Development and

implementation
of national action
plans for infection
prevention and control
Practical guide
Development and
implementation
of national action
plans for infection
prevention and control
Practical guide
Development and implementation of national action plans for infection prevention and control: practical guide

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Contents
Acknowledgementsv
Abbreviations and acronyms viii
Glossaryix
Before you start: how to navigate this practical guide xi

Part 1.
Introduction to the practical guide 1
1.1. Quick summary2
1.2. Background and introduction2
1.3. Purpose3
1.4. Target audience3
1.5. Development methodology4
1.6. Key considerations5

Part 2.
Recap on strategic directions, key actions, indicators and targets 7
2.1. Quick summary8
2.2. Recap on the vision, objectives, strategic directions, key actions, indicators and targets8

Table 2.2. Strategic direction 1: political commitment and policies11

Table 2.3. Strategic direction 2: active IPC programmes13
Table 2.4. Strategic direction 3: IPC integration and coordination16
Table 2.5. Strategic direction 4: IPC knowledge among health and care workers and career
pathways for IPC professionals18
Table 2.6. Strategic direction 5: data for action21
Table 2.7. Strategic direction 6: advocacy and communications23
Table 2.8. Strategic direction 7: research and development24
Table 2.9. Strategic direction 8: collaboration and stakeholder support25

Part 3A.
Developing and implementing your infection prevention and control
national action plan 27
3A.1. Quick summary28
3A.2. The five steps of implementation28
3A.3. Spotlight on governance29

Step 1 – Preparing for action29

Step 2 – Baseline assessment37
Step 3 – Developing and implementing the IPC NAP42
Step 4 – Evaluating impact45
Step 5 – Sustainability47
Part 3B.
Implementation of each strategic direction 51
3B.1. Quick summary52
3B.2. Strategic directions: targeted activities, resources and considerations52

Strategic direction 1: political commitment and policies53

Strategic direction 2: active IPC programme61
Strategic direction 3: IPC integration and coordination74
Strategic direction 4: IPC knowledge among health and care workers
and career pathways for IPC professionals81
Strategic direction 5: Data for action. (i) IPC monitoring and hand hygiene
monitoring, and (ii) HAI surveillance100
Strategic direction 6: advocacy and communications107
Strategic direction 7: research and development116
Strategic direction 8: collaboration and stakeholder support124

References133

Annexes139
Annex 1. IPC core components and the eight strategic directions140
Annex 2. Key WHO documents143
Annex 3. Stakeholder mapping grid 148
Annex 4. SWOT analysis: example of a national SWOT analysis for AMR surveillance152
Annex 5. Sample evaluation matrix for activity prioritization  154
Annex 6. Sample IPC national action plan template 155
Annex 7. Template for detailed operational plan and budget  156
Annex 8. Country story: Integrating policies and professionals to build a robust IPC framework
in China (strategic direction 1, Political commitment and policies)157
Annex 9. A new national IPC programme to enhance quality of care in Nepal (strategic direction 2,
Active IPC programme)161
Annex 10. Insights and suggestions for integration and coordination between IPC and other key
programmes165
Annex 11. Country story: IPC and role model hospitals: a demonstration of how coordination and
integration can become a reality to reduce AMR in Egypt (strategic direction 3, IPC integration and
coordination)175
Annex 12. Assessment framework summary (national and facility level) for education and training179
Annex 13. Strategic direction 4: country story – Addressing the educational needs of the new IPC
professional in Canada (strategic direction 4, IPC knowledge among health and care workers and
career pathways for IPC professionals)181
Annex 14. Country story: From research to action: strengthening IPC in Sierra Leone using
operational data (strategic direction 5, Data for action)185
Annex 15. Communications and advocacy mapping template190
Annex 16. Country story: A decade of success: strengthening IPC advocacy and communication
during Qatar IPC Week (strategic direction 6, Advocacy and communication)191
Annex 17. Country story: Integrating research into the activities of the national IPC unit in Norway
(strategic direction 7, Research and development)195
Annex 18. Country story: Promoting partnership and teamwork to strengthen IPC across Nigeria
(strategic direction 8, Collaboration and stakeholder support)199
 Acknowledgements

Acknowledgements
The World Health Organization (WHO) gratefully acknowledges the many individuals and organizations who
contributed to the development of this practical guide to implementation.

The development of the guide was coordinated by the Department of Integrated Health Services (IHS), Universal
Health Coverage and Life Course Division of the WHO. Benedetta Allegranzi (Department of IHS) coordinated the
overall development process and was a co-writer of the document. Claire Kilpatrick (infection prevention and
control (IPC) consultant, Department of IHS) co-led the writing of the document together with Julie Storr (IPC
consultant, Department of IHS). Peter Bischoff (IPC consultant, Department of IHS), Mandy Deeves (Department of
IHS), Giovanni Satta (Department of IHS), Maha Talaat (IPC consultant, Department of IHS) and Ermira Tartari (IPC
consultant, Department of IHS) contributed to the writing of some sections of the document.

The following WHO staff and consultants provided input to the document: Omar Abouelata, (WHO Country Office,
Cairo, Egypt); Lucia Alonso (WHO Regional Office for the Americas, Washington, DC, United States of America);
Gertrude Avortri (WHO Regional Office for Africa, Brazzaville, Congo); April Baller (Department of Country Readiness
Strengthening, WHO Health Emergencies Programme); Landry Cihambanya (WHO Regional Office for Africa,
Brazzaville, Congo); Ana Paula Coutinho Rehse (WHO Regional Office for Europe, Copenhagen, Denmark); Daniela
Demiscan (WHO Country Office, Chişinău, Republic of Moldova); Rudi Eggers (Department of IHS); Aina Erastus
(WHO Country Office, Windhoek, Namibia); Sergey Eremin (Department of Surveillance, Prevention and Control,
Antimicrobial Resistance [AMR] Division); Bobson Derrick Fofanah (WHO Country Office, Freetown, Sierra Leone);
Bruce Gordon (Environment, Climate Change and Health Department); Monica Guardo (WHO Country Office,
Mexico City, Mexico); Alaa Hashish (WHO Country Office, Muscat, Oman); Iman Heweidy (WHO Regional Office for
the Eastern Mediterranean, Cairo, Egypt); Claudia Hoyos (WHO Country Office, Quito, Ecuador); Benedikt Huttner
(Control and Response Strategies Unit, AMR Division); Ivan Ivanov (Environment, Climate Change and Health
Department); Vannda Kab (WHO Country Office, Phnom Penh, Cambodia); Nirmal Kandel (Evidence and Analytics
for Health Security Unit); Catherine Kane (Health Workforce Department); Bahtygul Karriyeva (WHO Country Office,
Moscow, Russian Federation); Pierre Claver Kariyo (WHO Regional Office for Africa, Ougadougou, Burkina Faso);
Zhao Li (WHO Regional Office for the Western Pacific, Manila, Philippines); Margaret Montgomery (Environment,
Climate Change and Health Department); Dorothy Ngajilo (Environment, Climate Change and Health Department);
Kathy O’Neill (Department of IHS); Pilar Ramon-Pardo (WHO Regional Office for the Americas, Washington, DC,
United States of America); Paul Rogers (Department of IHS); Yang Ruikan (WHO Country Office, Beijing, China);
Rana Saleh (WHO Country Office, Cairo, Egypt); Murad Sultan (WHO Country Office, Dakka, Bangladesh); Ayda Taha
(Department of IHS); Aparna Singh Shah (WHO Regional Office for South-East Asia, New Delhi, India); Anuj Sharma
(WHO Country Office, New Delhi, India); Lina Yu (Evidence and Analytics for Health Security Unit).

WHO acknowledges the following experts for their strategic and/or technical input for the development of this
guide: Majid Al Shamrani (WHO Collaborating Centre for IPC and AMR, Riyadh, Saudi Arabia); Yewande Alimi
(Africa Centres for Disease Control and Prevention, Addis Abba, Ethiopia); Chedly Azzouz (Infection Control
Africa Network, Tunis, Tunisia); Colin Brown (WHO Collaborating Centre for Reference and Research on AMR and
Healthcare-Associated Infections, London, United Kingdom of Great Britain and Northern Ireland); Tania Bubb
(Association for Professionals in Infection Control and Epidemiology); Natalie Bruce (Public Health Agency Canada,
Ottawa, Canada); Lauren Clack (University of Zurich, Zurich, Switzerland); Maya Chavez (Médecins Sans Frontières
[MSF; Doctors Without Borders] International); Ben Cowling (WHO Collaborating Centre for Infectious Disease
Epidemiology and Control and University of Hong Kong, Hong Kong SAR, China); Jessica Dangles (Certification
Board of Infection Control and Epidemiology, Arlington, United States of America); Neelam Dhingra (Joint

v
Development and implementation of national action plans for infection prevention and control: practical guide

Commission International, Geneva, Switzerland); Tim Eckmanns (Robert Koch Institute, Berlin, Germany); Christine
Fears (Healthcare Infection Society, London, United Kingdom of Great Britain and Northern Ireland); Carole Fry
(WHO Collaborating Centre for Reference and Research on AMR and Healthcare-Associated Infections, London,
United Kingdom of Great Britain and Northern Ireland); Stephan Harbarth (WHO Collaborating Centre on IPC and
AMR and Geneva University Hospitals, Geneva, Switzerland); Gerry Hansen (Infection Prevention and Control
Association Canada, Canada); Emilio Hornsey (Infection Prevention Society, United Kingdom of Great Britain and
Northern Ireland); Kalisvar Marimuthu (National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore);
Devin Jopp (Association for Professionals in Infection Control and Epidemiology [APIC], United States of America);
Lata Kapoor (Ministry of Health, New Delhi, India); Moi Lin Ling (Asia Pacific Society of Infection Control, Singapore);
Stacey Mearns (Resolve to Save Lives, United States of America); Sally Mohy El Din (Ministry of Health, Cairo, Egypt);
Florence Mulonda (Ministry of Health, Windhoek, Namibia); Nico Mutters (European Committee on Infection
Control [EUCIC] and University of Bonn, Bonn, Germany); (Babacar Ndoye (IPC consultant, WHO Regional Office
for Africa, Brazzaville, Congo); Ramatu Elizabeth Ngauja (Ministry of Health, Freetown, Sierra Leone); Amal Saif Al
Maani (Ministry of Health, Muscat, Oman); Andreas Sandgren (Ministry of Health, Stockholm, Sweden); Supriya
Sarkar (Ministry of Health, Dhaka, Bangladesh); Stephan Stenmark (Ministry of Health, Stockholm, Sweden); Angela
Paraschiv (Ministry of Health, Chişinău, Republic of Moldova); Elena Pavlovna Igonina (Ministry of Health, Moscow,
Russian Federation); Pierre Yves Oger (United Nations International Children’s Fund [UNICEF], New York, United
States of America); Colette Ouellet (Infection Prevention and Control Association Canada, Canada), Diamantis
Plachouras (European Centre for Disease Prevention and Control, Stockholm, Sweden); Kemal Rasa (World Surgical
Infection Society, Kocaeli, Türkiye); Tania Villa Reyes (Ministry of Health, Mexico City, Mexico); Gabriel Rodriguez
(Ministry of Health, Mexico City, Mexico); Atsushi Samura (The Global Fund, Geneva, Switzerland); Massimo Sartelli
(Global Alliance for Infections in Surgery and Macerata Hospital, Macerata, Italy); Juliette Severin (International
Society of Antimicrobial Chemotherapy and Erasmus MC, Rotterdam, The Netherlands); Peixin Song (Nanjing Drum
Tower Hospital; Public Health Research Center, Nanjing University, Nanjing, China); Thomas Talbot (Society for
Healthcare Epidemiology of America and Vanderbilt University Medical Center, Nashville, United States of America);
Valeria Torres (Ministry of Health, Quito, Ecuador), Koy Virya (Ministry of Health, Phnom Penh, Cambodia); Kristy
Weinshel (Society for Healthcare Epidemiology of America, United States of America).

WHO particularly acknowledges the external review and written contribution to this practical guide by the following
experts: Emine Alp Meşe (European Committee on Infection Control [EUCIC], Ankara, Türkiye); Birgitta Lytsy
(International Federation of Infection Control, Uppsala, Sweden); Shaheen Methar (University of Stellenbosch and
Infection Control Africa Network, Cape Town, South Africa).

WHO particularly acknowledges the written contribution to and approval of the country examples by the following
individuals: Samira Abdisamed (Ministry of Public Health, Doha, Qatar); Omar Abouelata (WHO Country Office,
Cairo Egypt); Kimat Adhikari (WHO Country Office, Kathmandu, Nepal); Jameela Al Ajmi (Ministry of Public Health,
Doha, Qatar); Rekayahouda Baaboura (Ministry of Public Health, Doha, Qatar); Syed Hassan Bin Usman Shah
(Ministry of Public Health, Doha, Qatar); Hanne Eriksen-Volle (Norwegian Institute of Public Health, Oslo, Norway);
Siri Feruglio (Norwegian Institute of Public Health, Oslo, Norway); Bobson Derrick Fofanah (WHO Country Office,
Freetown, Sierra Leone); Dhouha Hamdani (Ministry of Public Health, Doha, Qatar); Iman Heweidy (WHO Regional
Office for the Eastern Mediterranean, Cairo, Egypt); Bjørn Gunnar Iversen (Norwegian Institute of Public Health,
Oslo, Norway); Gerry Hansen (Infection Prevention and Control Association Canada, Canada); Ibrahim Franklyn
Kamara (WHO Country Office, Freetown, Sierra Leone); Joseph Sam Kanu (Ministry of Health, Freetown, Sierra
Leone); Yara Mohsen Khalaf (WHO Country Office, Cairo, Egypt); Olena Komarcheva (Ministry of Public Health, Doha,
Qatar); Shaffi Fazaludeen Koya (WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt); Sally Mohy El Din
(Ministry of Health and Population, Cairo, Egypt); Ramatu Elizabeth Ngauja (Ministry of Health, Freetown, Sierra
Leone); Eman Radwan (Ministry of Public Health, Doha, Qatar); Tochi Okwor (Nigeria Centre for Disease Control,
Abuja, Nigeria); Bala Rai (Ministry of Health and Population, Kathmandu, Nepal); Yang Ruikan (WHO Country Office,

vi
 Acknowledgements

Beijing, China); Rana Sherif Saleh (WHO Country Office, Cairo, Egypt); Anders Skyrud Danielsen (Norwegian Institute
of Public Health, Oslo, Norway); Peixin Song (Nanjing Drum Tower Hospital; Public Health Research Center, Nanjing
University, China); Rony Zachariah (Special Programme for Research and Training in Tropical Diseases).

All external experts mentioned completed a declaration of interest form in accordance with the WHO declaration of
interests’ policy for experts. No potential conflicts were identified.

Acknowledgements of financial and other support

Core funds from WHO headquarters and the WHO Hub for Pandemic and Epidemic Intelligence (Berlin, Germany)
supported the development and publication of this document. WHO acknowledges the financial support of
the Centers for Disease Control and Prevention, USA. All technical and funding inputs from institutions and
individuals from the USA preceded 20 January 2025. Funds from the European Commission, Directorate-General for
International Partnerships, also supported the development and publication of this document.

vii
Abbreviations and acronyms
AMR antimicrobial resistance
AMS antimicrobial stewardship
AWaRE Access, Watch, Reserve
CDC Centers for Disease Control and Prevention
ECDC European Centre for Disease Prevention and Control
e-SPAR electronic States Parties self-assessment annual reporting
GAPMF Global action plan and monitoring framework
GLAAS Global analysis and assessment of sanitation and drinking water
GLASS Global antimicrobial resistance and use surveillance system
HAI health care-associated infection
HHSAF hand hygiene self-assessment framework
IPC infection prevention and control
IPCAT2 infection prevention and control assessment tool
IPCAT-MR infection prevention and control assessment tool minimum requirements
IPCAF infection prevention and control assessment framework
IPCAF-MR infection prevention and control assessment framework minimum requirements
NHSN National Healthcare Safety Network
NAP national action plan
OHS occupational health service
PAHO Pan American Health Organization
QIPCW Qatar Infection Prevention and Control Week
SD strategic direction
SMART specific, measurable, actionable, realistic and timely
SORT IT Structured Operational Research and Training IniTiative
SPAR States Parties Self-Assessment Annual Reporting 
SWOT strengths, weaknesses, opportunities and threats
TDR Special Programme for Research and Training in Tropical Diseases
TrACSS (Global database for) Tracking antimicrobial resistance country self-assessment survey
UNICEF United Nations Children’s Fund
WASH water, sanitation, waste management and hygiene
WHO World Health Organization

viii
Glossary
Accountability: the obligation to report, or give account of, one’s actions – for example, to a governing authority
through scrutiny, contract, management, regulation and/or to an electorate (1).

Champion: a particular type of stakeholder who is a supporter, but also more broadly aware and committed to the
transformational changes your team is driving towards achieving impact; potential to be strong advocates and help
sustain change over the long haul (2).

Culture: a set of values that you translate in practices and behaviours to effect change within an organization or
group of stakeholders (2).

Decision maker: a particular type of stakeholder who has a relatively high position and/or power to influence
decisions for action related to implementation (2).

Governance: refers to the processes, systems and structures through which authority is exercised, decisions are
made and resources are managed.1

Health care-associated infection (also referred to as “nosocomial” or “hospital-acquired infection”): an

infection acquired by a patient during the process of care (including preventive, diagnostic and treatment services)
in a hospital or other health care facility, which was not present or incubating at the time of admission; health care-
associated infections can also appear after discharge. Health care-associated infections can also be acquired by
health workers during health care delivery and by visitors (3).

Infection prevention and control (IPC) minimum requirements: IPC standards that should be in place at both
national and health facility level to provide minimum protection and safety to patients, health care workers and
visitors, based on the WHO core components for IPC programmes. The existence of these requirements constitutes
the initial starting point for building additional critical elements of the IPC core components according to a stepwise
approach based on assessments of the local situation (3).

IPC programme: based on the eight WHO core components for IPC which are the foundation for establishing or
strengthening effective programmes at the national and facility level (4).

IPC committee: a multidisciplinary group with interested stakeholders across the health care facility, which
interacts with and advises the IPC team. For example, the IPC committee could include senior facility leadership;
senior clinical staff; and leads of other relevant complementary areas, such as biosafety, pharmacy, microbiology
or clinical laboratory, waste management, water, sanitation and hygiene services and quality and safety, where in
place (5).

IPC professional: health care professional (medical doctor, nurse or other health-related professional) who has
completed a certified postgraduate IPC training course, or a nationally or internationally recognized postgraduate
course on IPC, or another core discipline including IPC as a core part of the curriculum, as well as IPC practical and
clinical training (5).

IPC focal point: IPC professional (according to the above definition) appointed to be in charge of IPC at the national,
sub-national or health care facility/organization level (5).

1
Health Systems and Governance Team. Geneva: World Health Organization, personal communication, 2025.

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Development and implementation of national action plans for infection prevention and control: practical guide

Multimodal improvement strategy: a multimodal strategy comprises several components or elements (three
or more, usually five) implemented in an integrated way with the aim of improving an outcome and changing
behaviour. It includes tools, such as bundles and checklists, developed by multidisciplinary teams that take into
account local conditions. The five most common elements include: (i) system change (availability of the appropriate
infrastructure and supplies to enable IPC good practices); (ii) education and training of health workers and key
players (for example, managers); (iii) monitoring infrastructures, practices, processes and outcomes and providing
data feedback; (iv) reminders in the workplace/communications; and (v) culture change within the establishment or
the strengthening of a safety climate (3).

Multi-sectoral taskforce (at the national level): an entity that spans sectors outside of those usually involved in
national IPC committees and may include technical, policy and civil society actors. Such an entity may also involve
private sector, insurers and community representatives.2

Stakeholders: those with an interest in or influence over the issue. Defining the role of stakeholders is important for
successful stakeholder engagement (6).

Stakeholder mapping: the first step in securing multi-stakeholder engagement, developing a collaboration agenda
and, importantly, multi-sectoral action. Stakeholder mapping is a way to learn the perspectives of stakeholders,
their affiliation, area they represent, and what interests and/or perspectives and influences they bring to the issue. It
offers a structured approach for gathering and assessing information on different stakeholders who are relevant to
implementation of the IPC national action plan (policy, strategy, or intervention) (6).

References*
1. WHO global strategy on people-centred and integrated health services: interim report. Geneva: World Health
Organization; 2015 (https://iris.who.int/handle/10665/155002).
2. Implementation playbook, pocket edition: a quick-reference guide to delivering impact for health, with tools
and templates. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/376467).
3. Minimum requirements for infection prevention and control programmes. Geneva: World Health Organization;
2019 (https://apps.who.int/iris/handle/10665/330080). Licence: CC BY-NC-SA 3.0 IGO.
4. Adapted from: Guidelines on core components of infection prevention and control programmes at the
national and acute health care facility level. Geneva: World Health Organization; 2016 (https://iris.who.int/
handle/10665/251730). Licence: CC BY-NC-SA 3.0 IGO.
5. Global report on infection prevention and control 2024. Geneva: World Health Organization; 2024 (https://iris.
who.int/handle/10665/379632). Licence: CC BY-NC-SA 3.0 IGO.
6. Adapted from: Implementation guide for the medical eligibility criteria and selected practice recommendations
for contraceptive use guidelines. Implementation guide toolkit. Stakeholder mapping guide. Geneva: World
Health Organization; 2018 (https://www.who.int/publications/i/item/9789241513579).
* All references were accessed on 2 April 2025.

2
Infection Prevention and Control Unit. Geneva: World Health Organization, unpublished data, 2025.

x
Before you start: how to navigate this
practical guide
This practical guide is in three parts and includes annexes. Ideally, each part should be read in sequence. However, it
may be helpful to read across different parts at the same time. Fig. 1 summarizes how to use the practical guide and
a quick summary is provided at the start of each section to help orientate readers.

• Part 1 provides a summary of the background and introduction to the guide and should be read first to support
the implementation journey. It is estimated that Part 1 should take no more than 10 minutes to read.
• In Part 2, those using the guide are reminded of how the infection prevention and control (IPC) national action
plan (NAP) will support achievement of the World Health Organization (WHO) global IPC strategy, including its
eight strategic directions, and the WHO global action plan and monitoring framework (GAPMF) on IPC. You can
review all the targets, indicators and actions to help develop the IPC NAP. This is essential reading to set up all
future actions and should take around 15 minutes to read.
• Part 3A guides on how to develop or update an IPC NAP. This part is the true starting point for IPC NAP
development and implementation, considering a 5-step implementation cycle, and signposts users to tools and
templates. The time taken to work through Part 3A will depend on a country’s situation – users are advised to
work at their own pace.
• In Part 3B, for each of the eight strategic directions of the WHO global strategy on IPC, targeted activities are
provided together with a list of considerations, tools and templates to inform the IPC NAP. It contains useful tips
on how to address some known challenges. The time taken to work through Part 3B will depend on a country’s
situation – users are advised to work at their own pace.
• The annexes contain the supplementary materials referred to in Parts 1–3, including action plan templates, a
stakeholder mapping grid and country stories.
• Icons are used across this practical guide to support usability and navigation. They highlight different sections
of the guide that provide useful further reading; clicking on the icons will take the user directly to the relevant
section.
The SD highlights a strategic direction of relevance; clicking on this will take the user directly to the strategic
direction.
The highlights a tool or resource of relevance; clicking on this will take the user directly to tool or resource
reference.
The highlights another page or section of relevance in the guide; clicking on this will take the user directly to
the page.
To return to your previous page, use Alt + Left Arrow (PC) or Command + Left Arrow (Mac).

xi
Development and implementation of national action plans for infection prevention and control: practical guide

Fig.1. Summary of how to navigate the practical guide

Part 1 Introduction and background

containing what you need
to know about this guide.
A short essential read

Part 2 Recap on strategic directions

including recommended
actions, indicators and targets.
The foundations of the
implementation journey

Part 3A A reminder about using

the five-step cycle and details
on how to develop an IPC NAP.
Implementation steps
and actions

Part 3B Developing and implementing

the IPC NAP according to each
Implementation steps strategic direction.
and actions by strategic
directions

Annexes Supplementary materials

related to Parts 1-3 to support
the implementation journey.
Useful templates, reading
and country stories

Abbreviations: IPC, infection prevention and control; NAP, national action plan.

xii
Part 1.
Introduction to the
practical guide

A short essential read

Introduction and background containing
what you need to know about this guide.
Development and implementation of national action plans for infection prevention and control: practical guide

1.1. Quick summary

• This section summarizes the intended target audience of this practical guide for individuals/teams responsible
for developing and implementing an infection prevention and control (IPC) national action plan (NAP).
• It summarizes the background and drivers underpinning the practical guide, associated World Health
Organization (WHO) guidance and manuals, and its purpose.

1.2. Background and introduction

• Infections acquired in health care settings (also referred to as health care-associated infections [HAIs]),
including those caused by antimicrobial-resistant organisms, continue to cause tremendous suffering to
patients, families and health workers and pose a high burden on health systems. Thus, implementation of IPC
actions are critical now more than ever (Fig. 1.1) (1).
• Recognizing this significant health threat and building upon lessons learned from the COVID-19 pandemic,
the WHO global IPC strategy was adopted in 2023/2024 by countries (2). The strategy was followed by the WHO
global action plan and monitoring framework (GAPMF) (3) for IPC, which indicates the strategic directions and
actions to develop, implement and monitor NAPs.
• These strategic directions and actions aim to achieve the effective implementation of IPC at national, sub-
national and facility levels, with the goal to reduce the risks and burden of HAIs and antimicrobial resistance (AMR).
• The GAPMF also provides agreed-upon indicators and targets for countries and facilities to track progress over
time (for more information see Part 2 ).
• Following the development and implementation of their IPC NAPs, it is expected that countries will monitor
and evaluate progress made, including the extent of its actual impact. Indicators, targets and specific objectives
should be adopted according to a country’s own situation and context, but always building on those featured in
the GAPMF (see Part 2 ).
• This practical guide is complementary to and expands upon information contained within existing guidance
and implementation manuals (Box 1.1). It is also complementary to countries and organizations’ own national
IPC guidance, action plans, implementation approaches and resources.
• The guide was co-developed with external experts through a virtual multi-country, three-level working group
comprised of all regional IPC leads and focal points, ministry of health focal points, and related WHO technical
programmes. This strategy was used to provide an implementation approach that supports all countries in how
to tailor their IPC NAP to their specific context and to meet targets and indicators over time.

Fig. 1.1. The harm caused by health care-associated infections

      

    
  





 
    
  


 

 
  
  
     ­




  

Abbreviations: HAI, health care-associated infection; LMICs: low- and middle-income countries; HICs, high-income countries; EU/EEA, European
 ‡ 
Union/European Economic Area.   ƒ„   
a  
Global estimates based on key review and WHO report published in 2011; EU/EEAestimates


based on 2012–2023 data from the European Centre
  
€‚ ƒ„
for Disease Prevention and Control point prevalence survey.









Source: WHO (1). 




†


  
ˆ






  


2





 



   
        
 Part 1. Introduction to the practical guide

Box 1.1. Existing IPC guidance and implementation manuals

Existing IPC global guidance

• The GAPMF directly refers to WHO recommendations and standards included in the guidelines on
IPC core components (4) and minimum requirements (5). A recap on the core components for IPC
programmes and how these relate to all eight strategic directions can be found in Annex 1 .

Existing IPC global implementation manuals

• Guides to the implementation of the core components for IPC programmes at both the national (6) and
facility levels (7) exist and many countries using this practical guide will be familiar with one or both of
these manuals to support previous and ongoing IPC implementation efforts. This guide builds upon
these.

• Where relevant, any existing implementation manuals are signposted for reference. In addition, a range
of implementation resources, which also exist in relation to fields such as AMR and quality and patient
safety are signposted throughout.

Relationships to other related guidance, standards and plans

• The GAPMF also directly refers to the essential water, sanitation, waste management and hygiene (WASH)
standards in health care, as well as the IPC sections of the global patient safety action plan and the global
action plan on AMR. Referring to these documents will provide additional useful details when using this
practical guide. Further details can be found in Annex 2 .

Abbreviations: AMR, antimicrobial resistance; GAPMF, global action plan and monitoring framework; IPC, infection prevention and control; WASH,
water, sanitation, waste management and hygiene.

1.3. Purpose
The purpose of this practical guide is to:

• provide a practical, stepwise approach to the development and implementation of an IPC NAP;
• outline a suite of tools, resources and inspirational country stories to help prioritize, cost, implement, monitor
and evaluate NAP activities.

1.4. Target audience

The primary target audience is those who are tasked with the development/update and implementation of the
IPC NAP in the country - referred to within this document as ‘the team’.

• In many countries this will be the national focal point for IPC;
• Where an IPC focal point does not exist, a responsible person(s) (for example, within the ministry of health,
public health and other national institutes) should be appointed and empowered to lead on the development
and/or updating and implementation of the IPC NAP.

A list of those who may lead this work or be concerned with using this practical guide are listed in Box 1.2.

3
Development and implementation of national action plans for infection prevention and control: practical guide

Box 1.2. Potential users

• those working in associated programmes such as AMR, patient safety, WASH, emergencies/emergency
preparedness and quality of care (non-exclusive list);
• political leaders and policy-makers (including those responsible for programme planning and financing
at the ministry of health);
• accreditation bodies;
• others working in occupational health or involved in International Health Regulations and One Health;
• educational institutions and professional and scientific organizations, societies and unions;
• key partners and donors;
• community and civil society;
• media and communication professionals.

Abbreviations: AMR, antimicrobial resistance; WASH, water, sanitation, waste management and hygiene.

1.5. Development methodology

The development process of this practical guide included the review and use of content of existing WHO documents
regarding the implementation of IPC programmes and plans. The strategic approach and content were developed
in active consultation with a multi-country, three-level working group comprising all WHO regional IPC focal points,
ministry of health focal points, and related WHO technical programmes at headquarters. The document was also
externally reviewed.

The development process included the following steps:

• an initial outline of the content was prepared by the lead authors;

• structured discussions were then held with the above-mentioned three-level working group members;
• a desk review for the identification of existing WHO and partner documents and implementation resources to
help inform the guide was performed, for example:
□ Interim practical manual: supporting national implementation of the WHO guidelines on core components
of infection prevention and control programmes (6);
□ Improving infection prevention and control at the health facility: interim practical manual supporting
implementation of the WHO guidelines on core components of infection prevention and control
programmes (7);
□ Implementation playbook, pocket edition: a quick-reference guide to delivering impact for health, with
tools and templates (8);
□ Implementation guide toolkit: stakeholder mapping guide (9);
□ WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the
human health sector (10);
• development of the first draft of the guide to implementation using existing WHO documents and implementation
resources and further consultation with the three-level working group was undertaken by the lead authors;
• the first draft was reviewed by members of the WHO IPC Unit team at headquarters and the three-level working
group members and a meeting was held to discuss the comments and feedback received;
• development of a second draft was undertaken and shared with all regional IPC focal points, members of the
WHO Global Infection Prevention and Control Network, and peer reviewed by external experts in IPC who all
provided feedback and comments;

4
 Part 1. Introduction to the practical guide

• development of a third draft capturing all comments received, with ongoing internal WHO discussions to refine
the content and summarize important ideas for design/usability;
• a final review by the regional IPC focal points was also requested;
• the practical guide was then finalized and professionally edited.

1.6. Key considerations

The practical guide acknowledges that budget restrictions, trained health workers (including support workers) and
high levels of turnover significantly impact on the implementation of IPC actions in many countries. The lack of a
designated IPC focal point to drive the development and implementation of the IPC NAP will be a key barrier and
this is addressed throughout the practical guide. Where possible, mitigations are suggested to overcome or at least
start to address these challenges. These include capacity-building initiatives, task shifting and strategies to improve
workforce retention, as well as recognition that applying even some aspects of this guide to implementation can
help to progress IPC at national level. Influencing policy-makers to recognize and address systemic challenges will
ensure that IPC interventions are not only well designed, but also practically applicable and sustainable and this is
why strategic direction 1 SD1 is of particular relevance in this regard.

5
Part 2.
Recap on strategic
directions, key
actions, indicators
and targets

The foundations of the

implementation journey
Focus on the global context including
recommended actions, indicators and
targets.
Development and implementation of national action plans for infection prevention and control: practical guide

2.1. Quick summary

• The section presents eight summary tables listing the key actions, indicators and targets for each of the eight
strategic directions. They also indicate where indicators already exist, as well as signposting to existing systems
for data collection.
• The global context for IPC is outlined, including the global IPC strategy and the eight strategic directions, which
are essential to develop and implement an effective IPC NAP.

2.2. Recap on the vision, objectives,

strategic directions, key actions,
indicators and targets
• The WHO global IPC strategy (2) outlines a clear vision and three key objectives (to prevent infections in health
care; to act to ensure IPC programmes are in place and implemented and to coordinate IPC activities with
other complementary areas such as AMR and WASH) and proposes eight strategic directions (Fig. 2.1) to help
Member States achieve measurable improvements and to substantially reduce the ongoing risk of HAIs.
• The strategic directions provide the overall guiding framework for countries in the development and
implementation of their own IPC NAP, which should contribute to achieving the strategic directions, informed
by the local context (Fig. 2.1).
• The WHO GAPMF 2024-2030 (3) lists the actions, indicators and targets based upon the eight strategic
directions for the global, national, subnational and facility levels to achieve the strategy vision. A set of core and
additional targets have been identified at each of the levels.
• The core targets of the GAPMF at the global and national level are summarized in Table 2.1.

Table 2.1. Core targets of the IPC monitoring framework at the global and national level
Eight core targets at globala level
1. Increase of proportion of countries with a costed and approved national action plan and monitoring framework on IPC (>
80% by 2030)
2. Increase of proportion of countries with legislation /regulation to address IPC (> 80% by 2030)
3. Increase of proportion of countries having an identified protected and dedicated budget allocated to the national IPC
programme and action plan (> 90% by 2030)
4. Increase of proportion of countries meeting all WHO IPC Minimum Requirements for IPC programmes at national level
(through WHO IPC portal) (> 90% by 2030)
5. Increase of proportion of countries with national IPC programmes at Level 4 or 5 per SPAR 9.1 and Level D and E in TrACSS (>
90% by 2030)
6. Increase of the proportion of countries with basic water (1), sanitation (2), hygiene (3), and waste services (4) in all health care
facilities (100% by 2030)
7. Increase of proportion of countries that have achieved their national targets on reducing HAIs (> 80% by 2030)
8. Increase of proportion of countries with a national HAI surveillance system (> 90% by 2030)
Four core targets at nationalb level
1. Increase of proportion of facilities meeting all WHO IPC Minimum Requirements for IPC programmes (> 90% by 2030)
2. Increase in the proportion of facilities with a dedicated and sufficient funding for WASH services and activities (100% by 2030)
3. Increase of proportion of facilities providing training to all frontline clinical and cleaning staff upon employment and
annually and to managers upon employment (> 90% by 2030)
4. Increase of proportion of tertiary/secondary health care facilities having an HAI and related AMR surveillance system (> 80%
by 2030)
Abbreviations: HAI, health care-associated infections; IPC, infection prevention and control; SPAR: States Parties self-assessment annual
reporting; TrACSS, Tracking antimicrobial resistance country self-assessment survey; AMR, antimicrobial resistance.
ᵃ Reflecting progress at national level.
ᵇ Reflecting progress at facility level.
Source: WHO (3).

