Evaluating Zambia's Implementation of IHR Core Capacities: Insights from the 2017 and 2023 Joint External Evaluations

Zambia’s commitment to the International Health Regulations (IHR, 2005) is periodically assessed through Joint External Evaluations (JEEs) across 19 technical areas. This study compares Zambia’s 2017 and 2023 JEE results to assess progress in IHR core capacities. We extracted scores from official JEE reports and undertook descriptive comparisons by category (Prevent, Detect, Respond, and Other IHR-related hazards and Points of Entry), complemented by a brief thematic review of recommendations. Differences in JEE tool editions were addressed through systematic indicator mapping to ensure comparability.Between 2017 and 2023, Zambia recorded the largest gains in the Respond category (mean 1.62 to 2.25; +0.63 points, + 38.5%). Marked improvements were observed in IHR coordination (1.00 to 2.70; +170.0%), surveillance (2.40 to 3.70; +54.2%), and points of entry (1.00 to 3.70; +270.0%). Detect improved modestly (2.70 to 2.90; +7.4%), while Prevent was essentially unchanged (2.39 to 2.37; −0.8%). Notable declines were seen in antimicrobial resistance (3.50 to 2.40; −31.4%), immunisation (4.00 to 2.70; −32.5%), and chemical events (2.50 to 1.00; −60.0%). Qualitative findings suggest strengthened coordination via the Zambia National Public Health Institute (ZNPHI), but persistent gaps in antimicrobial resistance and chemical-event preparedness.Overall, Zambia has advanced emergency response and surveillance capacities, likely reflecting ZNPHI establishment and COVID-19 investments, yet weaknesses remain in antimicrobial resistance, routine immunisation, and chemical hazard management. Priorities include restoring immunisation coverage, expanding One Health antimicrobial resistance surveillance, and improving chemical event readiness. These insights can guide updates to the National Action Plan for Health Security and resource allocation in resource-constrained settings.