World Health Organization · 1st edition, 2026 · 86 pages
Practical guide for translating the ERPHC framework into implementation at PHC level for health ministries and partners.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2026
- Audience
- Ministries of health, national and subnational programme implementers, PHC managers, district health teams, facility-level leaders, public health institutions, implementing partners, donors
- Evidence
- Expert consensus; informed by four-country pilot implementation evidence (Ethiopia, Nigeria, Sierra Leone, Uganda) and extensive review of global frameworks (IHR, JEE, SPAR, HEPR, Health EDRM, PHC operational framework)
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
The Emergency Ready Primary Health Care (ERPHC) operational guide provides step-by-step practical guidance for countries to translate the ERPHC framework into action. It operationalises a system-wide approach that strengthens primary health care to prevent, detect and respond to health emergencies while maintaining essential services, through four integrated capacities: connect, detect, protect and treat. These enable coordinated frontline performance delivering faster responses (speed), safer care (safety) and the ability to manage increased demand and service disruption (surge).
The guide supports countries through eight core implementation steps: preliminary high-level engagement and alignment; stakeholder analysis and mapping; stakeholder engagement; country assessment, planning and prioritisation; co-creation of implementation strategy; development of country ERPHC strategy; resource identification and costing; and implementation planning, support and monitoring. Implementation begins with rapid analysis of hazards, vulnerabilities and PHC system readiness, followed by national co-creation workshops to prioritise gaps, adapt technical options and develop a contextualised national ERPHC strategy and roadmap.
ERPHC is implemented as a coordinated, whole-system approach across national, subnational, facility and community levels. Effective implementation depends on cross-cutting system enablers including strong leadership and coordination, a trained and supported workforce, sustainable financing and procurement systems, interoperable information and surveillance platforms, resilient infrastructure and logistics, and strengthened digital health and data integration. The guide includes practical tools, structured country planning and prioritisation templates, and learning from four-country pilot implementation.
Key points
For clinicians — doses and thresholds as stated in the guideline
- ERPHC operationalises emergency readiness through four core capacities: <em>connect</em> (community engagement and risk communication), <em>detect</em> (surveillance and early warning), <em>protect</em> (infection prevention and control, safe care), and <em>treat</em> (case management, referral and essential service continuity).
- Implementation follows eight steps: high-level engagement, stakeholder mapping, engagement, country assessment/prioritisation, co-creation workshops, strategy development, resource identification/costing, and implementation support/monitoring.
- Country planning uses structured self-assessment across the four capacities, scored on four levels: (1) not implemented, (2) partially implemented, (3) implemented, (4) fully implemented with best practice.
- Implementation is coordinated across four health system levels: national (policy, standards, supply chains), subnational/district (planning, supervision, coordination), facility (triage, surveillance, IPC, case management), and community (CHWs, outreach, community-based surveillance).
- Pilot results from four countries (Ethiopia, Nigeria, Sierra Leone, Uganda) demonstrated 97% of outbreak cases detected within 7 days and 99% reported within 1 day; in Sierra Leone, ERPHC facilities detected mpox cases in median 3 days versus 5 days at non-ERPHC sites (P=0.006).
- Sustainable financing requires embedding ERPHC in national PHC budgets, creating flexible ring-fenced funds for surveillance, IPC, RCCE and medical countermeasures, and using blended capitation or performance-based payments to incentivise integrated functions.
- Cross-cutting enablers essential for implementation: strong leadership/governance, trained and supported health workforce (including CHWs), sustainable financing/procurement, interoperable information systems, resilient referral/logistics, and digital health integration.
- Digital health platforms enable timely threat detection, real-time service continuity monitoring, rapid information dissemination and support for 7-1-7 performance (detection within 7 days, notification within 1 day, response within 7 days).
Key roles and responsibilities for ERPHC implementation by level of health system
Table extracted from the guideline
| Level of implementation | Primary purpose in ERPHC | Key focus areas for implementation |
|---|---|---|
| National | Create the enabling environment for emergency ready PHC | Development of policies, standards and operational guidance; strengthening health information and early warning systems; national supply chain and logistics coordination; laboratory and referral network stewardship; multisectoral coordination and data-sharing arrangements, including one health linkages. |
| Subnational / district | Translate national plans into subnational and district operational readiness and oversight | District preparedness and response planning; routine analysis and use of surveillance and service data; facility supervision and mentorship; coordination with local authorities and partners; management of referral networks; ensuring availability and distribution of vaccines, diagnostics and medical countermeasures. |
| Facility | Deliver integrated PHC and emergency functions at the point of care | Screening and triage; event-based and routine surveillance and reporting; infection prevention and control; case management and referral; continuity of essential services planning; flexible service delivery arrangements during surges or disruptions. |
| Community | Strengthen early detection, trust and local response capacity | Community engagement and outreach; stakeholder mapping and mobilization; community feedback and reporting mechanisms; training and support of community health workers and community responders; risk communication and preparedness actions for households and vulnerable groups. |
Source: World Health Organization, Emergency ready primary health care operational guide. Reproduced in summary form.