8
 Part 2. Recap on strategic directions, key actions, indicators and targets

Fig. 2.1. Achieving vision 2030 for IPC at a glance

Strategic directions

Political commitment
SD1 and policies SD5 Data for action

Advocacy and
SD2 Active IPC programmes SD6 communications

Research and
SD3 Active IPC programmes SD7 development

IPC knowledge Collaboration and

SD4 and career pathways SD8 stakeholders’ support

Key actions are described for each strategic

direction at the national and facility level.

For every action,

indicators are listed.

A set of core and additional

targets are outlined.

Vision 2030
“By 2030, everyone accessing or providing
health care is safe from associated infections.”

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

9
Development and implementation of national action plans for infection prevention and control: practical guide

Reporting on progress
• At the national/subnational and facility levels, countries are strongly encouraged both to monitor and evaluate
progress in implementing their action plans and provide information for global reporting through WHO.
• Reporting will take place on a biennial basis to WHO on the core global and national indicators and targets and,
as relevant to local conditions, reporting will also take place on any additional contextual national indicators.
• The mechanism for reporting will be through data collection at the facility and national level by using WHO
standardized IPC monitoring tools measuring the indicators included in the GAPMF. The WHO Global IPC portal
(11) (Fig. 2.2) will provide the opportunity to enter the data in a common platform where reports and data
summaries can be downloaded by users. Raw data can also be requested to WHO by the country authorities for
their own use. The WHO Secretariat will perform aggregated analyses to assess the achievement of the global
and national targets and report to the World Health Assembly.

Fig. 2.2. WHO Global IPC portal

The WHO Global IPC portal is a resource that supports countries to

make a situation analysis, track progress and make improvements to
IPC programmes and/ or activities at the national and facility levels
in accordance with WHO standards and associated implementation
materials.

Abbreviations: IPC, infection prevention and control.

National, sub-national and facility-level strategic directions,

key actions, indicators and targets at a glance
• The GAPMF is designed to support and enable the implementation of the WHO strategy and was developed
through an extensive consultative process including global and regional consultations with Member States,
international experts and across the three levels of the WHO Secretariat.
• Tables 2.2–2.9 present each of the eight strategic direction and their key actions, indicators and targets as they
relate to the national, sub-national and facility levels.
• It is important to also consider the additional actions and indicators that can be found in the full version of the
WHO GAPMF 2024–2030 (3).
• Familiarization with each strategic direction and its targets is important before moving on.
• Facility-level actions, indicators and targets are in line with the actions, outputs and outcomes expected at the
national and sub-national levels and users of this practical guide should become familiar with these as they
prepare their IPC NAPs.

10
 Recap on strategic directions, key actions, indicators and target
Table 2.2. Strategic direction 1: political commitment and policies
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Develop a NAP and monitoring • IPC NAP and monitoring framework WHO Global IPC portal (11) GLOBAL
framework for IPC, outlining costs developed, costed, validated, and IPCAT2 (12) – 1.1.7 Core target 1/top 8 global targets
and sources of financing. approved by the ministry of health or IPCAT2 – 1.2.2 • Proportion of countries with a costed
other relevant national authorities IPCAT2 – 1.2.3 and approved NAP and monitoring
within the context of national health e-SPAR (13) – SPAR (14) 9.1: IPC framework on IPC.
plans. programmes • Increase of proportion of countries
with a costed and approved NAP and
2. Establish the legal framework for IPC • Legislation/regulations in place No current indicators monitoring framework for IPC:
to mandate the implementation of to address IPC (including IPC □ 30% by 2026
IPC programmes nationally and at professionals) in the public health □ 50% by 2028
all levels. regulatory framework. □ >80% by 2030.
3. Develop the national financial • National financial investment case No current indicators
investment case aligned with the developed based on global models Core target 2/top 8 global targets
global business case for IPC. (2026). • Proportion of countries with

Part 2. Recap on strategic directions, key actions, indicators and targets

legislation/regulations in place for
4. Establish a dedicated IPC budget to • Dedicated budget (in line with WHO Global IPC portal IPC (including IPC professionals) as
fund the national IPC programme the IPC NAP) allocated to the IPC IPCAT2 – 1.1.7 part of the public health regulatory
and action plan. national programme and NAP IPCAT-MR (15) – 1.4 framework.
identified and available. e-SPAR - SPAR 9.1: IPC programmes • Increase of proportion of countries
• Proportion of health care facilities IPCAF (16) – 1.9 with legislation/regulations for IPC:
with an adequately funded and □ 30% by 2026
dedicated budget for IPC. □ 50% by 2028
□ >80% by 2030.
5. Demonstrate evidence of investment • Dedicated and sufficient funding GLAAS (17)
by national authorities in WASH and allocated at the national level for Sufficiency of funding to reach the
Core target 3/top 8 global targets
infrastructure services and staffing to WASH services and activities. national target.
• Proportion of countries with an
ensure that all health care facilities
identified and dedicated (in line
have safely managed WASH services
with the IPC NAP) budget allocated
to enable IPC practices.
to fund the IPC national programme
and NAP.
• Increase of proportion of countries
with an identified and dedicated
budget allocated to the national IPC
programme and NAP:
11

□ 50% by 2026
12

Development and implementation of national action plans for infection prevention and control: practical guide
□ 75% by 2028
□ >90% by 2030
□ baseline (2021–2022): 41%.

Facility level

Demonstrate the commitment and Adequate dedicated budget available for e-SPAR
support of health care facility senior IPC (that is, to fund the IPC programme SPAR 9.1: IPC programmes
managers to IPC through an adequate and team and the annual action plan,
dedicated budget allocation to the IPC including equipment for IPC practices). WHO Global IPC portal
programme and team, including funding IPCAF – 1.9
to implement the annual action plan.

Abbreviations: NAP, national action plan; IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; e-SPAR, electronic States Parties self-assessment annual
reporting; IPCAT-MR, infection prevention and control assessment tool-minimum requirements; WASH, water, sanitation, waste management and hygiene; GLAAS, Global analysis and assessment of
sanitation and drinking-water, IPCAF, infection prevention and control assessment framework.
 Table 2.3. Strategic direction 2: active IPC programmes
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Establish a national IPC programme • All WHO IPC minimum requirements WHO IPC Global portal GLOBAL
and/or demonstrate evidence of for IPC met at national level (to IPCAT-MR – all indicators (national level) Core target 4/top 8 global targets
improvement of IPC programmes, be assessed through the WHO IPC IPCAF-MR (18-20) - all indicators (tools • Proportion of countries meeting all
including WASH (namely, meet WHO Global portal). for primary, secondary and tertiary WHO minimum requirements for
minimum requirements at national • Proportion of health care facilities health care facilities) IPC programmes at national level
and health care facility levels). meeting all WHO minimum WHO/UNICEF Joint Monitoring (through the WHO IPC Global portal).
requirements for IPC at facility level Programme for Water Supply, • Increase of the proportion of
(to be assessed through the WHO IPC Sanitation and Hygiene data (21) countries meeting all WHO minimum
Global portal). requirements for IPC programmes at
• Proportion of health care facilities national level to:
with basic WASH and waste services □ 30% by 2026
(according to each indicator, to be □ 60% by 2028
assessed through the definitions of □ >90% by 2030
the WHO/UNICEF Joint Monitoring □ baseline (2021‒2022): 4%.
Programme for Water Supply, Core target 5/top 8 global targets
Sanitation and Hygiene). • Proportion of countries with national

Part 2. Recap on strategic directions, key actions, indicators and targets

IPC programmes at levels 4 or 5 in
2. Support the establishment of • Proportion of tertiary/secondary e-SPAR- SPAR C9.1: IPC programmes section C9.1 of the SPAR and levels D
active IPC programmes (that is, health care facilities with an active or E in section 3.5 of TrACSS (highest
with objectives and an action plan IPC programme. WHO Global IPC portal levels).
supported by dedicated human • Proportion of primary health care IPCAF – 1.1-1.4 and 1.8-1.9; IPCAF-MR – • Increase of the proportion of
resources and financing), at least in facilities with an IPC link person. core component 1 indicator 1.1 countries with national IPC
tertiary and secondary health care programmes at levels 4 or 5 in
facilities, and identification of an IPC section C9.1 of the SPAR 9.1 and
link person in each primary health levels D or E in section 3.5 of the
care facility, within the broader TrACSS to:
health services development. □ 50% by 2026
3. Establish national targets on • Proportion of facilities with WHO Global IPC portal □ 75% by 2028
reducing HAIs and support the implemented interventions based IPCAT2 – 5.1.1 (and IPCAT-MR – 5.1) □ >90% by 2030.
implementation of multimodal on multimodal strategies to IPCAT2 – 5.1.2 Core target 6/top 8 global targets
improvement strategies to reduce decrease specific HAIs according to IPCAT-MR – 5.2; IPCAT-MR – 5.3 • Proportion of countries with basic
HAIs in health care facilities at all local priorities. WASH and waste services in all
levels, according to local priorities. health care facilities (according to
each indicator as monitored in the
4. Develop national IPC guidelines, • Evidence-based IPC guidelines and WHO Global IPC portal definitions of the WHO/UNICEF Joint
including policies for an enabling policies available at the national All indicators in core component 2 in Monitoring Programme for Water
environment for IPC, infrastructure, level. IPCAT2 (and IPCAT-MR) Supply, Sanitation and Hygiene).
13
14

Development and implementation of national action plans for infection prevention and control: practical guide
Key actions Indicator(s) Existing indicator(s) Targets

supplies, infection prevention • Increase of the proportion of

among health and care workers at countries with basic WASH and waste
health care facility level, and link services in all health care facilities to:
these guidelines with strategic □ 60% by 2026
principles for the control of AMR. □ 80% by 2028
□ 100% by 2030
Facility level □ baseline (2022) – water: 78%;
sanitation: not determined; hand
1. Establish an active IPC programme • Active IPC programme established e-SPAR hygiene: 51%; waste services: not
for tertiary and secondary (that is, with objectives and an SPAR C9.1: IPC programmes determined.
health care facilities (that is, with annual action plan supported by Denominator for core target 7
objectives and an annual action dedicated human resources and WHO Global IPC portal • Proportion of countries that have
plan supported by dedicated human adequate funding) (by 2026). IPCAF-MR: all indicators in core a national target on reducing HAIs
resources and budget) and ensure component 1 (tools for secondary/ (monitored by WHO Patient Safety
that there is an IPC link person in tertiary health care facilities) Flagship Secretariat).
each primary health care facility, IPCAF – 1.1-1.4 and 1.8-1.9 • Increase of the proportion of
within the broader health services countries that have a national target
development. on reducing HAIs to:
□ 50% by 2026
2. Make, fund and implement IPC • WHO minimum requirements for WHO Global IPC portal
□ 75% by 2028
improvement plans in order IPC in the health care facility met IPCAF-MR: all indicators (tools for
□ 100% by 2030
to achieve WHO minimum according to the facility level. primary, secondary and tertiary health
□ baseline (2023): 31%.
requirements for IPC according • Percentage met of WHO minimum care facilities)
Core target 7/top 8 global targets
to the health care facility level, requirements for IPC in the health
• Proportion of countries that have
including the availability of an care facility, according to the facility
achieved their national targets on
adequate facility infrastructure and level.
reducing HAIs (existing indicator in
IPC supplies.
the Global Patient Safety Action Plan
2021‒2030).
• Increase of the proportion of
countries that have achieved their
national targets on reducing HAIs
(among those having such target) to:
□ 30% by 2026
□ 50% by 2028
□ >80% by 2030.

NATIONAL
Core target 1/top 4 national targets
• Proportion of health care facilities
meeting all WHO IPC minimum
 Key actions Indicator(s) Existing indicator(s) Targets

requirements for IPC programmes.

• Increase of proportion of health
care facilities meeting all WHO IPC
minimum requirements for IPC
programmes to:
□ 30% by 2026
□ 60% by 2028
□ >90% by 2030
□ baseline (2019): 16%.

Core target 2/top 4 national targets

• Percentage met of WHO IPC
minimum requirements at national
level.
• Increase in the percentage met of
WHO IPC minimum requirements at
national level to:
□ 50% by 2026
□ 75% by 2028
□ >90% by 2030.

Part 2. Recap on strategic directions, key actions, indicators and targets

Abbreviations: HAI, health care-associated infection; IPC, infection prevention and control; WASH, water, sanitation, waste management and hygiene; IPCAF, infection prevention and control assessment
framework; IPCAT-MR, infection prevention and control assessment tool-minimum requirements; IPCAT2, infection prevention and control assessment tool 2; e-SPAR, electronic States Parties Self-
assessment Annual Reporting; IPCAF-MR, infection prevention and control assessment framework-minimum requirements; TrACSS, Tracking antimicrobial resistance country self- assessment survey.
15
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Development and implementation of national action plans for infection prevention and control: practical guide
Table 2.4. Strategic direction 3: IPC integration and coordination
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Ensure inclusion of IPC principles, • Desk review and situational analysis WHO Global IPC portal GLOBAL
standards and indicators within of integration of IPC within other IPCAT2: all indicators in section 1.3 Core top target 6/top 8 global targets
strategies and documents of programmes completed (by 2028). Professional organizations • Proportion of countries with costed
other complementary national • Key existing IPC principles, IPCAT2 – 6.1.2 road maps (namely, national plans)
programmes.1 standards and indicators identified, for WASH in health care facilities.
appropriately included, and cross- • Increase of the proportion of
referenced within other national countries with costed road maps
complementary programmes as (namely, national plans) for WASH in
appropriate (by 2030). health care facilities to:
□ 80% by 2024
2. Ensure that the IPC programme • Desk review and situational WHO Global IPC portal □ 90% by 2028
is aligned with and contributes to analysis of integration of other IPCAT2: all indicators in section 1.3 □ 100% by 2030
other complementary national complementary programmes within □ baseline (2022): 63%.
programmes’ strategies and the IPC programme completed (by
documents. 2028)
• Key existing policies, principles,
standards and indicators from
other complementary programmes
identified, appropriately included,
and cross-referenced within IPC
documents and programmes, as
appropriate (by 2030).
3. Ensure that IPC clinical practices • Clinical packages (for example, No current existing indicators or
and appropriate prescribing of policies and standard operating systems
antimicrobial agents (that is, procedures) available for integrating
antimicrobial stewardship) are IPC and appropriate antimicrobial
embedded in policies related to prescribing within clinical care (such
patient care pathways/programmes as surgery, maternal and neonatal
at the national, sub-national and care) (by 2028).
health care facility levels for tertiary,
secondary and primary health care.

1
Examples of programmes/areas of work complementary to IPC programmes include those on AMR, occupational health, patient safety, public health emergencies, quality of care, WASH and health care
waste, and specific infectious diseases (such as HIV infection and tuberculosis).
 Facility level
1. Establish an IPC committee ensuring • IPC committee established with WHO Global IPC portal
representation of and collaborative representation of and collaborative IPCAF – 1.6.
activities with other complementary activities with other complementary IPCAF – 1.7
programmes (for tertiary/secondary programmes (by 2026).
health care facilities).
2. Ensure that both IPC clinical • Standard operating procedures No current existing indicators or
practices and appropriate available integrating IPC and systems
antimicrobial prescribing are appropriate antimicrobial
embedded in all patient care prescribing within clinical care (for
pathways/wards. example, surgery, maternal and
neonatal care) (by 2028).
• Increased compliance with IPC
practices in specific wards and
among specialized professionals
(for example, injection safety, hand
hygiene and waste management in
surgical wards, operating theatres
and critical care units) demonstrated
(by 2030).
• Increased compliance with

Part 2. Recap on strategic directions, key actions, indicators and targets

appropriate antimicrobial
prescribing (for example, at least one
annual audit) demonstrated.
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAF, infection prevention and control assessment framework.
17
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Development and implementation of national action plans for infection prevention and control: practical guide
Table 2.5. Strategic direction 4: IPC knowledge among health and care workers and career pathways for IPC
professionals
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Develop a national curriculum for • Curriculum for IPC professionals WHO Global IPC portal NATIONAL
IPC professionals aligned with WHO developed or an international • IPCAT2 – 3.2.1- 3.2.3 Core target 3/top 4 national targets
IPC core competencies for IPC or curriculum endorsed and in use • Proportion of health care facilities
endorse an international curriculum. (2028). providing and/or requiring training
• Proportion of countries with a for all frontline clinical and cleaning
curriculum for IPC professionals staff upon employment (and
developed and in use (indicator for annually) and to managers upon
global target). employment.
• Increase of the proportion of health
2. Establish a national postgraduate • Postgraduate IPC certification No current existing indicators or care facilities providing and/or
IPC certificate programme (including programme established OR systems requiring training for all frontline
training courses on emergency requirement for an existing clinical and cleaning staff upon
preparedness on specific situations) certificate (2030). employment (and annually) and to
for IPC professionals that are • Proportion of colleges and managers upon employment:
aligned with existing international universities offering postgraduate □ 30% by 2026
standards, or require existing IPC training. □ 60% by 2028
certificates. • Proportion of countries with an IPC □ >90% by 2030.
certificate programme or equivalent
or requiring existing certificates GLOBAL
(indicator for global target). Additional targets (global)
3. Develop and establish a national • IPC pre-graduate curriculum for WHO Global IPC portal • Proportion of countries with a
IPC curriculum (or adopt an all relevant health care disciplines • IPCAT2 – 3.2.1 curriculum for IPC professionals
international one) for pre-graduate developed and endorsed by the • IPCAT-MR core component 3.1-3.4; developed or endorsed, and in use.
training and education for all appropriate national or international 5.1; 6.4 • Increase of proportion of
relevant health care disciplines body ensuring that quality and countries with a curriculum for
(for example, medical, nursing and standards (national/International) IPC professionals developed or
midwifery schools), endorsed by the are met (by 2028). endorsed, and in use:
appropriate national or international □ 30% by 2026
body, and integrate it within • IPC pre-graduate curriculum No current existing indicators or □ 50% by 2028
health educational curricula, with integrated within health educational systems □ >80% by 2030.
embedded evaluation mechanisms. curricula, with embedded evaluation • Proportion of countries with an IPC
mechanisms (by 2030). certificate programme or equivalent
or requiring existing certificates.
• Increase of proportion of countries
with an IPC certificate programme or
 Key actions Indicator(s) Existing indicator(s) Targets

4. Develop a national in-service • National in-service IPC curriculum WHO Global IPC portal equivalent:
curriculum on IPC (or adopt an developed (by 2026). • IPCAT2 – 3.2.4; 3.2.5 □ 30% by 2026
international one) for all health and • National (or sub-national) IPC • IPCAT-MR – core component 3.1-3.4; □ 50% by 2028
care workers, in particular frontline training programme to support 6.4 □ >80% by 2030.
clinical, cleaning and management in-service training created (by 2028), • Proportion of countries having IPC
staff and create a national (or introduced and regularly updated training programme for staff
subnational) training programme to (2030). • Increase of proportion of countries
support in-service IPC training. • Proportion of countries with a having an IPC training programme
national IPC in-service curriculum on for staff:
IPC (indicator for global target). □ 30% by 2026
□ 50% by 2028
5. Mandate that all health and care • Legal mechanism or well-defined No current existing indicators or □ >80% by 2030.
workers, in particular frontline strategies established to mandate systems
clinical, cleaning and management IPC in-service training (2028).
staff, receive education and training
in standard operating procedures for • Proportion of health care facilities WHO Global IPC portal
IPC upon employment and regularly providing and/or requiring • IPCAF – 3.3-4
(for instance, annually) thereafter. mandatory training for all frontline • IPCAF-MR (tools for primary,
clinical, and cleaning staff upon secondary and tertiary health care
employment and annually, as well as facilities) – indicators 3.1-2
for managers upon employment.

Part 2. Recap on strategic directions, key actions, indicators and targets

• Proportion of health care facilities WHO Global IPC portal
achieving all WHO minimum IPCAF-MR (tools for primary, secondary
requirements for IPC training and and tertiary health care facilities) – all
education according to the facility core component 3 indicators
level.
• Proportion of countries with a No current existing indicators or
national (or sub-national) IPC systems
training programme (indicator for
global target).
6. Create a career pathway for IPC • Framework available that outlines No current existing indicators or
professionals. the steps that create a career systems
pathway for IPC professionals (2028).
• Specific positions for IPC
professionals/focal points created in
the national health care system.
• Proportion of hospitals with at least WHO Global IPC portal
one full-time IPC professional per • IPCAF – 1.3
250 beds. • IPCAF-MR – 1.1 (tool for secondary
19

health care facilities); 1.2 (tool for

tertiary health care facilities)
20

Development and implementation of national action plans for infection prevention and control: practical guide
• Proportion of hospitals with at least WHO Global IPC portal
one full-time IPC professional per • IPCAF – 1.3
250 beds. • IPCAF-MR – 1.1 (tool for secondary
health care facilities); 1.2 (tool for
tertiary health care facilities)

Facility level
1. Make implementation plans • All WHO minimum requirements WHO Global IPC portal
and provide resources (human for IPC training and education met, IPCAF-MR: all indicators in core
and financial) to achieve all according to the health care facility component 3 (tools for primary,
WHO minimum requirements level (by 2030). secondary and tertiary health care
for IPC training and education facilities)
and to progressively achieve all
requirements of core component 3
on IPC education and training.
Abbreviations: IPC, infection prevention and control; IPCAT-MR, infection prevention and control assessment tool-minimum requirements; ; IPCAT2, infection prevention and control assessment tool 2;
IPCAF, infection prevention and control assessment framework; IPCAF-MR, infection prevention and control assessment framework-minimum requirements.
 Table 2.6. Strategic direction 5: data for action
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Establish and/or strengthen national • National strategic plan for IPC WHO Global IPC portal GLOBAL
IPC monitoring systems and ensure monitoring in place, including an IPCAT2 – 6.1.1 + 6.1.2 + 6.1.6 + 6.3.6 Core target 8/top 8 global targets
that health care facilities participate integrated IPC monitoring system IPCAT-MR – 6.2 + 6.5 • Proportion of countries with a
in the national IPC monitoring for collection, analysis and feedback e-SPAR - SPAR C.9.2: HAI surveillance national surveillance system for HAI
networks. of data. WHO IPC Global portal and related AMR, including for early
• Proportion of tertiary/secondary IPCAF-MR tools for secondary/tertiary warning to detect epidemic- and
health care facilities with an IPC care facilities)– 6.2-6.4. pandemic-prone pathogens causing
monitoring system for collection, HAIs.
analysis and feedback of data. • Increase of proportion of countries
• Proportion of countries with a with a national HAI and related AMR
national IPC monitoring system surveillance system to:
(indicator for global reporting). □ 30% by 2026
□ 50% by 2028
2. Establish and/or strengthen a • National strategic plan for HAI and WHO Global IPC portal □ >80% by 2030.
national HAI and related AMR related AMR surveillance (with a IPCAT2 – all indicators in core
surveillance system, including for focus on priority infections based component 4 NATIONAL

Part 2. Recap on strategic directions, key actions, indicators and targets

early warning to detect epidemic- on the local context) developed IPCAT-MR – all indicators in core Core target 4/top 4 national targets
and pandemic-prone pathogens, by a multidisciplinary technical component 4 • Proportion of tertiary/secondary
and for monitoring antimicrobial group (2026) within the context of a health care facilities with a
consumption; ensure that tertiary/ broader surveillance system. IPCAF – all indicators in core component surveillance system for HAI and
secondary health care facilities (at • National/sub-national systems for 4 related AMR, including for early
least referral facilities) participate in HAI and related AMR surveillance e-SPAR - SPAR C9.2 warning to detect epidemic- and
the national or international HAI and (including for early warning to detect pandemic-prone pathogens.
AMR surveillance networks. epidemic- and pandemic-prone • Increase of proportion of tertiary/
pathogens causing HAIs) established secondary health care facilities with
and supported (including financially) a HAI and related AMR surveillance
by government and national/sub- system:
national authorities (by 2028). □ 30% by 2026
• Proportion of tertiary/secondary □ 50% by 2028.
health care facilities participating
in the national/sub-national or
international network for the
surveillance of HAI and related AMR,
if existing.
• Proportion of tertiary/secondary
health care facilities with a
surveillance system for HAI and
21
22

Development and implementation of national action plans for infection prevention and control: practical guide
Key actions Indicator(s) Existing indicator(s) Targets

related AMR, including for early

warning with the ability to detect
outbreaks, epidemic- and pandemic-
prone pathogens.
3. Establish and/or strengthen a • Hand hygiene compliance monitoring WHO Global IPC portal
system for monitoring hand hygiene and feedback established as a key IPCAT2 – 6.2.1 (IPCAT-MR 6.5) + 6.3.3
in health care as a key national national indicator, at the very least for IPCAF – 6.3 + 6.5
indicator. reference hospitals (by 2026). Assessment tool on IPC minimum
• National programme for improving requirements for secondary/tertiary
hand hygiene compliance in place (by health care facilities – 6.3
2026). Hand hygiene self-assessment
• National hand hygiene monitoring framework (22)
system (compliance or product WHO hand hygiene observation form
consumption) established and and data analysis tool (23)
implemented (by 2028).
• Proportion of health care facilities at
all levels monitoring hand hygiene
and providing data through the
national system.

Facility level
1. Make implementation plans and Percentage met of WHO minimum WHO Global IPC portal
provide resources (human and requirements for HAI surveillance (only IPCAF-MR (tools for secondary/ tertiary
financial) to achieve all WHO for tertiary and secondary health care care facilities): all indicators in core
minimum requirements for HAI facilities). component 4
surveillance according to the health IPCAF – indicators 4.1-15
care facility level and to progressively
achieve all requirements of core
component 4 on HAI surveillance.
2. Make implementation plans and Percentage met of WHO minimum WHO Global IPC portal
provide resources (human and requirements for IPC monitoring and IPCAF – 6.1-8
financial) to achieve all WHO feedback.
minimum requirements for IPC
monitoring and feedback according
to the health care facility level
and to progressively achieve all
requirements of core component
6 on multimodal strategies for
implementing IPC activities.

Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection; AMR, antimicrobial resistance; IPCAT2, infection prevention and control assessment tool 2; IPCAF, infection
prevention and control assessment framework; IPCAT-MR, infection prevention and control assessment tool-minimum requirements; e-SPAR, electronic States Parties Self-assessment Annual Reporting.
 Table 2.7. Strategic direction 6: advocacy and communications
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Develop and deploy a national IPC • National advocacy strategy and No current existing indicators or GLOBAL
advocacy and communications implementation plan, including systems. Global additional target
strategy and implementation plan the identification of local experts/ • Proportion of countries having
(as a stand-alone or a part of wider champions, developed and a national advocacy and
strategies, for example, on AMR, implemented (by 2026). communication strategy and
patient safety or WASH), aligned for implementation plan
consistency with the WHO global • Increase of proportion of countries
strategy and including engaging having a national advocacy and
local champions and the community. communication strategy and
implementation plan to:
Facility level □ 30% by 2026
□ 50% by 2028
1. Organize events and/or • At least one event/communication No current existing indicators or □ >80% by 2030.
communications and campaigns organized each year. systems.
on IPC priority topics (for example,
hand hygiene, AMR and WASH),
including patient and community

Part 2. Recap on strategic directions, key actions, indicators and targets

participation.
2. Participate in the annual WHO World • Activities for WHO World Hand No current existing indicators or
Hand Hygiene Day. Hygiene Day organized every year. systems.
Abbreviations: IPC, infection prevention and control; AMR, antimicrobial resistance; WASH, water, sanitation, waste management and hygiene.
23
24

Development and implementation of national action plans for infection prevention and control: practical guide
Table 2.8. Strategic direction 7: research and development
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Develop a country-specific national • National research agenda and No current existing indicators or GLOBAL
research agenda and priorities for priorities for IPC developed. systems. Global additional target
IPC (as a stand-alone or part of • Proportion of countries with a
wider strategies, for example, AMR, national IPC research agenda.
patient safety and WASH) adapted • Increase of proportion of countries
from the global research agenda having a national IPC research
and including a multi-sectoral and agenda to:
multidisciplinary approach. □ 30% by 2026
□ 50% by 2028
2. Prioritize, fund and implement • Biennial number of scientific No current existing indicators or □ >80% by 2030.
research projects on IPC in selected publications/publicly available systems.
health care facilities, according to reports of research results on priority
local priorities. IPC topics.

Facility level

1. Seek research funds for projects on • Grant proposals for IPC research No current existing indicators or
IPC, according to the health care projects submitted systems.
facility’s priorities.
2. Implement research projects on IPC No current existing indicators or
and report on the results. systems.
Abbreviations: IPC, infection prevention and control; AMR, antimicrobial resistance; WASH, water, sanitation, waste management and hygiene.
 Table 2.9. Strategic direction 8: collaboration and stakeholder support
Key actions Indicator(s) Existing indicator(s) Targets

National level

1. Map national partners, professional • National research agenda and No current existing indicators or GLOBAL
societies, civil society organizations, priorities for IPC developed. systems. Global additional target
patient advocacy and community • National agenda for collaboration • Proportion of countries with a
groups, and international developed to improve the national multi-sectoral/multi-
organizations relevant for IPC with a collaborating agenda on IPC (by partner taskforce that includes a
multi-sectoral and multidisciplinary 2028). strong focus on IPC/WASH in health
approach. • Profiles of IPC national stakeholders care.
(such as organizations, societies, • Increase of the proportion of
partners, donors supporting and/or countries with a national multi-
working on IPC) regularly updated sectoral/multi-partner taskforce that
(by 2030). includes a strong focus on IPC and
WASH in health care facilities to:
2. Encourage and implement multi- • Proportion of countries with a multi- No current existing indicators or □ 30% by 2026
stakeholder activities and/or sectoral taskforce that includes a systems. □ 50% by 2028
initiatives, according to country strong focus on IPC/WASH in health □ >80% by 2030.
needs, including data sharing on IPC, care facilities.
HAI, AMR and WASH. • Number of joint IPC activities with

Part 2. Recap on strategic directions, key actions, indicators and targets

national IPC stakeholders in line with
the national plan and local needs
and context (2030).

Facility level

1. Seek collaborations, networking • Proportion of collaborative or No current existing indicators or

and partnerships with other health multidisciplinary projects, or systems.
care facilities and national IPC networking events or partnerships
societies (if present) to support IPC established.
implementation.
Abbreviations: HAI, health care-associated infection; IPC, infection prevention and control; AMR, antimicrobial resistance; WASH, water, sanitation, waste management and hygiene.
25
Part 3A.
Developing and
implementing your
infection prevention
and control national
action plan

Implementation steps and actions

A reminder about using the five-step cycle and details on
how to develop an IPC NAP with a focus on; leadership
and organization, stakeholder engagement and
resources, reviewing the current situation and feeding
back results, identifying priority areas and taking action,
and beginning to implement the IPC NAP, maintaining
ongoing assessments and feeding back with a focus on
sustainability.
Development and implementation of national action plans for infection prevention and control: practical guide

3A.1. Quick summary

• This section presents an overview of the WHO five-step implementation cycle (6).
• The importance of preparation (step 1) to successful implementation is emphasized, as well as how governance
plays a role.
• Based on each of the five steps, details of how to develop and implement your IPC NAP are described, including
signposting to tools and templates and a list of action checks.

3A.2. The five steps of implementation

A five-step cycle of implementation (Fig. 3A.1) was developed by WHO and has been successfully used for many
years to support IPC interventions or programmes, based on implementation and quality improvement science
(6,7).

Fig. 3A.1. Five-step cycle

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Developing Sustaining
Preparing Baseline Evaluating
and executing the programme
for action assessment impact
the plan

Use this five-step approach to support preparing for action, baseline assessment,
developing and executing the plan, evaluating impact, and sustainability. The ultimate
goal is the execution of a realistic, achievable, costed and sustainable IPC NAP.

Abbreviations: IPC, infection prevention and control; NAP, national action plan.
Source: WHO (6).

• If you are already familiar with the five-step cycle and confident in your implementation approach
or if you have already developed an IPC NAP and have the tools and resources for implementation,
you could choos to rapidly review Part 3A, focusing on the action checks at the end of each
step.
• For a systematic and comprehensive IPC NAP development, working through the five steps in Part
3A is critical.
• On completion of Part 3A, all users are recommended to go to Part 3B , which provides
additional activities and considerations to achieve each strategic direction for IPC.
• Each step contains links and references to tools and resources, where relevant. Additional tools
and resources are listed in Tables 3A.2, 3A.12 and 3A.14 .

28
 Part 3A. Developing and implementing your infection prevention and control national action plan

3A.3. Spotlight on governance

• Governance determines who has the power and authority, who makes decisions, and who is held to account.
Governance is concerned with people, processes, structures and institutions that are in place including
leadership, accountability, coordination, stakeholder engagement, regulation, monitoring and resources.
• The activities and considerations described in each of the five steps aim to address aspects of governance for a
successful outcome.
• Governance, including the actions of governments and stakeholders, therefore influences the successful
development and implementation of an IPC NAP.

Step 1 – Preparing for action

This step is concerned with implementation readiness and aims to ensure that all of the prerequisites are
considered and in place to develop an IPC NAP. These include starting to think about the identification of key players
and their roles and responsibilities, as well as the necessary resources (human and financial), infrastructure/s,
planning and coordination of activities. Note: Step 3 then builds upon these prerequisites to further progress
implementation and sustainability, based on the local situation (assessed through step 2 and again in step 4).

Leadership and organization

• Identify and confirm lead(s) for the IPC NAP development and implementation, usually the IPC focal point.
• Explore the right leaders, people and teams for establishing committees and groups tasked to support the
development, promotion, implementation, monitoring and reporting of the IPC NAP and to provide approvals
and sign off for critical IPC documentation, for example, a national IPC committee.
• Identify professionals from other programmes with experience in implementation to be part of the
multidisciplinary group supporting NAP development/implementation. For example, those working in existing
implementation projects in the field of IPC, AMR, patient safety, quality, WASH or related areas.
• Establish the team – ideally a team, rather than an individual – and the relevant roles and responsibilities,
such as identifying those who will be accountable for guiding the work, leading efforts, ensuring completion of
tasks and progress reporting. Alternatively, review the existing team functions in relation to implementation
readiness.
• Identify adequate time to dedicate to NAP development/implementation.
• Start to build team competence regarding the process of implementation including all team members being
familiar with this practical guide (see also Part 3B , strategic direction 2 SD2 and strategic direction 4 SD4 ).
• Identify necessary ongoing support for those to be involved in the IPC NAP development and implementation,
such as supervision and information to motivate ongoing action.
• Explore the mechanisms for accountability alongside identifying roles and responsibilities, such as
authoritative roles, conflicts of interest, mitigation of risks, incentives and course correction, so as to anticipate
how to address challenges in IPC NAP development, implementation and sustainability.
• Explore if organizational governance structures already exist to give IPC oversight, that is, national and sub-
national committees and groups.
• Outline the required meeting structures and terms of reference, financing and lines of accountability necessary
to develop and implement the IPC NAP, as well as a draft timeline of activities.

29
Development and implementation of national action plans for infection prevention and control: practical guide

• Establish an inclusive meeting schedule and agenda for all those who should attend, focusing on the relevance
of an IPC NAP for the country context and to consider implementation plans/actions within existing structures.
• Confirm the jurisdiction for the creation and maintenance of policies and procedures, reporting and
communications.
• Outline the necessary commitment to IPC NAP sensitization, within the timeline of activities.
• Outline the benefits of implementing and improving IPC over time using the IPC NAP (see also strategic
direction 6 SD6 ). Use the communication and engagement plan templates in the WHO Implementation
playbook, pocket edition (8).
• Start to explore validated tools, approaches and available expertise and data sources that can be used for the
development of your IPC NAP and associated monitoring plans (see steps 2 and 4). Use Annex 1 of the WHO
Implementation playbook, pocket edition (8), it includes a number of key tools and templates that will
support this, for example, ‘Context analysis wheel’, ‘Assessing readiness for action criteria’, ‘Issue tree’, ‘Problem
statement’. The WHO National health planning tools (24) is an on-line repository of tools designed to assist
health authorities at both national and sub-national level in elaborating health policies, strategies and plans; it
also includes tools on leadership and governance.
• Explore the evaluation approaches that can be used to report against the NAP, that is, systems and tools that
already exist, and start to consider the review and reporting schedule for the team.
• Explore the readiness and commitment to undertaking evaluations and reporting mechanisms.
• Prepare to consider health care facility-level implementation and evaluation, including pilot testing where
appropriate, and a method for gathering lessons learned for sharing across facilities.
• Outline and discuss the reality of NAP development and implementation in the national and health care facility
context, exploring how long it may take to achieve.
• Build in strategies to manage changes in the workforce and the perceived burden of the IPC NAP development
and implementation work.
• Table 3A.2 at the end of this section features additional tools and resources.

