Main challenges of the detection in the context of global health security: systematic review of Joint External Evaluation (JEE) reports.

Introduction: since 2016, Joint External Evaluation (JEE) missions have been organized in various countries. This systematic review of the JEE reports is intended to identify the main challenges (MC) of detection in WHO regions.

Methods: we accessed JEE reports on the WHO website. Challenge was defined as a variable of the indicators of detection where there was a need of improvement. MC was a challenge common to at least one-third of countries in each region and globally. For consistency, we assessed challenges reported under "Areas which need strengthening/challenges" in reports.

Results: we analyzed 96 JEE reports. African Region (91.7%), Eastern Mediterranean Region (80.9%) and South East Asia Region (72.7%) had the highest rates of JEE completion. The MC were 24 in European Region, 26 in Mediterranean Region, 30 in Western Pacific Region, 33 in South East Asia Region and 34 in African Region. 24 MCs were identified at global level. National laboratory system and Real time surveillance had the highest number of MC. Eleven MCs were common to all WHO regions and global level. These include insufficient capacity for core test confirmation, insufficient specimen referral system, weak quality management system, issues in laboratories licensing and accreditation, weak data management, weak electronic reporting system, absence /weak mechanism of information exchange between International Health Regulation and animal health focal points, insufficient health professional specialists, the need of workforce strategy, the need of field epidemiology and insufficient workforce retention capacity.

Conclusion: the MCs identified should be addressed through a global approach.