WHO

Guidance for contingency planning

World Health Organization

“Everyone deserves the chance to survive. I think of this every time I see another disaster. There are probably people dying who don’t have to.”
Dr James Hubbard

FOREWORD

The goal of the WHO Health Emergencies Programme is to help countries and to coordinate international action to prevent, prepare for, detect, rapidly respond to, and recover from outbreaks and emergencies in order to reduce the mortality and morbidity of affected populations.

This includes WHO’s own capacity to manage risks and respond to emergencies in a timely, predictable and effective manner. Headquarters, regional and country offices all need to plan, well ahead of a crisis, for the appropriate resources, systems, policies, procedures and capacities to undertake effective risk mitigation and response operations in support of, and in collaboration with, ministries of health and other partners.

Understanding the risk that threatens people’s health, planning to mitigate the impact, and preparing to respond can significantly save lives and preserve health and well-being. Thus all WHO offices need to undertake, along with governments, other UN agencies and partners, or alone if needed, regular strategic risk analysis and monitoring, and related contingency planning.

In this contingency planning guidance, a set of actions to prepare for emergencies from all hazards and to help minimize their impact, is proposed. These actions include the development, implementation, simulation, monitoring and regular update of risks-based contingency plans.

This guidance is based on a common organizational approach and procedures for risks management and emergency response across all hazards and at every level of the Organization. It encompasses WHO’s responsibilities under the International Health Regulations1 (2005) and other international treaties, as the United Nations’ lead agency for health and the health cluster, and as a member of the United Nations or humanitarian country teams. The guidance has therefore been developed in line with the WHO corporate risk management framework and the WHO readiness checklist, as well as the Inter-Agency Emergency Response Preparedness Framework and its Contingency Plan Guidance2.

1http://apps.who.int/iris/bitstream/10665/43883/1/9789241580410_eng.pdf 2https://www.humanitarianresponse.info/en/programme-cycle/space/emergency-response-preparedness-guidance-and-templates

Table of Contents
Introduction	4
Purpose	5
Scope	5
Accountability	5
Guidance	6
Key principles of contingency planning	6
Developing scenarios and assumptions: what could happen?	7
Mitigation strategy: how can health risks linked to the hazard be reduced?	8
Preparing to respond: how can all health needs of affected populations be addressed?	8
Health sector preparedness	8
Developing a response plan	10
WHO specific responsibilities	11
Action plan: how will WHO fulfill its responsibilities?	13
Monitoring: how have the risks evolved?	13
Testing: how can readiness be improved?	14
Hazard based contingency planning flow chart	Error! Bookmark not defined.
Template WHO office contingency plan	14
Introduction	15
Scenarios and assumptions	15
Mitigation strategy	15
WHO preparedness strategy	15
Preliminary response plan	16
WHO action plan	16
Testing and maintaining the contingency plan	16
References	17
Annexes	17
Preparedness timelines	17
This document was elaborated in partnership with all WHO regional offices and some country offices who provided precious and valuable inputs based on their experience and expertise. The current guidance and template build on previous guidance and templates from WHO offices in headquarters, the regions and countries, and is an attempt to align with the new policies and standard operating procedures promoted by the WHO Health Emergencies Programme and WHA Resolution A69/30 of May 2016. We are deeply grateful to and would like to thank all those who contributed to the elaboration of this document.

Introduction

Contingency planning is part of a cycle in which the identification and regular monitoring of risks, vulnerabilities and capacities informs the planning and implementation of measures to mitigate the risks and prepare to respond.

Risk mitigation includes all actions to reduce the severity, probability of occurrence of, or exposure to, a given hazard and therefore lessen its impact.
Preparedness refers to all actions to increase knowledge and capacity to anticipate, respond to and recover from the impact of one or more events.
Readiness is the outcome of preparedness actions – it refers to the outcome of planning, allocation of resources, training, exercising and organizing to build, sus- tain and improve operational capabilities based on risk assessments.

