Olubunmi Eyitayo Ojo
Olusola Francis Abioye
Olugbenga Joseph1- 1Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- 2Osun State Ministry of Health, Osogbo, Nigeria
The COVID-19 pandemic highlighted the urgent need to strengthen national health systems to better manage public health threats. The National Action Plan for Health Security (NAPHS) helps countries implement the International Health Regulations (IHR 2005) by building essential health security capacities. However, fragmented reporting and low prioritization hinder progress. To improve outcomes, systematic monitoring and evaluation (M&E) are essential for tracking progress, identifying gaps, and guiding decisions. Integrating real-time data, cross-sector coordination, and performance indicators into a unified M&E system enhances accountability and resource use. Institutionalizing NAPHS M&E across all IHR stakeholders and aligning it with national agendas will improve pandemic preparedness. The paper urges stronger political will, capacity building, and investment in health security monitoring to ensure resilience against future pandemics.
Highlights
● Countries resilient and effective preparation and response to public health threats can be improved by.
● Harmonization of NAPHS and stakeholders’ mandates and indicators.
● Streamlining reporting systems of NAPHS activities.
● Ensuring cross-sectoral coordination by IHR coordinating body. (National focal point/National IHR authority).
Introduction
The increasing frequency and scale of public health emergencies, such as the Ebola, Mpox, and Cholera outbreaks, the COVID-19 pandemic, earthquakes and floods, have underscored the necessity for robust health security frameworks worldwide. Central to these frameworks is the National Action Plan for Health Security (NAPHS), a strategic tool designed to enhance countries’ capacities to prevent, detect, and respond to health threats in alignment with the International Health Regulations (1).
Despite its importance, the optimal implementation of NAPHS has faced persistent challenges. A major barrier is the absence of harmonized, cross-sectoral indicators aligned with national mandates. This lack of standardization hampers progress tracking, comparability, and aggregation across countries. For example, One Health initiatives in West Africa have struggled due to unclear evaluation metrics within global health security frameworks (2, 3). In addition, fragmented reporting systems often driven by vertical programs and donor priorities create duplication, data silos, and inefficiencies. These systems overwhelm frontline workers and dilute resource effectiveness (4). Nigeria’s HIV monitoring and evaluation (M&E) system exemplifies this issue, where competing reporting mechanisms and sectoral rivalries undermined operational efficiency (2).
Other systemic constraints include the de-prioritization of health security activities, inadequate infrastructure, and a shortage of trained personnel with cross-sectoral expertise. In Sierra Leone, limited human resources and intersectoral coordination contributed to the spread of the 2014 Ebola outbreak and recurring threats such as Lassa fever, cholera, rabies, and mudslide-related illnesses. Furthermore, the absence of dedicated funding for NAPHS, such as during the 2018–2021 implementation phase—has hindered sustainability and impact (5).
Evidence shows that comprehensive M&E frameworks significantly enhance project outcomes and long-term success (6). When stakeholders are actively involved in designing and reviewing M&E systems, their sense of ownership increases, fostering smoother implementation and greater sustainability (7). Building on the IHR M&E framework, a systematic approach to monitoring NAPHS—from implementing ministries, departments, and agencies (MDAs/Stakeholders) to national-level assessments—is essential for identifying gaps, improving performance, and ensuring accountability (8).
Evolution and strategic framework of NAPHS
Definition of NAPHS
The National Action Plan for Health Security (NAPHS) is a country-led, multi-year planning process that accelerates the implementation of IHR core capacities. It adopts a One Health and whole-of-government approach to address all hazards. NAPHS translates recommendations from various health security assessments into actionable steps that enhance national preparedness and operational readiness (World Health Organization (WHO) (9).
In May 2015, the World Health Assembly adopted resolution WHA68.5, shifting IHR monitoring from exclusive self-assessment to a hybrid model that includes peer reviews and voluntary Joint External Evaluations (JEE). The JEE assesses compliance across 19 technical areas, assigning scores from 1 (no documented capacity) to 5 (sustained capacity). Countries that complete the JEE are expected to develop NAPHS to address identified gaps using an all-hazards and One Health lens (5).