From the guideline
Verbatim
“The difference between rapid control and widespread harm depends on what happens at the frontline.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute of Georgia, I see this operational guide as directly applicable to our context. Georgia's experience during COVID-19 exposed gaps in PHC-level surveillance, community engagement and surge capacity that this structured approach addresses. The guide's emphasis on 7-1-7 targets (detect within 7 days, notify within 1 day, respond within 7 days) aligns with our commitments under the International Health Regulations and provides a practical roadmap for strengthening our regional public health centres and primary care facilities. I would stress to Georgian clinicians the importance of the structured self-assessment tool and co-creation workshops—these enable us to move from fragmented donor-funded projects to an integrated, sustainable national system. The realistic caveat is financing: while the guide provides costing templates, transitioning from external donor support to sustained domestic PHC investment will require sustained political commitment and multi-year budget allocations, particularly challenging given competing health sector priorities and fiscal constraints in the South Caucasus region.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this operational guide is highly relevant given the region’s experience with cross-border disease threats (including COVID-19, seasonal influenza, measles outbreaks), climate-related hazards (flooding, heatwaves) and the presence of conflict-affected and displaced populations. Georgia’s established PHC network and national Public Health Institute provide a foundation, but capacity for integrated surveillance, community-based detection and surge management varies across regions. Countries in the South Caucasus would need to assess existing capacities using the structured planning tool, prioritise investments in community health worker training and surveillance linkages, strengthen digital health information systems for real-time reporting, and establish sustainable domestic financing rather than relying on external donor support. The guide’s emphasis on all-hazards readiness and service continuity aligns with Universal Health Coverage priorities in the region. National programmes should adapt the co-creation workshop methodology to local governance structures (centralised in Armenia and Georgia, more decentralised in some districts) and consider cross-border coordination mechanisms given shared disease risks.
Questions this guideline answers
Quick answers
What is the purpose of the ERPHC operational guide?
The guide translates the ERPHC framework into practical, step-by-step actions for implementation. It helps ministries of health and partners plan, implement and monitor interventions that strengthen PHC capacity to prevent, detect and respond to emergencies while maintaining essential services. It provides adaptable tools, processes and resources to support country-led implementation tailored to local risks, system capacity and governance arrangements.
How does the country planning and prioritisation process work?
Countries conduct: (1) desk review of national policies, JEE/SPAR reports, 7-1-7 data and health system assessments; (2) review of current indicators related to HEPR framework, IHR and PHC; (3) mapping of existing programmes to ERPHC's four capacities; (4) key informant consultations; (5) field visits to collect data through observations and interviews. Findings are synthesised using a structured self-assessment tool (scored 1–4: not implemented to fully implemented) across connect, detect, protect and treat capacities, then translated into a context-specific roadmap through national co-creation workshops.
What evidence supports the ERPHC approach?
A four-country pilot (Ethiopia, Nigeria, Sierra Leone, Uganda) in nearly 1,000 health facilities demonstrated rapid improvements: 214 confirmed cases of outbreak-prone diseases detected (mpox, measles, diphtheria, cholera, yellow fever, Lassa fever), with 97% detected within 7 days and 99% reported within 1 day. In Sierra Leone's mpox outbreak, ERPHC facilities detected cases significantly faster (median 3 days vs 5 days, P=0.006) than non-ERPHC sites. Feedback from >1,400 frontline health workers showed 99% reported improved clinical suspicion and strengthened epidemic readiness.
What are the main financing requirements for ERPHC implementation?
ERPHC requires sustained domestic investment in PHC with: embedding in national financing strategies; flexible, ring-fenced funds for surveillance, IPC, RCCE, medical countermeasures and service continuity; timely disbursement to subnational and frontline levels; strategic financing reforms including rebalancing spending towards PHC, expanding fiscal space, and using blended capitation or performance-based payments to incentivise integrated ERPHC functions. In low-income or crisis-affected settings, health equity funds, community insurance and pooled humanitarian financing are vital but should progressively transition to harmonised, country-led systems aligned with UHC2030 principles.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
- CDC Mpox Information Page Becomes Target of Political Controversy Over Health CommunicationMay 2026
- The Pennsylvania Measles Deaths Are a Failure of Will, Not EpidemiologyOct 2026
- Bangladesh's Measles Crisis: How a Vaccination Success Turned Into 120,000 CasesOct 2026
- Diphtheria Cases Rise Across Americas: PAHO Calls for Urgent Vaccination PushJul 2026
Quality & accreditation
- ASF Hospital — Standard 20 — Supporting the Care Workforce
- ASF Laboratory — Standard 3 — Personnel & Competence
- ASF PHC — Standard 4 — Acute & Same-Day Care · Primary Health Clinic
- ASF PHC — Standard 7 — Governance & Staffing · Primary Health Clinic
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Emergency ready primary health care framework
- Emergency ready primary health care framework
- Public health advice on multisectoral action for social and economic protection of communities during Ebola and Marburg disease outbreaks
- Risk communication and community engagement readiness and response toolkit: cholera
- Guidelines on leishmaniases: treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis in eastern Africa and South-East Asia
- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2026
- Status
- Current
- Published
- 2026-05-11
- Languages
- English
- Scope
- Global; applicable across diverse settings and countries with adaptation to local risks, system capacity and governance arrangements
- Audience
- Ministries of health, national and subnational programme implementers, PHC managers, district health teams, facility-level leaders, public health institutions, implementing partners, donors
- Pages
- 86
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus; informed by four-country pilot implementation evidence (Ethiopia, Nigeria, Sierra Leone, Uganda) and extensive review of global frameworks (IHR, JEE, SPAR, HEPR, Health EDRM, PHC operational framework)
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
Emergency ready primary health care operational guide. Geneva: World Health Organization; 2026. https://doi.org/10.2471/B09751. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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