Building Local Capacity for Emergency Coordination: Establishment of Subnational Public Health Emergency Operations Centres in Nigeria

"The importance of coordination of public health emergency response in Nigeria was demonstrated by the role the polio EOCs played towards the elimination of the virus. It tremendously contributed towards the interruption of wild polio virus transmission..."



Public health emergency operations centres (PHEOCs) provide a platform for multisectoral coordination, collaboration, and communication to enhance the efficiency of outbreak response activities and enable the control of disease outbreaks. The earliest use of EOCs in Nigeria was with the national polio response. With its tropical climate, high population density, and poor socioeconomic indicators, Nigeria experiences large outbreaks of infectious diseases annually. The International Health Regulations (IHR, 2005) emphasises the importance of establishing PHEOCs where health leaders can receive information from multiple sources, coordinate decision-making, communicate across levels and sectors, and mobilise rapid response teams (RRTs) and resources. This paper shares the experience and importance of establishing PHEOCs at national and subnational levels in Nigeria and the lessons learned, which can be used by other countries considering the use of PHEOCs in managing complex emergencies.



After establishing a national PHEOC in 2017, the Nigeria Centre for Disease Control (NCDC) began setting up state PHEOCs. To do so, NCDC undertook an engagement process with states that involved a high-level advocacy visit to the state commissioner of health and agreement of a policy framework for preparedness and response activities. The prioritised states for the first phase of the implementation were Ebonyi, Bayelsa, Cross River, Zamfara, Enugu, and the Federal Capital Territory (FCT). These states did not have a polio EOC, had witnessed large outbreaks in the last year and were committed to providing the resources required to establish the PHEOCs.



Five major themes describe the key benefits of the PHEOC process:

1. Improved coordination: For example, in most states, traditional and religious leaders, who do not necessarily work within the Ministry of Health, have supported outbreak response activities through the PHEOC.
2. Coherence of thought among public health officials: Staff are more aware of developing actions that have clear outputs and a pathway towards this.
3. Commitment: According to those interviewed, they are better informed about the importance of their roles and measures towards performing these. This has enabled an improved sense of ownership and therefore commitment to public health preparedness and response activities.
4. Collaboration. In some states, the PHEOCs are now being used beyond infectious disease outbreak preparedness and response, for other public health activities. For example, some PHEOCs are used for the coordination of maternal, newborn, and child health interventions.
5. Government ownership: For example, during outbreaks, the appointment of an incident manager by the state government has also enabled state-government ownership and leadership of response activities.

Challenges associated with and lessons learned from the establishment of subnational PHEOCs are outlined. One lesson was that regular objective-based training and simulation exercises at individual and organisational levels should be instituted at the early phase of the establishment to build skills, relationships, and understanding of the plans and procedures in place to support the response activities. Furthermore, establishing train-the-trainer programmes to enable stepping down of the training from NCDC can sustaining the capacity at state level.



The researchers conclude: "The establishment of PHEOCs at the subnational level in Nigeria has proven to be extremely valuable....Our experience provides formative elements, lessons and challenges from establishing subnational PHEOCs in a federal country with annual large disease outbreaks. If adopted, these could provide a route to better results in disease outbreak response coordination....Many countries face serious challenges in coordinating a multisectoral response to public health events. The use of PHEOCs can solve this challenge, towards stronger global health security."