Stakeholder engagement
• Identify stakeholders. Use a stakeholder mapping tool such as the WHO stakeholder mapping guide and tool
(9). The WHO Stakeholder network analysis tools to support collaboration for better health (25) can
also help this process.
• Explore whether stakeholder mapping exercises have already been undertaken for IPC or for related
programmes, for example, AMR, patient safety, quality, WASH, and source available documents.
• Explore all existing lists of potential stakeholders, for example, where multiple sectors and stakeholders are
already convened, such as attendee lists at cross-sector meetings/forums/conferences and/or networks and
initiative lists.
• Consider listing all persons who may have an interest in the IPC NAP and its implementation and all those who
might influence this now and potentially in the future.
• Outline stakeholders’ level of influence, type of influence, priority of engagement and the role and type of
engagement that is needed (see Table 3A.1 that is partially populated for illustration; the full template can be
found in Annex 3 ).
• Explore the level and phase (when) at which stakeholders should be engaged, including according to each
strategic direction and their objectives/targets. Those with a high level of influence may be prioritized at the
outset of the implementation of a particular strategic direction.
• Explore and create a draft outline of how to engage key stakeholders, including the resources that may be

30
 Part 3A. Developing and implementing your infection prevention and control national action plan

required (see also strategic direction 6 SD6 ). Consider a spectrum of engagement spanning four elements:
inform – consult – involve – collaborate – co-create (Fig. 3A.2 ).
• Develop a realistic timeframe to engage and communicate with stakeholders, taking account of local
circumstances and drivers that you should be familiar with following the mapping exercise and initial
IMPLEMENTATION GUIDE TOOLKIT
communications.
STAKEHOLDER MAPPING GUIDE
Fig. 3A.2. Spectrum of engagement

SPECTRUM OF ENGAGEMENT KEY

Less More
engagement engagement
In

Co

In

Co

Co
vo
fo

-C
la
rm

su

l
ve

bo

re
lt

at
ra

e
te
Inform – provide information Collaborative – to partner in each aspect of
decision-making
Consult – to obtain feedback
Co-Create – to empower to make decisions
Involve – to ensure that concerns are
consistently understood and considered

Source: WHO (9).

• Start to gather written and verbal commitments from stakeholders and influencers for use in influencing key
leaders, decision-makers and funders, for example, for inclusion in newsletters, web pages and social media
(see also Part 3B , strategic direction 6 SD6 ).
• Plan and publicize a ‘kick off’ meeting (face-to-face or virtually). Attempt to hold at least one face-to-face
meeting with all identified team members, leaders and stakeholders present. Ensure equitable voices at
meetings/discussions, especially where patient representatives are included.
• Elaborate and share the agreed meeting schedule.
• Clearly describe all roles and responsibilities, including by using existing examples of approaches to
implementation, such as leads, supervisors, engagers, influencers, creators, informers, and confirm that
people are clear and happy with what they have been allocated for NAP development and implementation, for
example, in the kick off meeting.
• Plan the timeline for revisiting engagement with other programmes/stakeholders as part of the IPC NAP, that is,
are meetings being attended, do people remain engaged over time?
• Establish the engagement of health care facility-level stakeholders. As previously noted, this is also important at
this stage in relation to pilot testing, sharing of implementation and improvement examples (see Fig. 3A.2 ).

REFERENCES
31
1. Stakeholder Mapping. BSR (Business for Social Responsibility). November 2011. Available at https://www.bsr.org/reports/BSR_Stakeholder_Engage-
ment_Stakeholder_Mapping.final.pdf. Accessed 1 April 2018.
Development and implementation of national action plans for infection prevention and control: practical guide

• More details on stakeholder mapping can be found in strategic direction 8 SD8 .

• Communication and advocacy are also important when engaging with stakeholders in order to
prepare the way for the remaining four steps; more details on communications and advocacy can
be found in strategic direction 6 SD6 .
• It may not be practical or necessary to engage with all stakeholder groups with the same level of
intensity all of the time.
• Prioritization is important and the stakeholder list may change over time, for example the influence
of patient groups across regions and countries will vary depending on context.
• Avoid setting up parallel structures where existing stakeholder engagement exists. This is especially
important where a dedicated IPC implementation team is not feasible in the short term and human
resources are limited.

Table 3A.1. Example of a stakeholder mapping grid for illustration purposes*

Name of Name of Level of Type of Priority of Role and type of
organization/ contact influence influence engagement engagement
entity person (title/
level)

Ministry of AMR focal High Input in Important, Continuous

health person development, inform, consult, engagement
dissemination collaborate
and
implementation
Other national Infectious High Dissemination Important, Continuous
bodies, for disease/ and inform, consult, engagement
example, epidemiology implementation collaborate
public health lead
institutions
Non- Programme High Budget/funding Important Continuous
governmental officer influence – inform, engagement
organizations collaborate,
involve

Professional President Moderate-to- Development, High – inform, Early engagement

societies high dissemination consult, involve – presentations
and at meetings,
implementation webinars

Industry Sales or Moderate-to- Dissemination Important, Continuous

partners and research lead high and inform, consult, engagement
insurers implementation collaborate

Patient groups Lead High Dissemination High – inform, Early engagement

and consult, involve
implementation

*Based on the WHO stakeholder mapping guides and tools listed in tools and resources. The full template is shown in Annex 3 .
Source: WHO (9).

32
 Part 3A. Developing and implementing your infection prevention and control national action plan

Finance and budgeting

• Explore the likely costs required to develop and implement the IPC NAP based on initial estimates. A number
of tools are available in this regard, such as the WHO costing and budgeting tool for national action plans on
AMR (26). Table 3A.2 at the end of this section features tools and resources, including additional costing
tools that may be useful. Cost estimates will also relate to the activities and considerations outlined for each
strategic direction in Part 3B and the need for a multimodal improvement strategy.
• Start to consider a budget outline for foreseeable activities (this will be further informed by the actions taken in
step 2).
• Explore the best strategy and times to convince decision-makers (identified through stakeholder mapping) to
allocate and sustain a budget for funding the IPC NAP development and implementation, which includes an IPC
programme, human resources and funds for activities, especially where a budget is not yet allocated. This should
be based upon a country's health care facilities and available funds. Use the WHO IPC investment case (27)
and WHO IPC budget case tools (28) and draw on related tools such as Presenting an “investment case” for
AMR support at the country level in annex 6 of the WHO implementation handbook for national action plans on
antimicrobial resistance (10).
• Consider discussing the possibility of securing funding to cover the NAP through existing national budgets for
health with relevant decision-makers, as well as local and international funding mechanisms.
• Start to develop the proposed contents of an investment case and business case, for example, to be presented
to the ministers of health and finance, etc., including a contribution by other experienced stakeholders where
necessary; refer to the WHO IPC investment case (27).
• Discuss the possibility of funding contributions (not one-off donations) for the implementation of IPC activities
within the NAP that currently have no funding with partners and donors identified through stakeholder
mapping, as well as monitoring activities and systems to track progress and impact.
• Consider coordination and integration when possible of IPC activities within existing programmes for health
system strengthening and/or other programmes (such as AMR, WASH) to avoid unsustainable funding of siloed
IPC activities (see also strategic direction 3 SD3 and annex 10 ).
• Identify the right times to discuss the NAP with relevant ministry of health stakeholders, partners and donors,
including in relation to budget/funding allocation, for example, unique situations/drivers including annual
release of monies, budget cycles, press attention on HAI.

“An important step is to advocate for an IPC budget line item at national level, even if it’s
small. One can do a lot with this recognition and also take the opportunity to leverage existing
resources.”

IPC professional, WHO African Region

“Trying to estimate the direct and indirect costs of an IPC programme using currently
available tools, which are designed for high-income contexts can be a challenge. However,
using basic information and best estimates can be useful. Do not fix solely on demonstrating
cost effectiveness - equally important is empowering the person in charge to influence policy.”

National and international IPC expert, WHO African Region

33
Development and implementation of national action plans for infection prevention and control: practical guide

Other resource considerations

• Identify the human and other types of resources necessary for NAP development and implementation to
estimate how much support will be given at the national level to implement an IPC NAP, including support of
an active IPC programme at all health care facility levels (see also strategic direction 2 SD2 and strategic
direction 4 SD4 ).
• Explore surveillance, monitoring, research and evaluation systems and tools that exist (see also strategic
direction 5 SD5 and strategic direction 7 SD7 ).
• Confirm the availability of laboratory services for necessary testing, analyses and reporting (see also strategic
direction 5 SD5 ).
• Consider necessary advocacy and communication resources to support NAP development and implementation
(see also strategic direction 6 SD6 ), including for surge capacity in support of emergency situations/outbreaks.
• Search for and be familiar with other existing documents and resources that will support IPC NAP
implementation, for example, the WHO core components for IPC programmes at both the national (6) and
facility level (7) and the WHO AMR resource pack (29). These may be in-country, from globally-
developed resources, or other experienced countries. Annex 2 summarizes a number of relevant
implementation resources.
• Explore what needs to be developed to support overall IPC NAP development and implementation, including at
health care facility level, and the resources necessary to do this.
• Identify which resources will be required to support reporting to the regional and global levels to fulfil the WHO
GAPMF requirements. Refer back to Part 2 on reporting on progress.

• Ethiopia’s recent success in securing government funding for the country’s first-ever
national budget for IPC represents a milestone for the country and global health security
efforts. Securing this dedicated budget line was not an overnight success. It resulted
from two years of dedicated work by Ethiopia’s government ministries and the health
advocacy community working in partnership with Resolve to Save Lives. This assured
sustained IPC funding—starting with 3.2million Birr (about US$58,000) in the first year—is
a strategic investment by national decision-makers that strengthens essential components
of the country’s capacity to respond to future public health threats. One step in budget
advocacy is to conduct a landscape analysis that documents the need for funding and
identifies approaches for targeted advocacy campaigns.
• Instrumental to this process was gaining a deep understanding of the Ethiopian
government’s budget cycle, which follows a three-year schedule. Although every country
has its own timetable and process for developing its national budget, they all have a
specified process involving budget proposals, ministry and legislative hearings, and
a series of committee and full legislative floor votes before budgets are approved and
implemented. It is difficult to effectively advocate for budget allocations without an
intimate knowledge of the relevant budget development processes. In Ethiopia, this
comprises four phases—budget preparation, approval, execution and control—running
each year from November through July.
• In Ethiopia, as in many countries, the two main government agencies involved in IPC are
the Ministries of Health and Finance, although others with overlapping portfolios, such
as WASH programme implementation, are also involved. Each has its own priorities and
crafting understanding and consensus between them is crucial to moving forward
with the budget process. While the Ministry of Finance sets budget guidelines and

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 Part 3A. Developing and implementing your infection prevention and control national action plan

ceilings by sector, the Ministry of Health identifies funding requests for specific divisions
and programmes. The planning department in most ministries of health plays a critical
role in determining budget allocations within the health sector and negotiating with
the ministry of finance during budget development. Ultimately, the ministry of finance
compiles the final, consolidated budget for final approvals, so providing clear requests and
documenting their justification to the ministry of finance is essential. Another important
step is to identify the individuals within each ministry who are able to push the agenda
forward. While it is important to keep senior leaders informed and engaged, mid-career
staff are often well-placed to champion projects and advise their senior colleagues.
Representatives of non-governmental stakeholder organizations can also play important
roles in advocating for key programmatic and funding decisions. As it can take time to
identify these potential champions, a point person within the organization spearheading
advocacy for the budget line must meet with a large number of individuals.
• Once the ministries of health and finance are in agreement about establishing a dedicated
budget line and the amount to be funded, in most countries, it must be then shepherded
through the legislative process for final approval. The dedicated IPC budget line was
ultimately approved as part of the overall Ethiopian national budget.

Source: Resolve to Save Lives (30).

“Yes, it's important that a budget is in place but this can take time and be hard to achieve. We
cannot always wait for that before starting work. Many of us must use the resources that we
have today."

IPC focal person, Ministry of Health, Sweden, WHO European Region

Table 3A.2. Additional tools and resources to support step 1 (preparing for action)*
• Making the business case for infection prevention and control. Arlington, VA: Association for Professionals in Infection
Control and Epidemiology (APIC); 2017 (https://apic.org/Resource_/store/books/preview/SLS7003P_Preview.pdf).

• HAI cost calculator tools. Arlington, VA: Association for Professionals in Infection Control and Epidemiology (APIC); 2020
(https://www.ahrq.gov/hai/tools/clabsi-cauti-icu/implement/apic-cost-calculator.html).

• Bartles R, Reese S, Gumbar A. Closing the gap on infection prevention staffing recommendations: Results from the beta
version of the APIC staffing calculator. Am J Infect Control. 2024;52(12):1345-1350. doi: 10.1016/j.ajic.2024.09.004.

• Wozniak TM, Graves N, Barnett AG. How much do superbugs cost Australian hospitals? An evidence-based open-access
tool. Infect Dis Health. 2018 Mar;23(1):54-56. https://www.idhjournal.com.au/article/S2468-0451(17)30227-4/fulltext.

• Kickbusch I, Gleicher D. Governance for health in the 21st century. Copenhagen: World Health Organization Regional Office
for Europe; 2012 (https://iris.who.int/handle/10665/326429).

• Health systems governance for universal health coverage: Action plan. Geneva: World Health Organization; 2014 (https://
iris.who.int/handle/10665/341159).

• Barbazza E, Tello JE. A review of health governance: definitions, dimensions and tools to govern. Health Policy. 2014;
116(1):1–11. doi: 10.1016/j.healthpol.2014.01.007.

• Quality health services: a planning guide. Geneva: World Health Organization; 2020 (https://iris.who.int/
handle/10665/336661). Licence: CC BY-NC-SA 3.0 IGO.

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Development and implementation of national action plans for infection prevention and control: practical guide

• Quality toolkit: navigating tools to improve the quality of health services. Geneva: World Health Organization; 2025
(https://qualityhealthservices.who.int/quality-toolkit/qt-home).

*All tools and resources were accessed on 10 April 2025.

To support step 1, review the specific activities and considerations for each strategic direction by clicking on the boxes below

Strategic direction 1 Strategic direction 2 Strategic direction 3 Strategic direction 4

Political commitment and Active IPC Programmes IPC integration and IPC knowledge
policies coordination and career pathways

Strategic direction 5 Strategic direction 6 Strategic direction 7 Strategic direction 8

Data for action Advocacy and communications Research and development Collaboration and stakeholder
support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

Table 3A.3. Action checks

Leadership and organization

☑ IPC NAP lead(s) appointed and a multidisciplinary support team secured, as well as champions.

☑ Governance structures, committees and accountability mechanisms established.

☑ Team competence regarding implementation reviewed.

☑ Professionals/groups to provide implementation support identified, as well as ongoing supervision.

☑ Meetings, timelines (including realistic timeframes) and terms of reference outlined.

☑ Tools, templates, and advocacy materials to be used for implementation sourced.

☑ Reporting structures and other communication strategies explored and drafted.

☑ Facility-level implementation, pilot testing and evaluations explored.

Stakeholder engagement

☑ Existing stakeholder mapping exercises identified and reviewed.

☑ IPC NAP implementation stakeholders listed and categorized by influence and role.

☑ Stakeholder engagement strategies outlined and commitments secured.

☑ Kick-off meeting organized and meeting schedule proposed.

☑ Specific stakeholder roles and responsibilities drafted and ongoing engagement and periodic reviews proposed.

Finance and budgeting

☑ Costs estimated and a budget outlined.

☑ Sustainable funding explored, including cycles for securing long-term financing and stakeholder contributions.

☑ An investment case for the IPC NAP drafted, including any connections with other health programmes and involvement of
national authorities, partners and donors.

☑ Other resources identified, including necessary human resources for IPC NAP implementation.

☑ Monitoring and reporting systems, including laboratory services, explored and confirmed.

☑ IPC guidelines, implementation and advocacy tools gathered.

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 Part 3A. Developing and implementing your infection prevention and control national action plan

Step 2 – Baseline assessment

Conducting an objective baseline assessment of the current situation is critical for the identification of existing
strengths and gaps that supports the development of a tailor-made IPC NAP based on local priorities. National
and facility level standardized tools to assess the situation are signposted throughout step 2 and existing IPC
assessments are listed in Box 3A.1 .

Understand the current situation

• Gather together results of all recent IPC assessments, where available, including those addressing
epidemiological risk-related infections that are likely to be transmitted in health care. Ideally, coordinate
facility-level surveys to understand health care facilities in your country and the specific support required from
the national level.
• Use IPCAT2 (12), IPCAT-MR (15), IPCAF (16) and IPCAF-MR (18-20) and other national and
facility IPC assessment tools (see Box 3A.1) if no recent data are available. This will help to understand where
your country currently stands regarding the implementation of the WHO recommendations on IPC core
components and minimum requirements and identify current strengths and existing gaps. This is key to enable
activity to be prioritized and targeted to develop a specific, measurable, actionable, realistic and timely (SMART)
action plan to be refreshed every year or biannually.
• Table 3A.12 includes additional tools and resources.

Box 3A.1. List of existing national and facility IPC assessment tools

HHSAF: hand hygiene self-assessment framework.

Hand hygiene observation form and data analysis tool.
IPCAT2: core components for IPC programmes national assessment tool.
IPCAT-MR: assessment tool of the minimum requirements for IPC programmes at the national level.
IPCAF: IPC assessment framework at the facility level.
IPCAF-MR (tertiary care): assessment tool on IPC minimum requirements for tertiary health care facilities.
IPCAF-MR (secondary care): assessment tool on IPC minimum requirements for secondary health care
facilities.
IPCAF-MR (primary care): assessment tool on IPC minimum requirements for primary health care
facilities.

Abbreviations: HHSAF, hand hygiene self-assessment framework; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR,
infection prevention and control assessment tool-minimum requirements; IPCAF, infection prevention and control assessment framework;
IPCAF-MR, infection prevention and control assessment framework - minimum requirements.

• Use locally-available tools that have been validated and contain key indicators reflecting the indicators and
targets included in the WHO GAPMF (3), WHO core components (4) and minimum requirements (5).
• Review and discuss the relevance of other existing assessments used in other programmes that have included
or addressed IPC-related matters. For example, the open access Global Database of the Tracking AMR country
self-assessment survey (TrACSS) (31), Global AMR and use surveillance system (GLASS) (32), States
Parties Self-Assessment Annual Reporting (SPAR) (13), WASH FIT (33), United Nations Global analysis
and assessment of sanitation and drinking water (GLAAS) (17), WHO Patient safety assessment manual
(34), and other health system assessments such as WHO national health planning tools (24).
• Consider focusing on specific aspects of existing assessment tools to inform the current status related to each

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Development and implementation of national action plans for infection prevention and control: practical guide

strategic direction to help with prioritization from the outset.

• Tables 3A.4–3A.11 list the exact sections of assessment tools as they relate to each strategic direction (see also
Part 3B ).

Specific assessment tools for each strategic direction

Available resources to allow for baseline data relevant to each strategic direction are summarized in the tables
below. A country may decide to undertake all relevant assessments at one time, or individually when addressing
specific strategic directions.

Table 3A.4. Tools for strategic direction 1: political commitment and policies
Strategic direction Assessment tool Relevant section Area assessed
1: political
commitment and IPCAT2 1.1.7 IPC budget
policies IPCAT-MR 1.4 IPC budget
IPCAF 1.9 IPC budget
IPCAF-MR 1.9 IPC leadership support and funding
IPCAT2 1.2.2 IPC national plan
IPCAT2 1.2.3 National monitoring frameworks
e-SPAR-SPAR C9.1 IPC programmes
GLAAS Finance WASH budgets and funding
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements; IPCAF, infection prevention and control assessment framework; e-SPAR, electronic States
Parties self-assessment annual reporting; GLAAS, Global analysis and assessment of sanitation and drinking-water; WASH, water, sanitation,
waste management and hygiene.

Table 3A.5. Tools for strategic direction 2: active IPC programmes

Strategic direction Assessment tool Relevant section Area assessed
2: active IPC
programmes IPCAT-MR All Establishment of a national IPC programme and
demonstrating improvement evidence
IPCAF-MR All Establishment of a national IPC programme and
demonstrating improvement evidence
WHO/UNICEF Search for WASH, Establishment of a national IPC programme and
Joint Monitoring environmental cleaning demonstrating improvement evidence
Programme and health care waste
management
e-SPAR -SPAR C9.1 Active IPC programmes (dedicated human
resources)
IPCAF 1.1-1.4 and 1.8-1.9 Active IPC programmes (dedicated human
resources)
IPCAF-MR Core component 1 indicator Active IPC programmes (dedicated human
1.1 resources)

IPCAT-MR 5.1 Implementation of a multimodal improvement

strategy

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 Part 3A. Developing and implementing your infection prevention and control national action plan

IPCAT2 5.1.2 Implementation of a multimodal improvement

strategy
IPCAT-MR 5.2 and 5.3 Implementation of a multimodal improvement
strategy
IPCAT2 All in core component 2 National IPC guidelines and policies
IPCAT-MR All in core component 2 National IPC guidelines and policies
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements; e-SPAR, electronic States Parties self-assessment annual reporting; IPCAF, infection
prevention and control assessment framework-minimum requirements; WASH, water, sanitation, waste management and hygiene.

Table 3A.6. Tools for strategic direction 3: IPC integration and coordination
Strategic direction Assessment tool Relevant section Area assessed
3: IPC integration
and coordination IPCAT2 1: 1.1.8, 1.2.5, 1.3 (in IPC committee; collaboration in the context of
particular, 1.3.1 to 1.3.5) surveillance; programme linkages
IPCAT-MR 4.1 Collaboration in the context of surveillance
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements.

Table 3A.7. Tools for strategic direction 4: IPC knowledge among health and care workers and career
pathways for IPC professionals
Strategic direction Assessment tool Relevant section Area assessed
4: IPC knowledge
among health IPCAT2 3.2.1- 3.2.5 National IPC curricula
and care workers IPCAT-MR Core component 3.1-3.4; National programme, curricula and monitoring;
and career 5.1; 6.4: national expertise in implementation; mechanism
pathways for IPC for training auditors
professionals
IPCAF 1.3 and 3.3-4 IPC staff-bed ratio; facility-level training frequency
IPCAF-MR All core component 3 Facility-level training of workforce, including IPC
indicators, particularly staff
3.1-2.
IPCAF-MR 1.1 (secondary care IPC staff-bed ratio
secondary facilities)
IPCAF-MR tertiary 1.2 (tertiary care facilities) IPC staff-bed ratio
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements. IPCAF-MR, infection prevention and control assessment framework-minimum requirements.

Table 3A.8. Tools for strategic direction 5: data for action

Strategic direction Assessment tool Relevant section Area assessed
5: data for action
IPCAT2 6.1.1 + 6.1.2 + 6.1.6 + 6.3.6 Monitoring
IPCAT-MR 6.2 + 6.5 Monitoring
IPCAF-MR 6.2-6.4 Monitoring
IPCAT2 6.2.1 & 6.3.3 Hand hygiene monitoring
IPCAT-MR 6.5 Hand hygiene monitoring

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Development and implementation of national action plans for infection prevention and control: practical guide

IPCAF 6.3 + 6.5 Hand hygiene monitoring

IPCAF-MR 6.3 Hand hygiene monitoring
HHSAF All Hand hygiene monitoring
Observation form All Hand hygiene monitoring
e-SPAR-SPAR C.9.2 HAI surveillance
IPCAT2 Core component 4 HAI surveillance
IPCAT-MR Core component 4 HAI surveillance
IPCAF-MR Core component 4 HAI surveillance
Abbreviations: IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention and control assessment tool-
minimum requirements; IPCAF, infection prevention and control assessment framework; IPCAF-MR, infection prevention and control assessment
framework-minimum requirements; e-SPAR, electronic States Parties self-assessment annual reporting; HAI, health care-associated infection.

Table 3A.9. Tools for strategic direction 6: advocacy and communications

Strategic direction Assessment tool Relevant section Area assessed
6: advocacy and
communications IPCAT2 5.2.3 Multimodal improvement strategy

Abbreviations: IPCAT2, infection prevention and control assessment tool 2.

Table 3A.10. Tools for strategic development 7: research and development

Strategic Assessment tool Relevant section Area assessed
development
7: research and No formal WHO / /
development assessment tool
available

Table 3A.11. Tools for strategic development 8: collaboration and stakeholder support
Strategic direction Assessment tool Relevant section Area assessed
8: collaboration
and stakeholder No formal WHO / /
support assessment tool
available

Review and feedback results

• Using a collaborative and consultative approach, convene all relevant stakeholders (as established in step 1) to
review and interpret all assessment results and, ideally, compare them with previous results.
• Explore the relevance of the results to other programmatic areas to integrate data and actions where possible
(for example, in the AMR programme) and prepare to outline this in the NAP.
• Share and discuss all detailed results with the team/IPC committee (if it exists, or another national body if it
does not exist).
• Based on the results, undertake a strengths, weaknesses, opportunities and threats (SWOT) analysis (see Annex
4 for an example of a SWOT analysis).
• Feedback targeted results at existing and agreed upon meetings to all relevant leaders and stakeholders using

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 Part 3A. Developing and implementing your infection prevention and control national action plan

an engaging format that motivates their involvement in the IPC NAP implementation plans.
• Share information with other national leaders and decision-makers, including ministers, using impactful
presentations and other locally relevant approaches.
• Share targeted information with other relevant programme leads to address joint areas of implementation and
improvement going forward (see also strategic direction 3 SD3 and strategic direction 8 SD8 ).

To support step 2, review the specific activities and considerations for each strategic direction by clicking on the boxes below

Strategic direction 1 Strategic direction 2 Strategic direction 3 Strategic direction 4

Political commitment and Active IPC Programmes IPC integration and IPC knowledge
policies coordination and career pathways

Strategic direction 5 Strategic direction 6 Strategic direction 7 Strategic direction 8

Data for action Advocacy and communications Research and development Collaboration and stakeholder
support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

Table 3A.12. Additional tools and resources to support step 2 (baseline assessment)*
• WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human health
sector. Annex 1: Situational analysis. Geneva: World Health Organization; 2022 (https://iris.who.int/handle/10665/352204).
Licence: CC BY-NC-SA 3.0 IGO.
*All tools and resources were accessed on 10 April 2025.

Table 3A.13. Action checks

☑ IPC assessments conducted.
☑ Recent IPC assessment results collected and collated.
☑ Assessments based on the strategic directions prioritized.
☑ Validated assessment tools used and aligned with WHO indicators and requirements.
☑ Other relevant assessments linked to IPC collated and reviewed.
☑ All results reviewed and interpreted, including with key stakeholders.
☑ Findings shared in targeted engaging formats with the IPC committee and other relevant groups, including other leads,
decision-makers, ministries.
☑ Results aligned with other relevant health programme activities.
☑ A SWOT analysis performed, based on results.
☑ All identified barriers/challenges to implementation listed.

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 3 – Developing and implementing

the IPC NAP
Developing and implementing a tailor-made IPC NAP that addresses the local reality and focuses on priority
areas identified through baseline assessments is essential. The development and implementation of a robust,
representative IPC NAP should be supported by an allocated, dedicated budget and should be based upon a
multimodal imrovement strategy.

Establish priority areas for action using assessment results

• Convene stakeholders and confirm their categorisation, leveraging the committees and groups identified in
step 1 using the completed stakeholder mapping list.
• Use baseline assessment results to confirm existing gaps and actions required for the IPC NAP, including each
of the strategic directions.
• Present and discuss any interdependencies that might inform prioritization, for example, across different
health programmes.
• Analyse all potential barriers to implementation and discuss how these could be overcome.
• Map all proposed actions against the required budget or investment/business case.
• Map what can be achieved with existing resources.
• Draw up a preliminary list of priority areas for action using, for example, the prioritization matrix in the WHO
Implementation playbook, pocket edition (8) and as agreed by the stakeholders, with a focus on each
strategic direction (see Annex 5 ). This will enable you to consider the potential impact and effort needed to
implement the proposed IPC NAP.

Translate all findings into the IPC NAP

• Develop your own detailed IPC NAP (or update it if one already exists) using one of the action plan templates
provided (sample action plan template [Annex 6 ] and a sample detailed operational plan and budget [Annex 7 ]).
• Apply SMART (specific, measurable, achievable, relevant, timely) objectives. Your objectives should be clearly
related to your goal and based on the policies, strategies or interventions that you will implement as part of the
IPC NAP.
• Populate your IPC NAP based on the priority areas identified for your country at the national and facility level.
• Map the IPC NAP to the ministry of health priorities for health programmes to ensure alignment with existing
health policies and strategies and modify/integrate on an ongoing basis as relevant.
• Secure approval (and specific funding if still necessary) for the IPC NAP, preferably from the ministry of health
or relevant ministry.
• Designate lead persons, from the team in particular, to support each action, according to competencies and
capacity, thus allowing to continue to build capacity and provide support as necessary.
• Make a specific budget plan/outline, identifying which of the actions are already funded and addressing
funding gaps, as well as allocating all other necessary resources (as identified in step 1).
• Implement your fundraising plan to address gaps, including identifying entities within the government,
which might be in charge of certain actions within other existing programmes, as well as potential donors and
partners (this should all build on the preparatory activities in step 1).

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 Part 3A. Developing and implementing your infection prevention and control national action plan

• Explore and confirm sustainability of all actions before implementing the IPC NAP.
• Outline surge strategy actions, that is, how to react when adjustments to the IPC NAP are needed during
emergencies/outbreaks, for example.
• Table 3A.14 at the end of this section features additional tools and resources.

Implement the IPC NAP

• Use the IPC NAP to guide all implementation activities.
• Confirm that the meeting schedule works for all stakeholders and hold meetings at agreed, set time intervals,
working with all those identified to implement the NAP and not just the IPC team.
• Maintain the agreed upon governance, accountability and reporting mechanisms.
• Follow agreed-upon roles and responsibilities, timeframes and actions (for example, use a Gantt chart to
illustrate the schedule).
• Revisit and restate roles and responsibilities as necessary, as well as the need for commitment to the IPC NAP,
and revisit accountability, mitigation of risks, etc.
• Update stakeholder names and influence as necessary to support the finalized IPC NAP.
• Make and implement a plan for dissemination of the IPC NAP, including a plan for the ongoing engagement of
leaders and stakeholders informed by available tools, for example, the WHO dissemination tool (35).

Table 3A.14. Additional tools and resources to support step 3 (developing and executing the plan)*
• Strategizing national health in the 21st century: a handbook. Geneva: World Health Organization; 2016 (https://iris.who.
int/handle/10665/250221).

• Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the
national level. Geneva: World Health Organization; 2021 (https://iris.who.int/handle/10665/345251. Licence: CC BY-NC-SA
3.0 IGO.

• WHO benchmarks for strengthening health emergency capacities. Geneva: World Health Organization; 2023 (https://iris.
who.int/handle/10665/375815). Licence: CC BY-NC-SA 3.0 IGO. See also the associated digital platform (https://www.who.
int/publications/i/item/9789241515429). The WHO benchmarks tool provides operational actions and a reference library
to guide implementation.

• WHO advocacy video on the core components. Geneva: World Health Organization; 2018 (https://www.youtube.com/
watch?v=LZapz2L6J1Q).

• Health care without avoidable infections - peoples' lives depend on it advocacy video. Geneva: World Health Organization;
2017 (https://youtu.be/K-2XWtEjfl8?si=sPf1CuFX8oM77xHr).

• Refer also to tools and resources in strategic direction 6 SD6 .

*All tools and resources were accessed on 10 April 2025.

43
Development and implementation of national action plans for infection prevention and control: practical guide

To support step 3, review the specific activities and considerations for each strategic direction by clicking on the boxes below

Strategic direction 1 Strategic direction 2 Strategic direction 3 Strategic direction 4

Political commitment and Active IPC Programmes IPC integration and IPC knowledge
policies coordination and career pathways

Strategic direction 5 Strategic direction 6 Strategic direction 7 Strategic direction 8

Data for action Advocacy and communications Research and development Collaboration and stakeholder
support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

Table 3A.15. Action checks

☑ Stakeholder categorization confirmed and stakeholders convened.
☑ Interdependencies across relevant health programmes outlined.
☑ Barriers to implementation analysed and solutions developed.
☑ Proposed implementation and improvement actions mapped to the budget, with available resources and funding gaps
highlighted.
☑ Actions prioritized using prioritization matrix.
☑ IPC NAP using SMART objectives developed and aligned with ministry priorities.
☑ Roles and responsibilities updated and assigned based on competencies and capacity.
☑ Budget plan created.
☑ Sustainable, long-term fundraising plan developed.
☑ Surge strategies outlined, addressing potential adjustment, for example, during emergencies.
☑ Approval for the IPC NAP secured and IPC NAP updated/finalized and issued.
☑ Ongoing/follow-up meeting schedules established and governance, accountability and reporting maintained.
☑ IPC NAP dissemination and ongoing stakeholder engagement plans established and issued.
☑ Facility-level implementation plans confirmed.

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 Part 3A. Developing and implementing your infection prevention and control national action plan

Step 4 – Evaluating impact

Conducting follow-up assessments is crucial to determine the effectiveness and impact of the IPC NAP. Where
appropriate, use the tools and approach employed in step 2. This is a summary of what should occur in this step, but
also refer back to step 2.

Maintain assessments
• Use the IPC NAP to guide all necessary evaluation activities.
• Activate follow-up assessments, using the standardized, valid tools and approaches used in step 2 where
appropriate, according to your NAP. Confirm and reiterate modalities for follow-up assessments.
• Repeat assessments at least annually in the first instance; note that ongoing monitoring and evaluation of
action plans should take place over many years.
• Refer back to Tables 3A.4–3A.11 for the assessment tools specific to each strategic direction.
• Undertake refresher training on assessments methodology, if needed.
• Evaluate the IPC NAP against the allocated budget, including for each strategic direction that has been
prioritized, including reviewing the impact that infrastructure and resources are having on IPC NAP
implementation progress.
• Document all the processes involved, not just outcome evaluations, in order to evaluate these to support
sustainability of IPC NAP implementation.
• Integrate ongoing assessments into other national monitoring and evaluation programmes as appropriate,
addressing all available sources of data and technical expertise (see also strategic direction 3 SD3 ).
• Confirm whether the use of the national health information system can support data collection going forward.

Review and feedback results and update the IPC NAP

• Analyse and interpret all results at meetings with all relevant stakeholders, focusing on how the data will inform
future prioritization and decision making.
• Take stock of the successes and failures of the IPC NAP, including prevailing barriers, and plan activities for the
following year based on current priorities.
• Use available tools such as the ‘Delivery check-up’ and ‘Proof points’ in the WHO Implementation playbook,
pocket edition (8). The ‘Delivery’ check-up helps to identify whether implementation is working and
what adjustments are needed. The ‘Proof points’ tool documents the impact of your NAP and enhances
communication. For more information on the development of a communications and advocacy strategy (see
also strategic direction 6 SD6 .
• Report on processes, outcomes and impact against the agreed indicators as outlined in the NAP and as related
to the IPC programme and each strategic direction (see also Part 3B ), including at key decision-making
meetings.
• Update the IPC NAP as necessary.

