Zambia: A regional leader in NPHI development and emergency management

Dr. Victor Mukonka,
Director of the Zambia National Public Health Institute
The Zambia National Public Health Institute (ZNPHI) is young but is already emerging as a leader for public health in Southern Africa. We are proud of our growth over the past four years and the increasing role we have assumed in the region. As ZNPHI  Southern Africa’s first regional workshop on public health emergency management (PHEM), we reflect on the progress we have made thus far.
ZNPHI was born out of a need to bridge gaps in Zambia’s public health security. This was galvanized by the spirit and broader vision of the Africa Centers for Disease Control and Prevention (Africa CDC) of “Safeguarding Africa’s Health”. The Zambian government leadership, at the highest level, recognized that developing a national public health institute (NPHI) would help consolidate and coordinate essential public health functions, including disease surveillance, emergency preparedness, and response to outbreaks and other events of public health importance. Established in February 2015, ZNPHI serves as a focal point for integrating and coordinating public health activities and addressing major public health problems that affect our country.
The Zambia Ministry of Health (MoH) identified public health emergency preparedness and response as a critical public health function for ZNPHI. Prior to the establishment of ZNPHI, there was no central coordination of emergency preparedness and response activities, and the link between local and district levels and the national level was weak. ZNPHI has helped improve coordination and is providing a more robust communications channel between the various levels in the public health sector. The establishment of a public health emergency operations center (PHEOC) provides not only a physical structure and basic equipment for PHEM, but also a system for coordination during public health events and emergencies in Zambia.
The Zambia National Public Health Institute (ZNPHI)
In the coming years, we plan to develop standard operating procedures (SOPs) within the PHEOC and increase the number of trained personnel who are equipped with the necessary skills to participate effectively in emergency response. ZNPHI will continue to refine Zambia’s emergency management plan to incorporate best practices and outputs from the Threat and Hazard Identification and Risk Assessment (THIRA) workshop convened in 2017. We also hope to expand the PHEOC’s capacity to detect and respond to public health events through new technology, drills, and simulation exercises.
ZNPHI has had immense external support. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) invested in ZNPHI to serve as a vehicle for HIV epidemiology, research, and public health action. This funding was catalytic to ZNPHI’s establishment and provided the required impetus for turning the idea of an NPHI into reality. The US Centers for Disease Control and Prevention (US CDC), the International Association of National Public Health Institutes (IANPHI), and the National Institute of Health of Mozambique have also been vital partners in ZNPHI’s growth and development.
In 2017, ZNPHI held a three-day emergency management training facilitated by US CDC PHEM experts. During the training, an alert was received about individuals with Ebola-like symptoms located 60 km from Zambia’s capital, Lusaka. Our ZNPHI team worked together with the US CDC experts to respond to this public health threat. Ebola was ultimately ruled out, but the event served as a good test of ZNPHI’s nascent emergency management system.

ZNPHI team in the PHEOC: Analysing data and devising response strategies during the 2017/18 cholera outbreak.

Shortly after establishing the emergency operations center, ZNPHI activated the Incident Management System (IMS) and utilized the PHEOC for the very first time during the complex and widespread cholera outbreak that began in October 2017. Using the principle of One Health, ZNPHI convened a multi-sectoral technical taskforce to coordinate the response. High-level support from the President’s office through a ministerial oversight committee chaired by the minister of health facilitated the mobilization of resources, policy direction, and invocation of necessary legal instruments for an unprecedented and successful response. This outbreak demonstrated the key role that ZNPHI plays in PHEM, as well as the value of an efficient and coordinated multi-sectoral response to public health events.
In 2017, Zambia was designated to host the Africa CDC Regional Collaborating Centre (RCC) for Southern Africa, with the role of coordinating NPHIs and public health activities in 10 member states in the SADC region: Angola; Botswana; eSwatini; Lesotho; Malawi; Mozambique; Namibia; South Africa; Zambia; and Zimbabwe. To achieve this, it is necessary that the RCC maintains strong relationships with other countries and serves as a leader for public health emergency management for the region. This underscores the importance of having a strong ZNPHI with a fully established PHEM system.

ZNPHI team in the PHEOC: Analysing data and devising response strategies during the 2017/18 cholera outbreak.
The Southern Africa PHEM workshop in August 2018 will  help the ZNPHI refine priority actions for emergency management and build cross-border, intra-regional and international relations and networks that will be essential for efficient and coordinated responses to public health events and emergencies. We believe that the biggest roles for Zambia as an RCC are the coordination of Africa CDC support and activities, and helping the region prepare for international emergencies that require cross-border and regional collaboration. Zambia eagerly looks forward to hosting the regional PHEM workshop and hope that it shall be a meaningful and productive experience for everyone in attendance!

Posted on by Dr. Victor Mukonka, Director of the Zambia National Public Health Institute