All WHO offices need to have available a strategic analysis of the hazards which threaten the health of the populations they serve. This analysis is used to identify the major health threats for which contingency plans (CPs) need to be developed and implemented. The aim of contingency planning is to mitigate the potential health consequences of these threats and to be ready to respond should the threats cause an emergency. In countries, the analy- sis of risks and subsequent contingency planning is usually initiated by the government or the UN Inter-Agency Standing Committee country team, and is jointly performed with all sectors and partners3. It should cover all hazards; WHO and the ministry of health need to ensure that all health related issues are effectively included and all health partners are in- volved.

WHO and the ministry of health also need to ensure that specific health sector CPs are available for all major health threats. Each CP should clearly define the roles, responsibili- ties, planned actions and support that each partner committed to prepare for and provide in case of an emergency.

As part of this process, WHO needs to perform an independent analysis of the plan‘s com- prehensiveness and quality. Any gaps identified need to be addressed by govern- ment/partners.

Finally, WHO must develop its own set of time-bound actions to be accomplished in order to address the threats. The implementation of these actions can be organized and moni- tored through an action plan.

3 see: Emergency response and preparedness (ERP). Risk analysis and monitoring, minimum preparedness, advanced preparedness and contingency planning. Inter-Agency Standing Committee; July 2015 (available at https://www.humanitarianresponse.info/en/programme- cycle/space/emergency-response-preparedness-guidance-and-templates)

Purpose

WHO offices at country, regional and headquarters levels must take all possible measures to mitigate risks and have in place the appropriate resources, systems, policies, procedures and capacities in order to prepare for and respond to emergencies whenever and wherever they occur.

Contingency planning is the framework that enables each WHO office to:
prepare for threats and reduce their potential public health consequences
identify needs and outline related actions
plan the implementation of these actions
identify resources and the time needed for implementation
monitor progress in implementation.

This guidance note is to be used to direct the planning of mitigation and preparedness ac- tions to address specific health threats; the note can be adapted to the context and needs of each WHO office.

Scope

Contingency plans need to be developed for each major threat identified in the risks analy- sis. All plans must be regularly updated based on the evolving risks and environment.

Accountability4

As a member of the UN system, and lead in the health sector, WHO needs to be involved in contingency planning exercises and ensure the inclusion of all necessary health issues and partners. Quality, comprehensiveness, efficiency, timeliness and effective implementation and monitoring of plans are also essential.

The head of each WHO office is responsible for ensuring that:
health is appropriately integrated in all multisectoral contingency planning;
high quality, health sector specific CPs are developed and implemented;
the WHO action plans developed and implemented:
set out the roles and responsibilities to which WHO is committed as part of the UN, and as lead in the health sector;
prepare WHO to respond to emergencies as per the Emergency Response Framework;
plans are regularly tested, updated, monitored, and maintained;

4 Accountability is defined in WHO’s Accountability Framework as the obligation of every member of the Organization to be answerable for his/her actions and decisions, and to accept responsibility for them.
http://intranet-pdrive.who.int/public-drives/PubDept/DGO-CRE%20-
 %20Compliance%2C%20Risk%20Management%20and%20Ethics%20Office/CMP/reference/accountability_framework.pdf	

the resources necessary to implement the action plans are identified and mobilized;
the office contingency plans are formally handed over to his/her successor.

Guidance

Key principles of contingency planning

While each emergency is different in nature and context, there are many similarities, such that common emergency management practices and policies can be built into the health system to create resilience. Thus, although a separate CP should be developed for each type of threat, much of WHO contingency planning is generic and applicable to all types of emergencies.

The key principles to bear in mind are that contingency planning should be:
practical
simple and easy to do
realistic and feasible
needs based and efficient, ensuring fair use of resources
process driven for effective operationalization
regularly tested through exercises
monitored and updated.

Hazard based contingency planning flow chart

Developing scenarios and assumptions: what could happen?

The planning process is initiated by a strategic risk assessment5. The purpose of this as- sessment is to identify and rank the risks and their geographical locations, and define those hazards and scenarios for which contingency planning is required. Each priority hazard needs its own contingency plan based on flexible and realistic scenarios. Scenario devel- opment provides a basis for planning and generates consensus on the nature of the poten- tial crisis and the response to be provided.