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Development and implementation of national action plans for infection prevention and control: practical guide

Global reporting

• Every two years, beginning in 2026 and until at least 2030,

WHO will conduct a global survey across its three operating
levels to collect, collate, analyse and display data for
national-level indicators on a dedicated portal that can be
accessed from the main WHO web pages on IPC (11).
• These data will be used to inform WHO strategies for
supporting country implementation and donor advocacy of
the GAPMF. Data will also be collated into official global IPC
reports. The 2024 IPC global report (1) illustrates how data
will be presented to track progress.
• The WHO Secretariat is required to report progress on implementation of the GAPMF to the World
Health Assembly every two years, with the first report in May 2025.
• WHO IPC national and facility level (at primary, secondary and tertiary levels) assessment tools are
available on the WHO Global IPC portal (11).

To support step 4, review the specific activities and considerations for each strategic direction by clicking on the boxes below

Strategic direction 1 Strategic direction 2 Strategic direction 3 Strategic direction 4

Political commitment and Active IPC Programmes IPC integration and IPC knowledge
policies coordination and career pathways

Strategic direction 5 Strategic direction 6 Strategic direction 7 Strategic direction 8

Data for action Advocacy and communications Research and development Collaboration and stakeholder
support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

Table 3A.16. Action checks

☑ Follow-up assessments and ongoing evaluations agreed upon and conducted (for example, annually), using standardized,
validated tools and the IPC NAP to direct activities, and including alignment with other national monitoring and evaluation
systems.
☑ IPC NAP implementation processes evaluated and reviewed.
☑ Overall IPC NAP progress assessed, including against the allocated budget.
☑ Impact of infrastructure and resources on progress assessed and necessary solutions outlined.
☑ All results reviewed against indicators and targets, and barriers and gaps revisited with solutions proposed.
☑ Findings shared with the IPC committee and other relevant groups, including other leads, decision- makers, ministries,
stakeholders.
☑ IPC NAP revised.

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 Part 3A. Developing and implementing your infection prevention and control national action plan

Step 5 – Sustainability
Further review of the acceptability and long-term impact of the IPC NAP to ensure its sustainability are important
steps in the cycle of implementation. This also allows a review of the next steps for its update and identification of
long-term priorities in order to achieve the agreed-upon indicators and targets.

Refresh the IPC NAP with a focus on sustainability

• Revisit learning from the previous steps. Consider revisiting activities and considerations in steps 1–3.
• Involve the whole IPC NAP implementation team, IPC committee/steering committee, stakeholders, etc. in
reviewing, maintaining, updating/revising and approving the IPC NAP. This should be based on the results of the
evaluation, considering the effectiveness of the programme, acceptability and value for money.
• Secure long-term commitment from identified champions and stakeholders.
• Secure long-term, policy-level support aligned with priorities identified in the IPC NAP.
• Establish and approve a process for regular annual or biennial assessments for example and the provision of
regular feedback on IPC NAP progress – ongoing monitoring and evaluation of action plans should take place
over many years.
• Aim to understand the cause of ongoing barriers, as well as facilitators.
• Adjust the IPC NAP accordingly.
• Build a financial case for long-term investment and harness available financial, human and other necessary
resources for a long-term IPC NAP.
• Review if resources necessary for the successful implementation of the IPC NAP have been diverted away to
other work.
• Revisit business plans that exist, if necessary. Where these have included entities such as non-governmental
organizations to support in-country capacity and expertise, sustainability must be at the forefront of long-term
planning.
• Conduct further evaluations of the IPC NAP processes for planning and review commonly encountered barriers
to achieve solutions, especially where there is a lack of monitoring and evaluation systems for the plan to track
the IPC NAP and implementation progress. Use available tools such as the ‘Delivery check-up’ in the WHO
Implementation playbook, pocket edition (8), which helps to identify whether implementation is working,
what adjustments are needed, and how to sustain changes over time.
• Share learning to support motivation. For example: (a) celebrate and communicate success on an ongoing
basis; (b) build a portfolio of success stories and communicate examples of success to key stakeholders and
networks as part of awareness raising; (c) consider the possibility of setting up peer-to-peer support networks
at the regional level, for example, established through a collaboration between WHO country and regional leads
for IPC.
• Distil learnings on implementation by developing targeted briefs, for example, knowledge and action briefs, and
share these (see also strategic direction 6 SD6 ). See knowledge and action brief examples on the WHO Health
Services Learning Hub (36).
• Document progress in the form of periodic reports and recommendations as agreed during step 3.
• Input report findings into the WHO Global IPC portal (11).

47
Development and implementation of national action plans for infection prevention and control: practical guide

To support step 5, review the specific activities and considerations for each strategic direction by clicking on the boxes below

Strategic direction 1 Strategic direction 2 Strategic direction 3 Strategic direction 4

Political commitment and Active IPC Programmes IPC integration and IPC knowledge
policies coordination and career pathways

Strategic direction 5 Strategic direction 6 Strategic direction 7 Strategic direction 8

Data for action Advocacy and communications Research and development Collaboration and stakeholder
support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

Summarizing the five-step cycle for Senegal

• Preparing for action is important, including consideration of potential challenges such as
the absence of qualified personnel to manage the project and the absence of an adequate
infrastructure and equipment.
• For baseline assessment, the IPCAT-MR and IPCAF-MR were used.
• Informed by the assessment results, a five-year strategic plan, an annual operational plan and
a framework for monitoring and evaluation were developed.
• Underpinning our approach was a focus on prioritization, keeping it realistic and aiming for
efficiency, that is, ensuring interconnections across related programmes and the pooling of
resources within related programmes.
• To ensure progress, we conducted annual evaluations that allowed us to assess progress,
identify bottlenecks and adjust plans for the following year. New activities, if necessary, were
addressed with additional tools like WASH-FIT or HHSAF.
• The focus for sustainability was on moving from minimal IPC standards to striving for full
compliance.
IPC focal person, Senegal

Bringing the five-step implementation cycle to life in Sierra Leone – adapting it to the local
context
• First, the NAP development and review committee members were identified and roles
defined. Members agreed upon the terms of reference and a workplan.
• Next, a situational analysis was conducted, using a stakeholder consensus approach and
a workshop to review results and undertake a SWOT analysis.
• The first draft of the IPC NAP was developed at the stakeholder engagement workshop.
Activities and sub-activities for each strategic intervention and an operational plan were
outlined. This work included the Ministry of Health and Sanitation, Ministry of Finance,
civil society, academic institutions, Private, health partners, donors and policy-level
stakeholders. The AMR costing and budgeting tool was used, adapting it to the local
context. Potential funding sources for all budgeted activity were confirmed.
• An ongoing monitoring and evaluation plan with clear indicators, baseline and targets,
data sources and reporting timeline was developed.
• Further meetings were convened to review and validate the IPC NAP, focusing on ensuring
that the NAP was in line with other national priorities and the global IPC strategy. All final
documents were submitted for endorsement by appropriate national authorities.
IPC focal person, WHO Country Office, Sierra Leone

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 Part 3A. Developing and implementing your infection prevention and control national action plan

Table 3A.17. Action checks

☑ Long-term support and commitment secured from champions and policy-level actors.
☑ Annual or biennial assessments established and mechanisms for continuous feedback addressed.
☑ Ongoing barriers and challenges identified and resolved, including through internal/process evaluations.
☑ IPC NAP, including its timeline and roles and responsibilities reviewed and updated (to be a long- term plan) with IPC team,
committee and stakeholders involved.
☑ Financial sustainability addressed through a financial case for long-term investment, including ensuring that IPC NAP
human and implementation resources are not diverted to other projects.
☑ Strategies identified and implemented to optimize available resources and capacities to sustain activities.
☑ Successes communicated and a portfolio of stories to engage stakeholders created.
☑ Progress documented and reviewed/analysed through periodic reporting as part of meeting agenda items.
☑ Global reporting coordinated and undertaken.

49
Part 3B.
Implementation
of each strategic
direction

Application of the steps and actions

by strategic directions
Implementing the IPC NAP according to each strategic
direction with a focus on; leadership and organization
structures, strengthening stakeholder engagement,
securing resources, validating the current situation and
feeding back results, confirming priority areas and taking
action, and fully implementing the IPC NAP, maintaining
regular assessments and feedback cycles, ensuring
sustainability.
Development and implementation of national action plans for infection prevention and control: practical guide

3B.1. Quick summary

• This section focuses on the five-step implementation cycle according to each of the eight strategic directions.
• Details of considerations, activities, tools and templates to finalize and implement your IPC NAP according to
each of the strategic directions are outlined, including useful tips on how to address challenges.

3B.2. Strategic directions: targeted

activities, resources and considerations
• In addition to the activities outlined in Part 3A , there are specific targeted activities and considerations
required for the development, finalization and implementation of your IPC NAP, which are relevant to each of
the strategic directions. These include the following:
□ a stepwise list of activities and associated tools and resources
□ example of barriers and facilitators
□ action checks
□ signposting to country examples
□ further reading where applicable.
• Work through the following pages which address strategic directions 1–8 sequentially. Alternatively, go straight to
a specific strategic direction relevant to your context and building upon activities already undertaken in Part 3A.
• For results of assessments related to each strategic direction, simultaneously explore the use of the WHO IPC
global portal (11) to enter collated data in support of regional and global reporting.

To review a specific strategic direction relevant to your context, click on the boxes below

Strategic direction 1 Strategic direction 2 Strategic direction 3 Strategic direction 4

Political commitment and Active IPC Programmes IPC integration and IPC knowledge
policies coordination and career pathways

Strategic direction 5 Strategic direction 6 Strategic direction 7 Strategic direction 8

Data for action Advocacy and communications Research and development Collaboration and stakeholder
support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

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 Part 3B. Implementation of each strategic direction

Strategic direction 1: political

commitment and policies
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 1 – refer to
Part 2, Table 2.2 .

Î Ensure that you have considered all of the activities in Part 3A and focus on the action checks
at the end of each step.

Î Work through this section and you will have the elements that will support achievement of
the following national indicators for strategic direction 1 in the context of your IPC NAP.

Indicators

1. IPC NAP and monitoring framework developed, costed, validated and approved by the
ministry of health or other relevant national authorities within the context of national
health plans.
2. Legislation/regulations in place to address IPC (including IPC professionals) in a public
health regulatory framework.
3. National financial investment case developed based on global models (2026). Dedicated
budget (in line with the IPC NAP) allocated to the IPC national programme and action plan
identified and available.
4. Proportion of health care facilities with adequately funded and dedicated budget for IPC.
5. Dedicated and sufficient funding allocated at the national level for WASH services and
activities.

Context and considerations

• In some cases, national actions and action planning will be influenced by actions being
taken at the regional or global level.
• For example, a dependency is the ability of the WHO Secretariat and partners to engage
and motivate countries to rapidly implement the IPC GAPMF, including by disseminating
the results of the global investment case, which will play a critical role in supporting the
national investment case for IPC.
• Another example is the creation of IPC units within every WHO regional office and IPC focal
points located in each WHO country office. In many countries, this will be an important
factor to strongly support the successful implementation of IPC NAPs.
• Some of the activities across all strategic directions are linked in some way and this is
highlighted throughout the steps.

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 1 – Preparing for action SD1

Leadership and organization

• Reflect on what needs to be prepared in order achieve political commitment to support the development and
implementation of the NAP IPC and what policies need to be reviewed, updated and/or developed.
• Establish an IPC committee (if not already existing), an official multidisciplinary group, or a subgroup of an
existing national committee. An example of the list of responsibilities of a national IPC committee is shown
below in Table 3B.1 .
• Invite a range of expertise from other national programmes to the committee/group to direct the IPC NAP work,
as well as external expertise.
• Define the objectives of the committee/group, including an interaction with the team responsible for the IPC
programme (see also strategic direction 2 SD2 ).
• Outline the group’s mandate and accountability in order to support development of the IPC NAP and a
monitoring framework, including complementary programmes, especially WASH. Other tasks of the group
should be to build the investment case and budget, as well as reviewing national regulations for IPC and the
engagement of adequately-funded health care facilities.
• Focus multidisciplinary group meetings on drawing on those who have a previous experience of political
engagement and commitment.
• Create time-bound targets and articulate the need for ongoing engagement, discussions and actions to finalize
(and update) the IPC NAP.
• Support the preparation of an approved IPC investment/budget in support of the NAP (should be part of your
timeline started in Part 3A). Make these discussions part of existing meetings (where possible) and be realistic
about how long this might take and any political instability that might affect plans.
• Prepare to undertake consultations on how to achieve political commitment, including a legal framework, if the
process is not already clear. Outline the approach to engaging other ministries, apart from health, including the
ministry of finance.
• Achieve the engagement of accreditation and health regulatory bodies, if not already secured.
• Review existing laws and policies relevant to IPC to inform a legal framework if not already existing. Map legal
instruments related to IPC and outline the domains to be addressed in support of IPC.
• Start to explore the necessary information and data that will likely engage policy-makers.
• Explore the right times for building momentum for political commitment, for providing information to
ministries, for presenting at parliament initiatives, and, for example, running legal framework assessment and
investment case workshops.
• Explore the potential for IPC to be in existing or forthcoming legislation by searching for these and using
professional connections experienced in this process (see also strategic direction 3 SD3 ).
• Support the preparation of openly available political declarations for the IPC NAP.
• Start to consider how political commitments and allocated budgets will be monitored, evaluated and renewed
over time. Include the proportion of activities with adequate, dedicated funding for IPC.
• Explore how WASH services and activities are funded and allocated in support of IPC at national and facility level
(see also strategic direction 2 SD2 ), referring to the WASH facility improvement tool (FIT) guide (33).

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 Part 3B. Implementation of each strategic direction

Table 3B.1. Roles and responsibilities of the national IPC advisory committee (37)
Provide input to IPC policy, strategic plans (including for outbreaks), guidelines, standard operating procedures and
1.
management issues as needed, for effective, evidence-based practices.
Be an advocate for obtaining financial and human resources for IPC, including procurement of adequate supplies for
2.
IPC practices.
Set national and district goals for preventing HAIs with both endemic and epidemic potential and IPC quality indicators,
3.
and will review the progress toward these national goals, objectives and strategies.
Provide input into the development of a) training and education programmes for the facility level b) national
4. monitoring frameworks to measure implementation with policies, guidelines and standards c) surveillance and
epidemiology of HAI and HAI-related aspects of AMR.

Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection; AMR, antimicrobial resistance.

Stakeholder engagement
• Review your stakeholder mapping conducted while working through Part 3A to identify those who can help
and where gaps may still exist in achieving political commitment and investment for the IPC NAP, for example,
external expertise, including those in other countries if necessary.
• Engage local experts/champions (if not already done) to achieve wide buy-in and to provide endorsements
in support of the legal framework and its implementation, as well as investment and business cases (see also
strategic direction 6 SD6 ).

Finance and budgeting

• Review available information for creating targeted investment and business cases, based on initial estimates
undertaken through Part 3A activities, as well as health care facility IPC budgets.
• Start to calculate costs and outline a dedicated budget to further inform the IPC NAP (as started in Part 3A),
including information on the specific country problems/burden of HAI and the value of IPC interventions
(see also strategic direction 2 SD2 and strategic direction 5 SD5 ). Use available tools to support the process,
for example, WHO costing and budgeting tool for national action plans on AMR (26), annex 6 in the WHO
implementation handbook for national action plans on AMR (10), and the WHO IPC investment case (27).

Other resource considerations

• Start to collate/develop tools and resources for drafting the legal instruments.

• “Resources are not only financial, but also include partnerships and networks and political
commitment. Political commitment and governance play key roles!”
• “The top facilitator to garner political support is to use a top-down and bottom-up
approach.”
• “Getting political commitment is crucial to achieve the vision set out in the global strategy
- a whole-of-system and whole-of-government approach is needed to bridge the gaps and
stop working in silos.”

IPC leaders and experts from across all WHO regions

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 2 – Baseline assessment SD1

The assessments listed will help present the case for political commitment and accountability on IPC by, for
example, providing evidence on the situation with regards to current IPC and WASH budget gaps, including gaps in
implementing the IPC core components and minimum requirements.

Understand the current situation

• Undertake baseline assessments as described in Part 3A , using valid assessment tools and resources.
• Focus on assessment results according to Table 3B.2 .
Table 3B.2. Assessment tools
Strategic direction Assessment tool Relevant section Area assessed
1: political
commitment and IPCAT2 1.1.7 IPC budget
policies IPCAT-MR 1.4 IPC budget
IPCAF 1.9 IPC budget
IPCAF-MR 1.9 IPC leadership support and funding
IPCAT2 1.2.2 IPC national plan
IPCAT2 1.2.3 National monitoring frameworks
e-SPAR-SPAR C9.1 IPC programmes
GLAAS Finance WASH budgets and funding
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements; IPCAF, infection prevention and control assessment framework; IPCAF-MR, infection
prevention and control assessment framework - minimum requirements; e-SPAR, electronic States Parties self-assessment annual reporting;
GLAAS, Global analysis and assessment of sanitation and drinking-water; WASH, water, sanitation, waste management and hygiene.

• Consider conducting epidemiological studies on the frequency and consequences of HAIs and AMR (for
example, a prevalence survey), and/or using existing HAI surveillance data.
• If outbreaks have recently occurred in health care facilities, include information and data in briefing documents
and key messages for politicians and decision-makers.
• Analyse data regarding costs of HAIs and AMR and include them in briefing documents and key messages for
politicians and decision-makers.
• Evaluate if there are local or international successful examples of IPC interventions that led to improvement of
practices and/or reduction of harm due to HAIs and AMR and prepare engaging stories with a specific focus on
demonstrating the impact and sustainability of IPC.
• Collate baseline assessment data that you consider will be powerful in influencing and securing political
engagement and will be most relevant to your context, based on your understanding of the drivers that
influence policy-makers in your country, for example, data on outbreaks, extra length of stay due to HAI and
associated costs where known.
• Undertake additional fact-finding exercises to identify drivers for political commitment including those that will
be most attractive to political leaders, for example, public and media statements or patient feedback (see also
strategic direction 6 SD6 ).
• Conduct cost investment analysis.

56
 Part 3B. Implementation of each strategic direction

Review and feedback the results

• Describe all the analyses, particularly specific HAI cost analyses, and IPC programme budget outlines where
possible in an investment case or similar document.
• Present and share all results in a meaningful, accessible way to all identified stakeholders, including health
regulatory bodies – be prepared to accept feedback in order to adjust how to present IPC priorities and an
investment case.

Step 3 – Developing and implementing the plan SD1

Establish priority areas for action using assessment results

• List the areas that need to be actively funded over time to achieve the priorities associated with strategic
direction 1, if not already done while working through Part 3A .
• Outline the current drivers that might stimulate the IPC NAP priority actions for political engagement,
legislation/regulation and investment, including during outbreaks and increased media attention (see also
strategic direction 6 SD6 ). Present how IPC is a solution to many service delivery problems.
• Finalize targeted consultations with stakeholders to outline the approach for approvals to sustainable political
commitment, a legal framework and IPC regulation.
• Describe the ‘voices’ that will need to be heard for political engagement, for example, health and care workers,
patients, their families, and others using health services (see also strategic direction 6 SD6 ).

Translate all findings into the IPC NAP and implement the NAP
• Highlight priorities within the existing IPC NAP to achieve and maintain political commitment and policies, a
legal framework (if not already in place) and regulations – discussing with the IPC team and multidisciplinary
group/committee and regulatory bodies.
• Describe the IPC investment, based on all exploratory and assessment exercises – frame this in a way that will
reach policy-makers, for example, their priorities and language, rather than technical speak.
• Outline a schedule of events to raise awareness of the IPC NAP among a range of policy- and decision-makers,
including those working across different programmes and considering the need for approvals for IPC political
commitment and policies.
• Secure political commitment using the multidisciplinary group and the meeting/engagement timeline.
• Validate any legal instruments.
• Support amendment of any existing government legislation that supports the IPC NAP and programme as
necessary (see also strategic direction 2 SD2 ).
• Outline the necessary actions to evaluate progress and outcomes/impact, for example, number of ministers
committed to IPC, allocation of budget, and adherence to the legal framework.
• Outline the necessary surge capacity actions and investments for when these might be needed and achieve
commitment for these (this links IPC programmatic work with outbreak preparedness work).
• See additional tools and resources in Table 3B.3 .

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 4 – Evaluating impact SD1

Maintain assessments
• Use the IPC NAP to guide ongoing evaluations.
• Activate follow-up assessments, that is, the same as in step 2, using approved tools and approaches.
• Evaluate the political commitment/policies, legal framework and established regulations.
• Assess a wide range of ministry documents indicating political commitment to IPC.
• Assess ministry communications and personal communications by policy-makers and champions showing
commitment to IPC.
• Assess where commitments and regulation were acted upon and maintained, including if IPC was addressed
within other programmes, particularly WASH, AMR and public health emergencies.

Review, feedback results and update the IPC NAP

• Analyse and interpret follow-up assessments at existing meetings with all relevant stakeholders, targeting
feedback to the audience.
• Report on progress, outputs/outcomes of political commitments for example.
• Reflect on results and how to further raise awareness among political leaders, considering the current
landscape.
• Adjust the IPC NAP as necessary.
• Provide detailed information on evidence of progress to secure long-term IPC commitment and investment.

Step 5 – Sustainability SD1

Refresh the IPC NAP with a focus on sustainability for political commitment
and policies
• Outline necessary activities to sustain political commitments and policies based on all learning in steps 1–4.
• Prepare and issue policy briefs to secure engagement on a long-term basis and to demonstrate the value of
IPC based on ongoing assessment results (see also strategic direction 6 SD6 ). Review existing policy briefs for
inspiration, for example, the Africa Centres for Disease Prevention and Control (CDC) policy brief for the legal
framework on infection prevention and control (38).
• Maintain committee/group meeting schedules and stakeholder relationships, especially when the political
landscape changes, in order to update the IPC NAP and secure political support for actions by the national IPC
programme.
• Commit to actively achieving ongoing political commitment, endorsements and approvals for the
implementation of IPC policies, a legal framework, regulation and investments (see also strategic direction 2 SD2
and strategic direction 6 SD6 ).

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 Part 3B. Implementation of each strategic direction

Table 3B.3. Additional tools and resources*

• Water, sanitation and hygiene in health care facilities: practical steps to achieve universal access to quality care. Geneva:
World Health Organization; 2019 (https://iris.who.int/handle/10665/311618). Licence: CC BY-NC-SA 3.0 IGO.

• WASH in health care facilities. Country progress tracker. Geneva: World Health Organization & United Nations Children’s
Fund; 2025 (http://www.washinhcf.org/country-progress-tracker).

• Toolkit on mainstreaming of gender equality, disability and social inclusion (GEDSI) in WASH in health-care facilities. New
Delhi: World Health Organization. Regional Office for South-East Asia; 2023 (https://iris.who.int/handle/10665/373608).
Licence: CC BY-NC-SA 3.0 IGO.

*All tools and resources were accessed on 10 April 2025.

Barriers and facilitators

• Differences in in-country perceptions related to the importance of a Bill; immediately aim to

understand local perspectives, expected outcomes, and the time needed for actions associated
with passing a Bill, that is, the process of turning a proposed piece of legislation into law. Build
relationships, consult key stakeholders and highlight the importance of IPC in the national health
system. Moving forward, use data from step 2 to show how IPC can help solve national issues.
• Difficulties securing political commitment, particularly getting the attention of policy-
makers; focus your energy on establishing a multidisciplinary group with representation from
priority stakeholders – this is mission critical. Use the power of this group to consult with and
raise awareness among key stakeholders, including on the streamlining of political commitment,
accountability and processes. Learn from other programmes that have successfully achieved policy
level engagement, for example, AMR.
• Lack of collaboration with experts for the publication of an effective legal framework and
investment case; ensure effective stakeholder mapping and governance procedures that allow
engagement of the right expertise in a timely manner.

Table 3B.4. Action checks

☑ Political commitment secured, including ministry of health fully engaged.

☑ Decision-makers and stakeholders from across different ministries and other national authorities identified and engaged.
☑ Champions secured and sensitized.
☑ Relevant policies and legal frameworks reviewed.
☑ A dedicated multidisciplinary group established with objectives, responsibilities and accountability allocated.
☑ Dedicated meeting agenda items outlined, consultations conducted and progress reported.
☑ An investment case and dedicated budget for the national IPC programme outlined, including for WASH services and
activities and health care facilities, and focused on available assessment data and tools.
☑ Tools and resources for drafting legal instruments collated and drivers for IPC legislation and regulation identified.
☑ A legal framework developed (aligned with existing legislation) and approved.
☑ Clear, time-bound targets and mechanisms for monitoring and evaluation set and acted upon, including on the impact of
political commitment and a legal framework.

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Development and implementation of national action plans for infection prevention and control: practical guide

☑ Legal instruments and government Acts validated and amended as needed.

☑ IPC NAP updated.
☑ Assessments and evaluations maintained and results fed back, with decision-makers sensitized to IPC NAP/priorities.
☑ Relationships maintained and strategies/IPC NAP adapted as the political landscape shifts.

Find out more about implementing strategic direction 1 in the country story in Annex 8 .

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 Part 3B. Implementation of each strategic direction

Strategic direction 2: active IPC

programme
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 2 – refer to
Part 2, Table 2.3 .

Î Ensure you have considered all of the activities in Part 3A and focus on the action checks at
the end of each step.

Î Work through this section and you will have the elements that will support achievement of
the following national indicators for strategic direction 2 in the context of your IPC NAP.

Indicators

1. All WHO IPC minimum requirements for IPC met at national level.
2. Proportion of health care facilities meeting all WHO minimum requirements for IPC at
facility level.
3. Proportion of health care facilities with basic WASH and waste services.
4. Proportion of tertiary/secondary care health facilities with an active IPC programme.
5. Proportion of primary care facilities with an IPC link person.
6. Proportion of facilities with implemented interventions based on multimodal strategies to
reduce specific HAIs according to local priorities.
7. Evidence-based IPC guidelines and policies available at the national level.

Context and considerations

• In some cases, national actions and action planning will be influenced by actions being
taken at the regional or global level.
• One example is that one of the global actions of strategic direction to be undertaken by the
WHO Secretariat is to work across the three levels of WHO to support countries to establish
or strengthen active national IPC programmes.
• Some of the activities and considerations across all strategic directions are linked in some
way and this is highlighted throughout the steps.

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 1 – Preparing for action SD2

All countries should ensure the existence of active IPC programmes (Table 3B.5 ) at the national and
health care facility levels in both the public and private sectors. “Active” is defined as a functioning
programme with annual work plans (objectives and action plans) and supported by dedicated human
resources and financing. Implementation considerations and guidance on this already exist in the WHO
Guidelines on the core components for IPC programmes (4) and the Interim manuals for their
implementation at the national and facility level (6,7).

Table 3B.5. IPC programme at-a-glance according to WHO minimum requirements

The IPC programme (4)
• An IPC focal point is in place and in charge of the programme, including the development of guidelines, education and
training, HAI surveillance, use of multimodal strategies and IPC monitoring/audit and feedback.
• The IPC focal point(s) have undergone training in IPC and in the prevention of HAIs.
• The IPC focal point(s) have dedicated time for the tasks (at least one full-time equivalent).
• An identified, protected and dedicated budget is allocated to the IPC programme, according to planned activity.

IPC guidelines IPC education and HAI surveillance Multimodal strategies Monitoring/audit
training of IPC practices and
feedback
IPC programme is IPC programme A multidisciplinary The national IPC focal A multidisciplinary
mandated to produce provides guidance and technical group for point has knowledge technical group for IPC
guidelines. recommendations for HAI surveillance is of implementation monitoring is in place.
in-service IPC training established at the science and the
at the facility level. national level by the application of
national IPC focal point. multimodal
strategies-
Evidence-based IPC programme A national strategic The national IPC focal A strategic plan for
scientific knowledge provides content and plan for HAI point coordinates/ IPC monitoring is in
and international/ support for IPC training surveillance is supports the local place, including an
national standards of health workers at the developed by the implementation of IPC integrated system for
inform guideline facility level. multidisciplinary improvements. the collection, analysis
development. technical group. and feedback of data.
The guidelines cover A national IPC The national IPC focal Multimodal strategies A minimal set of core
all acute health care curriculum for the point/team is trained are included as the indicators for health
facilities (both public in-service training of in HAI surveillance best approach for care facilities in the
and private.) health and care workers concepts and methods. implementation in country is defined.
has been developed IPC guidelines, as well
and aligned with as IPC education and
national guidelines. training programmes.
The guidelines are A national system and A mechanism to train
regularly reviewed (at schedule of monitoring national and local
least once every five and evaluation of auditors is in place.
years) and updated training and education
to reflect the current is in place (at least
evidence base. annually).

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 Part 3B. Implementation of each strategic direction

IPC guidelines IPC education and HAI surveillance Multimodal strategies Monitoring/audit
training of IPC practices and
feedback
The IPC programme Hand hygiene
actively addresses compliance monitoring
adaptation and and feedback is
standardization identified as a key
to reflect local national indicator,
conditions. at the very least for
reference hospitals.

Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection.

Leadership and organization

• Identify or create an organizational structure to support the IPC programme development, maintenance and
implementation – see an example governance structure (Fig. 1, page 2) in WHO Pan American Health Organization
(PAHO) implementation of programmes for the prevention and control of HAIs – a roadmap (39).
• Position the organizational structure in line with existing health systems and priorities.
• Clearly define or review IPC programme functions at leadership and operational levels (roles, committees,
reporting lines, etc.).
• Review the core components for IPC programmes to inform or verify the active IPC programme outline.
• Explore the composition, competence and remit of a sustainable IPC team to meet the plan for the IPC
programme (Table 3B.6 ).
• Explore how the IPC team can be fully competent over time in executing the IPC programme, guideline
implementation and multimodal improvement strategy activities (see also strategic direction 4 SD4 ).
• Draft the outline of the role of competent IPC focal points in different settings, including primary care, in relation
to the programme and guidelines (see also strategic direction 4 SD4 ).
• Use an existing national coordinating group to help to identify partners, both government and non-
government, and other possible contributors to the IPC programme.
• Secure IPC team lead attendance in high-level committees, meetings, etc. to influence aspects of health systems
and service delivery where IPC should be included as a priority – this might be achieved by using other existing
influential leaders with whom relationships have been developed.
• Identify the relevant administrative or political jurisdiction that will be delegated the responsibility for the IPC
programme, if not already in place.
• Establish/attend meetings with a dedicated agenda item focused on the IPC programme and guidelines
specifically – use existing meetings where possible.
• Set up a technical working group to develop and disseminate evidence-based IPC guideline content and ensure
publication.
• Identify existing global or other national guidelines.
• Explore the format of guidelines to ensure that they are relevant for the end user and impactful and include the
multimodal improvement approach.
• Ensure that meeting agendas include discussions on the use of the WHO multimodal improvement strategy
at national level and across the health care system by providing the questions posed in the WHO multimodal
improvement strategy one-page document (40).
• Discuss how targets regarding an effective, active IPC programme, IPC guidelines and reducing HAIs can be set
and monitored (see also strategic direction 5 SD5 ), including the role of a multimodal improvement strategy.
• Outline how the IPC programme and guideline updates (review cycle, for example, every 5 years) and

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Development and implementation of national action plans for infection prevention and control: practical guide

implementation will be evaluated over time, as well as HAI targets (see also strategic direction 5 SD5 ).
• Explore and secure close coordination plans with the national reference laboratory to support the IPC
programme activities.
• Secure IPC champions – invest in ways to secure their protected time and develop their capacity, capability and
leadership skills – plan for their supervision and outline how they will be dedicated to implementation of the
IPC programme, guidelines and multimodal improvement strategies.
• Review the opportunities for establishing and enhancing an active IPC programme, including a multimodal
improvement strategy, IPC guidelines and IPC targets, at least across tertiary and secondary health care
facilities, such as annual budget cycles, outbreak situations, etc.
• Start to prepare short explanatory documents on the importance of an IPC programme, guidelines and targets
in tertiary and secondary settings and what they can achieve, for example, a two-page document targeted at
leaders who can influence progress (see also strategic direction 6 SD6 ).
• Start to write and explore the approval processes for the IPC programme plan and terms of reference for
necessary committees, etc.
• Start to facilitate the collation of examples of excellence/vignettes on improvement in particular (see also
strategic direction 6 SD6 ).
• Outline how the standard operating procedures based upon the national IPC guidelines and targets will be
written for different levels (secondary and tertiary, and primary if possible) and approved.
• Explore the contents of a comprehensive guideline dissemination strategy.
• Establish a mechanism to alert all those who need to be aware about the existence of or proposed plans for the
IPC programme as part of the IPC NAP.
• Explore the expected timeframe for executing/addressing the active IPC programme, guideline development,
adaptation and implementation, and HAI targets, for example, by looking at other programmes that have been
successful (see also strategic direction 5 SD5 ).
• Set up a process for timely guideline development, adaptation or updates, for example, by reviewing the latest
HAI reports, exploring the availability of new international guidance, etc.
• Outline how all plans will link with the overall IPC NAP development, roll-out and updates.

“We recognized that we had to first train committed IPC professionals so that they would be
able to understand IPC, its epidemiology, and how to advocate for its importance, thereby
increasing political will.”

Regional IPC focal point, WHO Region of the Americas

“We found that the national action plan on AMR work provided a good opportunity for
advocating for a multimodal strategy. For addressing AMR in the IPC strategic pillar, we proposed
activities as part of a multimodal approach.”

IPC national lead, WHO European Region

“We selected “model” IPC hospitals. In these hospitals, the selected IPC professionals made
up a team that was tasked to lead the guideline writing and provide the necessary technical
expertise for its development.”

IPC professional, WHO South-East Asia Region

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 Part 3B. Implementation of each strategic direction

Table 3B.6. Example of roles and responsibilities of the national IPC team (6)
Roles of the IPC national team
1. Develop and implement the national IPC programme, including setting formal objectives and plans and establishing a
formal IPC group or committee.
2. Develop and disseminate national guidelines and support implementation.
3. Develop and coordinate a programme of continuous education and training.
4. Develop and coordinate systems for HAI surveillance, including an alert system for outbreak detection, including
monitoring, audit and feedback of IPC indicators.
5. Facilitate access to the essential infrastructures, materials and equipment necessary for safe IPC practices. Support and
promote adequate workload, staffing and bed occupancy levels (that is, an enabling environment).
6. Build effective linkages with related national programmes.
7. Promote and support the implementation of multimodal improvement strategies to achieve improvements at the health
care facility level.

Responsibilities of the IPC national team

1. National programme, objectives and plans
1.1. Formulate clear goals for the prevention and control of endemic and epidemic infections.
1.2. Prepare national plans for the prevention of HAI aligned with the International Health Regulations (2005) and AMR
programmes and involving key players and partners.
1.3. Conduct monitoring and evaluation of the national programme and disseminate feedback of results.
1.4. Establish an official multidisciplinary IPC group, committee or an equivalent structure to support the integration of IPC
within the national health system, including the IPC programme and its monitoring and evaluation.
1.5. Ensure that a national outbreak prevention plan is in place.

