After-action reviews as a best practice tool for evaluating the response to urban disease outbreaks in Nigeria

The International Health Regulation (IHR) monitoring and evaluation framework includes voluntary instruments such as after-action reviews (AAR) as part of a five-year global strategic plan to improve public health preparedness and response. The Nigeria Centre for Disease Control conducted three AARs post-response to multi-city outbreaks of Monkeypox, Cerebrospinal Meningitis and Lassa Fever in 2018. All outbreaks were in urban local government areas (LGA)/cities across more than 20 states lending credence to the rise of city-states as a locus of risk for infectious disease re-emergence. Aspects of modern life in urban LGAs such as encroachment of humans into new environments and destruction of forests for agriculture puts residents in close contact with wildlife and at risk for infectious disease outbreaks. This chapter discusses the usefulness of AARs as a tool for evaluating responses to urban disease outbreaks and assess preparations for future ones using an approach that combines self-evaluation and peer review complying with the recommendations of the IHR for mandatory State Parties self-assessment annual reporting. This experience helped Nigeria identify how best practices can be maintained, improved, institutionalized and shared with relevant stakeholders. The AARs also determined how actions were implemented as opposed to how they were planned, identified processes that worked and those that didn’t, determined root causes for success and failure, and finally, provided SMART corrective recommendations to improve future performance actions and to strengthen cities pandemic readiness.