The Joint External Evaluation (JEE) Process: Assessing health security in Côte d’Ivoire
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Conducting a JEE
Côte d’Ivoire (Ivory Coast) is a small country in West Africa, neighboring Liberia, Guinea, Mali, Burkina Faso, and Ghana. It has a population of over 25 million people, about half of whom live in urban centers across the country. Diseases of great concern for the country include yellow fever, cholera, meningitis, measles, and Acute Flaccid Paralysis.
When I was selected as CDC Global Health Security Agenda (GHSA) Program Director for Côte d’Ivoire in 2015, early GHSAactivities gave the country confidence that both financial and technical resources would be available to help them truly build health security capacity. The government voluntarily conducted its first Joint External Evaluation (JEE) in 2016, thanks in part to strong advocacy by CDC and early awareness of the importance of conducting a JEE in order to develop a plan to strengthen Côte d’Ivoire’s capacity to prevent, detect, and respond to public health threats. Côte d’Ivoire was among the first countries to conduct this formal external assessment under the International Health Regulations (IHR 2005) umbrella. Before that, an objective evaluation was not formally done. The JEE gave the country a true baseline across 19 technical areas and identified gaps for improvement. Côte d’Ivoire developed a National Action Plan for Health Security (NAPHS) based on these results in 2017. This plan laid the foundation for improving the country’s health security.
Next steps toward a strong surveillance system across the country
The JEE is an internationally recognized evaluation, whose results contribute to understanding the global impact of infectious disease risks. This made it clear how important the JEE was—it wasn’t just about Côte d’Ivoire, but about the world’s ability to be better prepared for public health emergencies.
Côte d’Ivoire used recommendations from the JEE to drive decisions and actions that can help shape our work around health security, especially in surveillance, laboratory, emergency response and workforce development.
A strong real-time surveillance system that incorporates both human and animal health reporting systems is critical to detecting public health risks quickly. In Côte d’Ivoire, the country team and the external evaluation team worked together to identify the strengths and weaknesses in the surveillance system and then identified the next steps necessary to help Côte d’Ivoire build capacity in this area.
Since the JEE, I have been part of a CDC team working closely with the Ministry of Health to strengthen their disease surveillance system, helping to detect a public health emergency more quickly. The earlier a risk is identified, the quicker a response can be launched, and the easier it is to contain the risk—before it spreads.
About one fourth of the country’s population are immigrants. Disease surveillance is particularly important in the northwestern part of Côte d’Ivoire, bordering Guinea and Liberia. Population movements can be very fluid between the three countries, making the northwest a high-risk area for disease transmission. This is also a very rural part of Côte d’Ivoire with close knit communities, which makes community-based surveillance an excellent tool in identifying potential outbreaks. Community-based surveillance complements already-existing routine surveillance by teaching communities about diseases that could affect them. We also encourage community members to report possible cases of diseases, which could pose a threat to the community and to the country’s health security.
Together, we worked with community leaders across the northwest to build critical relationships. We developed a text-based reporting system and taught more than 500 community health workers how to use this system to communicate suspected cases of priority diseases to the appropriate medical authorities, triggering follow-up case investigations. Strengthening this system allows Côte d’Ivoire to quickly detect diseases even in remote areas so that it can address them quickly and prevent them from spreading.
This month, the 100th JEE was completed in Haiti. This represents over half of all UN member states that agreed to support the JEE process on a global scale just over three years ago. This is a monumental achievement! One of the greatest parts of the JEE that I experienced was working with health partners and other officials from across governmental sectors in Côte d’Ivoire. As the number of countries completing a JEE grows, continuing this work together is key to building global health security and to making the world a safer place for everyone.
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