GRF · Health and Biosecurity Governance
Health system readiness
Health systems must keep routine care going while absorbing an emergency surge. Readiness depends on workforce, beds, supplies, laboratory capacity, financing and the plans that link them. Assessments under the IHR measure some of this; real events reveal the rest. This page sets out how readiness is built and where it fails, the records that show it, and who decides.
Health system readiness on the record.
Health system readiness: how the risk develops.
Essential services and preparedness. The dossier below sets out how the risk develops, what is measured, where the data come from, how it is modelled and who decides.
Workforce is the binding limit
Beds and equipment are useless without trained staff. Shortages, burnout and absenteeism in an emergency cut capacity faster than any supply gap.
Routine care is displaced
Emergencies divert staff and facilities from routine services. Missed immunisations, delayed diagnoses and interrupted treatment cause harm that outlasts the emergency.
Lean supply meets surge
Just-in-time supply chains for medicines and protective equipment keep costs down and leave no buffer. Stockpiles expire unless rotated and managed.
Assessments miss performance
Capacity assessments count plans and resources. Exercises and after-action reviews show whether they work, but are done less often and published less.
Environmental exposure in Southern Africa.
Population density, daytime surface heat and haze over Southern Africa, from NASA GIBS. Each layer carries its own date.
The interactive map needs JavaScript; the layer list and sources are below.
Layers 3
Environmental exposure, for this page
Keyboard, with the map focused
Hold Ctrl or ⌘ and scroll to zoom
Latest available
NASA GIBS / EOSDIS · ASTER GDEM (METI, NASA) · Blue Marble (NASA) · © OpenStreetMap contributors (ODbL) · Natural Earth
Loading the latest NASA imagery.
Drag to move. Ctrl or ⌘ and scroll, pinch or the buttons to zoom; hover for the values under the pointer; reset returns to the region.
Environmental exposure, framed on Southern Africa.Satellite and model products as NASA publishes them, each with its own date. They are indicators, not assessments of any place.
Data: NASA GIBS · ASTER GDEM · Blue Marble · © OpenStreetMap contributors · Natural Earth · NASA EONET · U.S. Geological Survey · NOAA GOES-East ABI GeoColorSources and licences
- We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS). Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS). Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- Center for International Earth Science Information Network (CIESIN), Columbia University. 2018. Gridded Population of the World, Version 4 (GPWv4): Population Density, Revision 11. NASA Socioeconomic Data and Applications Center (SEDAC). Licensed under CC BY 4.0. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). doi:10.7927/H49C6VHW. CC BY 4.0
- VIIRS near-real-time products (flood, land surface temperature, snow cover, corrected reflectance), NASA LANCE; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- MODIS and VIIRS atmosphere products, NASA LANCE and LAADS DAAC; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- OMI nitrogen dioxide (Aura) and OMPS aerosol index (Suomi NPP), NASA; distributed by the NASA GES DISC; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- NASA Fire Information for Resource Management System (FIRMS), VIIRS 375 m active fire product, NASA LANCE; vector tiles via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- ASTER GDEM is a product of METI and NASA (ASTER Global Digital Elevation Model V003, NASA LP DAAC); imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). Cite as: NASA/METI/AIST/Japan Spacesystems and U.S./Japan ASTER Science Team (2019). ASTER Global Digital Elevation Model V003. doi:10.5067/ASTER/ASTGTM.003. NASA open data
- Made with Natural Earth. Free vector and raster map data @ naturalearthdata.com. Public domain
- © OpenStreetMap contributors (ODbL), via NASA GIBS (coastlines, boundaries, roads and place names). Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). ODbL
- Blue Marble, NASA Earth Observatory; imagery via NASA GIBS. Colours redrawn from the published colour map; values averaged into hexagonal cells where shown (modified). NASA open data
- Context on the globe and flat map: coastlines, boundaries, roads and place names from NASA GIBS reference layers (OpenStreetMap data, ODbL, © OpenStreetMap contributors); Blue Marble imagery as an optional base; 3D terrain and the elevation read-out from the ASTER GDEM elevation colour index (5 m to 200 m classes, exaggerated for legibility). Boundaries are drawn as published and imply no position on any territory.
