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International Health Regulations

 The International Health Regulations (IHR) provide a framework and predictable structure for countries. Implementation of core components is measured, preferably annually, and the response rate in 2018 was a successful 96%.

In October 2021, WHO referenced IHR when formulating 7 recommendations for resilience in health [1]

With IHR, global health sets unspoken expectations. However, we cannot anticipate IHR to be consistently interpreted, let alone adopted and accepted as necessary, without respect for individualism in countries. 

Completing a survey as a side thought versus completing a survey with full investment in healthcare improvement are two very different activities. Let’s do better to ensure full investment of IHR with every country, by being welcomed into countries.


In their space:  

* Create focused leadership groups with the SPAR and survey responders, grouped by country and region. https://extranet.who.int/e-spar/#submission-details

* Create focused leadership groups for those not responding to the survey; ask for country representatives with response failures. 

* Cultivate a team of national champions. 

* Task countries with IHR components, indicators and attribute review. Which metrics are deemed unnecessary? What metrics are missing and should be included? Once this feedback has been received, make sincere changes and utilize evidence for support. [2] 

* Provide a liaison to support epidemiological needs.

* Provide a liaison to support cost analyses. What are costs necessary to implement the indicators? How can funding be detailed in ask and supported through global networks? 

* Be assertive and respectful regarding national security. What are the national security concerns to data reveal and how can countries work to assure and address issues?

* Gain insight on what professional credentials for IHR representation would look like, by country. 

*Assess the progress of IHR work by asking countries directly. The 2/3 of IHR-tasked countries  still unable to perform the main functions of assess, detect, and respond (about 132 of the 196 countries) should be addressed. What are recommendations for an international, coordinated strategy, nearly twenty years after initiation (2005), to help these ~132 countries?  [3]

* Validate the support that has been reportedly offered. Ask these countries about the support offered, and whether or not it has been offered and/or received without alternative agenda attached. 

* Determine how countries use IHR data and how they rely on the Global Health Observatory.  Ask them for unbiased, sincere response. 

* Determine methods for verification and validation. How can leadership confirm the responses are reliable, consistently interpreted and accurate with a respectful tone? How can countries prepare to receive feedback with professionalism?

* Clarify how regional support can provide efficiency for multiple countries. [4]

* Clarify how ongoing education could be conducted alongside a global peer network of IHR champions.

* Speak with actions, not words. If we ask for honesty and transparency, reciprocate. If we ask for unbiased effort and response, do not retaliate.

We can refresh and maximize the IHR framework only once welcomed into countries’ space. 



1. https://www.who.int/news/item/19-10-2021-who-s-7-policy-recommendations-on-building-resilient-health-systems

2. https://extranet.who.int/e-spar/#capacity-score

3. https://coronavirus.jhu.edu/map.html

4. https://extranet.who.int/e-spar/#capacity-score

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