Plans for Health Security (n=11) that had been completed as of October 2019 (n=91) to determine the extent to which military organizations have been involved in the evaluation process, country military contributions to health security are accounted for, and specific recommendations are provided for the country’s military. For JEE reports, military involvement was highest for the “Respond” core area (73%) but much lower for the Prevent (36%) and Detect (30%) core areas. Similarly, 73% of NAPHS documents mentioned military involvement in the Respond core area, compared to 27% and 36% for Prevent and Detect, respectively. Additionally, only 26% of JEE reports provide recommendations for the military in any of the core areas. Our results indicate the need to more fully incorporate military roles and contributions into the GHSA framework and other health security activities in order to improve national capabilities to prevent, detect, and respond to infectious disease threats.

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Global Health Security Preparedness and Response: An Analysis of the Relationship between Joint External Evaluation Scores and COVID-19 Response Performance

BMJ Open ◽

10.1136/bmjopen-2021-050052 ◽

2021 ◽

Vol 11 (12) ◽

pp. e050052

Author(s):

Laura Nguyen ◽

Morgan Sydney Brown ◽

Alexia Couture ◽

Sharanya Krishnan ◽

Mays Shamout ◽

...

Keyword(s):

Global Health ◽

Weighted Kappa ◽

Kappa Statistics ◽

External Evaluation ◽

Global Health Security ◽

Health Security ◽

Emergency Operations ◽

Response Capacity ◽

Response Performance ◽

Joint External Evaluation

ObjectivesThe COVID-19 pandemic has highlighted the importance and complexity of a country’s ability to effectively respond. The Joint External Evaluation (JEE) assessment was launched in 2016 to assess a country’s ability to prevent, detect and respond to public health emergencies. We examined whether JEE indicators could be used to predict a country’s COVID-19 response performance to tailor a country’s support more effectively.DesignFrom April to August 2020, we conducted interviews with Centers for Disease Control and Prevention country offices that requested COVID-19 support and previously completed the JEE (version 1.0). We used an assessment tool, the ‘Emergency Response Capacity Tool’ (ERCT), to assess COVID-19 response performance. We analysed 28 ERCT indicators aligned with eight JEE indicators to assess concordance and discordance using strict agreement and weighted kappa statistics. Generalised estimating equation (GEE) models were used to generate predicted probabilities for ERCT scores using JEE scores as the independent model variable.ResultsTwenty-three countries met inclusion criteria. Of the 163 indicators analysed, 42.3% of JEE and ERCT scores were in agreement (p value=0.02). The JEE indicator with the highest agreement (62%) was ‘Emergency Operations Center (EOC) operating procedures and plans’, while the lowest (16%) was ‘capacity to activate emergency operations’. Findings were consistent with weighted kappa statistics. In the GEE model, EOC operating procedures and plans had the highest predicted probability (0.86), while indicators concerning response strategy and coordination had the lowest (≤0.5).ConclusionsOverall, there was low agreement between JEE scores and COVID-19 response performance, with JEE scores often trending higher. JEE indicators concerning coordination and operations were least predictive of COVID-19 response performance, underscoring the importance of not inferring country response readiness from JEE scores alone. More in-depth country-specific investigations are likely needed to accurately estimate response capacity and tailor countries’ global health security activities.

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