2. National guidelines
2.1. Develop or strengthen national policies and standards of practice (including technical, evidence-based guidelines
for the prevention of relevant risks informed by local risk assessment and/or adapted to local conditions) regarding IPC
activities in health care facilities.
2.2. Prepare dissemination plans and a programme of support for local implementation.
2.3. Ensure that a system is in place for the documentation and dissemination of successful local or national initiatives to
highlight examples of effective interventions and their implementation.

3. Continuous education and training

3.1. Support the development and enhancement of educational programmes on IPC.
3.2. Ensure advanced educational programmes that target IPC specialists, all health and care workers involved in service
delivery and patient care, as well as other personnel that support health service delivery, including administrative,
managerial and all other support staff.

4. Surveillance, monitoring, audit and feedback

4.1. Formulate processes to monitor the implementation of and adherence to national policies and standards and put in
place feedback mechanisms.
4.2. Formulate a system of surveillance of HAIs, as well as AMR, including early outbreak detection and the associated
dissemination of data. This could be done in collaboration with one or more national reference microbiology laboratories
and/or starting initially with some health care facilities as pilot sites.
5. Enabling environment
5.1. Ensure national procurement of an appropriate selection of adequate supplies relevant for IPC practices, for example,
personal protective equipment, hand hygiene products, disinfectants, etc.
5.2. Ensure effective waste management and adequate access to safe water, sanitation and environmental cleaning across
health care facilities.

6. Programme linkages
6.1. Ensure that effective relationships and collaborations (see also strategic direction 3 SD3 ) are built with related teams,
programmes and other ministries including: WASH; environmental authorities and waste management; those responsible
for the prevention and containment of AMR, including antimicrobial stewardship programmes, tuberculosis, HIV and other
priority public health programmes; national referral laboratories and laboratory biosafety programmes; occupational
health; quality and safety programmes; patient associations/civil society bodies; scientific professional organizations;

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Development and implementation of national action plans for infection prevention and control: practical guide

training establishments/academia; relevant teams or programmes in other ministries; relevant sub-national bodies, such as
provincial or district health offices; immunization programmes; and maternal and child health programmes.

7. Multimodal improvement strategies

7.1. Provide coordination and support to health care facilities in the development and implementation of multimodal
strategies aligned with other national quality improvement programmes or health facility accreditation bodies, including
providing support and the necessary resources, policies, regulations and tools.

Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection; AMR, antimicrobial resistance; WASH, water,
sanitation, waste management and hygiene.

Stakeholder engagement
• Build relationships with the main stakeholders who will help drive forward the IPC programme, guideline
implementation and the multimodal approach. Establish networks at national and health facility levels if not
already in place (see also Part 3A and strategic direction 8 SD8 ).
• Identify existing or external expertise required for IPC guideline preparation, adaptation or updates specifically.
• Engage stakeholders from other health programmes, such as WASH, AMR, quality and safety, if not already
involved in the IPC programme work, as well as other specialists where necessary, for example, waste
management, logistics, environmental hygiene, behavioural scientists.
• Start to enlist the support of the identified stakeholders to advocate for implementation of the IPC programme
and guidelines, particularly through the use of a multimodal approach, depending on the prevailing culture in
the country (autocratic, technocratic, etc.) – engage health leaders, health workers, the public, etc.
• Engage those who have championed multimodal improvement strategies in their work and/or consider how to
enlist new champions based on the collated vignettes.
• Explore existing non-governmental organizations and networks and outline how they could (continue to)
champion and embed the IPC programme, guidelines and multimodal improvement strategies.
• Start to sensitize all those involved regarding the expected outcomes from the IPC programme (see also
strategic direction 6 SD6 ).

Finance and budgeting

• Explore the dedicated budget for all aspects of the active IPC programme, including multimodal improvement
strategies and HAI targets, and outline the necessary requirements if this has not already been included in an
investment case (see also Part 3B , strategic direction 1 SD1 and the core components for IPC programmes
– this also includes activities and considerations outlined in the other strategic directions as part of an IPC
programme.)
• Revisit existing budget lines to consider if they will support actions recommended in guideline development
and updates, their implementation, and the necessary multimodal improvement strategy actions.
• Build connections across programmes and sectors and explore collaborations and possibilities for co-funding
as a short-term solution, especially where sources of funding for the IPC programme are minimal (see also
strategic direction 3 SD3 and strategic direction 8 SD8 ).
• See additional tools and resources in Table 3B.8 .

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 Part 3B. Implementation of each strategic direction

“Implementation of the workplan activities relies on funding. When considering how to meet
the indicator of having an “active” IPC programme it is important to focus on the adequacy of
the budget for IPC. One suggestion is to consider the number (proportion) of work plan activities
funded by domestic funding through government or partner/donors. Although this will differ
across countries, one approach could be to aim for at least 50% of workplan activities to be
funded. Achieving such an aim would be considered as having an adequate budget.”

IPC professional from Sierra Leone

Other resource considerations

• Explore how guidelines, a multimodal improvement strategy and proposed HAI targets will impact on a range of
resources, including existing training and monitoring programmes and WASH services.
• Consider where existing infrastructure, resources and staff can be leveraged to achieve an active IPC
programme including a multimodal improvement strategy by exploring joint areas of work across other health
programmes, networks, etc.

Step 2 – Baseline assessment SD2

Understand the current situation

• Undertake baseline assessments as described in Part 3A using valid assessment tools and resources.
• Focus on assessment results according to Table 3B.7 .
Table 3B.7. Tools for strategic direction 2: active IPC programmes
Strategic direction Assessment tool Relevant section Area assessed
2: active IPC
programmes IPCAT-MR All Establishment of a national IPC programme and
demonstrating improvement evidence
IPCAF-MR All Establishment of a national IPC programme and
demonstrating improvement evidence
WHO/UNICEF Search for WASH, Establishment of a national IPC programme and
Joint Monitoring environmental cleaning demonstrating improvement evidence
Programme and health care waste
management
e-SPAR-SPAR C9.1 Active IPC programmes (dedicated human
resources)
IPCAF 1.1-1.4 and 1.8-1.9 Active IPC programmes (dedicated human
resources)

IPCAF-MR Core component 1 indicator Active IPC programmes (dedicated human

1.1 resources)

IPCAT-MR 5.1 Implementation of a multimodal improvement

strategy

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Development and implementation of national action plans for infection prevention and control: practical guide

IPCAT2 5.1.2 Implementation of a multimodal improvement

strategy
IPCAT-MR 5.2 and 5.3 Implementation of a multimodal improvement
strategy
IPCAT2 All in core component 2 National IPC guidelines and policies
IPCAT-MR All in core component 2 National IPC guidelines and policies
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements; IPCAF-MR, infection prevention and control assessment framework - minimum
requirements; e-SPAR, electronic States Parties self-assessment annual reporting; IPCAF, infection prevention and control assessment
framework-minimum requirements; WASH, water, sanitation, waste management and hygiene.

• Consider a short survey of a cross-section of health care facilities to drill into specific aspects of the NAP and its
understanding and to provide more comprehensive information for action.
• Consider conducting epidemiological studies on the frequency and consequences of HAIs and AMR (for
example, a national prevalence survey or incidence studies on specific types of HAIs) in order to decide on the
appropriate target for HAI reduction in your country.
• Consider inviting health care facilities (all or a sample, depending on feasibility) to undertake the WHO HHSAF
(22) as an initial proxy for the use of a multimodal improvement strategy.
• Consider undertaking or promoting safety culture assessment surveys (for example, Agency for Healthcare
Research and Quality hospital survey on patient safety culture (41).
• Understand what national guidelines/guidance exist on IPC topics and assess the priority areas that need to be
covered and/or require updates.
• Assess if contents of existing guidelines have been implemented, for example, through mapping the assessment
results listed here with guideline content and conducting surveys.
• Undertake inventories of existing capacities and resources that influence the implementation of guidelines
using, for example, the ‘workforce indicators of staffing need’ tool (42).
• Assess the availability of IPC champions.
• See additional tools and resources in Table 3B.8 .

“In Sierra Leone, baseline assessment was conducted using a group consensus approach. The
IPCAT2/IPCAT-MR was used to generate a SWOT table (strengths, weaknesses, opportunities
and threats) to guide priority setting within the operation plan. This collective analysis, using the
IPCAT-MR, was applied during stakeholder consultative meetings to develop the action plan.”

WHO country office IPC lead, Sierra Leone

Review and feedback results

• Present and share all results in a meaningful, accessible way to all identified stakeholders, including health
regulatory bodies who can contribute to plans for improving the IPC programme.
• Provide the technical working group with the results related to existing guidelines/guidance on IPC.
• Provide key stakeholders with feedback on the results related to the use and understanding of multimodal
improvement strategies – use this opportunity to provide more explanations and examples of these strategies
and their value.
• Map current assessment results with HAI reduction activities (see also strategic direction 5 SD5 ).

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 Part 3B. Implementation of each strategic direction

Step 3 – Developing and implementing the plan SD2

Establish priority areas for action using assessment results

• Describe and discuss the proposed areas of improvement for an active IPC programme, including a multimodal
improvement strategy, IPC guideline development and updates, IPC champions and HAI targets, which need
to be funded across different settings over time and as part of the IPC NAP, if not already done while working
through Part 3A .
• Finalize the priorities through review in meetings with stakeholders, high-level committees and in targeted
consultations, including raising awareness for the need for ongoing investment and a dedicated budget.

Translate all findings into the IPC NAP

• Highlight the steps to achieve an active IPC programme, guidelines and HAI targets within the existing IPC NAP.
• Outline aspects of the active IPC programme actions and implementation progress for meeting agendas and
governance.
• Finalize and issue terms of reference for the IPC programme (based on prioritization of the WHO core
components) if not already in place.
• Confirm the role and competence of champions – engage with line managers and leads of other health
programmes, such as WASH, being clear about the expected commitment.
• Identify priority areas for the use of multimodal improvement strategies to implement IPC interventions
in line with the established HAI reduction targets and develop support materials for health care facility
implementation.
• Outline plans for dissemination of the materials to support multimodal improvement strategy implementation
and for communications to the sub-national and health care facility levels.
• Disseminate case study/vignette examples of the multimodal improvement strategy, as well as other advocacy
materials on the need for an IPC programme.
• Adapt or develop and issue guidelines as deemed necessary.
• Outline and share guideline implementation plans with all relevant stakeholders, settings/leaders.
• Develop and use accountability frameworks, accreditation and reward systems to support implementation of
the IPC programme.
• Update the budget outline for the IPC programme, implementation and updates of guidelines and multimodal
improvement strategy actions.

“We provided workshops for facility administrators to build awareness about this approach
(multimodal strategies) and its importance.”

National IPC lead, WHO African Region

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 4 – Evaluating impact SD2

Maintain assessments
• Use the IPC NAP to drive repeat assessments undertaken in step 2.
• Monitor guideline and multimodal improvement strategy implementation and adherence as it relates to HAI
reduction.
• Monitor the input of IPC champions and the impact on the IPC programme.
• Review the inventory of capacities to be sure that the IPC programme can be sustained.

Review, feedback results and update the IPC NAP

• Report on progress, outputs and outcomes related to the IPC programme components.
• Reflect on remaining gaps and how to further drive progress with stakeholders.
• Adjust all plans and update the IPC NAP as necessary.

Step 5 – Sustainability SD2

Refresh the IPC NAP with a focus on sustainability

• Outline and include necessary activities to sustain the active IPC programme in the updated IPC NAP, including
the team, guidelines’ implementation, and consider the necessary actions to boost the implementation of
multimodal improvement strategies, based on all learning in steps 1-4.
• Consider achievements made on HAI targets over time and any changes to be made according to the risks and
epidemiology.
• Re-highlight the IPC organizational structure to emphasize its links with existing health systems and priorities to
secure long-term policy support and funding.
• Continue to use link persons/champions – review their role and active contribution.
• Revisit existing plans for WASH services, operation and maintenance and their role in IPC programme
implementation progress and report advancement to high-level committees.
• Maintain meeting schedules with stakeholders to emphasize the role of the IPC programme (see also strategic
direction 1 SD1 and strategic direction 8 SD8 ).

Table 3B.8. Additional tools and resources*

• Hand hygiene, ward infrastructure, knowledge and perception surveys. Geneva: World Health Organization; 2025 (https://
www.who.int/teams/integrated-health-services/infection-prevention-control/hand-hygiene/monitoring-tools). See also
the additional resources’ list at the end of strategic direction 2 SD2 .

• WHO National health planning tools. Geneva: World Health Organization; 2010 (https://extranet.who.int/nhptool/).

• Bartles R, Reese S, Gumbar A. Closing the gap on infection prevention staffing recommendations: results from the beta
version of the APIC staffing calculator. Am J Infect Control. 2024;52(12):1345-1350. doi: 10.1016/j.ajic.2024.09.004.

• WHO multimodal strategy video. Geneva: World Health Organization; 2021 (https://youtu.be/
pcKBIltlE3c?si=_0ZPdATLaOSx8ATD).

• Resource considerations for investing in hand hygiene improvement in health care facilities. Geneva: World Health
Organization; 2021 (https://iris.who.int/handle/10665/341128). Licence: CC BY-NC-SA 3.0 IGO.

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 Part 3B. Implementation of each strategic direction

• Understanding accelerators and overcoming barriers - the journey for developing or adapting an infection prevention
and control guideline: An easy to follow country approach. Copenhagen: World Health Organization. Regional Office for
Europe; 2022 (https://www.who.int/andorra/publications/m/item/understanding-accelerators-and-overcoming-barriers-
--the-journey-for-developing-or-adapting-an-infection-prevention-and-control-guideline--an-easy-to-follow-country-
approach). Licence: CC BY-NC-SA 3.0 IGO.

• See WHO guidelines on hand hygiene, surgical site infection, bloodstream infection, safety engineered syringes, and
decontamination. Geneva: World Health Organization; 2025 (https://www.who.int/teams/integrated-health-services/
infection-prevention-control).

• Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response at the
national level. Geneva: World Health Organization; 2021 (https://iris.who.int/handle/10665/345251). Licence: CC BY-NC-SA
3.0 IGO.

• Core competencies for infection prevention and control professionals. Geneva: World Health Organization; 2020 (https://
iris.who.int/handle/10665/335821). Licence: CC BY-NC-SA 3.0 IGO.

• Strategic toolkit for assessing risks: a comprehensive toolkit for all-hazards health emergency risk assessment. Geneva:
World Health Organization; 2021 (https://iris.who.int/handle/10665/348763). Licence: CC BY-NC-SA 3.0 IGO.

• Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://iris.who.int/
handle/10665/311537). Licence: CC BY-NC-SA 3.0 IGO.

*All tools and resources were accessed on 10 April 2025.

Barriers and facilitators

• Lack of national IPC focal point and/or any other responsible person(s) for an IPC programme,
including a NAP: focus on the urgent need to secure a national focal point and leadership for
the IPC programme. As a starting point, identify a focal point in the ministry of health to take
forward the work. Make a list of the national, sub-national and local authorities and leaders and
professional groups/bodies. Engage influential leaders and stakeholders to advocate for an IPC
focal point. Focus on how this will strengthen health service resilience, prevent catastrophic
outbreaks, prevent the spread of AMR and support the achievement of health service quality and
safety. Focus on available data (global and regional, if none at national level) and highlight how the
situation is contrary to international IPC guideline recommendations. Set up a series of advocacy
and sensitization meetings. Establish even an interim team to include national champions, quality
and safety colleagues – identify who might form the national IPC lead, team and committee. Draft a
preliminary budget and develop together a budget case for presentation to the ministers of health
and finance.
• Lack of investment in IPC, including lack of sufficient budget via direct government financing,
especially at health care facility level: fundraise alongside other leaders/programmes and
potentially through options such as the inclusion of IPC in social health insurance schemes. Start
the IPC programme with whatever small funding is available – funding can come later during
different implementation steps.
• Overambitious plans and budget with unrealistic activities/priorities, leading to an unfunded
and unachievable NAP: aim to adopt a systematic approach to an IPC programme and NAP
implementation, including use of the tools and resources and learning from country examples (the
information provided in this practical guide).
• A lack of perceived benefit of the IPC programme, for example, lack of support for guideline
development, a multimodal improvement strategy, etc.: provide information and statements of

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Development and implementation of national action plans for infection prevention and control: practical guide

peoples’ personal experiences of IPC, AMR, WASH, quality and safety, including the use of available
guidelines, multimodal improvement strategies and targets. Outline entry points, such as focusing
on one specific area of IPC to start with, in order to show results and scale-up an IPC programme
and its implementation. From other examples, practically outline the elements of the multimodal
improvement strategy in the IPC NAP, national IPC policy documents, guidelines, standard
operating protocols, etc.
• Lack of competency and technical expertise of the national IPC team, in order to provide the
required guidance and support for implementation: explore external support/capacity where this
is necessary to build competency, while avoiding a shift in the responsibility/leading role for the
development of the IPC NAP to external/international partners for example.
• Governance and coordination hampered by a lack of institutionalization or harmonization of
related ministries/programmes at the national level or institutionalization within inappropriate
directorates: unstable situations, a fragmentation and lack of coordination, cooperation and
joined-up networks necessary to implement actions will hinder projects – institutional reform
may be required to support harmonious and effective working. For example, if the IPC national
programme is anchored within environmental health services without direct hierarchical links with
facilities, this is not conducive to effective working. Establish an organizational structure of national
and sub-national IPC programmes into existing health systems, including clearly defined functions
at the operational level based on context (with personnel roles, committees/teams, reporting lines
and linkages with other programmes). Mitigations can include (a) building on previous examples of
cooperation across disciplines and sectors (for example, in the development of AMR NAPs) and (b)
periodic partner engagement meetings to discuss work plans and priorities.
• A negative impact of political instability and conflict on IPC: build a case for IPC inclusion in
fragile, conflict-affected and vulnerable settings using the WHO Early Warning, Alert and Response
System (43) and Health Resources and Services Availability Monitoring System (44), water
quality monitoring, and other types of epidemiological and monitoring approaches that indicate a
risk. Plan to follow up to see how well (or not) risks are being mitigated and the level of sustainability
of current approaches. Use facilitators for action, including culturally competent field staff that are
supporting the ministry of health and local health authorities. Ministries in fragile, conflict-affected
and vulnerable contexts usually appreciate dedicated support to develop localized and context-
specific standard operating protocols, assessment tools, including training for health and care
workers and community-based volunteers. Explore how to offer context-specific IPC supplies and
materials (hard goods) to engage these poorly resourced settings. Use the resource: WHO Quality of
care in fragile, conflict-affected and vulnerable settings: taking action (45).

Table 3B.9. Action checks

☑ An IPC programme organizational structure outlined and aligned with health system priorities.
☑ Responsibility for the IPC programme at political level identified and confirmed.
☑ Roles, responsibilities and reporting lines for the IPC programme allocated and agreed, including consideration of IPC
team competency and leadership and terms of reference for an IPC committee.
☑ IPC champions identified and empowered with protected time.

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 Part 3B. Implementation of each strategic direction

☑ Stakeholders and necessary experts from across IPC, WASH, AMR and other areas at national and facility level identified
and engaged in the IPC programme, with co-funding opportunities and cross-programme collaborations.
☑ An active IPC programme established, maintained and budgeted.
☑ IPC leadership representation in high-level committees achieved.
☑ A technical working group for IPC guideline development formed.
☑ Global/national IPC standards and multimodal improvement strategies reviewed and referenced and a structured review
and update cycle for guidelines established.
☑ Assessment tools collated – at least to monitor the IPC core component minimum requirements and with a focus on a
multimodal improvement strategy.
☑ Monitoring, evaluation and feedback of the IPC programme established and undertaken in coordination with laboratories,
including its impact over time and as a regular meeting agenda item.
☑ IPC and multimodal improvement strategy guidelines issued.
☑ IPC NAP updated.
☑ A dissemination strategy for IPC guidelines WASH and a multimodal improvement strategy implemented, including WASH.

Find out more about implementing strategic direction 2 in the country story in Annex 9 .

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Development and implementation of national action plans for infection prevention and control: practical guide

Strategic direction 3: IPC integration and

coordination
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 2 – refer to
Part 2, Table 2.4 .

Î Ensure you have considered all of the activities in Part 3A and focus on the action checks at
the end of each step.

Î Work through this section and you will have the elements that will support achievement of
the following national indicators for strategic direction 3 in the context of your IPC NAP.

Î Associated with this chapter, insights and suggestions for integration and coordination
between IPC programmes and the following complementary programmes can be found in
Annex 10 : AMR; occupational health and safety of health and care workers; patient safety;
and quality of care.

Indicators

1. Desk review and situational analysis of the integration of IPC within other programmes4
completed (by 2028).
2. Key existing IPC principles, standards and indicators identified, appropriately included and
cross-referenced within other national complementary programmes, as appropriate (by
2030).
3. Desk review and situational analysis of integration of other complementary programmes
within the IPC programme completed (by 2028).
4. Key existing policies, principles, standards and indicators from other complementary
programmes identified, appropriately included and cross-referenced within IPC
documents and programmes, as appropriate (by 2030).
5. Clinical packages (for example, policies and standard operating procedures) available
for integrating IPC and appropriate antimicrobial prescribing within clinical care (such as
surgery, maternal and neonatal care) (by 2028).

Context and considerations

• In some cases, national actions and action planning will be influenced by actions at the
global level.

4
Including – but not limited to – AMR, quality of care, patient safety, WASH, occupational health and health emergencies, as well as HIV,
tuberculosis, hepatitis, maternal/child health, clinical and surgical care.

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 Part 3B. Implementation of each strategic direction

• Implementation of strategic direction 3 at the global level involves, for example, that the
WHO Secretariat (at all three levels) ensures the integration and collaboration among all
programmes and teams, which work on areas complementary to IPC.
• If this is done, particularly at the regional and country level (for example, by organizing
joint country missions or meetings and by proposing unified approaches in WHO
documents and implementation resources), it will provide a solid example to inspire
countries to follow this approach and will highlight the positive effect of achieving
consistency and avoiding duplications among programmes and initiatives.
• Ensuring consistency of IPC principles and standards promoted by WHO and international
and national stakeholders and partners is critical to avoid conflicting messages and for
countries to feel confident and supported in IPC implementation and integration. In
particular, this is important when WHO and partners promote and support IPC under
different lenses, for example, through AMR reduction programmes, WASH initiatives, or
preparing and responding to outbreaks and other public health emergencies.
• Using the same or similar monitoring systems to track the impact of their activities and
supporting countries to collect common, agreed indicators in line with the WHO IPC
monitoring framework is another critical priority, which should be embraced by WHO and
international and national stakeholders and partners in the context of their role to achieve
strategic direction 3.
• Some of the activities and considerations across all strategic directions are linked in some
way and this is highlighted throughout the steps below.
• For example, development of actions and implementation related to strategic
directions 1 SD1 and 2 SD2 will be an important facilitator in many countries in the
achievement of the key actions of strategic direction 3.
• Furthermore, a number of the key actions within strategic direction 3 are linked with or
dependent on actions within strategic direction 5 SD5 and strategic direction 8 SD8 .

Step 1 – Preparing for action SD3

Leadership and organization

• Sensitize ministry leadership on the importance of establishing and supporting strong coordination and
integration mechanisms between IPC and other health priorities and programmes and vice-versa.
• Explore a mandate from ministry authorities to the IPC team/lead to fulfil a coordination and integration role
with other programmes (including – but not limited to – AMR, quality of care, patient safety, WASH, occupational
health and health emergencies, as well as HIV, tuberculosis, hepatitis, maternal/child health, and clinical
and surgical care) that are complementary to IPC as part of the IPC programme and NAP (see also strategic
direction 1 SD1 and strategic direction 2 SD2 ).
• Review Annex 10 , which provides guidance on integration and coordination with the other most critical
programmes.
• Review the role of the IPC committee to provide continuous coordination across a range of programmes.
• Start to establish or strengthen trust and productive relationships with other programmes. It pays off in the
medium-/long-term because it has the potential to lead to strong support for the IPC work across different
programmes, minimizes duplications, and magnifies the spread of IPC principles and activities across many

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Development and implementation of national action plans for infection prevention and control: practical guide

other programmes and stakeholders.

• Engage the leaders, teams and focal points of the other programmes, motivating them to build stronger
collaborations (see also strategic direction 5 SD5 and strategic direction 6 SD6 ).
• Establish initial communications with other programmes to explain the objectives and expected actions.
• Gather agreements to work together and ask for a focal person from teams.
• Outline the mechanism for undertaking desk reviews of IPC integrated into other programmes.
• Describe how to maintain the specificities and the unique mandate of the IPC programme, while exploring areas
for integration that would streamline the work and benefit both IPC and other programmes.
• Explore how to develop and cost WASH in health care facilities as both part of the IPC NAP and WASH in
health care facilities’ action plans, and how IPC can be a part of occupational health and safety programmes
specifically.
• Start to explore how to implement and evaluate targeted actions to establish long-term, strong coordination
and integration mechanisms.
• Convene the national IPC committee and review the proposed terms of reference including objectives, way of
working and expected results specifically related to integration and coordination.

“We don’t need to break the silos because IPC is a distinct discipline requiring expertise and
dedicated resources and the same applies to other programmes, but we need to bridge the silos.”

Director, Disease Surveillance and Control, Sultanate of Oman

Stakeholder engagement
• Review the stakeholder list developed in Part 3A and, where relevant, explore and engage the main stakeholders
to improve coordination and integration between IPC and other programmes. Maintaining a stakeholder
mapping using the mapping tools (9) will ensure a targeted, country specific list of stakeholders to achieve
integration.
• Discuss with stakeholders and partners how to improve coordination and integration mechanisms between IPC
and other health priorities and programmes and vice-versa as part of national and sub-national coordination
mechanisms and meetings, including IPC committee meetings. Ask for draft suggestions of approaches/
mechanisms for integration and coordination.

Other resource considerations

• Explore the dedicated resources necessary to achieve strong coordination and integration as part of the IPC
programme, including the necessary financial resources to cover activities and other considerations.
• Identify people with the right expertise to be involved in the implementation of strategic direction 3, with
strong collaboration and communication skills, as well as knowledge about basic concepts relevant to different
programmes (such as AMR, WASH, outbreak preparedness and response, patient safety, quality of care and
occupational health).

“Integration and coordination requires sharing some resources (human and financial) across
different programmes to make it happen, with the confidence that a stronger collaboration will
pay back these efforts.”

National lead for IPC and AMR in Nigeria (Nigeria Centre for Disease Control and Prevention)

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 Part 3B. Implementation of each strategic direction

Step 2 – Baseline assessment SD3

Understand the current situation

• Undertake baseline assessments as described in Part 3A , using valid assessment tools and resources.
• Focus on assessment results according to Table 3B.10 .
Table 3B.10. Tools for assessment
Strategic direction Assessment tool Relevant section Area assessed
3: IPC integration
and coordination IPCAT2 1: 1.1.8, 1.2.5, 1.3 (in IPC committee; collaboration in the context of
particular, 1.3.1 to 1.3.5) surveillance; programme linkages
IPCAT-MR 4.1 Collaboration in the context of surveillance
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention
and control assessment tool-minimum requirements.

• Map all existing national programmes complementary to the IPC programme (for example, AMR, WASH,
outbreak preparedness and response, patient safety and quality of care, occupational health, vaccination) and
those for which IPC is critical to deliver safe care (for example, maternal, neonatal, surgical or cancer care).
Identify these programmes from across the entire health system; do not focus only on acute care. For example,
identify programmes/services in charge of primary health care, rehabilitation or elderly care.
• Conduct a desk review and situational analysis regarding the integration of IPC within other programmes5
considering the specificities of each of these programmes in assessing the areas of interest. This entails
reviewing other programmes’ action plans and monitoring frameworks and identifying activities and indicators
that are relevant for IPC. Ideally, it should also include a review of the main technical documents and tools
issued by these programmes to check if key principles and concepts are consistent and aligned with those
promoted by the IPC programme.
• Conduct a desk review and situational analysis of the integration of other complementary programmes1 within
the IPC programme. This entails reviewing the IPC action plans and ensuring that they are aligned with those
of other complementary programmes, with a view to avoiding duplications and promoting other programmes’
initiatives and resources within IPC activities. This should also ideally include a review of the main technical
documents and tools issued by these programmes and the identification of key principles and concepts that are
relevant for IPC.
• Conduct a desk review of policies and clinical packages related to patient care pathways/programmes at the
national, sub-national and facility levels to check if key IPC principles and practices are included and promoted
to achieve high-quality care and ensure patient and health and care worker safety.

Review and feedback results

• Prepare reports and presentations of the results of the reviews by outlining consistency, accuracy, cross-
referencing, mutual promotion of programmes and initiatives, and identification of further integration and
coordination opportunities.
• Use the national IPC committee to share the findings from the desk reviews and to start discussions about
opportunities for improvement across programmes.

5
Including – but not limited to – AMR, quality of care, patient safety, WASH, occupational health and health emergencies, as well as HIV,
tuberculosis, hepatitis, maternal/child health, clinical and surgical care.

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Development and implementation of national action plans for infection prevention and control: practical guide

• Meet with the complementary programmes’ focal points and/or teams on a one-to-one basis to target feedback
of the results and to start to highlight which documents and areas of work are relevant for IPC.
• Convene stakeholders and partners to share the results of the reviews and discuss their role in supporting
collaborations and integration.

Step 3 – Developing and implementing the IPC NAP SD3

Establish priority areas for action using assessment results

• Review with other programmes the respective plans for new documents, resources and activities, outlining
those that are suitable for collaboration and mutual input in the IPC NAP.
• Review together other respective annual action plans and outline activities of mutual interest for
implementation/improvement.

Translate all findings in the IPC NAP and implement the NAP
• Outline the plans for integration and collaboration in the IPC NAP with clear objectives, roles and
responsibilities, deliverables and timelines that incorporate the necessary time for discussions and input across
programmes and joint activities.
• Outline specifically the steps to develop and cost WASH in health care facilities as part of both the IPC NAP and
WASH in health care facilities’ action plans, and IPC as part of occupational health and safety programmes
specifically.
• Specify the opportunities for partnering and networking, for example, joint training, assessments, guidance
documents, reports, advocacy campaigns, etc.
• Jointly prepare communications to highlight integration and coordination activities (see also strategic
direction 6 SD6 ).
• Outline ways to knowledge exchange, for example, existing communities of practice, etc. and where they
already exist, consider how they could promote each other and conduct any joint activities.
• Describe alignment of IPC and HAI indicators across programmes in the IPC NAP.
• Describe ongoing plans for evaluating the effectiveness and impact of the integration and coordination
activities.
• Outline opportunities for joint fundraising as applicable.

Step 4 – Evaluating impact SD3

Maintain assessments – according to step 2 and Part 3A

Review, feedback results and update the IPC NAP

• Meet with the focal points and/or teams of complementary programmes on a regular basis (at least every six
months) with the following objectives:
□ to review joint activities according to collaborative plans and debrief on achievements, challenges, impact
on results, unfinished work;

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 Part 3B. Implementation of each strategic direction

□ to update each other on ongoing activities;

□ to agree on approaches and channels for reporting and providing feedback to the health authorities,
partners and donors.
• Regularly inform the IPC committee about joint activities with other programmes, for example, as a standing
agenda item.
• Write and disseminate activity reports and results using different channels, including national or local reports,
media communications and scientific publications for example.
• Organize events to disseminate results of joint activities with other programmes.
• Report results of IPC and HAI indicators across other programmes, as well as other programmes’ indicators
as part of integrated IPC monitoring and HAI surveillance, including testing any correlation (see also strategic
direction 5 SD5 ).
• Outline the use of common systems for monitoring and surveillance; include these activities in the joint action
plans (see also strategic direction 5 SD5 ).

Step 5 – Sustainability SD3

Refresh the IPC NAP with a focus on sustainability

• Meet with the complementary programmes focal points and/or teams on an annual basis to refresh
collaboration strategies, plans and activities.
• Outline ongoing, necessary activities to ensure collaborative initiatives in the long term.
• Maintain opportunities for joint fundraising.
• Update opportunities for partnering and networking together with stakeholders.
• Maintain the IPC NAP.

Barriers and facilitators

• Limited or lack of human resources to dedicate to coordination and integration among

programmes: convince national authorities about the importance and advantages of integrating
with IPC by using persuasive communications and messaging. A specific mandate from national
authorities to the respective teams as part of their terms of reference and objectives could help to
establish the need for human resources for this issue.
• Protective attitude of own programmes (including the IPC one) by leaders/focal points
and teams: make an analysis of the benefits and opportunities, but also the potential risks of
establishing active and formal collaborations with specific plans between IPC and complementary
programmes. This could be presented in discussions within the national IPC committee and in
meetings with other programmes leads. Providing model examples of successful partnerships
and collaborations would be extremely useful, including asking for testimonials to share with
others. If possible, and in accordance with the national context and norms, gathering incentives
and recognition of the value of cross-cutting collaboration by the ministry of health would create
motivation in the respective teams.
• Competition for funds: the fact that complementary programmes often compete among each
other through the same funding mechanisms/calls can be a significant barrier to collaboration.
Actively explore common fundraising strategies and approaches that can be developed to secure

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Development and implementation of national action plans for infection prevention and control: practical guide

donors together and develop joint proposals where the diversification of objectives for specific
areas of work is maintained, but integration is also valued.
• Complementary programmes at different stages of institutionalization: if other programmes
are more advanced, it could be a challenge for IPC to become integrated. Institutionalization of
the IPC programme at a very high level of the administrative hierarchy can enable coordination
and integration with other programmes.

Table 3B.11. Action checks

☑ Mapping of programmes that are complementary to IPC performed, including key documents, systems and action and
monitoring plans critiqued.
☑ Focal points in the IPC team and in other programmes identified to achieve integration with IPC priorities/targets
highlighted, as well as other key stakeholders engaged in integration activities.
☑ The role of IPC in coordinating with other health programmes highlighted, including to ministry leadership, and approval
for this coordination role achieved across programmes, including the necessary resources.
☑ Other programmes’ standards, principles, indicators, assessments, etc. reviewed for IPC integration.
☑ Policies and clinical packages related to patient care pathways/programmes reviewed for the integration of IPC principles
and practices.
☑ All results reviewed and reports communicated/disseminated, including through established meetings/governance
structures.
☑ Joint fundraising to achieve integration alongside relevant programme priorities undertaken, as appropriate, and joint
training, assessments and advocacy explored, for example.
☑ The uniqueness of IPC emphasized, while exploring and undertaking integration.
☑ A long-term process for reviewing IPC integration established.
☑ IPC NAP updated.

Find out more about implementing strategic direction 3 in the country story in Annex 11 .

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Strategic direction 4: IPC knowledge

among health and care workers and
career pathways for IPC professionals
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 4 – refer
to Part 2, Table 2.5 .

Î Ensure you have considered all of the activities in Part 3A and focus on the action
checks at the end of each step.

Î Work through this section and you will have the elements that will support achievement
of the following national indicators for strategic direction 4 in the context of your IPC
NAP.

Indicators

1. Curriculum for IPC professionals developed or an international curriculum endorsed

and in use (2028).
2. Postgraduate IPC certification programme established OR requirement for an existing
certificate (2030).
3. Proportion of colleges and universities offering postgraduate IPC training.
4. IPC pre-graduate curriculum for all relevant health care disciplines developed and
endorsed by the appropriate national or international body to ensure that quality and
standards (national/International) are met (by 2028).
5. IPC pre-graduate curriculum integrated within health educational curricula, with
embedded evaluation mechanisms (by 2030).
6. National in-service IPC curriculum developed (by 2026).
7. National (or sub-national) IPC training programme to support in-service training
created (by 2028), introduced and regularly updated (2030).
8. Legal mechanism or well-defined strategies established to mandate IPC in-service
training (2028).
9. Proportion of facilities providing and/or requiring mandatory training for all frontline
clinical and cleaning staff upon employment and annually, as well as for managers
upon employment.
10. Proportion of facilities achieving all WHO minimum requirements for IPC training and
education according to the facility level (IPCAF-MR).
11. Framework available that outlines the steps to create a career pathway for IPC
professionals (2028).
12. Specific positions for IPC professionals/focal points created in the national health care
system.
13. Proportion of hospitals with at least one full-time IPC professional per 250 beds.

