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The National Health Security Strategy Interim Implementation Guide

January 27, 2010

Earlier this month, I reviewed the quadrennial National Health Security Strategy (NHSS) published by DHHS right before the New Year. Accompanying the NHSS was an Interim Implementation Guide intended to guide the writing of the first biennial National Health Security Implementation Guide. This is the, “thinking about what should our roadmap document look like,” document.

And yes, it’s just as skinny as it sounds. Extrapolating out some of the pieces can give us an idea of what the authors are thinking about building into the Implementation Guide due in September. I’ll take you on a quick walk through the document, but encourage you to download it yourself (pdf), as it’s quite short without the appendices and plainly written.

Chapter two is the real meat of the document and walks the reader through what DHHS is going to focus on while developing the final Implementation Guide:

During the first nine months of 2010, HHS and its partners will focus on accomplishing eight initial activities that provide a foundation for further implementation of the NHSS:

  • Identify and prioritize a list of investments to enhance the capabilities required to achieve national health security (2.1)
  • Conduct a workforce gap analysis and develop workforce competencies for all sectors involved in national health security (2.2)
  • Coordinate HHS’s efforts to improve national health security with those of DHS and all federal agencies involved in national health security (2.3)
  • Begin to identify and develop methods for risk analysis appropriate to the broad range of risks to public health (2.4)
  • Develop an evaluation framework, including plans for performance monitoring and evaluating the impact of investments (2.5)
  • Promote and implement quality improvement (QI) methods for health security on a broader scale (2.6)
  • Propose an agenda for research to enhance national health security (2.7)
  • Conduct an assessment of the countermeasures enterprise with the aim of identifying how to develop, manufacture, and ensure availability and delivery of countermeasures faster and more efficiently (2.8)

Activity 2.1 is really the “let’s plan to plan” one. The Guide breaks it out into 11 probable “investments” that the final Guide will focus on. Among the 11 are:

  • Developing and improving plans for emergencies, including communication, security, transportation, etc.
  • Training and exercising specific capabilities
  • Building a fully national biosurveillance system

Like I said, skinny, though nothing one can really argue against including. There’s also a current of including partners and the community in developing this list of investments, which is commendable. Let’s see how much that happens.

Activity 2.2 is frustrating because the workforce gaps in the public health and health care fields are widely understood. And only continues to get worse. Taking two years to study the problem without acting does nothing to improve the situation.

Activity 2.3 makes sense, though, we’ve all seen how difficult it is (pdf) to get federal agencies to talk to each other. Noble goal!

Activity 2.4 intrigues me. Longtime reader Joel and I are both of the mind that the laser focus on anti-anthrax planning tends to hamstring all-hazards public health preparedness planning. I can only hope that through this risk assessment exercise we move towards a more open minded planning process.

Activity 2.5, 2.6 and 2.7, to me, all go hand-in-hand, and are right up my friends at NACCHO’s alley. And mine. Figure out what works. Assess it. Make it better based off of your assessment. Thesis, antithesis, synthesis. High school science here, folks.

As for Activity 2.8, I wonder if that got added sometime in November when all of the promised lots of H1N1 influenza vaccine never showed up. This is where all of the Project BioShield and BARDA funding will show up, that’s for sure.

Chapter 3 identifies whose should be involved in this process, and like I said above, they include lots of different audiences, so I’m really interested to see how much, for example, the general public is pulled into this process.

Chapter 4 is about examining funding and has this GREAT line:

[G]overnmental funding has been inconsistent over time; ebbs and flows in funding priorities and levels have often left local, state, territorial, and tribal agencies reluctant to make long-term commitments to the staff and activities required to develop and maintain robust national health security capabilities.

Is rationality coming? I guess we’ll see.

Finally, the Guide mentions that the final version will be published concurrently with the revised DHS Target Capabilities List document. The wording, and multiple times the two documents are mentioned together, leads me to believe that their development is closely intertwined with one (the TCLs) heavily influencing the other (the Guide). I have mixed feelings about this because I worry that as public health preparedness gets pulled more into the homeland security world, it gets further and further from the public health world (to the detriment of both). Hopefully preparedness can serve as a bridge between the two worlds, and not just as a means to funnel money from public health to homeland security. Time will tell.

I’ll be on the lookout for public comment periods and other opportunities to interact with the development of the final Guide document and will absolutely pass them along as soon as I hear about them.

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