Most contingency planning takes place at multisectoral or interagency level to ensure co- ordination and maximize synergy of the preparedness and response actions and the use of resources. WHO and the health sector need to be part of these efforts to ensure that health issues are included in the plans.

The specific health risks posed by each hazard should be considered. In this document, floods are used as an example hazard. This hazard:
carries specific health risks, such as trauma or water-borne diseases, that need to be addressed by the health sector; and
requires different approaches in urban settings and remote villages.

An example of a flood scenario is:

Hazard	Floods	
Early warning mechanisms	Rainfall forecast, high risks areas mapping	
Scenario	Number of people affected Number of people drowned/killed Number of people injured (50–100)
Number of inaccessible or damaged hospitals and health facilities (2 of the 3 hospitals not accessible by road)
Number of houses destroyed or damaged (10 000–20 000) Electricity cuts: highly likely
Lack of or limited access likely
Contaminated fresh water sources (5 out of 10) Crops destroyed	
Health needs and risks	Trauma care (short term)
Lack of access to essential services Watery diarrhoea including cholera
Malnutrition (longer term unless already present, and depending on the
harvest calendar)	
Assumptions	Security problems do not hamper access Boats are available for transport
Pre-positioned stocks are not affected by flooding	

5 An approach for the integrated and strategic risks assessment of public health threats. Draft version. Geneva: World Health Organization;
 October 2016	

Mitigation strategy: how can health risks linked to the hazard be reduced?

Once the risks to health have been identified, the next step is to ascertain which measures are already in place, and which can be taken, to prevent or mitigate the impact of the risks. These measures should be put in place or strengthened as soon as the risks have been identified.

Relevant actions to be taken in all areas and countries need to be identified in order to prevent and/or control public health risks. Such actions include: vaccination; enhanced surveillance and early warning, alert and response systems; vector control; infection control (including personal protection); enhanced sanitation and hygiene; increased provision of water and/or nutrients; prepositioning of drugs and medical supplies, etc.

Continuing with the example of floods, mitigation measures for this hazard include:

Identified health risks	Mitigation measures	
Trauma	Public risk communication to promote personal safe behaviours
Training in mass casualty management	
Lack of access to essential services	Identify flood prone areas and evaluate the health infrastructures
Strengthen community based first aid
Identify back-up for referral systems	
Risk for watery diarrhoea includ- ing cholera	Improve water and sanitation in high risk areas
Assess opportunities for cholera vaccination campaign in high risk areas
Develop and implement risk communication campaign	
Malnutrition	Map vulnerabilities and determine follow-up actions accordingly
Develop community based preventive interventions	

Preparing to respond: how can health needs of affected populations be addressed?

Once mitigation strategies are in place, potential response needs have to be determined; this will allow WHO to identify and plan for related preparedness actions and for the response itself.

Health sector preparedness 

Actions need to be developed, coordinated and planned with the ministry of health and all health sector partners. If a national contingency plan already exists for the hazard or scenario in question, it should provide a summary in which the respective roles and responsibilities of each stakeholder are outlined.

Specific timelines for preparedness actions are important to ensure that most of the response elements are in place at the time of the event/emergency. An example of a preparedness timeline for a seasonal epidemic disease such as meningococcal meningitis is provided in annex 1, which lists the main risk monitoring and preparedness actions advisable ahead of the outbreak season and their suggested sequence.

As well as for seasonal outbreaks, it is important to formulate preparedness timelines for other foreseeable or seasonal events such as mass gatherings, droughts and floods.