Strategic framework for implementation
In response to feedback from countries, regions, and partners, WHO developed a flexible NAPHS Strategic Framework to guide development and implementation. This three-step model—inception, development, and implementation—helps countries prioritize actions to achieve health security. The framework aligns with existing national, regional, and global strategies, emphasizing integration with national health plans and sectoral policies. Importantly, countries retain the autonomy to adapt the framework to their unique contexts, selecting components and actions that best suit their needs. This flexibility supports multisectoral planning and fosters alignment across health, agriculture, environment, and other critical sectors (10).
Current innovative approaches to implementing NAPHS
Adoption of the One Health approach
The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, has proven vital in addressing health security challenges, particularly in tropical regions. In Malawi, this approach was integrated into the Health Sector Strategic Plan II (2017–2022) through the establishment of a One Health Surveillance Platform (OHSP). Built on the open-source District Health Information System 2 (DHIS2), the platform enabled real-time data sharing across sectors, significantly enhancing outbreak detection and response capabilities (11).
Strengthening multisectoral coordination
Effective NAPHS implementation hinges on strong coordination among diverse sectors. Sierra Leone exemplifies this through the creation of a NAPHS Coordination Committee, comprising representatives from various ministries and agencies. This committee facilitated regular review meetings led by technical area (TA) leads, ensuring that activities remained aligned with NAPHS objectives and promoting accountability. Such multisectoral coordination mechanisms are essential for tackling complex health security challenges (11).
Integration of Health Information Systems
Robust Health Information Systems (HIS) are crucial for the timely collection, analysis, and dissemination of data. Indonesia leveraged its pandemic preparedness experience to develop a logic model-based NAPHS, integrating HIS to monitor and evaluate health security capacities. Following the avian influenza A(H5N1) outbreaks in 2005, Indonesia undertook strategic reforms that significantly strengthened its IHR capacities. This integrated approach enabled the identification of systemic gaps and supported evidence-based decision-making (12).
IHR M & E framework: components and guiding principles
The IHR Monitoring and Evaluation Framework (IHR-MEF) as shown in Figure 1 provides a comprehensive, country-level overview of IHR implementation. It supports the development and monitoring of capacities to detect, assess, and maintain public health functions, fostering mutual accountability between States Parties and the WHO Secretariat. The framework promotes transparency through standardized reporting, sharing of best practices, and continuous dialogue.
Figure 1. The four components of the IHR monitoring and evaluation framework (World Health Organization, 2018).
The IHR-MEF employs both quantitative and qualitative methods for monitoring and includes mechanisms for periodic and continuous evaluations (13). It comprises four components:
● Mandatory State Party Annual Reporting to the World Health Assembly.
● The three Voluntary components:
○ After Action Review (AAR).
○ Simulation Exercises.
○ Joint External Evaluation (JEE).
Together, these components offer a uniform structure for assessing IHR implementation status and help countries identify areas for improvement while building trust and collaboration across borders.
The International Health Regulations (IHR) Monitoring and Evaluation Framework is guided by four key principles that ensure effective implementation and continuous improvement of health security capacities:
1. Mutual Accountability and Transparency:
The framework fosters mutual accountability and transparency among stakeholders. By promoting clear responsibilities and commitments, it builds trust, encourages cooperation, and strengthens confidence between States Parties.
2. Country Ownership and WHO Leadership and Active partnerships:
Sustainable capacity development under the IHR hinges on strong country ownership. WHO plays a central leadership role in monitoring progress, evaluating outcomes, and reporting. Many Member States require technical and financial support to assess, build, and maintain the core capacities defined by the IHR as essential public health functions.
3. Continuum from Assessment to Planning and Implementation
The IHR-MEF supports a seamless transition from capacity assessments to national planning and implementation. Identified gaps and recommendations should be addressed through a multisectoral National Action Plan for Health Security (NAPHS), aligned with the One Health approach. Effective implementation of these plans is critical for building operational readiness and resilience against public health threats.
4. Multisectoral Partnership
Establishing and sustaining IHR capacities is a national responsibility that requires collaboration across all relevant sectors, ministries, agencies, and government bodies. A coordinated, multisectoral approach ensures comprehensive implementation of IHR at the national level (14).