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Development and implementation of national action plans for infection prevention and control: practical guide

Context and considerations

• Implementation of strategic direction 4 at the global level through the actions by WHO,
international and national stakeholders and partners (strong collaborations between them
– described in more detail in strategic direction 8 SD8 ). This will be an important facilitator
in many countries for the achievement of the key actions of strategic direction 4 at the
national level.  
• One of the global actions involves working across the three levels of WHO to help countries
to enhance active national IPC programmes, which will support the implementation of
strategic direction 4.
• A number of the key actions within strategic direction 4 are also linked with or dependent
on actions within other strategic directions.
• For example, many of the activities and considerations required to build education and
training initiatives and career pathways for IPC professionals depend on investment
and funding for an active IPC programme (strategic direction 1 SD1 ) and the existence
of an active IPC programme (strategic direction 2 SD2 ), thus providing a foundation for
developing an education curriculum for health and care workers and implementing
training programmes for IPC.

Step 1 – Preparing for action SD4

Leadership and organization

• Convene a multidisciplinary working group (that could also be a subgroup of the national IPC committee) to
focus on support for IPC education, training and career pathway efforts (Box 3B.1 ). Consider key activities
included in Box 3B.1 for the working group terms of reference.
□ If a complementary committee already exists (for example, AMR education has similar indicators, actors and
institutions responsible for education and training), consider pooling these resources.
• Identify and confirm the lead for this working group at the ministry of health or other national responsible body.
This may be the IPC focal point.
• Identify and invite the following stakeholders to be part of the working group: senior leads in key positions at
the ministry level, including ministries of health and education; representatives of local academic institutions
(public and private key stakeholders), including universities and others with a mandate on health workforce
education and a key role in curricula development, endorsement and training delivery; focal points from other
relevant programmes and experts from professional associations and societies with IPC knowledge.
• Consider how to secure external IPC technical support, including those who have pioneered successful
initiatives, for initial IPC curriculum development, implementation and delivery by trained professionals,
especially in a country where the IPC focal point/team is newly established and has limited experience/
expertise.

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Box 3B.1. Key activities for the working group, according to country needs

1. Make a desk review of any existing programme/curriculum on education in the field of IPC in your
country at all levels (pre-service, in-service or postgraduate).
2. Discuss the results and the quality of resources retrieved and the possible adaptation of any of the
existing resources for the national level.
3. Develop a national curriculum for IPC professionals aligned with the WHO IPC core competencies or
endorse an international curriculum.
4. Develop (or adopt an international one) a national IPC curriculum for pre-graduate training and
education for all relevant health care disciplines (for example, medical, nursing and midwifery
schools), endorsed by the appropriate national or international body, and integrate it within health
educational curricula with embedded evaluation mechanisms.
5. Develop (or adopt an international one) a national in-service IPC curriculum for all frontline clinical,
cleaning and management staff to support in-service IPC training.
6. Work with ministries to mandate that all health and care workers with direct patient contact, in
particular frontline clinical, cleaning and management staff, receive education and training tailored to
their roles/job duties in IPC standard operating protocols upon employment and annually.
7. Develop monitoring and evaluation mechanisms for assessing the impact of IPC education and
training.

Abbreviations: IPC, infection prevention and control.

• Explore the alignment of education and training activities with existing IPC policies and programme activities
and vice-versa by mapping content and setting review dates for when evidence and policy changes are made.
• Explore (with the subgroup) the feasibility of and approach to integrating IPC with other educational curricula
for the agreed, relevant target audiences (for example, health and care workers, WASH workers, patient safety
and quality of care curricula, etc.). See also strategic direction 3 SD3 .
• Explore a strategy for in-service planning and structures (for example, asynchronous teaching/learning, ‘train-
the-trainers’).
• Explore the evaluation methods that can be used to report against the education and training indicators in the NAP.
• Prepare to consider facility-level implementation and evaluation, including pilot testing in facilities for
each level of curricula (pre- and postgraduate and in-service), and how this can be scaled-up in educational
institutions and health care facilities across the country.

Stakeholder engagement
• Review the stakeholder list developed in Part 3A (see also strategic direction 8 SD8) and, where relevant,
identify additional stakeholders, champions, leaders and networks required to drive forward IPC education
and training efforts. These should be specifically focused on the development of the national curriculum
for IPC professionals, national postgraduate IPC certificate programme, national IPC curriculum for pre-
graduate training, and education and national in-service IPC curriculum for all frontline clinical, cleaning and
management staff, including the creation of a career pathway for IPC professionals.
• Engage local academic institutions (public and private), including universities and others with a mandate on
health workforce education, those who have a key role in curricula development and endorsement, and in
training delivery.
• Explore and start to discuss interdisciplinary collaboration between health care professionals, educators and
policy-makers/national regulators – use the subgroup where possible.

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Development and implementation of national action plans for infection prevention and control: practical guide

• Hold initial meetings with, for example, clinical leads to explore other existing health worker education and
training efforts in the country to identify joint areas of collaboration – invite people to the working group where
possible.
• Ensure that all stakeholders understand how education and training are key to improving IPC practices and
reducing HAI (see also strategic direction 5 SD5 and strategic direction 6 SD6 ).
• Explore which experts can be engaged in and give time to actual curriculum development and delivery, if
needed.
• Explore partnerships that can also offer opportunities for faculty development and student exchange
programmes, allowing for mentorship following training.
• Start to secure collaboration with recognized accreditation bodies in order to plan programme certifcation to
ensure that graduates meet international standards.

Finance and budgeting

• Consider country priorities for IPC education and secure sufficient financial resources in the IPC programme
budget (if one exists) to cover those which are most urgent, such as curricula development and implementation,
national training programme establishment and roll-out, IPC career development (pathways) and technical
support (see also strategic direction 1 SD1 and strategic direction 2 SD2 ) to be provided at the facility level.
• Explore the possibility of dedicated funding and time investments to ensure collaboration across sectors to
support sustainable delivery of IPC education and training.

Other resource considerations

• Allocate resources for the ongoing monitoring and evaluation of training and education, with a focus on
sustainable improvements and career pathways for IPC professionals.
• Explore how establishing online learning platforms, access to medical databases, and digital tools for
simulations and remote learning can be used for flexible, widespread access to the proposed in-service
curriculum.

Step 2 – Baseline assessment SD4

Understand the current situation

• Undertake baseline assessments as described in Part 3A, using valid assessment tools and resources.
• Focus on assessment results according to Table 3B.12 .

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 Part 3B. Implementation of each strategic direction

Table 3B.12. Tools for assessment

Strategic direction Assessment tool Relevant section Area assessed
4: IPC knowledge
among health IPCAT2 3.2.1- 3.2.5 National IPC curricula
and care workers IPCAT-MR Core component 3.1-3.4; National programme, curricula and monitoring;
and career 5.1; 6.4: national expertise in implementation; mechanism
pathways for IPC for training auditors
professionals
IPCAF 1.3 and 3.3-4 IPC staff-bed ratio; facility-level training frequency
IPCAF-MR All core component 3 Facility-level training of workforce, including IPC
indicators, particularly staff
3.1-2.
IPCAF-MR 1.1 (secondary care IPC staff-bed ratio
secondary facilities)
IPCAF-MR tertiary 1.2 (tertiary care facilities) IPC staff-bed ratio
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection
prevention and control assessment tool-minimum requirements. IPCAF-MR, infection prevention and control assessment framework-minimum
requirements ; IPCAF, infection prevention and control assessment framework.

• Focus on the content that is relevant to IPC education, training and career pathways (other results will also
indicate commitment to an active IPC programme, which will support education and training efforts).
• Collate research output on IPC supported by education efforts (see also strategic direction 7 SD7 ).

Pre-service education

Understand what should be delivered regarding IPC pre-service education for health care programmes (for
example, those related to physicians, nurses, midwives, paramedics).

• IPCAT2 –3.2.5 (12) : IPC training is integrated into continuing medical, nursing and allied health professional
education and training.
• IPCAT2 – 3.3.1 (12) : a national system and schedule of monitoring and evaluation is in place to check on the
effectiveness of training and education, for example, at least annually.
• Explore if an IPC pre-service curriculum for all relevant health care disciplines has been developed and
endorsed by the appropriate national or international body, thus ensuring that national/international quality
and standards are met.
• Explore if an IPC pre-graduate curriculum is integrated within health educational curricula with embedded
evaluation mechanisms.
• Collate existing student and faculty satisfaction survey results.

In-service training

Understand what should be delivered regarding IPC education and training for in-service training in facilities.

• IPCAT2 – 3.1.1 (12) : the national IPC programme provides guidance and recommendations for in-service
training at the facility level (for example, frequency, expertise required, requirements for new employee
orientation, monitoring and evaluation approaches).
• IPCAT2 – 3.1.2 (12) : the national IPC programme provides content and support for IPC training of all health
and care workers at the facility level.
• IPCAT2 – 3.3.1 (12) : a national system and schedule of monitoring and evaluation is in place to check on the
effectiveness of training and education, for example, at least annually.

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Development and implementation of national action plans for infection prevention and control: practical guide

• Review if a national policy on health facility education and training has been developed.  
• Review if a national IPC curriculum for health facilities has been developed, approved and endorsed by an
appropriate professional society/body.

Postgraduate education

Understand what should be delivered regarding IPC postgraduate education for IPC professionals.

• IPCAT2 – 3.2.2 (12) : national IPC curricula developed (or under development) in collaboration with local
academic institutions for postgraduate courses.
• Review if an IPC postgraduate curriculum exists for IPC professionals in the country and if it aligns with the WHO
core competencies for IPC professionals.

Career pathway

Begin assessing the presence of a career pathway for IPC professionals, consider the following exploration and
assessment points.

• IPCAT2 - 1.1.2 (12) (and IPCAT-MR - 1.2 (15) ): an appointed infection preventionist(s) in charge of the
programme can be identified.
• IPCAT2 - 1.1.5 (12) (and IPCAT-MR - 1.5 (15) ): the appointed infection preventionist(s) has dedicated
time for the tasks (at least one full-time person).
• IPCAF - 1.3 (16) : at least one full-time (1:250 beds) IPC professional or equivalent available.
• Review if there is a curriculum for IPC professionals developed or an international curriculum endorsed and in
use, and/or a postgraduate IPC certification programme or requirement for an existing certificate with clearly
outlined pass rates.
• Investigate if a framework is available that outlines the steps to create a career pathway for IPC professionals.
• Conduct a desk review of IPC positions at the national, sub-national and facility levels and their requirements
within relevant organizations (for example, health care facilities, public health agencies and the ministry of
health) to start to inform the career pathway activities and if they align with the national IPC programme and
WHO IPC core competencies for IPC professionals.
• Investigate if certification in IPC is promoted and incorporated into position descriptions.
• Examine if membership in a national IPC society (or international society if a national one does not exist) is
promoted and supported for ongoing professional development.
• Analyse if the pay scale reflects the leadership qualities required in this position.
• Explore if there are options for promotion of IPC as part of a career pathway.

Refer to Annex 12 for an assessment framework summary of factors specifically related to IPC education and
training.

Review and feedback results

• Use the baseline assessment results to identify gaps and priority areas.
• Share the results with the working group with feedback to all stakeholders using targeted presentations and
communications.

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 Part 3B. Implementation of each strategic direction

Pre-service, in-service and postgraduate IPC education

Focus on developing the presentation of results on education and training that includes IPC pre-service, in-service,
and postgraduate curricula for all health and care workers involved in service delivery and patient care (pre- and
in-service), including other personnel such as administrative and managerial staff, auxiliary service staff, cleaners
(in-service) and IPC specialists (postgraduate),

• If there is no national IPC in-service curriculum, but a facility level IPC in-service curriculum exists, explore if this
can be adapted to the national context and if it is aligned with existing national IPC guidelines.
• Review teaching methods employed where results are available. They should be grounded in adult education
principles and may include: train-the-trainer problem-based learning; hands-on workshops (including bedside
training); and peer-to-peer training innovative technologies (simulation, virtual reality, serious games).  

IPC career pathway

• Review what career pathway opportunities exist for IPC professional in your country.
• Identify professional organizations to engage (based on the results of the desk review) in planning for and
promoting postgraduate IPC training.
• Prepare to present results that focus on these gaps and outline opportunities that will help IPC professionals
advance in this field.

Step 3 – Developing and implementing the plan SD4

Establish priority areas for action using assessment results

• Conduct working group meetings to prioritize activities according to step 2 results and discussions. If you have
limited resources and additional priorities in the field of IPC, consider starting by prioritizing the minimum
requirements for core component 3 (5). If curricula are a gap, identify the steps/actions required to develop
these, considering questions and resources identified in step 2.
• Discuss the need for developing standardized training tools necessary to support curricula implementation,
ensuring alignment with national technical guidelines and international IPC standards.  
• Discuss the resources and plans needed to establish training programmes supporting the roll-out of the prioritized
curricula, including how in-service training will be conducted in all health care facilities, if not already in place.
• Secure the additional expertise required to develop and implement the agreed priorities, that is, curricula and
career pathways, including if you will need to collaborate with a professional association. The WHO IPC in-
service education and training curriculum provides guidance for suggested content for health and care workers
that can be adopted or adapted to the local context. WHO core competencies for IPC professionals provide
essential content to guide curriculum development and outline IPC professional responsibilities.
• Discuss the resources required to develop and implement a national IPC professional curriculum, including the
expertise required to deliver it, if this is considered a priority.
• Confirm methods to incentivize the professional IPC career pathways and offer training and education
opportunities. This could include a postgraduate IPC course to support optimal preparation or career
development for those interested in entering this field, linking to a national certificate/certification in IPC,
providing mentorship and leadership development opportunities (in country and internationally), fostering
interdisciplinary collaboration with other health care professionals and departments, and promoting
continuous professional development (for example, participation at conferences, networking opportunities,
presentations and publications).

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• Confirm models from other programmes or similar professions that can be leveraged when establishing the
foundational elements for an IPC career pathway.

Translate all findings into the IPC NAP

• Use the results, feedback and prioritization discussions to develop targeted plans for IPC training and
education within the IPC NAP, including steps to be undertaken to ensure curricula are approved, adopted and
implemented across various fields, such as medicine, nursing, midwifery, dentistry and laboratory.
• Refer to the sample action plan templates in Annexes 6 and 7 , and the GAPMF (3), for indicators
proposed to inform action planning as part of the overall activities to be achieved and deliverables for strategic
direction 4.
• Engage universities to partner for the creation of relevant programmes by ensuring representatives are
consistently involved in the working group.
• Outline the support for the formal training of IPC professionals and specify whether position descriptions
include this training as a requirement for IPC posts.
• Develop key messages regarding the findings and rationale why each of the results should be actioned (for example,
linkage to the GAPMF indicators, core components, minimum requirements and global report documents).
• Outline clear communication plans to widely share key messages and ensure that they resonate with target
audiences, including frontline health workers and facility managers (see also strategic direction 6 SD6 ).

Pre-graduate

• Outline priority programmes to target for curriculum development, focusing on professions with direct patient
contact.
• Describe steps to integrate IPC curriculum content into existing programmes (see Box 3B.2 examples).
• Outline the plan to develop the curriculum content with a clear timeline.
• Outline the necessary expertise required to develop this curriculum content.
• Use the following resources to support NAP development :
□ IPC in-service education and training curriculum (46)
□ WHO training webpage (tools and resources for training and education) (47)
□ IPC core competencies for health care providers; updated consensus document (48)
□ IPC education framework; NHS England (49).

In-service

• Develop the curriculum content with a clear timeline.

• Outline the necessary expertise to develop this content.
• Use the above-mentioned resources listed under pre-graduate to support NAP development.

Postgraduate IPC curricula

• Develop a plan for training of IPC professionals that will prepare them to meet the competencies identified
in the WHO core competencies for IPC professionals; this may include developing a national curriculum or
adopting an existing one.
• Outline the necessary expertise to deliver this training.
• Use the following resources to support NAP development :
□ core competencies for IPC professionals (50);
□ Association for Professionals in Infection Control and Epidemiology (APIC) Infection Prevention Academic

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pathway (51);
□ European Centre for Disease Prevention and Control (ECDC). Core competencies for infection control and
hospital hygiene professionals in the European Union (52);
□ Health Service Executive AMRIC Competency Framework for Infection Prevention and Control Practitioners
in Ireland (53);
□ see list of training resources available through the WHO Global Infection Prevention and Control Network
website (54).

Career pathway

• Develop a plan for the ongoing development of IPC professionals that will prepare them to meet the
competencies identified in the WHO core competencies for IPC professionals:
□ this includes promoting membership to the local IPC society.
• Use the following resources to support NAP development :
□ Infection preventionist career development and advancement guide (55);
□ definition of infection preventionist and sample job description (56, 57);
□ certification board of IPC and epidemiology (58).

Implement the IPC NAP

• Provide resources to support the implementation of all curricula.
• Share approvals for all plans and proposed curricula as well as career pathway proposals.
• Engage existing members of the multidisciplinary working group, educational networks, professional
associations and colleges and other relevant bodies to implement the plans.
• Utilize existing IPC and health care networks to disseminate information on plans and proposals, such as IPC
committees and societies,
• Work with other associated health programmes (for example, nursing, medicine, midwifery, dental and other
allied health programmes) to integrate IPC into pre-graduate and in-service training programmes.
• Hold working group meetings to monitor progress by presenting evaluation reports (both on processes for
developing curricula and career pathways and the outcomes of education and training programmes).
• Adjust the IPC NAP as necessary.

Pre-graduate

• Implement a pre-graduate IPC curriculum:

□ train educators in delivering the content, if required;
□ promote the adoption of the curriculum to academic institutions/universities;
□ link the curriculum with licensure requirements or include it as part of board exams by collaborating with the
leaders’ part of the stakeholder group.

In-service

• Deliver effective implementation once the content is developed:

□ link with the necessary laws or mandates to enforce training (see also strategic direction 1 SD1 );
□ coordinate ongoing training at a national level to maintain consistency, including training facility IPC focal
persons, if this is required to deliver the curriculum;
□ provide other training supports that will be required of facility IPC focal points to implement the training (for
example, presentation materials, online courses);

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□ promote IPC training as part of ongoing professional development initiatives.

Postgraduate IPC curricula

• Implement postgraduate IPC curricula:

□ coordinate the delivery of training
□ collaborate with a professional association to leverage their expertise and resources.

Career pathway

• Link IPC training with the job descriptions for IPC professionals (56, 57).
• Promote IPC training as part of ongoing professional development initiatives.
Box 3B.2. IPC pre-graduate curricula integration examples

• Nursing education: IPC standard precautions’ modules integrated into nursing school curricula, including
the importance of IPC in both inpatient and outpatient settings. Include case studies, hands-on training,
and assessments aligned with real-case scenarios.
• Medical education: IPC in medical education, including within courses on microbiology, public health,
infectious diseases and epidemiology. Can be aligned with modules on antimicrobial stewardship and
patient safety, for example.
• Public health programmes: IPC content in public health degree programmes, particularly those focusing
on epidemiology and health promotion, including outbreak management, surveillance and the role of
public health in controlling infections.
• Health governance/administration: aspects of IPC included in health administration and management
training, with a focus on the integration of IPC policies into health care facility management and the
economic implications of service delivery.

Abbreviations: IPC, infection prevention and control.

Step 4 – Evaluating impact SD4

Maintain assessments
• Conduct follow-up assessments using the tools used in step 2 in order to evaluate current status regarding (at
least) the implementation of the minimum requirements for education, training and career paths related to
IPC at both national and facility level (also links with evaluation of other aspects of the core components).  A
minimum annual frequency is recommended in the first instance.
• Conduct other assessments regarding education and training efforts to evaluate the programme’s impact and
relevance over time.

Review and feedback results and update the IPC NAP

• Present follow-up results and discuss with the group if plans for updating curricula are evolving with emerging
health threats, new research, and technological advancements for example.

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Step 5 – Sustainability SD4

Refresh the IPC NAP with a focus on sustainability

• Review the need for and objectives of the technical working group, refreshing membership and meeting
agendas as necessary.
• Review the monitoring and evaluation mechanisms to ensure that they reflect outcomes from education and
training efforts and adjust resources and approaches as necessary.
• Refresh and form long-term partnerships with academic institutions and professional societies, for example, to
promote sustainability and alignment of IPC education across various sectors (private and public).
• Explore and confirm the possibility of using a twinning partnership model over the long term (59) to
support local IPC training.

Barriers and facilitators

• No national IPC curriculum is in place (pre-graduate, in-service, postgraduate): draw on successful

models from other countries as a starting point in developing a national IPC curriculum. This can
then be tailored to local needs. Notably, tailoring IPC training and education to the local context,
including language, culture and health system structure, to enhance relevance and effectiveness
is important. In addition, leverage global and regional collaborations, such as those with WHO and
other international bodies to share resources, expertise and best practices in IPC.
• Lack of a designated national IPC focal point or leader to coordinate and advance activities
related to IPC education and training and career pathways: explore a dedicated focal person within
the ministry of health to oversee and drive IPC strategies on education and training, ensuring
alignment with other health programmes.
• Lack of recognition of the value of IPC education and training: develop messages to explain its
importance, including the importance of aligning with an active IPC programme and guidelines,
which will contribute to a reduction in HAI and AMR and a more skilled health workforce overall.
• Lack of a clearly defined career pathway for IPC professionals: promote opportunities for
certification, continuous professional development and advancement within different position
descriptions.
• Lack of robust systems for monitoring and evaluating IPC training and education programmes:
establish standardized monitoring and evaluation frameworks that allow for a regular assessment
of IPC training and education programme effectiveness.
• Inadequate or inconsistent funding for IPC programmes, making it challenging to sustain
long-term initiatives: advocate for dedicated IPC funding within national health care budgets and
explore alternative funding sources, such as international grants and public-private partnerships.
• Lack of training materials: apply an adoption and adaption approach, securing education and
training materials through a university or a national professional society.
• Lack of expertise to train all relevant staff: implement train-the-trainer programmes to cascade
knowledge and collaborate with external (national/regional/international) experts or institutions
for specialized training.
• Lack of time for training (training not a priority): integrate IPC training into existing professional
development sessions. For example, consider offering flexible, short, online courses for convenience.

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Table 3B.13. Action checks

☑ A multidisciplinary working group (including necessary expertise in education/curriculum development) convened, with
the lead from the ministry of health or other responsible body confirmed.
☑ Meetings held and sensitization to the work performed, including regarding health and care worker education and training
efforts, in order to identify and establish joint areas of work and to address alignment of priorities and outputs.
☑ Key stakeholders, champions, leaders and institutions (for example, local academic institutions, scientific societies)
identified, sensitized and engaged, including accreditation bodies/other institutions for curriculum approvals and ongoing
mentorship.
☑ Funding and budget assessed and secured, as well as existing resources that could be leveraged.
☑ Assessments and feedback of results undertaken to inform education and training products, with frequency of follow-up
assessments and reporting outlined.
☑ A national curriculum for IPC professionals (or endorsement of existing curriculum) pilot tested and established.
☑ A national postgraduate IPC certificate programme for IPC professionals pilot tested, then issued.
☑ A national IPC curriculum for pre-graduate training and education for all relevant health care disciplines pilot testing, then
established.
☑ A national in-service IPC curriculum for all frontline clinical, cleaning and management staff pilot tested, then issued.
☑ A mandate that all health and care workers, in particular frontline clinical, cleaning and management staff, receive
education and training in IPC standard operating procedures upon employment and regularly pilot tested, then issued.
☑ A career pathway for IPC professionals pilot tested, then launched.
☑ Education and training content mapped for alignment with IPC policies as well as health workforce, AMR, WASH and
patient safety curricula.
☑ A timeline for updates of education and training products agreed and roles and responsibilities allocated.
☑ IPC NAP updated to reflect product implementation.

Find out more about implementing strategic direction 4 in the country story in Annex 13 .

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Strategic direction 5: Data for action.

(i) IPC monitoring and hand hygiene
monitoring, and (ii) HAI surveillance
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 5 – refer
to Part 2, Table 2.6 .

Î Ensure you have considered all of the activities in Part 3A and focus on the action checks
at the end of each step.

Î Work through this section and you will have the elements that will support achievement
of the following national indicators for strategic direction 5 in the context of your IPC
NAP.

Indicators

1. National strategic plan for IPC monitoring in place, including an integrated IPC
monitoring system for collection, analysis and feedback of data.
2. Proportion of tertiary/secondary health care facilities having an IPC monitoring system
for collection, analysis and feedback of data.
3. National strategic plan for HAIs and related AMR surveillance (with a focus on priority
infections based on the local context) developed by a multidisciplinary technical group
(2026) within the context of a broader surveillance system.
4. National/sub-national systems for HAI and related AMR surveillance (including for
early warning to detect epidemic- and pandemic-prone pathogens causing HAIs),
established and supported (including financially) by government and national/sub-
national authorities (by 2028).
5. Proportion of tertiary/secondary health care facilities participating in the national/
sub-national or international network for surveillance of HAIs and related AMR, if
existing.
6. Proportion of tertiary/secondary health care facilities with a surveillance system for
HAIs and related AMR, including for early warning with the ability to detect outbreaks,
epidemic- and pandemic-prone pathogens.
7. Hand hygiene compliance monitoring and feedback established as a key national
indicator, at the very least for reference hospitals (by 2026). National programme for
improving HH compliance in place (by 2026).
8. National hand hygiene monitoring system (compliance or product consumption)
established and implemented (by 2028).
9. Proportion of health care facilities at all levels monitoring hand hygiene and providing
data through the national system.

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Context and considerations

• Global-level actions aim to support countries to establish or strengthen their national

IPC monitoring and HAI surveillance systems through the establishment of a technical
working group and the development/review of guidance on HAI surveillance (60). This
also comprises standardized protocols and data collection tools (including early warning
systems) for HAI surveillance, including surveillance of pathogens that are antimicrobial-
resistant and/or prone to epidemics and pandemics.
• Some of the activities and considerations in strategic direction 5 are linked in some way to
other activities/considerations in other strategic directions. This is highlighted throughout
the steps.

(i) IPC monitoring and hand hygiene

monitoring

Step 1 – Preparing for action SD5

Leadership and organization

• Review the section dedicated to strategic direction 5 in the WHO global IPC strategy (2) and prepare to
extensively articulate and advocate for the concept of ‘data for action’ to advocate for both IPC monitoring and
HAI surveillance, and related audit and feedback (see also strategic direction 6 SD6 ).
• Establish a technical sub-committee or working group dedicated to the development of a strategic plan for IPC
monitoring and feedback, if not yet available, including utilizing existing IPC committees/groups and identifying
members from across the team, as well as within stakeholder groups.
• Responsibility for achievement of the objectives is assigned to the national IPC lead/focal point supported by
members from the team.
• Engage representation from the national responsible body dedicated to overall health indicators monitoring
and feedback as well as other experts. Invite representatives from other relevant areas if not already involved,
for example, those responsible for the health workforce, WASH, waste management, AMR, SPAR, and quality
and safety, to ensure alignment to help govern the progress with monitoring and feedback.
• Outline a meeting schedule or standing agenda item within a scheduled committee meeting to explore the
status quo with respect to the use of monitoring, audit and feedback across the health care system.
• Start to develop a strategic plan for initiating or strengthening the national IPC monitoring system outlining the
objectives and expected outcomes. Present this to existing committees/groups as an important part of the IPC
NAP, as well as other relevant NAPs such as AMR or WASH.
• Explore the feasibility of integrating IPC monitoring, audit and feedback with existing systems or using
existing data, for example, SPAR (13), Tracking AMR country self-assessment survey (TrACCS) (31),
AMR surveillance and antimicrobial consumption data (32) (see also strategic direction 3 SD3 ).

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• Explore ways that IPC monitoring data can feed into accreditation/regulation/certification processes as
accountability levers for facilities (see also strategic direction 1 SD1 ).
• Establish or build on existing mechanisms to outline how regular reporting on progress against the strategic
plan and the status of national goals (outcomes) will take place.
• Explore how and when timely and effective feedback can be presented and consider how to promote the
feedback of the performance against the strategic plan suitable to the local culture, preferably according to a
non-punitive institutional culture. See WHO surveillance practical handbook (60).
• Draw up a preliminary list of examples of excellence at the health facility level based on what is already known
and consider developing a suite of examples and vignettes. Hand hygiene measurement can be a good initial
starting point.
• See additional tools and resources in Table 3B.15 .

Stakeholder engagement
• Review the stakeholder list developed in Part 3A .
• Identify additional stakeholders, champions, leaders and networks required to drive forward development of
the national strategic plan for IPC monitoring, as well as the engagement of health care facilities.
• Consider how best to identify health facility leaders, frontline health workers and the public to sell the benefits
of IPC monitoring, audit and feedback (see also strategic direction 6 SD6 ).
• Discuss experiences of country adaptation of monitoring, audit and feedback approaches at existing meetings
to inform options for moving forward to meet the proposed objectives.

Finance and budgeting

• Explore the necessary funding and other technical resources that will be required for implementation of the
strategic plan, including the local implementation of monitoring, audit and feedback.
• Present investment and budget outlines for monitoring and feedback to the relevant committees/working
group, involving all stakeholders.
• Align the strategic plan with the overall IPC investment case as part of the IPC NAP.
• Seek opportunities for making funding proposals to sustainably support the IPC monitoring, audit and
feedback system and activities.

Other resource considerations

• Consider resources needed to establish hand hygiene monitoring and feedback as part of a national
programme for hand hygiene improvement.

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Step 2 – Baseline assessment SD5

Understand the current situation

• Undertake baseline assessments as described in Part 3A using valid assessment tools and resources,
specifically regarding the status of IPC monitoring, audit and feedback in your country.
• Focus on assessment results according to Table 3B.14 .

Table 3B.14. Tools for assessment

Strategic direction Assessment tool Relevant section Area assessed
5: data for action
IPCAT2 6.1.1 + 6.1.2 + 6.1.6 + 6.3.6 Monitoring
IPCAT-MR 6.2 + 6.5 Monitoring
IPCAF-MR 6.2-6.4 Monitoring
IPCAT2 6.2.1 & 6.3.3 Hand hygiene monitoring
IPCAT-MR 6.5 Hand hygiene monitoring
IPCAF 6.3 + 6.5 Hand hygiene monitoring
IPCAF-MR 6.3 Hand hygiene monitoring
HHSAF All Hand hygiene monitoring
Observation form All Hand hygiene monitoring
Abbreviations: IPCAT2, infection prevention and control assessment tool 2; IPCAT-MR, infection prevention and control assessment tool-
minimum requirements; IPCAF-MR, infection prevention and control assessment framework - minimum requirements; IPCAF, infection
prevention and control assessment framework; HHSAF, hand hygiene self-assessment framework.

• Use the national IPC assessment tool 2 (IPCAT2)and instruction tool (61).
• Consider the use of self or peer-evaluation with other countries, or a joint evaluation approach with experts
from countries and regional/global agencies (utilizing examples of where this has already been undertaken) to
review progress with the strategic plan and monitoring results. Reports can be accessed via the Electronic joint
external evaluation platform (62).
• Critique an example of a national SWOT analysis for AMR surveillance - annex 4 .
• Gather other baseline information from previously conducted assessments, where they exist.

Review and feedback results

• Review, compare and present all results from different periods if possible.
• Critique within the team and in existing meetings on what results say about the current situation, in particular,
strengths and gaps in the IPC monitoring approach and prevention of HAI.
• Provide committees/groups/stakeholders with feedback on the status of monitoring, audit and feedback
systems and results within the context of how improvements can be made.
• Catalyze discussions about what needs to be improved and what are the best indicators to use going forward.

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 Part 3B. Implementation of each strategic direction

Step 3 – Developing and implementing the plan SD5

Establish priority areas for action using assessment results

• Identify their potential alignment or integration with other existing systems and seek approval for this approach
in existing meetings where possible.
• Draw up a list of priority areas for action, based on a review of all results and discussions.

Translate all findings into the IPC NAP and implement the NAP
• As part of the IPC NAP, focus on the development of a national strategic plan for IPC monitoring and the
establishment of a national programme for monitoring and improving hand hygiene practices in health care
facilities.
• Outline the practices/processes to be evaluated at the national level according to the local situation and
feasibility.
• Describe how monitoring, audit and feedback data will be collected, analyzed and fed back at the national and
facility levels as part of governance and IPC improvement efforts, also considering a benchmarking approach.
• Establish the frequency of monitoring activities and clear roles and responsibilities.
• Outline how you will build capacity in IPC monitoring, audit and feedback of data, for example, the training and
education of all relevant professionals to be involved (see also strategic direction 4 SD4 ).
• Outline the focus on hand hygiene monitoring, audit and feedback data, including the establishment of regular
hand hygiene compliance monitoring according to the WHO method, as a national indicator to be reported at
least by reference hospitals in the country.
• Define how you will promote the value of IPC monitoring, audit and feedback data (see also Part 3A and
strategic direction 6 SD6 ) and outline how monitoring contributes to a multimodal improvement approach (see
strategic direction 2 SD2 ).

Step 4 – Evaluating impact SD5

Maintain assessments
• Undertake follow-up assessments at the agreed frequency using the tools used in step 2. A minimum annual
frequency is recommended in the first instance.
• Embed the plan into other national monitoring and feedback programmes as appropriate.

Review, feedback results and update the IPC NAP

• Analyse the effectiveness of the IPC monitoring strategic plan activities, acceptability and value for money and
add this information to reports.
• Evaluate and discuss results including a comparison with previous assessments that used the same tools.
• Confirm the areas showing progress and highlight them in reports.
• Confirm the remaining gaps and reflect what additional actions need to be put in place to achieve
improvement.
• Update the IPC monitoring strategic plan as part of the IPC NAP, based on results.

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Development and implementation of national action plans for infection prevention and control: practical guide

Step 5 – Sustainability SD5

Refresh the IPC NAP with a focus on sustainability

• Secure long-term policy-level support for IPC monitoring, audit and feedback, aligning with other policy
priorities.
• Build a financial case for long-term investment.in IPC monitoring, audit and feedback.
• Harness available financial and human resources to maintain the strategic plan for IPC monitoring, audit and
feedback as part of the IPC NAP.
• Build a portfolio of success stories and communicate examples of success to key stakeholders and networks.
• Secure long-term commitment from donors and identified champions.
• Secure long-term support from health care facility leads to participate in the national IPC monitoring networks
and national hand hygiene compliance monitoring.
• Provide regular feedback on the progress of the national strategic plan, at least annually.

Table 3B.15. Additional tools and resources*

• To support establishment of national hand hygiene programme and national hand hygiene compliance monitoring:
A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva: World Health
Organization; 2009 (https://iris.who.int/handle/10665/70030).

• WHO Toolkit for Routine Health Information Systems Data. Geneva: World Health Organization; 2024 (https://www.who.
int/data/data-collection-tools/health-service-data/toolkit-for-routine-health-information-system-data/modules).

• Coker D, Phuong HTK, Nguyen LTP, Ninh T, Gupta N, Ha TTT et al. Establishing a standardized surveillance system for health
care-associated infections in Vietnam. Glob Health Sci Pract. 2022; 10(3):e2100284. doi: 10.9745/GHSP-D-21-00284 (See
Fig. 2 “Timeline of health care-associated infection surveillance implementation activities in 6 pilot hospitals, Vietnam”).

