Working Together to Address Gaps in Global Health Systems

The 2014 outbreak of the deadly Ebola virus in West Africa moved disease preparedness into the global spotlight. In today’s interconnected world, a health threat anywhere is a health threat everywhere. Global health gaps in areas such as disease surveillance, laboratory capacity and workforce development have a direct impact on Americans’ health, safety and security.

The best way to stop an outbreak is to stop it at its source. If an outbreak is not detected early and controlled, it can spread rapidly—causing loss of life, devastating health systems, stalling future development and even leading to political instability.

The CDC Foundation, in partnership with the Centers for Disease Control and Prevention (CDC) and global partners, is working to identify public health resource gaps and develop public-private partnership strategies in collaboration with ministries of health in countries with the most need.

As part of the collaborative work to identify the gaps, reviews of global epidemic readiness found that nearly five billion people live in countries that have not rigorously assessed their ability to find, stop and prevent diseases, leaving them and the rest of the world vulnerable to outbreaks and epidemics.

To better prepare these countries for threats, and protect people across the globe, the World Health Organization provided an assessment tool, called the Joint External Evaluation. Countries can use this tool to identify gaps in their health systems. Based on the evaluation results, each country is given a score of one through five, with a corresponding color rating of red, yellow or green depending on their national readiness to respond to health threats.

Of the 116 countries who completed the evaluation, 65 have established a National Action Plan for Health Security to evaluate their vulnerabilities in areas like food safety, national laboratory system and workforce development, and then put measures in place to raise their ratings in target areas. Uganda is one of the countries working to address key gaps in disease surveillance and prevention.

“Uganda’s average score fell in the yellow range, but there were three areas where the scores were red: health financing, points of entry and preparedness,” said Colby Wilkason, technical advisor for Resolve to Save Lives, an initiative of Vital Strategies, working globally to bolster epidemic preparedness for vulnerable countries.

To help Uganda address its readiness gaps, the CDC Foundation is partnering with Vital Strategies to support an acceleration team within the country to oversee the process and coordinate between government agencies. Comprised of various health, legal and evaluation specialists, the team is responsible for a checklist of activities designed to raise the country’s readiness score in the three target areas.

Colby Wilkason, technical advisor, Preventing Epidemics, Resolve to Save Lives

With so many government agencies involved in the process in each country, coordination is the biggest challenge of the job. 

“We really work through this acceleration team, all of whom are Ugandans,” Wilkason said. “The team has been able to help the country create a governance structure toward their National Action Plan and help the country assign who will be in charge of the different activities and push them forward.”

As a technical advisor working alongside those countries who have completed their action plans, CDC works with those implementing the plans to identify areas of weakness and determine how much funding will be needed to address each issue. The CDC Foundation is supporting this work, including funding a costing tool which countries can use to further gauge activity costs. Working closely with the World Bank, Resolve to Save Lives can then help to catalyze funding, while also providing technical support and disseminating lessons learned from other countries that have faced similar challenges.

With so many government agencies involved in the process in each country, Wilkason said, coordination is the biggest challenge of the job. Though an epidemic could affect many sectors within a country, those sectors are often ill-prepared and under-funded.

“We can help to educate outside of just human health on how these issues could severely impact other areas, like agriculture, water and livestock,” Wilkason said. “We need to be able to speak the language of other ministries.”

With a background in epidemiology and information management, Wilkason has been involved with several international outbreak responses in the past. But prevention work through Resolve to Save Lives has given her a different perspective on the role that preparedness plays in saving lives worldwide.

“One thing I always found myself asking during a response was, ‘How did it get to this point?’” Wilkason said. “This job is really interesting because it addresses that issue, and we are making sure it never gets to that point.”


The CDC Foundation and CDC are working to increase public health infrastructure in countries with global health gaps in areas such as surveillance, laboratory capacity, disease surveillance and workforce development. As a part of this work, Vital Strategies, in partnership with the CDC Foundation and CDC, is assisting countries with developing costed, funded action plans that address the gaps identified by the World Health Organization-led Joint External Evaluation (JEE) process. This work will support eight countries in developing draft costed plans and identifying funding to implement the plans.

Read more voices of impact in our 2019 donor report.