To continue with the floods example, preparedness actions are outlined here:
Health risk	Needs	Planned response	Preparedness action	

Trauma	

Trauma care and mass casualty man- agement sys- tems (MCM)
Referral of injured to hospitals
Provision of materials and drugs	

Rapid activation of reliable, predictable and quality MCM sys- tems, including refer- ral to secondary and tertiary health care as per agreed protocols
Continuous drugs and supplies chain man- agement based on regular needs assess- ments	Develop a rapid alert system with key ac- tors of MCM, from community-based first-aid actors to re- ferral hospitals to emergency medical teams
Train and exercise MCM actors, proce- dures and systems
Prepare memoran- dum of understanding with transport com- panies; predict boat requirements
Pre-position trauma kits
Evaluate warehouse
and supply chain ca- pacity	

Lack of access to essential health care	

Alternative access
Rapidly re- establish ac- cess to essen- tial health care	Mapping of areas and/or affected popu- lations without access to health care
Information sharing with partners, coordi- nation for in- creased/priority cov- erage of health opera- tions
Targeted mobilization of mobile clinics, field hospitals etc., as per needs	Prepare inventory of current capacities of field hospitals and/or mobile clinics, includ- ing staff, activities, drugs and supplies
Identify response gaps as per scenarios, and potential partners to fill gaps (e.g. emer- gency medical teams, Red Cross)
Identify potential ob- stacles to access (ge- ographic, political, so-
cio-cultural) and	

			needed actions to ad- dress these obstacles (negotiations and ad- vocacy, special transport such as heli-
copters, etc.)	

Outbreaks of diarrhoeal diseases	

Ensure rapid detection, confirmation and alert
Provide mate- rials to test for and treat cholera
Ensure treat- ment capacity	Activate early warning alert and response systems (EWARS) in hot spots
Deploy rapid response teams for rapid inves- tigation and early re- sponse
Provide case man- agement at rehydra- tion and treatment centres adapted to required infection
control standards	
Ensure availability and adapted coverage of EWARS, provide re- fresher training
Order rapid tests and cholera kits
Identify possible placement of future rehydration or chol- era treatment centres
Prepare for water testing and treating	

Malnutrition	Prevention of risks by food/cash dis- tribution
Screening and referral
Case man- agement at community and health fa- cility levels	Coordination with livelihood and nutri- tion cluster
Regular screening in hot spots and EWAR
Initiate community based management of malnutrition and re- ferral to appropriate health facilities for se- vere cases and/or
medical complications	Select sentinel sites for malnutrition screening
Identify potential health facilities to es- tablish therapeutic feeding centres
Pre-position kits for the management of severe acute malnour- ished children with
medical complications	
Developing a response plan 

With the response needs identified above, a preliminary response plan is developed with the objectives6 of:
fostering common understanding among all partners of the anticipated scope of the emergency, the possible health and health related needs, and the nature and scope of the planned operational response;

Adapted from: Emergency response and preparedness (ERP). Risk analysis and monitoring, minimum preparedness, advanced preparedness and contingency planning. Inter-Agency Standing Committee; July 2015 (available at: https://www.humanitarianresponse.info/en/programme-cycle/space/emergency-response-preparedness- guidance-and-templates)

clearly explaining WHO and the health sector/cluster response strategy to address the needs of the affected population in the first weeks of an emergency;
reflecting specific challenges/gaps in the potential response in order to communicate anticipated funding requirements;
supporting the timely drafting of a resource mobilization document, e.g. a flash appeal, in the event of an emergency.

This preliminary response plan sets out the initial response strategy and operational plan for meeting critical humanitarian needs during the first three to four weeks of an emergen- cy. The plan should therefore use the same format as a response plan and state the prelim- inary response objectives, activities, targets and indicators.

The response can be activated as soon as the event/emergency has been graded7. To con- tinue with the example of floods:

Activity	Target population	Indicator	Responsible
actors	Estimated cost	
First strategic objective: The immediate wounds and trauma of the people affected by the flood are
addressed	

Second strategic objective: All affected people have access to an essential package of health
services	

WHO specific responsibilities 

In addition to the overall health sector contingency plan, WHO has additional responsibilities to ensure it is prepared to respond and deliver on the specific functions it has committed to perform during an emergency, as per the Emergency Response Framework8. The WHO contingency plan therefore needs to include the preparedness and response actions to be implemented in order to achieve these goals.