• KoboToolbox https://www.kobotoolbox.org/.

*All tools and resources were accessed on 10 April 2025.

Barriers and facilitators

• Buy in and support for IPC monitoring, audit and feedback across health facilities can be a
challenge: lessons from countries that have successfully expanded their approach to monitoring
and feedback are summarized below.
□ Train a cadre of monitoring, audit and feedback experts to undertake periodic external
monitoring, audit and feedback. Identify at an early stage how the data will be used, for
example, the process of feedback to stakeholders, linkage of results to incentives (that is, non-
punitive) and improvement plans.
□ Integrate monitoring, audit and feedback with existing health management information systems.
□ Demonstrate the value of monitoring, audit and feedback to facility administrators, for example,
presentation of data, workshops.
□ Leverage outbreaks to secure commitment and resources and use as a foundation for
improvement.
• The perceived burden associated with the process of gathering and analyzing data: this
challenge can be exacerbated when relying on manual methods, which are often time-consuming,
prone to errors, and difficult to manage, especially when dealing with large volumes of information.

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 Part 3B. Implementation of each strategic direction

Aim to shift to electronic data collection methods, such as using specialized applications like
the open source data capture platform KoboToolbox. Outline the advantages of the efficient and
reliable collection of data via mobile devices or tablets, which significantly reduce the time and
effort needed for data entry.

Table 3B.16. Action checks

☑ A group to develop the IPC monitoring strategic plan, including involvement of experts on monitoring, audit and feedback
and hand hygiene improvement created or activated.
☑ Team/lead roles and responsibilities to focus on monitoring, audit and feedback allocated, as well as a national hand
hygiene programme.
☑ Key stakeholders, champions, leaders and networks to drive forward monitoring, audit and feedback and hand hygiene
improvement engaged.
☑ Alignment with relevant programmes and other monitoring systems explored, for example, with SPAR, TrACCS, etc.
☑ Funding and budget assessed and secured, as well as existing resources that could be leveraged, taking the opportunity to
secure policy support.
☑ Assessments and feedback of results undertaken, including using existing data collection from other relevant
programmes, if available, with frequency of follow-up assessments and reporting outlined.
☑ An IPC monitoring strategic plan issued and executed with training on monitoring, audit and feedback undertaken, as well
as an outline of planned review dates.
☑ IPC monitoring linked to health facility accreditation and certification, where possible, and best practices showcased to
support long-term monitoring engagement.
☑ IPC NAP updated to reflect plan implementation.

Find out more about implementing strategic direction 5 in the country story in Annex 14 .

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Development and implementation of national action plans for infection prevention and control: practical guide

(ii) HAI surveillance

Step 1 – Preparing for action SD5

Leadership and organization

• Integrate agenda items on HAI surveillance into existing committees and the multidisciplinary group (see also
strategic direction 1 SD1 ).
• Highlight the role of a technical multidisciplinary HAI surveillance group and establish it as a subgroup of
existing committees/groups for example.
• Identify a lead and a team, usually those leading the IPC programme, according to the WHO Practical handbook
on HAI surveillance at national and facility levels (Box 3B.3 ) (60).
• Designate clear roles and responsibilities for HAI surveillance.

Box 3B.3. Considerations for national HAI surveillance governance according to the WHO handbook on HAI
surveillance

• Ministries of health or alternative responsible national authorities should define a national governance
structure for the design, management, supervision, coordination, monitoring and evaluation of the
national HAI surveillance system in the context of the national IPC programme. Governance should
include specific structures with detailed responsibilities, for example, who is responsible for the design,
implementation, and monitoring of the HAI surveillance system, as well as clear roles and responsibilities
for each structure.
• The national HAI surveillance system lead should be specified if different from the national IPC
programme lead/focal point and should have sufficient expertise, experience and time to manage and
coordinate the national HAI surveillance system. The HAI surveillance lead should be supported by a HAI
surveillance team based on the anticipated workload.
• The national HAI surveillance lead/team, in collaboration with the national IPC programme lead (if
different), have the responsibility to convene the technical multidisciplinary HAI surveillance group.
This group is assigned to develop a written national HAI strategic surveillance plan, participate in the
development of a standardized national HAI surveillance protocol for data collection, develop a HAI
surveillance training programme, and participate in the monitoring and evaluation of the national HAI
surveillance system.
• The technical multidisciplinary HAI surveillance group should include all necessary expertise, for
example, health care epidemiologists, microbiologists, public health professionals, IPC and infectious
disease specialists, statisticians, data managers and informatics experts.
• Monitoring of the implementation of the national HAI surveillance plan should be the responsibility of the
national IPC committee, which is part of the national IPC programme structure and different from the
technical multidisciplinary HAI surveillance group.

Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection.

• Identify joint areas of work across surveillance programmes and plans (see also strategic direction 3 SD3 ).
• Explore alignment and opportunities for collaboration between HAI and AMR surveillance programmes and
International Health Regulations-related teams and activities (see also strategic direction 8 SD8 ). Other

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 Part 3B. Implementation of each strategic direction

important systems and services to be considered include laboratory national systems, emergency programmes,
occupational services (list not exclusive).
• Focus on how to strengthen laboratory capacity to support both AMR and IPC programmes, as well as building
upon global information/efforts (for example, in the context of the GLASS) (32).
• Discuss with those in charge of accreditation/regulation/certification systems and explore ways that HAI data
can be used and fed into these processes as accountability levers for facilities (see also strategic direction 1 SD1 ).
• Focus on processes to regularly review data quality, including assessment of case report forms, integration of clinical
microbiology results, data accuracy, and denominator determination (that is, total exposed population), etc.
• Outline the approach for regular communication with the national reference laboratory and focus on the
alignment of priorities.
• Start to outline how you will advocate for HAI surveillance resources with leadership, focusing on the expected
net benefit (see also strategic direction 6 SD6 ).
• Consider how to adopt reliable case defin itions by referring to the WHO HAI surveillance handbook (60).
• Consider the role of specialist training, supportive supervision or other related mentorship for professionals
and leads in charge of HAI surveillance.
• Explore whether hospital-based HAI surveillance programmes are adequately linked to national or sub-national
HAI surveillance networks.
• See additional tools and resources in Table 3B.18 .

Stakeholder engagement
• Review the stakeholder list developed in Part 3A and identify additional stakeholders, champions, leaders
and networks to drive forward HAI surveillance efforts needed to achieve the targets, where relevant. Focus
on stakeholders who will provide the additional, necessary technical capacity to establish or strengthen
surveillance systems and associated protocols.
• Focus on the level of influence, type of influence and where stakeholders can address resource requirements for
example.

Finance and budgeting

• Consider the necessary funding that will be required for the implementation of national HAI surveillance
systems and activities (in particular for their design, data collection, analysis, interpretation, communication/
feedback, monitoring and evaluation).
• Align HAI surveillance plans with the overall IPC investment case and IPC NAP budget and define where a
specific topic could fit into the overall national agenda, for example, patient safety.
• Consider ways to leverage resources and prioritize objectives. A pilot project in selected facilities to measure the
epidemiology of HAI (prevalence or incidence) may be a feasible starting point for countries that do not have a
HAI surveillance system yet.

Other resource consideration

• Consider the human resources necessary for technical support implementing HAI surveillance.

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Step 2 – Baseline assessment SD5

Understand the current situation

• Undertake baseline assessments as described in Part 3A using valid assessment tools and resources, specifically
regarding the status of HAI surveillance in your country.
• Focus on assessment results according to Table 3B.17 .

Table 3B.17. Tools for assessment

Strategic direction Assessment tool Relevant section Area assessed
5: data for action
e-SPAR-SPAR C.9.2 HAI surveillance
IPCAT2 Core component 4 HAI surveillance
IPCAT-MR Core component 4 HAI surveillance
IPCAF-MR Core component 4 HAI surveillance
Abbreviations: e-SPAR, electronic States Parties self-assessment annual reporting; IPCAT2, infection prevention and control assessment tool 2;
IPCAT-MR, infection prevention and control assessment tool-minimum requirements; HAI, health care-associated infection.

• Explore findings from other existing surveys and data collection from other policies and programmes.

Review and feedback the results

• Review and compare all results.
• Consider what they tell you about the current situation, in particular the strengths and gaps related to data.
• Provide feedback on the results related to the existing HAI surveillance system and/or gaps to key stakeholders
in a range of formats in order to raise awareness on needs and motivate necessary actions to strengthen
surveillance going forward.
• Hold meetings to assess existing surveillance systems nationally and across the health care system to further
discuss and identify centres of excellence and joint areas of work that can be harmonized.

Step 3 – Developing and implementing the plan SD5

Refer to the WHO Practical handbook on HAI surveillance (60) and GLASS resources (32) for detailed
guidance to develop a national strategic plan for HAI/AMR and establish or strengthen the system for HAI/AMR
surveillance.

Establish priority areas for action using assessment results

• Refer to Part 3A, step 3, with a focus on WHO national health planning tools (24).
• Draw up a list of priority areas for improvement based on ongoing surveillance and available results. Priority
infections could be based on the services and structure of the health care facilities, accreditation requirements,
expected frequency of HAI within specific types of health facilities, preventability of infection, and impact of the

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 Part 3B. Implementation of each strategic direction

infection (severity, case fatality and excess costs).

• Determine the goals and objectives, methods of HAI surveillance and data collection procedures in the HAI
strategic plan. Decide on the types of HAIs to be under surveillance using standardized HAI case definitions
to facilitate their analysis, data interpretation, communication and feedback, as well as a monitoring and
evaluation of the surveillance system. This could include through integrating with SPAR, national AMR
assessment, or other vertical disease programmes for example.

Translate all findings into the IPC NAP and implement the NAP
• As part of the IPC NAP, incorporate the strategic plan for HAIs and related AMR surveillance, as well as in other
NAPs (such as the AMR NAP). See Box 3B.4 .
• Hold targeted meetings to outline the plan and seek approvals.
• Outline agreed-upon roles and timeframes for the plan (for example, use a Gantt chart to illustrate the schedule).
• Develop or update standardized surveillance protocols and HAI case definitions to be used, such as the WHO
HAI case definitions in the surveillance protocol (60), or other standardized definitions, for example, the
United States Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN)
(63) or the ECDC (64, 65) (the latter two may not be feasible in low-resource settings).
• Tailor the surveillance methodology according to the local context. Include the types of infections to be under
surveillance, data collection and analysis methods, data interpretation techniques, feedback mechanisms, and
methods for the monitoring and evaluation of the HAI surveillance system.
• Address microbiology capacity-building and training on surveillance methods, while focusing on IPC process
monitoring, such as hand hygiene compliance.
• Describe actions related to point prevalence surveys versus incidence (prospective surveillance).
• Describe processes for reporting, including identified diseases of potential concern or outbreaks. Focus on
clear lines of communication and timely dissemination, for example, with decision-makers for advocacy of
organizational and behavioural change (see strategic direction 6 SD6 ).
• Address public reporting and legislation requirements.
• Set benchmarks using initial surveillance data that can be used for comparison, as appropriate.

Box 3B.4. HAI surveillance strategic plan according to the WHO Practical handbook on HAI surveillance

• Effective HAI surveillance begins with comprehensive planning.

• Surveillance planning involves development of a written national HAI surveillance plan, which is the
foundation of any national HAI surveillance system.
• The plan should include goals, specific objectives, HAI surveillance governance, approaches for data
collection, data analysis, reporting mechanisms, outcomes of surveillance and various methods to enable
tailoring of preventive measures to reduce HAI, based on surveillance results.
• The design of the national HAI surveillance system should be based on understanding the structure of the
health care facilities and their existing capacities to identify the scope of surveillance, including which
health care facilities to include in HAI surveillance, geographical coverage, variation in the status of the
IPC programme, including IPC staff and their training level, patient population of interest, capacities of
the microbiology laboratories, prevalent infections, and preparedness to respond to infectious disease
emergencies.
• The plan should be adaptable to different levels of health care and flexible to accommodate future
modifications.

Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection.

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Step 4 – Evaluating impact SD5

Maintain assessments
• Conduct follow-up assessments using the tools described in step 2.
• Assess the efficiency of data collection, analysis and dissemination systems using identified indicators.
• Evaluate the impact of data feedback in terms of informing IPC improvement strategies.

Review, feedback results and update the IPC NAP

• Update the plan as part of the IPC NAP based on the results of the evaluation, considering the effectiveness of
the programme, acceptability and value for money.
• Outline the plan to review data quality, including case report forms, clinical microbiology results and
denominators on an ongoing basis.

Step 5 – Sustainability SD5

Refresh the IPC NAP with a focus on sustainability

• Secure long-term policy-level support for the implementation of the national strategic plan for HAI surveillance
and alignment with other policy priorities.
• Secure long-term commitment from identified champions and networks.
• Provide feedback on the progress of the national strategic plan for HAI, including a wide range of stakeholders,
considering changing landscapes and engagement with HAI surveillance.
• Harness available financial and human resources to sustain the surveillance systems in the long term
• Build a portfolio of success stories at national and health facility level regarding surveillance and HAI reduction
and communicate examples of success to committees, stakeholders and networks.

Table 3B.18. Additional tools and resources*

• Protocol for surgical site infection surveillance with a focus on settings with limited resources. Geneva: World Health
Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. https://cdn.who.int/media/docs/default-source/integrated-health-
services-(ihs)/ipc/ssi-surveillance-protocol.pdf?sfvrsn=d24a1d1c_3&download=true

• WHO Toolkit for Routine Health Information Systems Data. Geneva: World Health Organization; 2024 (https://www.who.
int/data/data-collection-tools/health-service-data/toolkit-for-routine-health-information-system-data/modules).

• Possible funding source: Fleming Fund Country Grants focused on building laboratory capacity and establishing
surveillance systems (https://www.flemingfund.org/grants-funding/country-grants/).

*All tools and resources were accessed on 10 April 2025.

“In Sierra Leone, we undertook operational research and engaged policy makers and critical
stakeholders including collaboration with US CDC to establish our national surveillance
programme.”

WHO Focal person, Sierra Leone Country Office

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“In Guatemala, we had a meeting focused on surveillance led by the Ministry of Health and
Epidemiology to see how it was going to be established in the country; following this a team was
created and a professional was hired to focus on surveillance– it was a tremendously positive
approach.”

Regional IPC leader, Region of the Americas

Barriers and facilitators

• Lack of skilled human resources to lead surveillance efforts both nationally and in facilities:
regional or global expertise can potentially support surveillance training to build human resource
capacity, as can country partnering schemes. Explore publications or other supportive materials
relative to guidance on HAI surveillance and data collection and reporting to support ongoing
training on the development of a surveillance system using agreed definitions.
• Lack of infrastructures, resources and materials for laboratory, especially at operational level:
leverage existing resources, for example, by partnering with external, fully-equipped laboratories
or through a hospital network. Explore memorandums of understanding for processing samples
and obtaining timely results without the need for extensive in-house facilities in the interim. Focus
on high-risk departments such as intensive care units and surgical wards where the risk of HAIs is
higher. Implement a phased roll-out: start with a pilot programme with a specific department or
unit and gradually expand as resources become available. Outline necessary discussions/meeting
agendas on HAI surveillance methods and definitions to highlight the necessary resources.
• Scaling-up surveillance from exemplar facilities can prove an initial challenge: in Viet Nam,
scale-up was addressed through a ‘model IPC hospital approach’. IPC leaders from each model
hospital were trained and six of the model hospitals were engaged to implement standardized
HAI surveillance. Bloodstream and urinary tract infections were prioritized. The surveillance
protocol was adapted from an existing CDC/NHSN version (63) through an expert consultation
process and shared with the select leaders of the core IPC model hospital cadre who demonstrated
an initiative to provide feedback for further local adaptation of the surveillance system. Regular
support visits to the surveillance hospitals were planned and conducted to evaluate and address
implementation challenges. Visits included refresher training, stakeholder interviews (IPC team,
microbiology laboratory, clinicians in units performing surveillance), assessment of case finding
and denominator data collection practices, as well as the review of completed surveillance forms to
assess quality and discuss use of data for local action. The model hospital network provided useful
learning for scale-up. Coordination and mentorship across participating hospitals was key.
• Data sharing is a common challenge: explore ways to improve willingness to share across
countries (level of aggregation/granularity is important). Approaches need to differ between
public and private facilities with a focus on transparency. Metrics should be relevant, feasible and
meaningful for those ultimately using it at local level (for example, clinicians, IPC teams). This
may be supported through scientific society conferences in the first instance if governments are
reluctant.
• Continuous interpretation and use of HAI surveillance data to inform ways to address IPC gaps
at facility level: build data collection systems over time and pair with ongoing IPC programme

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actions. Collated data is only useful if it is presented in a way that is understandable by audiences
and able to be easily acted upon.
• Challenges with analysis at the facility level: providing tools to help facilities better generate
and use data (for example, run chart templates), as well as human resource capacity-building is
essential.

Table 3B.19. Action checks

☑ A multidisciplinary technical team to focus on HAI surveillance convened, including necessary laboratory/microbiology
and epidemiology/information technology capacity.
☑ Meetings held (or agenda item on existing committee meetings) to explore other existing surveillance efforts including
with the ministry of health and to identify joint areas of work, particularly for AMR.
☑ Assessments and feedback undertaken.
☑ Key stakeholders, champions, leaders, and networks (including hospital-based surveillance programme leadership)
identified to further involve and help drive forward surveillance efforts.
☑ Funding and budget assessed and secured, as well as existing resources that could be leveraged, taking the opportunity to
secure policy and other leadership support.
☑ HAI case definitions and surveillance methods identified (preferably based on WHO definitions), with careful consideration
of local adaptation as well as the need for data quality and accuracy.
☑ Existence of microbiology and laboratory capacity and quality and information technology systems to support HAI
surveillance assessed.
☑ A national strategic plan for HAI and related AMR surveillance and targets developed, with a focus on priority infections
based on assessments and the local context, with training on surveillance undertaken. as well as plan review dates outlined.
☑ A list of tertiary/secondary health care facilities with a HAI and related AMR surveillance system identified, including
for early warning to detect outbreaks, epidemics and pandemic-prone pathogens, that have the capacity to participate in
national (and other) surveillance networks according to country context .

☑ IPC NAP updated to reflect plan implementation.

☑ IPC surveillance linked to health facility accreditation and certification, where possible, and best practices showcased to
support long-term monitoring engagement.

Find out more about implementing strategic direction 5 in the country story in Annex 14 .

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Strategic direction 6: advocacy and

communications
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 6 – refer
to Part 2, Table 2.7 .

Î Ensure you have considered all of the activities in Part 3A and focus on the action checks
at the end of each step.

Î Work through this section and you will have the elements that will support achievement
of the following national indicators for strategic direction 6 in the context of your IPC
NAP.

Indicators

1. National advocacy and communications strategy and implementation plan, including

the identification of local experts/champions, developed and implemented (by 2026).

Context and considerations

• In some cases, national actions and action planning will be influenced by actions at the
global level. For example, implementation of strategic direction 6 at the global level
includes the development of global and regional IPC advocacy and communications
strategies, which will be an important facilitator in many countries in the achievement
of successful development and implementation of a national advocacy and
communications strategy.
• Some of the activities and considerations across all strategic directions are linked in
some way and this is highlighted throughout the steps below.

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Step 1 – Preparing for action SD6

Leadership and organization

“Clarity in what IPC actually means requires advocacy to convince politicians, stakeholders
and partners, and to raise awareness and knowledge among professionals and patients. This
needs a targeted approach towards different audiences and depending on the topic. Plans and
information should consider the important role of social media to disseminate content.”

IPC leaders and experts from across all WHO regions

• Confirm the lead for the national advocacy and communications strategy and implementation plan within the
IPC /implementation team.
• Identify the counterpart(s) in the communications department in the ministry of health.
• Find out what additional communications’ expertise is available, including to inform risk-based communication
strategies on IPC, and explore the availability of behavioural and cultural insights’ expertise.
• Explore the possibility to integrate IPC advocacy and communications in any other national/ministry planning/
communications, in particular regarding complementary areas of work such as AMR, WASH and public health
emergencies (see also strategic direction 3 SD3 ).
• Identify the relevant national committees/groups for the presentation of ongoing communications and advocacy
activities, including alongside other programmes of work, and ensure that there is an agenda item for this topic.
• Establish how to play a lead role in influencing meeting discussions, including on indicators to be used in
monitoring and evaluating IPC communications reach.
• Outline IPC team roles and responsibilities regarding development of the national advocacy and
communication strategy and implementation plan for IPC, as well as inputs from communications’ expertise.
• Outline plans for the team and identified local experts or champions to attend training and coaching
sessions held/informed by communications experts in order to achieve communication competence in IPC
professionals/others (may include media training). For example, to meet core competencies 3.1, 3.15 (50).
• Review any local visual identity, slogans and messages already in place for IPC/hand hygiene and list/outline
these to anticipate that new IPC communications do not confuse or conflict and are trusted and clear.
• Explore and consider signing up to (if not already done) existing global/regional activities/campaigns. For
example, WHO World Hand Hygiene Day (66) and World Antimicrobial Awareness Week (67), as well as
those in complementary fields such as WASH and patient safety.
• Review ethical frameworks to address gender, equity and human rights issues, including potential harms and
unintended consequences (for example, increased anxiety) from planned IPC communications/advocacy, for
example, the APIC/Infection Prevention and Control (IPAC) Canada ethical IPC decision-making framework (68).
• Start to map out an implementation plan for the advocacy strategy in line with the IPC programme (see also
strategic direction 2 SD2 ) and the overall IPC NAP.
• Explore sources of meaningful information and data to establish the problem(s) requiring communications and
advocacy on IPC and to support evaluation plans (see also strategic direction 5 SD5 ). Collate the existing, most
prominent/popular messages and communication themes around IPC.
• Map the current context and levers, for example, current political, policy and public drivers, as they relate
to the anticipated IPC advocacy and communications’ strategy and implementation plan (see also strategic
direction 1 SD1 and annex 15 ).

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Stakeholder engagement
• Secure multi-sectoral, influential stakeholder/champion representation with IPC, AMR and other insights,
as well as patient groups, in order to inform the national advocacy and communications’ strategy and
implementation plan. Do this from existing national IPC-related committees (see also Part 3A and Annex 4 –
stakeholder mapping grid – and strategic direction 8 SD8 ).
• Secure and include relevant stakeholders in the ongoing IPC advocacy and communication strategy work,
ensuring that they are clear on their roles and responsibilities.
• Further identify specific local experts/champions (who should be competent in communicating on IPC to
people and across groups) and community leaders to be part of the IPC advocacy strategy and implementation
plan roll-out.
• Prepare “trusted voices” from those listed/engaged to reach the proposed target audiences by planning to issue
the right communications at the right times.
• Inform all stakeholders of the advocacy and communication strategy and implementation plans using existing
meetings or other methods of communication, such as emails, including available tools and resources.

“There needs to be a clear definition of the target audience(s) depending on the situation or
topic, and the level of the system. A communication strategy, for example, could target patients
and families at a health facility level to influence practice and change behaviour.”

IPC leaders and experts from across all WHO regions

Finance and budgeting

• Explore sources of financing and budget for the proposed IPC advocacy and communication strategy and
implementation plan, activities and resources, if not already included in the overall IPC NAP. At times, this may
be possible through other programmes of work, for example, WASH, AMR, patient safety and quality of care.

Other resource considerations

• Reach out to AMR and/or other related programmes addressing advocacy and communications in order to pool
resources and tools.
• Explore existing communication and advocacy strategies/resources and messages that can be used and
adapted for IPC use (69-72).
• Assist in exploring the platforms and channels to be used for messaging, considering the proposed IPC target
audiences, frequency of messaging, desired IPC outcome(s), etc.
• Explore surge capacity resources for communications during outbreaks for example.
• See additional tools and resources in Table 3B.22 .

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Step 2 – Baseline assessment SD6   

Understand the current situation

• Focus on assessment results according to Table 3B.20 .
Table 3B.20. Tools for assessment
Strategic direction Assessment tool Relevant section Area assessed
6: advocacy and
communications IPCAT2 5.2.3 Multimodal improvement strategy

Abbreviations: IPCAT2, infection prevention and control assessment tool 2.

• Work closely with communications’ colleagues on assessment actions.

• Collate and review issues/problems that require advocacy/communication attention through interviews/focus
groups, surveys, for example, health and care worker perceptions (23, 70).
• Collate other tools and available information to monitor signals around IPC perceptions on an ongoing basis, for
example, in the media.
• Assess existing/proposed, draft messages to ensure that they will be clear, consistent and understandable to
the proposed target audiences and have the desired effect (do they command attention? are they clear? do they
create trust? do they demonstrate a benefit and have a clear call to action? that is, ‘talk to heart and head’). Test
and collate feedback.
• Assess barriers for reaching the proposed target audiences with existing/proposed IPC advocacy messages,
including who would be best placed to issue/make communications. Test messages and collate feedback.
• Contribute to: (1) assessment of the use of existing platforms and channels of communication and how they
perform with target audiences; (2) a review of any existing advocacy/campaign evaluation reports, including
against agreed indicators, ‘reach’ analytics and other information to be drawn from automated communication
channel monitoring, for example, Google analytics for web pages; and (3) wider communication focus groups
and/or surveys, for example, to understand what engages people and if the co-creation or embedding of IPC
advocacy communications will be possible.

Review and feedback results

• Use existing meetings to outline all findings and results, including against the context of the impact that an
advocacy strategy and implementation plan could have on IPC perceptions, knowledge and practices.

“The implementation of communication strategies needs to take account of evaluation of

impact, which can be difficult and requires expertise.”

IPC leaders and experts from across all WHO regions

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 Part 3B. Implementation of each strategic direction

Step 3 – Developing and implementing the plan SD6     

Establish priority areas for action using assessment results

• Consult on all findings/results at existing meetings, including with identified stakeholders.
• Collate feedback on the perceived priorities from discussions.
• Highlight the linkages of effective communication with the overall IPC programme of work.
• Review all potential priorities for the IPC advocacy and communication strategy, including alongside other
programmes of work and their advocacy strategies.
• Map proposed priorities with any existing or expected budget.

“Defining priorities is helpful in communication strategies. A lot can be learned from success
stories such as from World Hand Hygiene Day and World AMR Awareness Week. There is a need
to highlight the many activities and strategies that are already happening around the world
and make a clear link to IPC.”

IPC leaders and experts from across all WHO regions

Translate all findings into the IPC NAP and implement the NAP
• Finalize the national advocacy and communication strategy and implementation plan and include it as part of
the IPC NAP.
• Outline specific goals, objectives, indicators, metrics and timeline for the advocacy and communication plan, as
necessary.
• Include surge plans for increased advocacy and communications necessary in the event of outbreaks.
• Launch the advocacy and communication strategy and implementation plan, with the aim to have IPC viewed
by a broad range of stakeholders/target audiences as a priority and a life-saving component of safe, quality care
(see Table 3B.21 ).
• Launch pre-prepared, tailored and consistent communications/messages, carefully considering the timing of
their release over a period of time and also simultaneously to target different audiences/levels as necessary.
• Support ongoing message preparation and translation of highly technical subject matters into messages that
can be understood by broad audiences.
• Use information already identified from verified science-based sources and adapt text to suit different target
audiences.
• Support the preparation of advocacy toolkits, for example, the SAVE LIVES: Clean Your Hands toolkit (71).
• Use and outline mechanisms to promote the agreed channels/platforms and local experts/champions for
communications in order to reach the target audiences over time.
• Undertake specific campaign activities, as appropriate/agreed.
• Support specific media engagement as relevant. Consider the example of a news release associated with the
launch of new WHO guidance aiming to reduce bloodstream infections from catheter use (73).
• Outline and share advocacy approaches for stakeholders and champions to use and encourage them to cascade
messages.
• Outline and share the approach to any conflict resolution from communication rebuttals/complaints and be ready
to challenge rumours using the right language, always in close collaboration with the communications’ lead.

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Development and implementation of national action plans for infection prevention and control: practical guide

Table 3B.21. Template for a national advocacy strategy and implementation plan
Action description Target Person Start date Due date Necessary Intended
audience responsible resources outcome
Hold meetings
Hold training/ coaching
sessions
Perform assessments
Hold focus groups, run
surveys. Etc.
Identify local experts/
champions
Outline target audiences
(stakeholder map)
Outline platforms to be used
Outline the budget
Write the plan
Describe surge activities (that
is, increased communications
necessary during times of
outbreaks or media interest
or public petitions)
Issue the plan
Create, adapt or adopt
messages
Implement the plan (issue
messages)
Conduct campaign activities
Evaluate the plan
Sustain the plan through
regular contributions
to advocacy and
communications

Step 4 – Evaluating impact SD6

Maintain assessments
• Use the IPC NAP and advocacy and communication strategy and implementation plan to guide the assessments
and evaluation activities.
• Activate follow-up assessments, that is, those in step 2 by using approved tools and approaches.
• Contribute to discussions on any changing landscapes around communication channels/platforms to be used
going forward.
• Review the target audiences that should be reached with IPC messages through assessing impact/reach
evaluations.

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 Part 3B. Implementation of each strategic direction

• Review the impact of messages to date.

• Review roles and responsibilities, project management and budget for the IPC advocacy and communication
strategy and implementation plan.

Review, feedback results and update the IPC NAP

• Review, share and discuss assessment results in the context of the agreed communication indicators (revisit
steps 1 and 2).
• Analyse and interpret follow-up assessment results at existing meetings with all relevant stakeholders, focusing
on how the advocacy and communication strategy and implementation plan can be updated.
• Report strategy progress in line with broader communications reports.
• Update the target audiences as necessary.
• Adjust messages as necessary – avoid message fatigue.
• Adjust the plan and IPC NAP as necessary.

“A prolonged, multi-pronged approach is necessary to raise awareness. Stakeholders and

partners need to use all their channels of communication and dissemination.”

IPC leaders and experts from across all WHO regions

Step 5 – Sustainability SD6   

Refresh the IPC NAP with a focus on sustainability

• Outline necessary activities to refresh and sustain your national advocacy and communication strategy and
implementation plan, based on all learning in steps 1–4.
• Help build a substantial network/coalition for ongoing IPC advocacy, which might include engagement with
different champions and influencers over time and integration of IPC communications with other plans.
• Maintain support for fundraising/budget allocation to support ongoing communications and engagement
activities, including through the efforts of communications’ leads and with other programmes, such as AMR (see
also strategic direction 1 SD1 and strategic direction 2 SD2 ).
• Maintain a process of working with communication experts to constantly review the changing landscape
around communications and advocacy and how to reach target audiences as they evolve throughout the
lifespan of the plan.
• Maintain regular contributions to advocacy approaches, indicators and data collection, including to address
any current potential harms and unintended consequences.
• Maintain processes of raising issues/problems that require communication attention, taking this from current
IPC sources and data.
• Maintain engagement with relevant global campaigns.

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Table 3B.22. Additional tools and resources*

• Examples of posters/infographics: the role of IPC in preventing AMR in health care. Geneva: World Health Organization;
2017 (https://cdn.who.int/media/docs/default-source/documents/infection-prevention-control09320f4b-309f-4999-8e23-
23541eeb60a6.pdf?sfvrsn=1ea132d5_1); HAI infographic. Geneva: World Health Organization; 2017 (https://www.who.int/
multi-media/details/health-care-associated-infections-infographic).

• Implementation playbook, pocket edition: a quick-reference guide to delivering impact for health, with tools and
templates. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/376467.) Licence: CC BY-NC-SA 3.0
IGO.

• WHO dissemination tool: part of a toolkit associated with the Implementation guide for the medical eligibility criteria and
selected practice recommendations for contraceptive use guidelines. Geneva: World Health Organization; 2018 (https://
cdn.who.int/media/docs/default-source/reproductive-health/contraception-family-planning/dissemination-tool-bw.
pdf?sfvrsn=29308960_3).

• Example of knowledge, attitude and practice surveys for hand hygiene (facility level). Hand hygiene: monitoring tools.
Geneva: World Health Organization; 2025 (https://www.who.int/teams/integrated-health-services/infection-prevention-
control/hand-hygiene/monitoring-tools).

• Advocacy, communication and social mobilization for TB control - a guide to developing knowledge, attitude and practice
surveys. Geneva: World Health Organization; 2008 (https://iris.who.int/handle/10665/43790.)

• Example facts and figures: Key facts and figures. World hand hygiene day. Geneva: World Health Organization; 2025
(https://www.who.int/campaigns/world-hand-hygiene-day/key-facts-and-figures.)

• Advocacy action guide: a toolkit for strategic policy advocacy campaigns. Campaign for Tobacco-Free Kids and Consumers
International, 2019 (https://dfweawn6ylvgz.cloudfront.net/uploads/2019/01/Final-Advocacy-Action-Guide.pdf).

• Example of reports: World hand hygiene day 2023. Summary evaluation. Geneva: World Health Organization; 2023 (https://
iris.who.int/bitstream/handle/10665/376908/9789240093348-eng.pdf?sequence=1.)

• WHO advocacy video on the core components. Geneva: World Health Organization; 2017 (https://www.who.int/multi-
media/details/what-are-the-core-components-for-effective-infection-prevention-and-control).

• Cancer control: knowledge into action: WHO Guide for Effective Programmes. Module 6: Policy and advocacy. Advocacy
step 7: Developing and implementing the advocacy plan. Geneva: World Health Organization; 2008 (https://www.ncbi.nlm.
nih.gov/books/NBK195418/#:~:text=An%20advocacy%20plan%20should%20factor,of%20the%20cancer%20control%20
programme).

• WHO advocacy strategy for mental health, brain health and substance use. Geneva: World Health Organization; 2024
(https://iris.who.int/handle/10665/43790).

*All tools and resources were accessed on 10 April 2025.

Barriers and facilitators

• Lacking the right expertise: targeted communication training, including media training,
undertaken where appropriate and possible, should achieve a level of communications’
competence in IPC national focal points – this links with the core competencies for IPC.
• Lacking roles and responsibilities to ensure effective oversight to timely communications:
ensure availability of a clear plan, which outlines the role that IPC focal points can play in advocacy
strategies alongside communications expertise, including evaluations of reach, as described
throughout this strategic direction.
• Lacking engaging resources, including the absence of credible sources, links to local situations,
and disconnects with local beliefs, and failing to achieve the intended outcomes in target

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 Part 3B. Implementation of each strategic direction

audiences: use existing global, regional, national facts and figures, for example, as well as the use of
focus groups insights, involving local champions, which consider and review proposed messaging
and how these are perceived.

Table 3B.23. Action checks

☑ Communications expertise engaged and secured.
☑ Lead for advocacy and communications work (and other roles and responsibilities) confirmed (to work alongside a
communications expert focal point).
☑ Dedicated budget and other advocacy and communication resources secured.
☑ Communications expert focal point sourced and engaged.
☑ IPC team communication focal points identified and dedicated training on communication and media engagement set up
and delivered, including to identified champions.
☑ Key stakeholders engaged, including patient groups and influencers.
☑ Existing sources of IPC information/data to assess and inform communications over time established, avoiding potential
harms and unintended consequences.
☑ Exploratory exercises/assessments, using the right platforms/tools, undertaken and follow-up and reporting outlined.
☑ Clear IPC evidence-based messages tailored to target audiences created and tested.

☑ An advocacy strategy and implementation plan developed, including effective communication channels and trusted
messengers, ideas for advocacy toolkits, alignment with other national health strategies, ethical considerations and existing
branding of visuals and campaigns.

☑ Activities evaluated, including ongoing mis/disinformation issues, and plan adjusted.

☑ Integration of IPC communications into other national programmes achieved.

☑ Sign up to relevant global campaigns achieved and annual activities undertaken.

