The Kingdom of Eswatini has successfully completed its second Joint External Evaluation (JEE) of the implementation of the International Health Regulations (IHR) (2005) capacities. The JEE is a voluntary, collaborative, and multisectoral process designed to assess a country’s ability to prevent, detect, and respond swiftly to public health risks, whether they arise naturally or from deliberate or accidental events. It is a key component of the WHO International Health Regulations (IHR) Monitoring and Evaluation Framework, developed and implemented in collaboration with initiatives such as the Global Health Security Agenda (GHSA) and the World Organization for Animal Health’s (OIE’s) Performance of Veterinary Services (PVS) Pathway.

Under the IHR, States Parties are required to develop and maintain minimum core capacities for surveillance and response to detect, assess, notify, and respond to any potential public health event of international concern. The first JEE, conducted in 2018, identified gaps in Eswatini’s preparedness and response systems to health emergencies. The 2018 JEE rated the country low on preparedness with a score of 38 points, indicating limited capacity to detect and respond to emergencies. Additionally, based on the Global Health Security Index score, Eswatini was classified as a ‘least prepared’ country with a low score of 31.1.

The purpose of the second JEE was to assess the progress made since 2018. In September 2024, a team of external evaluators from the World Health Organization (WHO), Africa Centre for Disease Control (CDC), US CDC, USAID, UNFPA, IOM, and Zambia Public Health Institute, in collaboration with the World Bank, conducted the assessment. The process was validated through field trips to enhance the team’s understanding of national capacities.

Before this, an internal evaluation was conducted in August 2024, where Eswatini assessed its own systems to respond to health emergencies. The JEE was commissioned by the Minister of Health, Honorable Mduduzi Matsebula, in Ezulwini on September 23. The Minister highlighted that the JEE came at a crucial time when WHO and Africa CDC had declared Mpox as a Public Health Emergency of International Concern (PHEIC) and a Public Health Emergency of Continental Security (PHECS), respectively. 

“While the country has not yet confirmed any case of Mpox, we remain vigilant as our Public Health Emergency Operation Centre has transitioned from Watch Mode to Alert Mode for Mpox, with heightened surveillance systems activated,” the Minister stated.

He further outlined the strides made to improve the country’s preparedness and response to emergencies since the last JEE. On April 20, 2020, in response to the COVID-19 crisis, the World Bank approved a US$6 million loan for Eswatini to support the implementation of the COVID-19 National Emergency Response and Preparedness Plan through the COVID-19 Emergency Response Project. The project development objective was to prevent, detect, and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Eswatini.

Additional funding of US$8 million, comprising a US$5 million loan from the International Bank for Reconstruction and Development (IBRD) and a US$3 million grant from the Health Emergency Preparedness Trust Fund (HEPRTF), was approved on April 16, 2021, to support the expansion of activities under the COVID-19 Strategic Preparedness and Response Plan, using the Multiphase Programmatic Approach.

The Minister highlighted that the implementation of the Health Emergency Preparedness Trust Fund has significantly strengthened national preparedness for future emergencies and ensured the sustainability of interventions. Key achievements include the development of high-level guiding documents such as the Strategic Toolkit for Assessing Risks (STAR) report, the National Health Emergency Response Operations Plan, and specific contingency plans.

“Eswatini successfully tested its readiness to respond to incidents through its first-ever full-scale simulation exercise conducted in November 2023,” the Minister stated.

Additionally, the WHO, following recommendations from various WHO committees, developed three flagship programs to support member states in the African region in preparing for, detecting, and responding to public health emergencies. Consequently, a scoping mission for the EPR Flagship Initiative was conducted in Eswatini, resulting in the development and validation of a two-year EPR Flagship Initiative Roadmap. Eswatini also benefited from the WHO-EPR Flagship program, training the first-ever 20-member Eswatini “Nkwe” AVoHC-SURGE team, comprising members from various sectors and disciplines.

Dr. Susan Tembo, the WHO Representative, emphasized the necessity of adequate capacity across all relevant sectors to prevent and detect events or threats. She stated that the JEE would help the country identify the most critical gaps within the human and animal health systems, prioritize opportunities for enhanced preparedness and response, and engage with current and prospective partners and donors to effectively target resources.

“Let me commend the government of Eswatini for its dedication to safeguarding the health and well-being of Emaswati. This commitment is evident through the adoption of the IHR Monitoring and Evaluation Framework (MEF), which guides the assessment of progress in health security. I also commend the Government’s consistency in monitoring the core capacities under the IHR using standardized tools such as the State Party Annual Reporting Tool (SPAR),” she said.

Dr. Tembo further reiterated that the WHO, along with other partners, remains committed to collaborating with various sectors to sustain and achieve the necessary capacities outlined in the IHR (2005). This includes supporting the country in establishing a One Health coordination mechanism and implementing One Health approaches that integrate animal and human health interventions.

The JEE found that Eswatini demonstrates strong political will and a clear whole-of-government approach. There is also a robust multisectoral collaboration mechanism and strong technical leadership by the IHR focal point. Partner support for the implementation of IHR was also found to be strong in the country. However, the JEE recommended that Eswatini improve and establish a well-defined information-sharing structure for strategic health information across sectors. There is also a need to institutionalize review processes for the implementation of the National Action Plan for Health Security (NAPHS) to inform the next JEE and establish a multisectoral coordination platform (ONE HEALTH).