Continuing with the example of floods:

Responsibility	Response needs	Preparedness action	
Coordination	A collective and synergic health sector response which covers all needs and
all affected people	Define coordination mechanisms and architecture with host government, ministry of health,
UN agencies, other sectors and	

As per: Emergency Response Framework. Second edition. Geneva: World Health Organization; 2017 (in press) 8 Emergency Response Framework. Second edition. Geneva: World Health Organization; 2017 (in press)

	Synergy and complementarity with other sectors e.g. water sanitation and hygiene, nutrition, logistics
Harmonious decision- making with ministry of health and other decision-
makers	health partners
Ensure procedures are in place for requesting and coordinating international assistance (emergency medical teams(EMT), Global Outbreak Alert and Response Network (GOARN), standby partners)	
Information and plan- ning	Updated epidemiological profile of the affected or exposed population
Understanding of health system modus operandi
Updated data on partners’ activities and coverage (4Ws – who, what, where and when)
Joint risks and needs assessments
Identification of triggers for activation of the response
Response plan	Ensure availability and good understanding of:
baseline data
triggers of activation of response, including EOC..
needs assesment methodologies and tools
data collection tools for 4Ws, Health Resources Availability Mapping System (HeRAMS), EWARS
response plan templates and procedures	
Health operations and expertise	Technical guidances on mass casualty management (MCM), case management of waterborne diseases, and malnutrition.
Early warning, alert and response systems (EWARS) and rapid response teams (RRTs)
Risk communication campaign
Delivery of basic package of health services in areas with issues of access	Procure all needed guidelines
Training on EWARS, case management, MCM, infection prevention and control (IPC), etc.
Identify/clarify essential package of health services to deliver in areas with no or limited access
Prepare risk communication messages
Pre-identify possible communications channels	
Logistics	Uninterrupted supply chain
Communications facilities, transport, housing and accomodation for sub-offices and surge team	List warehouse capacity and transportation modalities
Ensure catalogues and lists of pre-positioned supplies available
Obtain waivers for customs or visas
Pre-identify accommodation for
surge teams	
Finance and admin- istration	Availability or rapid access to contingency funds
Availability of budget lines	Ensure emergency standard operating procedures (E SOPs)
are known and understood	

	that can be repurposed
Development of donor appeals
Development of proposals and grants management
Human resources management	Make proposal and reporting templates available
Ensure grant management procedures are known
Identify and contact potential donors
Ensure visa and work permit
procedures are in place	

Action plan: how will WHO fulfill its responsibilities?

The ultimate but most important planning step is to determine the means and resources by which WHO will implement its mitigation and preparedness actions according to the agreed schedule.

A standard logical framework format can be used to develop the details, timing and budget requirements of the different elements of each plan.

Continuing with the floods example:

Objectives	WHO activity	Pri ori
ty	Start date	End date	Resources need- ed	Responsible WHO staff	Estimated cost in USD	
Risk mitigation					-	-		
	Map flood- prone areas	2	Jan 2017		Geographical information system
Consultant	-	Public health officer	5000	
	Evaluate safe hospitals	3	Mar 2017		-	Consultant	-	Public health officer	5000	
	etc.				-	-		
Preparedness
actions								
	Pre-position trauma kits	1	Oct 2016	Dec 2016	Funding
Warehouse
Logistics supply sys-
tem	Emergency coordinator
Logistics officer	12 000	
	Train health care workers on cholera diag- nostics	1	Nov 2016	Dec 2016	Trainer
Funding
Training room
Training material	-	Public health officer	6000	
	etc.							

Monitoring: how have the risks evolved?

As risks are dynamic and evolve continuously, there is a need to keep monitoring them, and adjust plans and actions accordingly.

WHO staff should:
re-evaluate the risks and priorities, and revise the assumptions, adequacy of mitigation and preparedness activities, and the implementation schedule, as necessary;
regularly compare the actual and planned implementation;
diagnose delays and identify remedial actions.

Testing: how can readiness be improved?