- Live events: NASA Earth Observatory Natural Event Tracker (EONET); events are indicative and keep their original source links.
- Live: NASA EONET Events are indicative, not authority warnings.
- Live: U.S. Geological Survey Events are indicative, not authority warnings.
- Live: NOAA GOES-East ABI GeoColor (CIRA). We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS).
- NASA GIBS: We acknowledge the use of imagery provided by services from NASA's Global Imagery Browse Services (GIBS), part of NASA's Earth Science Data and Information System (ESDIS).
- Air quality forecast, 5 days, PM2.5 (CAMS via Open-Meteo): Contains modified Copernicus Atmosphere Monitoring Service information 2026.
- Past year, daily temperature (ERA5 via Open-Meteo): Contains modified Copernicus Climate Change Service information 2026.
- Weather data by Open-Meteo.com (https://open-meteo.com/), licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/).
- Optional layers (14 sources in the layer list: live, forecast, observed and context) print their provider credit on the map and here when switched on; forecasts are model output and derived indices are estimates.
Layers and dates
- Population density, 2020: Population: CIESIN, Columbia University, Gridded Population of the World v4.11 (2018), NASA SEDAC, CC BY 4.0 · static
- Land surface temperature, day, 8-day composite: VIIRS NOAA-20 Level 3, 8-day, NASA LANCE · 14 Sep 2026
- Aerosol optical depth, daily: VIIRS NOAA-20 Deep Blue AOD, NASA LANCE · 13 Oct 2026
- Flood water, 3-day composite: VIIRS Global Flood Product, NASA LANCE · 14 Oct 2026
- Nitrogen dioxide, lower atmosphere column: OMI Aura, NASA GES DISC · 10 Oct 2026
- Active fires and thermal anomalies: VIIRS NOAA-20 375 m (FIRMS), NASA LANCE FIRMS · 13 Oct 2026
What is measured, and how well.
Each indicator carries its unit, its cadence, the kind of source behind it and the evidence label a value would carry. No values are shown: a programme supplies them under its own authority.
| Indicator | Unit | Cadence | Source type | Label |
|---|---|---|---|---|
| Health workforce density | doctors, nurses and midwives per ten thousand population | annual | WHO National Health Workforce Accounts | Published statistics |
| Hospital beds | beds per ten thousand population | annual | National statistics | Published statistics |
| Joint external evaluation scores | score by technical area | periodic | WHO JEE reports | Published statistics |
| Essential health service disruption | share of services disrupted | periodic during emergencies | WHO pulse surveys | REPORTED |
| Universal health coverage service coverage index | index | periodic | WHO and World Bank | ESTIMATED |
| Public health emergency operations centre | yes or no, functional status | on change | National records | DECLARED |
IHR event governance desk.
The screen a team would use to follow this subject: its measures, states and decisions. Names are examples and values are illustrative.
IHR event governance desk
Health system readiness · National IHR focal point · Event EV-8416
Event handling
- Signaldetected
- Verifywith source
- AssessAnnex 2
- Notifywithin 24 h
- Respondmeasures
- Reviewafter action
Annex 2 questions
- Serious public health impact?
- Possibly
- Unusual or unexpected?
- Yes
- Risk of international spread?
- Assessing
- Risk of travel or trade restriction?
- Low
Core capacities
self-assessment score vs target
Where the evidence comes from.
Named public datasets and institutional records, each with its licence class. Sources by agreement are used only under their terms and never republished.
| Source | What it gives | Licence class |
|---|---|---|
| WHO Global Health Observatory | Workforce, facilities and service coverage | Free, WHO terms |
| WHO Joint External Evaluation reports | Independent assessments of IHR capacities | Free, WHO terms |
| WHO pulse surveys on continuity of essential health services | Service disruption during emergencies | Free, WHO terms |
| OECD Health Statistics | Health system resources and use in member countries | Free, OECD terms |
| National health accounts and facility surveys | Spending and facility readiness | Public records, terms per publisher |
Exercise a cascade in health system readiness with the people who decide.
