In 2016, the World Health Organization (WHO) adopted the Joint External Evaluation tool (JEE) to measure country-specific progress and help set goals in developing the capacities needed to prevent, detect, and respond to public health threats, as obligated under the International Health Regulations (IHR). This voluntary external evaluation, using standardized indicators, is intended to help countries identify and prioritize capacity-building needs. Targeting resources effectively to build and sustain capacities, however, requires stakeholders to develop plans that are actionable and contain sufficient costing information to support rational and sustainable implementation efforts.
Since the IHR entered into force in 2007, national stakeholders and their international partners have struggled to define the costs of strengthening and maintaining health security systems that cross levels and agencies and rely on multi-sectoral coordination for action. Without an assessment of the costs required to implement IHR, countries are unable to develop consistent budgets and plans upon which to build a case with domestic policymakers or external partners for appropriations, grants, or loans. We began with costing templates developed by our research team after a review of IHR implementation in 14 case study countries spanning multiple regions, refined by country feedback on user needs for IHR costing collected while supporting the World Health Organization in developing and pilot-testing an earlier conceptual framework for IHR costing in 6 countries. Since the JEE contains many more indicators than the previous IHR Core Capacity Monitoring Framework, the team reviewed published guidance from WHO, OIE, and other international authorities for specific requirements for capacity building and implementation that would address the new indicators. Finally, the team reviewed all of the published JEE evaluations to identify specific activities/capabilities that the assessment process had associated with the scores assigned in each indicator (i.e., what cumulative activities/capabilities were specifically identified as constituting a score of 2, 3, 4, or 5 for each specific indicator). Based on this approach, we have developed an open-access costing tool to support countries in estimating the costs of fully implementing IHR core capacities to fulfill the objectives of the planning process launched by the JEE.
The IHR web-based, open-access costing tool integrates user-supplied, country-specific data into a template derived from field practices and guidance for achieving the specific technical capabilities that contribute to IHR compliance. The tool provides an intuitive interface linked to a costing framework that provides users the ability to upload or assign their previously-determined JEE assessment scores and cost the necessary improvements to meet their targets for each of the 19 IHR Core Capacities, based on the JEE indicators. Because IHR requires capacities to detect, assess, and report unusual events from the local, intermediate, and national levels, the tool includes multipliers for each administrative level. Users can input JEE scores manually, or pull data directly from the JEE Technology Tool, developed by the Private Sector Roundtable Technology and Analytics Working Group and powered by Qlik Technologies.
Once the current JEE assessment scores are entered, users choose their target level of improvement (e.g., one step improved across all indicators; improvement to level 4 for all indicators). The user is then directed to costing pages for each JEE indicator, with options to select and modify as necessary. These costs include those for establishing the legal/policy foundation and infrastructure to support basic capacities, as well as the operating costs for personnel, training, processes, and consumables based on country-level datasets. The costs for each indicator include those required for start-up (e.g., cost of establishing legislation), capital (e.g., building construction, durable goods), and recurring costs (e.g., salaries). Once completed, the total cost requirements can be visualized by the indicator; by category; by type of cost; and for the first, third, and fifth years following implementation. In addition, costs can be viewed as start up support for countries to understand the required IHR expenses and comparative cost results across core capacities and capacity levels (performance), including the option to download results in a spreadsheet format. Indicators for which costing tools have already been determined elsewhere are linked and aligned to the degree possible to help prevent duplication or confusion.
The tool can be accessed at the following website: ghscosting.org.1 The tool includes links for feedback. We anticipate that once countries and other partners begin to use the tool, we will receive input regarding both indicators and usability. We intend to make adaptations to the tool as feasible, to be responsive to country and partner needs.
By understanding IHR-associated costs, national leaders can better match resources to urgent priorities and plan for long-term sustainability of complex systems. This costing tool, in combination with the JEE and financing tools already available and currently in development, represents a significant step in helping national and international decision makers develop and implement practical plans to improve global health security.
1 ghscosting.org is best viewed and accessed using Google ChromeAcknowledgements: We thank the entire research team at the Center for Global Health Science and Security for their research support in developing the IHR costing tool. Initial research and tool development was supported by the U.S. Defense Threat Reduction Agency- Cooperative, Biological Engagement Program and the Department of State Biosecurity Engagement Program. The conceptual framework was strengthened through collaboration with the World Health Organization and its technical partners. Current efforts were supported by Open Philanthropy Project and Georgetown University Medical Center. We are grateful to partners and colleagues for their feedback and support of this project, including: the World Health Organization, the Centers for Disease Control and Prevention, the World Bank, McKinsey and Company, the GHSA Private Sector Roundtable, Tom Frieden, Peter Sands, Anas El Turabi, and Phil Saynisch.