Regular review is a crucial element in assessing an office`s readiness to respond. In order to be effective and reliable, the contingency plan needs to be constantly improved through testing to ensure that emergency management capabilities are consistent with the plans, procedures and policy.

Exercises are therefore an integral part of contingency planning. Selection, planning and costing of exercises are well explained in section 3 of the WHO exercise manual and the related exercise planning tool9. The head of office ensures the contingency plan is tested before approval; he/she also ensures the contingency plan is well maintained and enhanced through yearly updates, reviews and exercises.

Exercises enable:
validation of the adequacy of emergency plans, systems and procedures;
familiarization of all stakeholders with the plan, procedures and systems;
assessment and enhancement of functionality;
identification of gaps or weaknesses, and subsequently of remedies for these deficiences;
maintainance and updating of the continuity plan.

The head of office ensures the continuity plan is tested before approval.

Template WHO office contingency plan

9 the WHO Exercise Manual, July 2016, and Exercise Planning Tool, November 2016, will soon be available on line

Title: WHO Office [name of country/region] Contingency Plan for [name of hazard] Date of approval
Signed by [name]

Introduction

Results of risk assessment related to hazard

Please provide a short description of:
the hazard and its characteristics (seasonality, transmission/amplification, scale, etc.)
impact and likelihood of the hazard.

Situation analysis

Please provide a short overview of:
the demographic and health profile of the country and the affected population
health system structure and services provision at national and sub-national levels
recent disasters/emergencies with public health impact.

Scenarios and assumptions

Description of specific contingency plan scenario(s)
Description of early warning systems
Description of health needs and risks linked to the hazard
Description of planning assumptions.

Mitigation strategy

List all mitigation measures for the identified health risks linked to the hazard:

Identified health risks	Mitigation measures	

		

WHO preparedness strategy

List all preparedness actions WHO has to deliver and which are linked to the identified response needs:

Health risk	Response needs	Preparedness action	

			

Preliminary response plan

From the identified response needs, define the key strategic objectives of the response and list the related main activities that will need to be implemented in the first weeks of the emergency in order to reach these objectives. Clearly identify the population targetted (based on assumptions) and the indicators, enabling monitoring of progress and/or achievments. If already identified, responsible actors can be listed for each activity. Estimating preliminary funding needs for the response avoids difficult discussions at the time of the response and developing the appeal.

Activity	Target population	Indicator	Responsible
actors	Estimated cost	
First strategic objective	

Second strategic objective	

WHO action plan

List all mitigation and preparedness actions that will be implemented by WHO and define the means and resources (human, logistics, financial) needed to implement these activities according to an agreed schedule.

Objectives	WHO
Activity	Pri- ority	Start	In place	Resources needed	Responsible WHO staff	Estimated cost in USD	
Risk mitigation								
								
Preparedness actions								

Testing and maintaining the contingency plan

Test calendar
Date	Objective of test	Type of exercise	Responsible staff	

				

References

Coularton R. Contingency planning and humanitarian action: A review of practice. UK: Humanitarian Practice Network (HPN); March 2007.
	Emergency response framework. Second edition. Geneva: World Health Organization; 2017.
	International Health Regulations (2005): second edition. Geneva: World Health Organization; 2008.
Framework for a Public Health Emergency Operations Centre. Geneva: World Health Organization; November 2015.
WHO Exercise Manual. Geneva: World Health Organization; July 2016. http://www.who.int/ihr/publications/WHO-WHE-CPI-2017.10/en/
Risk analysis and monitoring, minimum preparedness, advanced preparedness and contingency planning. Draft for field testing. Inter-Agency Standing Committee; 2015.
Readiness checklist. Geneva: World Health Organization; July 2015. https://intranet.who.int/homes/erm/readiness/
Approach for the integrated and strategic risk assessment of public health threats. Draft version. Geneva: World Health Organization; September 2016.
Early detection, assessment and response to acute public health events: implementation of early warning and response with a focus on event-based surveillance. Interim version. Geneva: World Health Organization; 2014.
	Technical brief. Scenario building: how to build scenarios in preparation for or during humanitarian crises. Geneva: ACAPS; August 2016.
	Contingency planning guide. Geneva: International Federation of Red Cross and Red Crescent Societies (IFRC); 2012.