Assembled from the Nexus Standards area profile Health security and One Health: the hazards it names, the systems and communities that carry the loss, the controls and institutions that dampen it and the data that observe it. Pick an initiating event and step through the cascade to see where mandates meet and which decisions fall to whom. The Map view places the run on an example geography with open data. Every weight is a stated assumption. An exercise for dialogue, not a forecast, an assessment or a position. To model a place of your own choosing, open the full System Builder.
Hazards
- Antimicrobial resistance
- Tuberculosis surge (set off downstream)
- Typhoid and paratyphoid fever (set off downstream)
- Health-system overload (set off downstream)
Systems and couplings
- Health security and One Health
- Biological hazard standards Mechanism
- Biodiversity and nature risk standards Common driver
- Food and agriculture risk standards Mechanism
- Global and systemic risk Cascade
Controls
NS-0Constitution and principlesNS-3Risk record UNIs (grammar, legacy crosswalk, allocation authority)NS-9Contextual UNIs (deployments, instances, programme instances)NS-10Policies and clauses (machine-readable obligations: definition, binding, evaluation and enforcement)NS-11Verification and monitoring (evidence, attestations, zero-trust conformance observation)NRS-H83Hazard family: Health system capacity failure (NHS-1 health.system)NRS-H42Hazard family: Rare and persistent human infections (NHS-1 health.other-human)NRS-H41Hazard family: Animal-to-human spillover (NHS-1 health.zoonotic)NRS-H43Hazard family: Livestock and aquaculture epizootics (NHS-1 health.animal-health)NRS-D3Humanitarian response and resilient recoveryNRS-H46Hazard family: Environmental and product harm to people (NHS-1 health.harm)
Observation
- WHO Disease Outbreak News (listed for reference)
- WAHIS animal health events (listed for reference)
- WorldPop gridded population (listed for reference)
- International Health Regulations capacity and health emergency preparedness
- Percentage of bloodstream infections due to selected antimicrobial-resistant organisms
Example geography
- West Africa: 59 hexagonal cells
- Night lights tonight, outages (VIIRS Day/Night Band), NASA GIBS
- Surface water through cloud, 30 m (OPERA DSWx-S1 radar), NASA GIBS
- Rain rate, last half hour (IMERG), NASA GIBS
Who decides, and what the evidence serves.
Health and Biosecurity Governance prepares evidence. The decisions below are taken by the authorities named, under their own rules, and never by the platform.
| Who decides | The question | Evidence this page serves |
|---|---|---|
| Health ministries | How to plan surge capacity and protect routine services | Capacity data, assessment findings and lessons from past events |
| Finance ministries | How much to invest in readiness between emergencies | Costed plans and evidence on returns to preparedness |
| Hospital and health service boards | How to prepare facilities and staff for surge | Continuity practice and exercise findings |
| Professional regulators | Whether to allow emergency registration or task shifting | Comparable arrangements and their outcomes |
Outputs this topic produces
- Guide to IHR capacity assessments and what they measure
- Comparative notes on surge workforce arrangements
- Dialogue briefs on continuity of essential services
- Questions for health ministries on stockpile governance
Who a decision on health system readiness reaches.
The sectors a policy on health system readiness has to coordinate: a choice in one ministry lands in the others.
Signature
Health and its partners
Health gives workforce for operations to infrastructure (0.3), farm labour to food (0.3) and utility workforce to water (0.2).
W · E · I · F · H · B
- Sectors
- 4 of 6
- Relations
- 6 of 15
- Coupling
- 0.42 share of total
Strongest relations in play
- Water → Food · irrigation0.8
- Food → Health · nutrition0.7
- Infrastructure → Water · pipes, dams and treatment works0.6
- Water → Health · drinking water and sanitation0.7
What experts ask.
Readiness questions ask whether plans can be carried out.
- Which essential services must be maintained in an emergency, and who decides?
- Is there legal and financial authority to surge staff, beds and supplies quickly?
- Are preparedness plans tested, and are lessons acted on?
- How is primary care, not only hospital care, included?
