Academic journal article Bulletin of the World Health Organization

Lessons Learnt from Implementation of the International Health Regulations: A Systematic Review/ Lecons Tirees De la Mise En Oeuvre Du Reglement Sanitaire International: Revue systematique/Las Lecciones Aprendidas De la Implementacion del Reglamento Sanitario Internacional: Una Revision Sistematica

Academic journal article Bulletin of the World Health Organization

Lessons Learnt from Implementation of the International Health Regulations: A Systematic Review/ Lecons Tirees De la Mise En Oeuvre Du Reglement Sanitaire International: Revue systematique/Las Lecciones Aprendidas De la Implementacion del Reglamento Sanitario Internacional: Una Revision Sistematica

Article excerpt

Introduction

While bi- and multilateral communication and collaboration are the foundation for global control of infectious disease epidemics, they are strengthened by the International Health Regulations (IHR). First introduced in 1969, IHR is global legislation requiring countries to link and coordinate specific actions. (1) These regulations were originally designed to control cholera, plague, yellow fever, smallpox, relapsing fever and typhus. Given the need to expand the scope to include new epidemics and to improve global coordination, the regulations were revised in 2005, as IHR (2005). (2) One of the key changes was the requirement for countries to notify the World Health Organization (WHO) of all events that may constitute a public health emergency of international concern and to respond to requests for verification of information about these events. (2) Since IHR (2005) was adopted by WHO States' Parties, several outbreaks, epidemics and pandemics have been declared public health emergencies of international concern: the H1N1 pandemic influenza in 2009, wild poliovirus in 2014, Ebola virus disease in 2014, and Zika virus and increases in neurological disorders and neonatal malformations in 2016. (3-6)

IHR (2005) also requires all countries to develop, strengthen and maintain eight core public health capacities. (2,7) These core capacities cover: (i) national legislation, policy and financing; (ii) coordination and national focal point communications; (iii) surveillance; (iv) response; (v) preparedness; (vi) risk communication; (vii) human resources; and (viii) laboratory. (8) Given varying levels of health and socioeconomic development across countries, there have been challenges in implementing these requirements. By the original deadline of June 2012, only 42 (22%) of the 192 WHO Member States had met the core capacity requirements. (9) Yet substantial progress has been made in some areas. These include establishing a 24-hour presence of a national focal point to communicate with all relevant sectors within government, all national stakeholders and WHO; increased transparency in reporting events; using early warning systems more systematically; and better communication and collaboration between the animal and human health sectors. Nevertheless, by the end of 2015, 127 of the 192 countries had not meet all IHR (2005) core capacity requirements. (9,10)

Although IHR (2005) describes what must be achieved by countries, there is limited knowledge on how countries should proceed in achieving the core capacities. To fill this gap and accelerate implementation of IHR (2005), the World Health Assembly in 2015 identified a need to evaluate and share the lessons learnt from countries that have implemented IHR (2005). (11) While country exchanges and regional meetings are one mechanism to achieve this, we systematically evaluated published literature and reports for lessons learnt from national experience in implementing IHR (2005).

Methods

This systematic review was conducted in accordance with Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines, using a predefined protocol (International Prospective Register of Systematic Reviews identification number: CRD42016038719). (12,13) We systematically searched the PubMed[R], Embase[R], Global Health, Scopus and WHO Global Index Medicus databases without any limitations of language, publication type or date on 13 November 2015. We searched all databases for the terms "IHR" or "International Health Regulations" to ensure we captured articles focusing specifically on IHR implementation. We did not search additional terms for the core capacities since this would decrease the number of results from the databases and potentially decrease the sensitivity of the search strategy. We also searched updates from the WHO bulletin on IHR implementation and abstracts from the International Society for Disease Surveillance annual conferences. …

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