In September 2017, the Ministry of Health of Mauritania organized an After Action Review (AAR) of the recent outbreak of Crimean Congo Haemorrhagic Fever (CCHF) which occurred May to July, 2017. The three day workshop was held 19-21 September in Nouakchott and involved over 50 participants, including health authorities from the two affected regions, Ministry of Health, Ministry of Agriculture and Livestock, Armed Services Medical personnel, and partners such as UNICEF, FAO, CDC-AFENET and IOM.

The methodology employed for this AAR was been developed by WHO in the context of the IHR Monitoring and Evaluation Framework, in which regular after action review, as means of assessing the functionality of core IHR capacities during a real event, is encouraged. An After Action Review is a qualitative review of actions taken to respond to a real emergency as a means of identifying best practices, lessons and gaps in capacity. It relies primarily on the personal experience and perceptions of individuals involved in the response to assess what worked and what did not, why and how to improve. AARs can provide relevant information for the conduct of other forms of assessment and learning exercises, including the Joint External Evaluations, IHR Annual Reporting and simulation exercises. Furthermore, results of AAR can be used to ensure that activities implemented as part of the NAPHS are having the intended impact on capacity to manage an emergency.  

The specific objectives of the AAR in Mauritania were to:

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Identify best practices, challenges and lessons observed during the response to the CCHF outbreak in Mauritania

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Identify opportunities for operational research on CCHF and other epidemic-prone diseases in Mauritania and to reduce their impact on the population.

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Propose actions to improve preparedness, early detection and response to public health emergencies.

The areas of the response covered in the AAR included

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Coordination of the response

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Epidemiological surveillance and laboratory

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Case management and infection prevention and control

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Risk communication and community engagement

The Ministry of Health of Mauritania regularly manages cases of CCHF and other viral haemorrhagic fevers of zoonotic origin, including Rift Valley Fever. The AAR revealed this experience and a number of best practices, such as an effective operational coordination between human and animal health sectors.  Participants also identified challenges which were faced and collectively developed priority activities to capitalize on the experience and to strengthen the management of CCHF outbreaks in the future. Some of the priority activities, included for example  

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Develop a manual of procedures for coordination between the response stakeholders involved in the management of public health emergencies

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Include a specific budget line for the management of public health emergencies

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Develop procedures and a database for the harmonization of human and animal health data

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Establish four sentinel surveillance sites for the monitoring of arboviruses and VHFs

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Development of operational communication plan for public health emergency situations

As a final step, participants of the AAR, as a multisectoral group, identified some of key steps that need to be followed to ensure implementation of the activities.