Global experiences in NAPHS monitoring and evaluation
Global experiences from countries such as Sierra Leone, Uganda, Pakistan, Cameroon, and Nigeria demonstrate that structured M&E processes can significantly enhance health security capacities. By adopting and refining these strategies, countries can build resilient health systems capable of withstanding future public health threats.
Sierra Leone
Between 2018 and 2021, Sierra Leone adopted a structured approach to NAPHS implementation. The country conducted annual State Party Annual Reporting (SPAR) and Joint External Evaluation (JEE) self-assessments, which informed the development of Annual Operational Plans (AOPs). These plans prioritized activities across 19 technical areas, with progress tracked through quarterly reviews and real-time online monitoring. This iterative process led to measurable improvements in health security, reflected in rising JEE scores over time (5).
Uganda
Uganda’s experience demonstrates the value of integrating self-assessment with operational planning. In 2021, the country conducted a multisectoral self-assessment using the JEE tool, resulting in a one-year operational plan that prioritized 72 specific activities. This targeted approach improved Uganda’s Ready Score by 20% between 2017 and 2021, demonstrating the impact of focused monitoring and evaluation (15).
Pakistan
Following its JEE, Pakistan developed a costed NAPHS with predefined goals, targets, and indicators aligned with the evaluation. This alignment enabled systematic progress tracking and informed subsequent assessments. Key lessons included the importance of multisectoral coordination, continuous monitoring, and mobilizing national resources to ensure sustainability (16).
Cameroon
Cameroon translated 84 JEE recommendations into prioritized activities using the WHO NAPHS framework and costing tool. This structured planning process guided resource allocation and informed policymakers of funding needs, underscoring the role of systematic M&E in strategic decision-making (17).
Nigeria
After its first JEE in 2017, Nigeria developed its inaugural NAPHS in 2018, based on identified gaps and capacities. To monitor implementation, the country deployed a NAPHS tracker that captures indicators by technical area, categorizing activities as “not done,” “ongoing,” or “completed.” Overseen by the IHR coordination team, the tracker is updated monthly by technical assistance leads and validated quarterly during IHR Technical Working Group (TWG) meetings (18).
Challenges in NAPHS monitoring and evaluation
Despite the progress made, countries face several challenges in systematically monitoring and evaluating NAPHS:
1. Data Limitations: Accurate assessment of health security capacities depends on reliable data collection and management systems. However, many countries face significant gaps in this area. Studies have shown that numerous costed NAPHS lack comprehensive datasets, resulting in an incomplete understanding of health security needs and priorities (19).
2. Resource Constraints: Limited financial and human resources pose a major obstacle to effective M&E implementation. For instance, Uganda’s initial NAPHS which included 264 broad activities, proved difficult to implement due to resource limitations. This challenge led to the development of a more focused operational plan, illustrating the need for realistic and scalable planning (15).
3. Multisectoral Coordination: Robust M&E requires seamless collaboration across multiple sectors—a goal that is often difficult to achieve. Pakistan’s experience highlighted the importance of engaging diverse ministries and stakeholders to ensure cohesive and integrated implementation of health security activities (16).
4. Sustainability: Long-term sustainability of M&E systems is essential for maintaining and enhancing health security frameworks. Countries must invest in institutional capacity building and secure consistent funding to ensure that M&E mechanisms remain functional and adaptive over time (20).
Systematic monitoring and evaluation of NAPHS
This innovative approach advocates for leveraging the existing Monitoring and Evaluation (M&E) units and tools within established Ministries, Departments, and Agencies (MDAs/Stakeholders) to avoid duplication and maximize resources. By aligning NAPHS activities with MDAs/Stakeholders’ mandates and workplans, countries can streamline implementation and reduce operational burdens (18). A well-integrated NAPHS and MDA workplan enables the development of a robust M&E framework and facilitates seamless routine data collection based on a clearly defined list of planned activities.
Key recommendations for effective integration
1. Embed NAPHS into Core MDAs/Stakeholders/Stakeholders Mandates and Workplans
MDAs/Stakeholders should go beyond peripheral contributions and fully integrate NAPHS into their core mandates. Effective collaboration among MDAs/Stakeholders with overlapping responsibilities is essential to prevent duplication, clarify leadership roles, and ensure accountability in implementation.