- How are the needs of marginalised groups protected when services are under strain?
How health system readiness is governed: instruments, mandates and commitments.
The instruments, mandates, actors and accountability arrangements a policymaker, diplomat or development agency works with, citing the agreements that set them. Structures follow the frameworks named. Any state or progress drawn is illustrative, not a record.
Policy instrument matrix
The kinds of instrument available on health system readiness, by level of government and cooperation.
| Instrument type | Local | National | Regional | Global |
|---|---|---|---|---|
| Regulatory | Zoning, building codes | Laws, standards, licensing | Harmonised rules | Conventions and treaties |
| Economic | Local levies, grants | Budget lines, taxes, insurance schemes | Risk pools, regional funds | Financing mechanisms |
| Information | Local warnings | Disclosure, early warning, statistics | Data sharing arrangements | Global monitoring and reporting |
| Institutional | Local committees | Lead agencies, coordination councils | Regional bodies and secretariats | Multilateral mandates |
| Cooperative | Community agreements | Partnership compacts | Memoranda and joint programmes | Agreements and joint commitments |
Mechanisms and drivers.
Readiness depends on investment made long before an emergency: workforce, surge capacity, supply reserves, information systems and relationships between institutions. Because these investments compete with routine pressures, they are often deferred. Plans that are not funded, exercised and updated tend to fail when tested.
During emergencies, maintaining routine essential services, such as maternal care, immunisation and chronic disease management, is as important as responding to the emergency itself, because disruption to routine care can cause substantial indirect harm.
Why now: heatwaves, power outages and supply disruptions increasingly threaten hospital continuity alongside outbreaks. The platform is designed to convene health authorities with the operators of the services hospitals depend on, and to exercise continuity in Universe with simulated alerts kept from the public.
How it is studied, and where the methods stop.
| Method or data | What it shows | Limits |
|---|---|---|
| Preparedness assessment frameworks | Capacities against agreed benchmarks | Scores may not predict performance |
| Exercises and after-action reviews | How plans work in practice | Lessons are not always implemented |
| Health financing analysis | Whether preparedness is funded | Preparedness spending is hard to isolate in budgets |
| Service continuity monitoring | Disruption to routine care | Data systems may fail during emergencies |
How it is studied, and what the methods cannot say.
- 01Epidemiology and public health scienceEarly outbreak parameters · Equity in outcomes · Evaluating measuresApplied here
- 02Policy, institutional and decision scienceComparing emergency health law · Tracing review recommendations · Mapping cooperationApplied here
- 03Molecular and life sciencesCountermeasure development pathways · Biosafety risk assessmentApplied here
Questions and answers.
What is a joint external evaluation?
Why does routine care matter in an emergency?
What is surge capacity?
Why do well-rated systems sometimes respond poorly?
What is an essential health service?
Who pays for readiness?
Does the platform assess national readiness?
Contribute evidence from this page.
Reports is the Consortium's quarterly publication. What you know about this subject can become evidence, a case or a correction in the next edition, credited to you and published under CC BY 4.0 where it is your own work.
- EmailGateway GW-GRFSend it from this pageEvidence, a correction, a case, a method, a review, a translation or profile input. It arrives tagged with this page, so the editor who owns it receives it.
- ZenodoOpen depositDeposit it and submit to the communityPublish your own record on Zenodo with your ORCID iD, then submit it to the Reports community there. Curators review it; the DOI stays yours.
- ReportsGlobal Risks ForumSee every way to contributeThe contribution types, how each is reviewed, what credit you receive, the licence and what is never accepted.
Never send personal data, sensitive infrastructure detail or anything you have no right to share. A contribution is reviewed before use; sending it confers no authorship or editorial rights, and sponsorship never buys a finding.
Bring a governance question to the Forum.
Information and enquiries are open today. An enquiry receives a reference and names the next step; applications, payments, compute allocations and registrations open only when their team, terms and review capacity exist.
Legal documents.
Show all 18 legal documents
Maps, data and figures on this site are shown for context and general information. They are not advice, forecasts or warnings; the limits of the information are set out in the Disclaimers and Data Notices.