Bangladesh completes its second Joint External Evaluation of the International Health Regulations core capacities

Highlighting strengths and identifying areas for improvement, the People's Republic of Bangladesh takes a significant step forward in improving its national health security.

Dhaka, Bangladesh

11 July 2024

The People's Republic of Bangladesh has successfully concluded its second Joint External Evaluation (JEE) of International Health Regulations (IHR) core capacities, marking a significant step forward in global health security. This JEE was notable for its use of the newly developed electronic JEE (eJEE) platform, which aims to streamline, standardize, and make the reporting process more efficient. Conducted from 7 to 11 July 2024, the evaluation reviewed 19 technical areas essential for the country to comply with the IHR through priority actions recommended to enhance Bangladesh’s health security and health system resilience for emergencies.

Bangladesh was the first country in the South-East Asia Region and the fifth globally to conduct a JEE in 2016. With this second successful evaluation, it joins three other countries in the region that have completed their second JEE. The results from this latest evaluation will guide the development of a new National Action Plan for Health Security consisting of a five-year strategic component with an estimated budget envelope and a two-year operational component with detailed costing of the activities to be implemented.

Bangladesh has demonstrated exemplary leadership in health security and pandemic preparedness, achieving over 83% vaccination coverage and showcasing strong immunization capabilities. The country is a pioneer of the “One Health” approach, which integrates human, animal, and environmental health sectors. This approach has been effectively utilized in combating antimicrobial resistance (AMR), one of the technical areas of the Joint External Evaluation (JEE).

“The importance of health security cannot be overstressed, especially after the significant struggle with COVID-19. Therefore, we are glad that the second Joint External Evaluation has been concluded. Its findings and, more importantly, its recommendations will be of utmost importance as we strive to build a resilient health system capable of responding to public health threats effectively," said Professor Dr Samanta Lal Sen, the Health Minister of Bangladesh.

“We are wholeheartedly focused on attaining comprehensive health security that can prevent, detect, and respond to various threats. The JEE has highlighted our strengths and clearly shown the areas where we need to work collaboratively to achieve our goal of building an exemplary health security and preparedness system in the country," said Prof Dr Meerjady Sabrina Flora, the Chair of the National IHR-JEE 2004 Implementation Committee and Additional Director General (Planning and development), Directorate General of Health Services, Ministry of Health and Family Welfare.

The JEE process is a peer-to-peer review and a highly collaborative effort involving experts from both external and host countries. This consensus-based process ensures full agreement on all aspects of the findings, including the capacity level scores, recommended priority actions, and the final report. Country counterparts, led by government representatives, are deeply involved and have full ownership of the process and results. Each technical area receives a score ranging from 1-5, indicating the level of capacity achieved by the country, with 3-5 recommended priority actions to advance to the next or sustainable level of capacity.

“Finance and skilled human resources are always challenges in building capacity. We hope that the JEE findings will also support resource mobilization efforts and guide partners and donors to priority areas for support,” said Dr Bardan Jung Rana, WHO Representative to Bangladesh. “We also advocate for continuous high political commitment and increased domestic funding for health security.”

“The successful completion of Bangladesh's second JEE underscores their unwavering commitment to health security and preparedness. This achievement not only highlights their strengths but also sets a benchmark for continuous improvement. It ensures a resilient and responsive health system capable of safeguarding public health against emerging threats,” said Dr Jun Xing, Unit Head, Health Security Preparedness Department, WHO Headquarters.

The external experts, working closely with national experts, determined that about 80% of the technical areas have varying levels of capacity. The area of immunization has achieved a sustainable level of capacity. Other technical areas show developed or demonstrated levels of capacity. However, three areas—financing, food safety, and infection prevention and control—displayed limited capacity, signalling that these require significant attention, effort and investment and should be prioritized for improvement.

At the end of the JEE, the following overarching recommendations were agreed upon:

• Commission a rapid legal review to ensure compliance with the International Health Regulations (IHR), expedite rule formulation and endorsement of strategies, plans and guidelines and establish effective implementation monitoring and accountability frameworks to strengthen health security through the One Health approach.
• Strategically increase financial allotment for national health system development and security strengthening, utilizing domestic resources and optimized financial management practices to advance priority actions to enhance IHR core capacities as recommended by the Joint External Evaluation.
• Ensure an adequate and motivated One Health workforce with appropriate competencies and skill mix, equitably distributed through rapid recruitment, addressing incentive, performance, and retention challenges, and committed to continuous professional development of enhanced human, animal, and environmental health personnel.
• Conduct a thorough review of One Health service delivery systems and referral pathways to streamline access, assure quality, and enhance coverage of human, animal, and environmental health services, ensuring system security and resilience amid rapid environmental and epidemiological changes.
• Move towards next-generation collaborative multi-source One Health epidemiological and laboratory surveillance systems for seamless information exchange, leveraging digital innovations for rapid decision-making; expand sub-national epidemiological units; and strengthen infrastructure and capabilities at all Points of Entry to link with national surveillance and emergency management systems.

The World Health Organization (WHO) emphasizes that JEE scores are not the ultimate measure of a country’s health security.

"We assigned scores to all technical areas during our first JEE in 2016, and we have done the same for this JEE. Due to the inherent characteristics of the JEE tool, direct comparison between different JEEs and countries based on scores alone is invalid and contraindicated. The first JEE used version 1 of the tool, and now we have version 3, which saw major changes following the learning from COVID-19," said Dr Karen Sliter, Team Leader for the external JEE team in Bangladesh. “However, it is important to note that scores themselves don't improve health security.”

Similarly, Dr Reuben Samuel, Programme Area Manager—Country Health Emergency Preparedness and IHR, Health Emergencies Programme, WHO South-East Asia Regional Office, and co-lead of the external JEE team, emphasized that Bangladesh should now conduct the Strategic Assessment of Multi-Hazard Risks building on the assessment previously completed for infectious hazards and repeat the National Bridging Workshop for IHR and Performance of Veterinary Services (PVS) before developing the next National Action Plan for Health Security.

"Critical to the development of the next five-year National Action Plan for Health Security is resource mapping to identify the financial and technical resource needs and gaps necessary for its implementation. Additionally, the country should focus on developing investment cases to mobilize resources to fill technical capacity and financial gaps," said Dr Samuel.

The external experts team for the JEE mission in Bangladesh comprised members from 13 international organizations. Additionally, officials from India and Timor-Leste, countries that plan to conduct their own JEE soon, were facilitated to participate to gain a firsthand understanding of the JEE process.