Annexes

Preparedness timelines

Preparedness timelines and matrices can be developed for predictable events such as important mass gatherings or seasonal epidemics of communicable diseases.

The example below is a preparedness timeline for meningococcal meningitis, in which the main risk monitoring and preparedness actions advisable ahead of the outbreak season are listed in a suggested sequence.

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18 |

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ACTIVITIES		months10	epidemic season	months1	
		- 4	- 3	- 2	- 1	E1	E2	E3	E4	E5	E6	+1	+2	
Collect, analyse and report surveillance data	Risk
monitoring													
Identify and monitor the distribution of bacterial meningitis pathogens and meningococcal serogroups	Risk monitoring													
Map and monitor the distribution of germs and drug resistance	Risk
monitoring													
Send specimens to WHO collaborating centres to monitor the distribution and emergence of epidemic strains	Risk monitoring													
Establish epidemic contingency funds mechanism	Preparedness													
Develop preparedness and response plans with clear priorities, funding and responsibilities	Preparedness													
Establish an epidemic preparedness and response committee	Preparedness													
Identify high risk epidemic areas	Preparedness													
Constitute a local strategic vaccine stockpile for epidemic response (according to risk identified)	Preparedness													
Ensure up-to-date knowledge on access to the International Coordinating Group on global emergency vaccine stockpile for meningitis, through availability of standard operating procedures (SOPs), training, etc.	Preparedness													
Reinforce laboratory diagnostic confirmation techniques and equipment	Preparedness													
Strengthen lumbar puncture capacity (policy,
training, personnel)	Preparedness													
Evaluate laboratory supply needs	Preparedness													
Procure/distribute laboratory diagnostics supplies	Preparedness													
Perform laboratory after actions review and establish/revise testing and feedback algorithms and SOPs across the laboratory network (tests conducted at peripheral level vs intermediate vs
central vs WHO collaborating centre level)	Preparedness													
Establish mechanism for transport of laboratory samples	Preparedness													
Evaluate laboratory supplies, reagents and equipment needs	Preparedness													
Procure/distribute laboratory diagnostics supplies, reagents and equipment														
Test laboratory capacity through proficiency testing														
Conduct on-site training and supervision visits to check the availability of all necessary reagents and laboratory proficiency	Preparedness													
Carry out additional corrective actions for low
1p0erTfohremtinimg ilnabgoirsaotonrileysproposed as an example.	
Preparedness tim													
Rnuemprobdeurcoefapnedodpisleseamffineactteedsta, nsdpaereddizeodf tdraatansmis ccoolmlecptlieonxiatynd(istrsaunessmoisfsaiocncetososl,sm, cualsteipdleefienmitioenrgs,en	siPorne,puarrbeadnnveesrssu cies, etc..) and lo					t								
guidelines and SOPs														
Establish standard surveillance data flow circuits and feedback	Preparedness													
Conduct training on epidemiological surveillance
– Integrated Disease Surveillance and Response/meningitis enhanced surveillance	Preparedness													

Estimate antibiotics needs according to risk, procure and preposition	Preparedness													
Identify hospital structures to care for increased number of cases	Preparedness													
Establish rapid investigation teams and protocols	Preparedness													
Prepare community awareness and information plan	Preparedness													
Inform population on meningitis during the season: risk of meningitis cases, symptoms,
importance of seeking prompt care/treatment, evolution of epidemic, etc.	Preparedness													
Conduct evaluation of meningitis epidemic season and response – identify challenges and
lessons learned to integrate in next preparedness plan	Preparedness													
10.The timing is only proposed as an example. Preparedness timing needs to be defined in relation to scale (expected number of people affected , speed of transmission, urban versus rural…), capacity (strong health
system, partners…), complexity (issues of access, multiple emergencies, etc..) and local epidemiology of the disease.

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