Costing Framework for International Health Regulations (2005)

Rebecca Katz

, Vibhuti Haté, Sarah Kornblet, and Julie E. Fischer

Author affiliations: George Washington University, Washington, DC, USA (R. Katz); and Stimson Center, Washington (V. Haté, S. Kornblet, J.E. Fischer)

Abstract

The revised International Health Regulations (IHR [2005]) conferred new responsibilities on member states of the World Health Organization, requiring them to develop core capacities to detect, assess, report, and respond to public health emergencies. Many countries have not yet developed these capacities, and poor understanding of the associated costs have created a barrier to effectively marshaling assistance. To help national and international decision makers understand the inputs and associated costs of implementing the IHR (2005), we developed an IHR implementation strategy to serve as a framework for making preliminary estimates of fixed and operating costs associated with developing and sustaining IHR core capacities across an entire public health system. This tool lays the groundwork for modeling the costs of strengthening public health systems from the central to the peripheral level of an integrated health system, a key step in helping national health authorities define necessary actions and investments required for IHR compliance.

In 2005, the member states of the World Health Organization (WHO) recognized the need to overhaul international public health cooperation, and they revised the International Health Regulations (IHR). The IHR (2005) focus on strengthening capabilities for confronting all potential public health emergencies of international concern when and where they occur. The 194 states parties made a commitment to develop core capacities to detect, assess, report, and respond to any public health event that might have international effects, regardless of type or origin of the event. The IHR (2005) also conferred new responsibilities on WHO and the global health community to share resources, information, and expertise to help nations prepare for and respond to public health events (1).
The WHO checklist and indicators for monitoring progress in the development of IHR core capacities by states parties, also known as the IHR Monitoring Framework, details 8 core capacities plus activities at points of entry that must be developed to fully implement the IHR (Table 1) (2). The IHR Monitoring Framework, first published in 2010, also defines country-level indicators within each core capacity. The regulations and the framework describe the core capacities needed for functional implementation of the IHR (2005) but leave flexibility for nations to determine how best to structure and develop these capacities (3).
The IHR also direct countries to strengthen and integrate existing systems for public health surveillance and response, rather than to create new, vertical programs. Various national approaches to IHR implementation have emerged, depending on factors such as the sophistication of preexisting systems and infrastructure, past and present objectives of health ministries and their external partners, availability of resources, architecture of health systems, and strength of regional commitments to health cooperation and coordination. Examples of the latter are the Integrated Disease Surveillance and Response strategy previously adopted by the WHO Regional Committee for Africa and shared standards developed through a Latin American subregional trade alliance (4–7). Two WHO regional offices, Southeast Asia Regional Office (SEARO) and Western Pacific Regional Office (WPRO), collaboratively developed the Asia Pacific Strategy for Emerging Diseases, providing a framework for coordinated approaches to rapid disease detection and public health emergency responses across sectors, countries, and regions (8).
Even with regional support, achieving the IHR core competencies is challenging for many nations at high risk for epidemic-prone or emerging infectious disease outbreaks and other public health crises. Member states initially agreed to implement IHR (2005) by June 2012, but a substantial proportion will clearly need at least one 2-year extension. Under Article 44 of the IHR, nations agreed to collaborate on developing and maintaining the public health capacities for IHR implementation by providing technical, logistical, and financial assistance to developing nations. The flexibility of the IHR framework, which enables national leaders to interpret the IHR requirements through mechanisms that are sensitive to local and regional contexts, makes it challenging to marshal such assistance effectively. The decision to measure IHR core capacity development in terms of functional outcomes rather than specific activities means that there could be 194 distinct but equally valid national approaches to fulfilling IHR (2005) obligations. Consequently, many nations that could use help with IHR implementation are still in the process of identifying opportunities for cooperative capacity building with external partners, often without information on how much it will cost to implement their national IHR action plans.
We describe steps for estimating the costs of achieving IHR (2005) implementation in countries with different economic climates by first identifying essential inputs. We identified functional pathways for implementing the 8 core capacities and actions at points of entry identified in the WHO 2010 IHR Monitoring Framework, on the basis of current and planned actions in 6 Southeast Asian case-study countries at different levels of economic and health systems development. We used this to develop a representative IHR implementation strategy to serve as a framework for a preliminary estimate of fixed and operating costs associated with developing and sustaining IHR core capacities across an entire public health system.

Costing Framework for International Health Regulations (2005) - Vol. 18 No. 7 - July 2012 - Emerging Infectious Disease journal - CDC