2. Develop a Unified Set of M&E Indicators
Establishing common, well-defined indicators is critical for consistent monitoring and evaluation. These indicators should align with IHR-MEF components while preserving the unique prerogatives of each MDA. Based on the integrated activity plan, MDAs/Stakeholders should generate a detailed list of relevant indicators for routine tracking.
3. Collect and Share data routinely
M&E units within implementing MDAs/Stakeholders should regularly compile progress updates on all activities. Data on NAPHS implementation should be shared monthly with the National IHR focal point or the particular country’s line of NAPHS reporting, referencing the integrated workplan and M&E plan.
4. Validate data regularly
Countries should utilize existing platforms, such as the IHR Technical Working Group (TWG) quarterly meetings, to validate shared or uploaded data. Validation should assess completeness, relevance, and quality, tailored to the country’s specific context.
This systematic approach provides a detailed, objective, and validated record of implementation progress. It ensures that data feeds directly into IHR-MEF components, enabling robust evaluations at the end of each operational year and during long-term assessments such as the Joint External Evaluation (JEE).
Conceptual framework: systematic monitoring and evaluation of NAPHS
This conceptual framework as shown in Figure 2 outlines a methodical M&E approach for NAPHS, leveraging existing M&E units and tools within implementing stakeholder agencies. It connects routine and NAPHS data collection and validation processes to the broader IHR-MEF components, ensuring coherence, efficiency, and accountability throughout the implementation cycle.
Figure 2. Conceptual framework: systematic monitoring and evaluation of NAPHS.
Conclusion
Strengthening health systems to prevent, detect, and respond to future pandemics necessitates innovative approaches in implementing NAPHS. Sustaining the One Health approach, enhancing multisectoral coordination, and integrating robust health information systems are pivotal strategies. Equally important is the establishment of systematic monitoring and evaluation mechanisms right from the implementing MDAs/stakeholders to the IHR MEF framework components to track progress, identify gaps, and drive continuous improvement.
Strengthening health systems through systematic monitoring and evaluation of NAPHS is not just a technical requirement—it is a strategic imperative. By harmonizing NAPHS and stakeholders’ mandates and indicators, streamlining reporting systems, and ensuring cross-sectoral coordination, countries can enhance their resilience against future public health threats. A robust M&E plan ensures that NAPHS implementation is effective, accountable, and adaptive—laying the foundation for a safer, healthier future.
Author contributions
OO: Project administration, Formal Analysis, Writing – original draft, Resources, Data curation, Visualization, Conceptualization, Writing – review & editing, Supervision, Methodology, Funding acquisition, Investigation, Validation, Software. OA: Conceptualization, Project administration, Supervision, Validation, Investigation, Writing – review & editing, Methodology, Funding acquisition, Formal Analysis, Writing – original draft, Data curation, Software, Visualization, Resources. OJ: Writing – review & editing, Validation. OI: Validation, Writing – review & editing, Methodology.
Funding
The author(s) declare that no financial support was received for the research, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Keywords: systematic, monitoring and evaluation (M&E)), NAPHS, integration, streamlined reporting
Citation: Ojo OE, Abioye OF, Joseph O and Ipadeola OB (2025) Strengthening health systems to prevent, detect, and respond to future pandemics: an innovative approach to implementing and systematically monitoring and evaluating the National Action Plan for Health Security. Front. Trop. Dis. 6:1720278. doi: 10.3389/fitd.2025.1720278
Received: 07 October 2025; Accepted: 31 October 2025;
Published: 26 November 2025.
Edited by:
Ian Njeru, Field Epidemiology Society of Kenya, KenyaReviewed by:
Edward Kurnia Setiawan Limijadi, Diponegoro University, IndonesiaRobert Musoke, World Health Organization, Sierra Leone
Copyright © 2025 Ojo, Abioye, Joseph and Ipadeola. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Olubunmi Eyitayo Ojo, b2x1YnVubWlvam8yMDAyQHlhaG9vLmNvbQ==; Olusola Francis Abioye, b2x1c29sYWFiaW95ZTE0QGdtYWlsLmNvbQ==