☑ IPC NAP updated to reflect plan implementation.

☑ Ongoing financing for the strategy and plan confirmed.

☑ Long-term processes for addressing the changing landscape of communications established, alongside communications
expertise and ministry of health priorities.

Find out more about implementing strategic direction 6 in the country story in Annex 16 .

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Development and implementation of national action plans for infection prevention and control: practical guide

Strategic direction 7: research and

development
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 7 – refer to
Part 2, Table 2.8 .

Î Ensure you have considered all of the activities in Part 3A and focus on the action checks at
the end of each step.

Î Work through this section and you will have the elements that will support achievement of
the following national indicators for strategic direction 7 in the context of your IPC NAP.

Indicators

1. National research agenda and priorities for IPC developed.

2. Biennial number of scientific publications/publicly-available reports of research results on
priority IPC topics.

Context and considerations

• In some cases, national actions and action planning will be influenced by actions at the
global level.
• For example, one of the indicators of strategic direction 7 at the global level is the
development of a global IPC research agenda. This includes a research gap analysis based
on country needs, taking a multi-sectoral and multidisciplinary approach into account,
and with a focus on AMR, WASH, public health emergencies and low-resource settings.
Implementation of strategic direction 7 at the global level will be an important facilitator in
many countries for the achievement of the additional activities/considerations described
here, including achieving a national research agenda.
• Some of the activities and considerations across all strategic directions are linked in some
way and this is highlighted throughout the steps below.
• For example, the availability of resources and dedicated funds for IPC as described in
strategic direction 1 SD1 , or the possible integration of a IPC research agenda with other
programmes, such as AMR (particularly, antimicrobial stewardship and AMR surveillance
and monitoring through the One Health approach) or patient safety, as mentioned in
strategic direction 3 SD3 .

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 Part 3B. Implementation of each strategic direction

Step 1 – Preparing for action SD7

Leadership and organization

• Appoint lead(s) to develop the national research agenda by leveraging existing research expertise and
collaborating with representatives from other relevant areas, such as AMR, communicable diseases, WASH,
patient safety and quality of care.
• Establish the technical multidisciplinary committee/group that will have oversight over the national research
agenda (this might be from existing committees) and develop its terms of reference.
• Outline and present a specific meeting agenda item in overarching committees to support approval of the
methodology and the necessary steps for the development of the research agenda.

“Lack of data and lack of research funding are often a stumbling block to provide good
evidence for decision making.”

IPC leaders and experts from across all WHO regions

• Identify existing or upcoming collaboration opportunities for research proposals/activities, and/or regional
funding opportunities, for example, a national programme of patient safety, AMR research, or national funds for
health research.
• Engage with the IPC committee/group to examine methodologies for formulating research questions and
prioritization strategies (for example, consensus versus metrics) for undertaking studies aligned with local
needs and context, including integrating research findings into practice, that could be taken into consideration
as part of the national research agenda.

Stakeholder engagement
• Review the stakeholder list developed in Part 3A . Where relevant, explore and engage the main stakeholders
to drive forward development of the country-specific national research agenda and priorities for IPC. The same
stakeholders may also be those driving forward funding and the implementation of research projects on IPC in
selected facilities, according to local priorities.
• Identify organizations and/or academic institutions (both within the context of national ministries and among
external partners) in the country or in other supporting countries/regions with similar interests/needs required
for collaboration and any regulatory compliance regarding IPC research. This includes national research
councils, professional societies, international organizations and donors potentially providing research funding
(see also strategic direction 8 SD8 and the stakeholder mapping list).
• Involve additional stakeholders in generating new evidence to inform IPC policies and interventions, as
appropriate. For example, policy-makers, experts from different disciplines, implementing partners, industry,
civil society and patient representative groups.
• Identify any conflicts of interest with regards to the areas of IPC research and set out mitigation measures,
including ongoing committee governance of those involved in the research agenda.
• Explore the possibility of including research support staff and students in the research agenda work and
publications.

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Development and implementation of national action plans for infection prevention and control: practical guide

Finance and budgeting

• Explore the necessary research funding (if not already done so) as part of the IPC investment case and overall
NAP budget.

Other resource considerations

• Secure the availability of guidance and resources for effectively conducting various types of research and,
ideally, provide further contact details for addressing more specific queries.
• Explore the existence of systems/networks to be used to share information on IPC research (including drawing
on AMR approaches).
• Explore the data collection research mechanisms, valid tools available for conducting research, and all
associated human resource requirements.
• See additional tools and resources in Table 3B.24 .

“Professional societies, where they exist, can be engaged and should be involved to influence
and establish national research agendas around IPC, to help coordinate efforts and funding.”

Head of HAI and AMR and co-director of a WHO Collaborating Centre, WHO European Region

Step 2 – Baseline assessment SD7

Understand the current situation

• Review results from surveillance systems and reporting (where available) to recognize HAI trends that can be
addressed through establishing research priorities (see strategic direction 5 SD5 ).
• Undertake scoping exercises to identify IPC research gaps and priorities, including using focus groups and a
Delphi survey, if relevant, to define the priorities for a research agenda (74).
• Perform target group analysis to understand research needs and to identify different groups with special needs.
• Review and map the global research agenda on IPC-related topics (75-78) and other existing data and
literature on local, regional and global IPC gaps and research recommendations.
• Review all existing work undertaken in relation to the development of the AMR and patient safety research
agenda and map which elements can be replicated/adapted to the IPC research agenda.
• Use available self-assessment tools to determine readiness for research, for example, the self-assessment of
organizational readiness (nursing research capacity) tool (79).

Review and feedback results

• Outline all findings at established committees/groups.
• Present targeted feedback to stakeholders and other leaders.

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 Part 3B. Implementation of each strategic direction

Step 3 – Developing and implementing the plan SD7    

Establish priority areas for action using assessment results

• Discuss within the designated technical committee/group all the assessments results from step 2, including
those of the Delphi survey.
• Outline draft research priorities identified – matching research methods to your context – and hold targeted
discussions to reach consensus.
• Use available tools to support priority setting (80-85) and see Fig. 3B.1 .

Translate all findings into the IPC NAP

• Develop and publish the national research agenda on IPC.
• Highlight the steps to achieve the research agenda and a number of publications within the existing IPC NAP,
including defining clear objectives, timelines and validating any research tools to be used.
• Outline the necessary investment to conduct the research and issue publications. Refer to the WHO evaluation
methodology guide as an example (86).
• Outline the options for dissemination and implementation of any research output.
• Outline how the research work will include AMR (and any other related field) to ensure mutually beneficial
approaches and prevent duplication.
• Outline the specific steps to engage with stakeholders, for example, to align calls for proposals for research
funding linked to the national research agenda and local needs for IPC – address funding gaps.
• Outline incentives that are available to stimulate research.
• Outline the approach to implement research into practice.

“In our overall national action plan, we include a lot of research targets and have a big IPC
component in it.”

Head of HAI and AMR and co-director of a WHO Collaborating Centre, WHO European Region

“In Sierra Leone, we have identified research questions for specific IPC challenges and linked
these with AMR.”

WHO IPC focal point, Sierra Leone

Step 4 – Evaluating impact SD7

Maintain assessments
• Revisit research priority needs using scoping exercises, etc.
• Record the number of funded proposals, research grants, projects implemented and publications on IPC
achieved in the last year or biennium across the country, including understanding whether they respond to the
identified research priorities.

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Development and implementation of national action plans for infection prevention and control: practical guide

Review, feedback results and update the IPC NAP

• Report on progress at existing meetings and to all stakeholders.
• Reflect on how to further implement the research agenda and publication writing.
• Adjust the NAP as necessary.

Step 5 – Sustainability SD7   

Refresh the IPC NAP with a focus on sustainability

• Outline necessary activities to sustain implementation of the research agenda based on all learning in steps 1–4.
• Consider ways to continue to outline the importance of research to secure engagement and funding on a long-
term basis.
• Provide detailed information on evidence of progress to secure long-term research funding.
• Maintain meeting schedules and relationships, especially as workforce and stakeholder changes occur, as well
as to suit national priorities and opportunities for research activity.
• Align the publication work with a long-term communication and dissemination strategy.
• Continue to disseminate results of research and, in particular, implement discovered solutions/innovations on a
larger scale, following expert consensus about the quality of the research and the interventions’ demonstration
of effectiveness and cost-effectiveness.
• Utilise opportunities to establish and centrally coordinate research activities, including to address funding and
connect researchers.
• Enhance national competence, build the capacity of IPC leaders (other key stakeholders) through training and
networking opportunities for individuals in both scientific and policy fields.

“Research should be used strategically throughout the implementation process, and should be
aligned globally to ensure everyone is pulling in the same direction.”

Member of the Global IPC Network

Table 3B.24. Additional tools and resources*

• Ali M, Seuc A, Rahimi A, Festin M, Temmerman M. A global research agenda for family planning: results of an exercise for
setting research priorities. Bull World Health Organ. 2013;92:93-8. doi: 10.2471/BLT.13.122242.

• Jones J, Hunter D. Qualitative research: Consensus methods for medical and health services research. BMJ.
1995;311(7001):376. doi.org/10.1136/bmj.311.7001.376.

• Evans CT, Jump RL, Krein SL, Bradley SF, Crnich CJ, Gupta K et al. Setting a research agenda in prevention of healthcare-
associated infections (HAIs) and multidrug-resistant organisms (MDROs) outside of acute care settings. Infect Control Hosp
Epidemiol. 2018;39(2):210-3. doi.org/10.1017/ice.2017.291.

• Hensman‑Crook A, Farquharson L, Truman J , Angell C. What matters to you? Public and pIatient involvement in the design
stage of research. Res Involv Engage. 2024; 10:100. doi.org/10.1186/s40900-024-00610-1.

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 Part 3B. Implementation of each strategic direction

• Livorsi DJ, Evans CT, Morgan DJ, Reisinger HS, Safdar N, Suda KJ et al. Setting the research agenda for preventing infections
from multidrug-resistant organisms in the Veterans Health Administration. Infect Control Hosp Epidemiol. 2018;39(2):186-
8. doi: 10.1017/ice.2017.302.

• Livorsi DJ, Branch-Elliman W, Drekonja D, Echevarria KL, Fitzpatrick MA, Goetz MB, et al. Research agenda for antibiotic
stewardship within the Veterans’ Health Administration, 2024–2028. Infect Control Hosp Epidemiol. 2024; 1-7. doi: 10.1017/
ice.2024.6.

• Lynch P, Jackson M, Saint S. Research priorities project, year 2000: establishing a direction for infection control and
hospital epidemiology. Am J Infect control. 2001;29(2):73-8. doi: 10.1067/mic.2001.112734.

• Marschall J, Snyders RE, Sax H, Newland JG, Guimarães T, Kwon JH. Perspectives on research needs in healthcare
epidemiology, infection prevention, and antimicrobial stewardship: what's on the horizon-Part II. Antimicrob Steward
Healthc Epidemiol. 2023;3(1):e212. doi: 10.1017/ash.2023.474.

• Marschall J, Snyders RE, Sax H, Newland JG, Guimarães T, Kwon JH. Perspectives on research needs in healthcare
epidemiology and antimicrobial stewardship: what’s on the horizon–Part I. Antimicrob Steward Healthc Epidemiol.
2023;3(1):e199. doi: 10.1017/ash.2023.474.

• Perencevich EN, Harris AD, Pfeiffer CD, Rubin MA, Hill JN, Baracco GJ, et al. Establishing a research agenda for preventing
transmission of multidrug-resistant organisms in acute-care settings in the Veterans Health Administration. Infection
Control Hosp Epidemiol. 2018;39(2):189-95. doi: 10.1017/ice.2017.309.

• Polašek O, Wazny K, Adeloye D, Song P, Chan KY, Bojude DA, et al. Research priorities to reduce the impact of COVID-19 in
low-and middle-income countries. J Glob Health. 2022;12. doi: 10.7189/jogh.12.09003.

• Chalkidou K, Li R, Culyer AJ, Glassman A, Hofman KJ, Teerawattananon Y. Health Technology Assessment: Global Advocacy
and Local Realities Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative
Processes, Not Just More Evidence on Cost-Effectiveness". Int J Health Policy Manag. 2017;6(4):233-236. doi: 10.15171/
IJHPM.2016.118.

• Baltussen R, Jansen MP, Mikkelsen E, Tromp N, Hontelez J, Bijlmakers L et al. Priority Setting for Universal Health Coverage:
We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness. Int J Health Policy
Manag 2016; 5(11): 615–618. doi: 10.15171/ijhpm.2016.83.

• Smith M, Crnich C, Donskey C, Evans CT, Evans M, Goto M, et al. Research agenda for transmission prevention within the
Veterans Health Administration, 2024–2028. Infect Control Hosp Epidemiol. 2024:1-10. doi: 10.1017/ice.2024.40.

• Suda KJ, Livorsi DJ, Goto M, Forrest GN, Jones MM, Neuhauser MM, et al. Research agenda for antimicrobial stewardship
in the Veterans Health Administration. Infection Control Hospital Epidemiol. 2018;39(2):196-201. doi: 10.1017/ice.2017.299.

• The WHO Global Observatory on Health Research and Development is a comprehensive source of information and
analyses on global health research and development: https://www.who.int/observatories/global-observatory-on-health-
research-and-development.

• Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM et al. Introduction to a compendium of strategies
to prevent healthcare-associated infections in acute-care hospitals: 2022 updates. Infect Control Hosp Epidemiol. 2023;
44(10):1533-9. doi: 10.1017/ice.2023.158.

• Bertagnolio S, Dobreva Z, Centner CM, Olaru ID, Donà D, Burzo S et al. WHO global research priorities for antimicrobial
resistance in human health. Lancet Microbe. 2024; 5(11):100902. doi: 10.1016/S2666-5247(24)00134-4.

*All tools and resources were accessed on 10 April 2025.

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Development and implementation of national action plans for infection prevention and control: practical guide

Fig. 3B.1. Example of a research agenda development process (77)

Expert research
advisory panel
• The APIC report on Research gaps
impacting the practice of infection
prevention and control explains the
multi-step process undertaken to solicit
Membership survey #1
comprehensive input from individuals
working in IPC.

• The process spanned a period

of 6 months (see visual) and was
spearheaded by the establishment of an Membership survey #2
expert research advisory panel and the
inputs of national societies and public
health organizations.
Organization
and association
feedback

Barriers and facilitators

• Lack of available funds and resources to support research, including the existence of competing
priorities: countries can leverage international funding opportunities and collaboration networks.
This can involve engaging with small research projects in selected facilities or academic institutions
already receiving research funding, thus allowing the development of initial results that can support
further funding, or partnering with organizations, research institutions, professional and scientific
and societies, key partners and donors. This could also include partnerships with other countries or
international research consortia for the development of national and international research projects.
Consider cross-sectoral funding opportunities and prioritize proposals that address the identified
research gaps. Explore public-private partnerships: governments can seek to establish public-private
partnerships where private sector companies contribute to funding IPC research.
• Time constraints and lack of expertise, including lack of skills and knowledge can prevent health
care professionals from engaging in research activities: engaging established research networks and
collaborating with academic institutions and health care facilities that already have strong research
foundations can help pool expertise and share knowledge. Promoting interdisciplinary collaboration
between different professionals (for example, IPC, epidemiology, public health, microbiology)
can help to bridge knowledge gaps and enhance research capabilities. In addition, developing
mentorship programmes for less experienced staff can build research expertise over time. Securing
dedicated research coordinators or assistants to assist with research activities can also improve
capacity. Finally, leveraging the use of online training platforms and tools can support professionals
to enhance their skills without requiring a significant time commitment, as can promoting the

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 Part 3B. Implementation of each strategic direction

importance of undertaking such activities to meet international recommendations and to address

critical gaps in preventable harm.
• Lack of collaboration: seek out other groups working on similar topics, while maintaining a unique
IPC research agenda that takes into account local priorities and gaps.
• No existing mechanisms in place to record research outputs: consider creating a national or
regional repository of published papers and scientific reports and add as a requirement for any
funding opportunities to regularly record the research output.

Table 3B.25. Action checks

☑ Technical multidisciplinary committee/group established, lead appointed and terms of reference and meeting schedule
outlined.
☑ Collaboration with organizations/research institutions/groups established.
☑ Specific expertise including relevant stakeholders secured, and potential facilities/academic institutions identified.
☑ Assessment, scoping and prioritization exercises conducted, particularly to identify gaps.
☑ Funding identified and secured, including in collaboration with other programmes, for example, AMR, WASH, and patient
safety.
☑ IPC research agenda formulated, including identifying priorities.
☑ Steps to achieve the IPC research agenda and publications taken, including inclusion in other NAPs/programmes of work.
☑ Research projects and publications recorded and reported and a dissemination strategy outlined.
☑ IPC NAP updated to reflect agenda implementation.

☑ Long-term engagement and funding for IPC research fostered.

Find out more about implementing strategic direction 7 in the country story in Annex 17 .

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Development and implementation of national action plans for infection prevention and control: practical guide

Strategic direction 8: collaboration and

stakeholder support
Instructions

Î To recap on the actions, indicators and targets for achieving strategic direction 8 – refer to
Part 2, Table 2.9 .

Î Ensure that you have considered all of the activities in Part 3A and focus on the action checks
at the end of each step.

Î Work through this section and you will have the elements that will support achievement of
the following national indicators for strategic direction 8 in the context of your IPC NAP.

Indicators

1. National IPC stakeholders’ mapping exercise performed and available (2026) and
mechanisms in place for regular updates.
2. National agenda for collaboration to improve a collaborating agenda on IPC developed (by
2028).
3. Profiles of IPC national stakeholders (such as organizations, societies, partners, donors
supporting and/or working on IPC) regularly updated (by 2030).
4. Number of joint IPC activities with national IPC stakeholders in line with the NAP and local
needs and context (2030).

Context and considerations

• In some cases, national actions and action planning will be influenced by actions at the
global level.
• For example, one of the indicators of strategic indicator 8 at the global level is the
undertaking of a global and regional mapping exercise with mechanisms in place for
regular updates. In many countries, this will be an important factor in the successful
development and implementation of a national mapping exercise.
• A number of the key actions within strategic direction 8 are linked with or dependent on
actions within all of the other strategic directions, especially strategic direction 3 SD3 .

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 Part 3B. Implementation of each strategic direction

Explaining some key terms

• Collaboration agenda – a framework for engaging identified stakeholders in a collaborative effort

to support IPC action and improvements in line with the NAP.
• Stakeholders – those with an interest in or influence over the issue. Defining the role of
stakeholders is important for successful stakeholder engagement (9).
• Stakeholder mapping – forms the first step in securing multi-stakeholder engagement, developing
a collaboration agenda and, importantly, multi-sectoral action (see also strategic direction 3 SD3 ).
Stakeholder mapping is a way to learn the perspectives of stakeholders, the affiliation area they
represent, and what interests and/or influences they bring to the issue (9). It offers a structured
approach for gathering and assessing information on different stakeholders who are relevant to
implementation of the IPC NAP (policy, strategy or intervention).
• A national multi-sectoral taskforce – an entity that spans sectors outside of those usually
involved in national IPC committees and may include technical, policy and civil society actors,
including partners and non-governmental organizations. Such an entity may also involve the
private sector, insurers and community representatives.

Step 1 – Preparing for action SD8

Leadership and organization

• Confirm that the team (described in Part 3A ) leading on IPC NAP development and implementation includes
within its remit: (a) the development of a collaborating agenda on IPC; (b) the undertaking and maintenance
of a national stakeholder mapping exercise; and (c) the establishment and maintenance of a national multi-
sectoral/multi-partner taskforce on IPC/WASH in health care facilities (if such an entity does not already
exist). Where existing multi-sectoral entities exist, for example, as part of the One Health agenda, IPC may be
addressed within this.
• Explore whether the WHO country office and other entities (such as UNICEF) could play a key role to support you
and the IPC team in the coordination of IPC efforts in the country.
• Review accountability for the taskforce and collaboration agenda as part of governance structures to ensure
effective, transparent and inclusive collaboration. This will include evaluation reporting to existing groups, if
they are not already part of other IPC programmatic work/committees.
• Explore and confirm the expertise available to undertake effective IPC collaboration efforts (see also strategic
direction 4 SD4 and strategic direction 6 SD6 ).
• Use/adapt existing terms of reference to inform the development/maintenance of the multi-sectoral/multi-
partner taskforce on IPC, including WASH, in health care facilities. Draw on previous actions and examples of
multi-sectoral taskforces/entities, for example, in the context of a One Health approach (87). The lessons
learned from countries on the tools and tactics needed to establish and sustain multi-sectoral collaboration for
AMR action are reproduced in Table 3B.26 and the conditions required are summarised in Fig. 3B.2 .

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Development and implementation of national action plans for infection prevention and control: practical guide

Table 3B.26. Lessons learned from focal country experience on the tools and tactics needed to establish and
sustain multi-sectoral collaboration for AMR action
Tool and tactis Lessons learned from focal country experience

Political
commitment • Political commitment and leadership are critical to drive the AMR agenda, mobilize resources, and
achieve action.

• Progress will not happen without someone in government at the right level, with the right decision-
making authority, to drive action on AMR.

• AMR data, champions and events can serve to raise AMR’s profile and keep it on the political agenda.

• Legal instruments, including presidential orders and international agreements, can be leveraged to
give AMR political visibility.

Resources
• It takes time, money, technical assistance and dedicated human resources to coordinate across
sectors and secure mutual trust, ownership and collaboration.

• Development partners have proven a strong source of support, especially in getting early AMR
efforts off the ground.

• In the long term, governments must take the lead in resourcing NAPs and funding activities to
combat AMR.

• In many countries, those responsible for AMR may require training and support to coordinate all
relevant stakeholders effectively.

Governance
mechanisms • Because AMR is a multisectoral issue, a NAP will necessarily be a ‘plan of plans’; that is, a plan linked
to many existing plans and programmes.

• There is no one-size-fits-all approach to AMR governance: countries must establish structures and
mechanisms to suit their own situations.

• To be effective in tackling AMR, governance structures should enable both vertical and horizontal
multisectoral collaboration.

• Whatever approach countries take to coordinating AMR, good communication and consultation is
essential for successfully cascading action from governing bodies to implementing units.

Practical
management • Clear institutional mandates, roles and deliverables strengthen the transparency and accountability
of NAP implementation efforts.

• Coordination can be smoothed by anticipating potential problems and developing practical

solutions in advance.

• Regular progress updates or technical briefings help keep politicians and collaborators informed,
interested and engaged.

• AMR initiatives can build on existing programmes and activities by: using existing structures, such
as One Health committees, for coordination; and linking to broader plans, such as Universal Health
Coverage, to leverage AMR action.

• A simple monitoring framework and feedback mechanism can help track progress and keep
collaborators on course.

Abbreviations: AMR, antimicrobial resistance; NAP, national action plan.

Source: WHO (87).

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 Part 3B. Implementation of each strategic direction

Fig. 3B.2. Creating the conditions needed to foster multi-sectoral collaboration takes time, money, people
power and technical assistance

Joint commitment
Trust and recognition

PEOPLE TIME Mutual respect

Focal points

MONEY TECH
SUPPORT

Sustained action New thinking

Creating the
conditions needed
to foster Early groundwork Skills and capacity
multisectoral
collaboration takes
time, money,
people power and
technical
assistance.
Source: WHO (87).

• Investigate how to ensure that the multi-sectoral taskforce can be chaired by a senior official (ministry-level) on
an ongoing basis to acknowledge the importance of collaborations with IPC.
• Draft/update objectives for the collaborating agenda, including how to address joint activities with stakeholders
in line with local needs, and the potential impact of coordinated efforts. This could be done while working with
leaders from other programmes of work on this, if appropriate.
• Outline roles and responsibilities for ongoing stakeholder mapping exercises, including mechanisms and a
timeline for updates that reflect the profiles of national stakeholders.
• Prepare to communicate on the national collaborating agenda (see also strategic direction 6 SD6 ).
• See additional tools and resources in Table 3B.27 .

Stakeholder engagement
• Refer to Part 3A , gather the stakeholder list and mapping matrix developed (if already done).
• Consider all stakeholders, including those to be added to existing list, if appropriate.
• Revisit the process for stakeholder engagement approvals.
• Revisit the tools introduced in Part 3A which are critical to your successful stakeholder engagement (8, 25). The
WHO implementation handbook for NAPs on AMR (10) includes a list of essential people skills for an effective
collaboration (page 11), a sample terms of reference (page 59), and an example of a stakeholder analysis (Annex 3).

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Development and implementation of national action plans for infection prevention and control: practical guide

Finance and budgeting

• Align necessary funding with the IPC investment case and overall IPC NAP budget to address activities
necessary for IPC collaborations. For example, activities that might require resources to collaborate on IPC in
the overall national agenda for patient safety (see strategic direction 1 SD1 and strategic direction 6 SD6 ).

Step 2 – Baseline assessment SD8   

Understand the current situation

• Analyse and critique the stakeholder mapping exercise undertaken in Part 3A . Review existing and potentially
new stakeholders from a range of sources to assess their influence.
• If the stakeholder mapping has not already been undertaken as outlined in Part 3A, undertake it now.
• Collate all notes/data/other information available from, for example, existing stakeholder meetings and analyse
the collaborative activities.
• Conduct exercises with priority stakeholders to discuss their scope of work and projects related to IPC and WASH
in health care facilities and potential priorities for collaboration. For example, a desk exercise and consultations to
collate current activities and determine their interest and potential role in supporting the IPC NAP going forward.

Review and feedback the results

• Present and share all findings at existing meetings, ensuring inclusivity of all stakeholders.

Step 3 – Developing and implementing the national

collaborating agenda SD8

Establish priority areas for action using assessment results

• Refer to the stakeholder mapping table and focus on the columns ‘priority of engagement’ and ‘role and type
of engagement’ to clarify that these are being met and what might be improved in order to develop an agreed
collaboration agenda.
• Further analyse how meeting and exploratory exercise information might be used to engage stakeholders, to
secure targeted collaborative working, and to help meet the proposed collaboration agenda.
• Review the existing stakeholder mapping list at meetings to highlight priority collaborations for example.
• Discuss the priorities contained within the IPC NAP spanning all strategic directions to further inform the
collaboration agenda and meet proposed objectives.

Translate all findings into the IPC NAP

• Develop the collaboration agenda aligned with and as part of the IPC NAP priorities and country needs (see
example below in Box 3B.5 ).

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• Outline a plan for regular stakeholder mapping updates (at least annually) to meet the collaboration agenda
objectives – including in the IPC NAP. The aim of this is to ensure that it includes relevant, current sectors
outside of IPC that would be applicable to effective collaborations and to meet the national collaboration
agenda. Refer to tools and resources used in Part 3A, step 2.
• Describe in detail the agreed collaboration agenda activities and include as part of the overall IPC NAP to
outline how they will be achieved and based on identified priorities. Include specific common goals, objectives,
indicators, metrics and timeline, and the approach for the collaborating agenda, both vertical (within a sector)
and horizontal (between sectors).
• Outline the mechanism for reporting and approvals.
• Outline a range of different methods for maintaining stakeholder collaboration engagement and activities,
monitoring and reporting, for example, face-to-face/virtual meetings at the taskforce level or in sub/working
groups.
• Outline the plans to maintain the regular convening of all identified stakeholders to ensure a functioning multi-
sectoral/multi-partner taskforce.
• Confirm the multi-sectoral taskforce coordination mechanism, roles and responsibilities and meeting agenda in
line with the collaboration agenda objectives.
• Describe the exact monitoring plans to outline the number of joint IPC activities with stakeholders.
• Outline and promote ways for stakeholders to knowledge exchange, for example, using existing communities of
practice, etc.
• Outline and describe ways to promote existing IPC guidance and other such resources, for stakeholders to drive
country support that meets IPC standards and needs (see also strategic direction 2 SD2 ).

“Driven by an empowered workforce and community, and based on a network of civil society
leaders, multi-stakeholder collaborations with aligned strategies are seen as another means to
raise awareness and push policymakers to taken action.”

IPC leaders and experts from across all WHO regions

Box 3B.5. Example of a structure of a national stakeholder collaboration agenda for IPC

The following headings can be used/adapted to form the basis of a collaboration agenda. Add in local
information and use the template to facilitate discussions in relation to an IPC collaboration agenda.

1. Introduction

• Purpose: outline the goals of multi-sectoral collaboration for IPC.

• Scope: define the problem that the collaboration agenda will contribute to tackling.
• Alignment: link with national health plans, global health goals (for example, WHO, Sustainable
Development Goals).

2. Formation of the national multi-sectoral taskforce

• Taskforce composition: identify representatives from different sectors.

• Leadership structure: specify the chairperson and governance framework.
• Terms of reference: outline the objectives, roles, and functions of the taskforce.
• Meeting frequency: list likely frequency of meetings.

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Development and implementation of national action plans for infection prevention and control: practical guide

3. Stakeholder engagement and mapping

• Key stakeholders: list the relevant stakeholders involved in IPC collaboration according to the results
of the stakeholder mapping exercise.
• Mapping mechanism: maintain a dynamic database of stakeholders.
• Engagement strategy: describe strategies to be employed.

4. Objectives and priorities

• Set short- and long-term goals: within the remit of the IPC NAP according to baseline assessment
results, identify areas where collaboration needs to be strengthened.

5. Assimilate the collaboration plan within the IPC NAP

• Collaborative activities: detail collaborative projects and joint initiatives.

• Communication strategy: explain how stakeholders will stay informed and engaged.
• Activities and timelines: clearly define actions with deadlines.
• Resource allocation: address budget requirements.
• Monitoring and reporting: outline data collection methods, reporting frequency, evaluation criteria.
• Review mechanism: develop periodic evaluation reports with recommendations for improvement
according to agreed reporting mechanisms.
• Sustainability plan: strategies to ensure long-term impact beyond initial project cycles.

6. Conclusion and next steps

• Summary of commitments from each stakeholder.

• Next steps for immediate implementation.
• Call for ongoing collaboration to sustain IPC improvements according to IPC NAP.

Abbreviations: IPC, infection prevention and control; NAP, national action plan.

Step 4 – Evaluating impact SD8

Maintain assessments
• Use the IPC NAP and current stakeholder mapping and collaboration agenda to guide evaluation activities to
provide taskforce and stakeholder reports.
• Activate follow up assessments, that is, those in step 2, including revisiting the mapping exercise. Review the
ongoing availability and willingness of stakeholder groups to participate in the national collaborating agenda.
• Assess the number of taskforce meetings and review the meeting notes with a view to discuss whether main
action points were achieved.
• Collate and describe the number of collaborations and specific implementation and improvement projects and
outputs.
• Analyse and present on financial contributions put towards collaboration activities.
• Establish any impact on the overall improvement of IPC based on stakeholder collaborations and include within
periodic reports (see also strategic direction 5 SD5 ).

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Review, feedback results and update the IPC NAP

• Provide progress reports to the multi-sectoral taskforce on all aspects of collaboration and discuss how to
further meet the objectives outlined in the agenda.
• Adjust the IPC NAP as necessary.
• Adjust the collaborating agenda as necessary.
• Adjust the multi-sectoral taskforce terms of reference and coordination mechanism, as necessary.
• Confirm the ongoing stakeholder mapping exercise update, as necessary.

Step 5 – Sustainability SD8   

Refresh the IPC NAP with a focus on sustainability

• Outline ongoing collaborations over the long-term, including through mapping exercises.
• Refresh the role of the multi-sectoral taskforce as necessary, driven by changing landscapes, stakeholder group
priorities and availability. Be prepared to move to other stakeholders if evaluations show collaboration and
support is not helping to meet the IPC NAP objectives and targets in order to keep the multi-sectoral taskforce
functioning and delivering.
• Share examples of the collaboration agenda successes widely (links with strategic direction 6 SD6 ).
• Confirm that the overall IPC NAP is part of the national health plans to further enhance collaborations over the
long term (see also strategic direction 1 SD1 and strategic direction 2 SD2 ).

“Small island states in the PAHO region are a good example of well-organized top-down
systems where local champions are key, but who have also created a community of practice to
share experiences, exchange professionals and share knowledge.”

WHO Regional Focal Point, PAHO, Region of the Americas

Table 3B.27. Additional tools and resources*

• Improving infection prevention and control at the health facility: interim practical manual supporting implementation
of the WHO guidelines on core components of infection prevention and control programmes. Geneva: World Health
Organization; 2018 (https://iris.who.int/handle/10665/279788). Licence: CC BY-NC-SA 3.0 IGO.

• Interim practical manual: supporting national implementation of the WHO guidelines on core components of
infection prevention and control programmes. Geneva: World Health Organization; 2017 (https://iris.who.int/
handle/10665/330073). Licence: CC BY-NC-SA 3.0 IGO.

• Health in all policies as part of the primary health care agenda on multisectoral action. Geneva: World Health Organization;
2018 (https://iris.who.int/handle/10665/326463). Licence: CC BY-NC-SA 3.0 IGO.

• Bennett S, Glandon D, Rasanathan, K. Governing multisectoral action for health in low-income and middle-income
countries: unpacking the problem and rising to the challenge. BMJ Glob Health 2018; 3(Suppl 4); e000880. doi.org/10.1136/
bmjgh-2018-000880.

• Draft workplan for the global coordination mechanism on the prevention and control of NCDs, 2022-2025. Geneva: World
Health Organization; 2022 (https://cdn.who.int/media/docs/default-source/documents/gcm-ncd-zero-draft-2022-2025-
workplan.pdf?sfvrsn=7b4741f_12).

*All tools and resources were accessed on 10 April 2025.

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Barriers and facilitators

• Lack of accountability and leadership to achieve the collaborative agenda: the role of the WHO
country office in supporting the mapping exercises and to set up/maintain collaborations can be
effective in some countries to engage the government at different levels and secure approvals for
collaborative activities, where necessary.
• Lack of promotion of the benefits of a collaboration agenda and joint actions: use of targeted
communications in different formats to reach stakeholders and achieve awareness about the IPC
NAP, other IPC documents, and country needs should be a priority as part of the collaborative
agenda; this links with the advocacy strategy and implementation plan (see strategic direction 6 SD6 ).
• Stakeholders unwilling to be part of the collaborating agenda: winning the hearts and minds of
‘reluctant’ stakeholders will take time and requires a strong narrative on the value of collaboration.
Use other examples where they exist.
• Perception of too many stakeholders involved and that engagement with all will therefore be
a challenge: be sure to revisit the stakeholder mapping and focus on how prioritization has been
undertaken. Priority stakeholders, that is, those to be engaged first, should be those with a high
level of influence over the particular action outlined in the IPC NAP. All stakeholders will likely
contribute to implementing different aspects of the IPC NAP through collaborative activities.
However, it is important to consider the level and phase at which they should be engaged.

Table 3B.28. Action checks

☑ A team with expertise to effectively engage stakeholders in collaborations, and from within the IPC programme, identified
and established.
☑ All current, relevant stakeholders to be part of the collaborative agenda mapped and engaged, including leveraging other
key, influential organizations.
☑ A multisectoral taskforce, with terms of reference and which has a senior, official chairperson and strong focus on IPC and
WASH, established, maintained and convened at regular intervals, with governance and accountability revisited to ensure
transparency and effectiveness in any collaborations.
☑ Assessments, including stakeholder exercises, undertaken.
☑ A collaboration agenda outlined, shared and discussed, and an update schedule agreed.
☑ Joint actions clearly articulated, in line with country needs and IPC standards, and reports provided.
☑ Dedicated funding secured, if deemed necessary and aligned with IPC investment case.
☑ Review dates for updating the stakeholder mapping set and conducted and follow-up evaluations performed.
☑ Taskforce role refreshed, as necessary.

☑ IPC NAP updated to reflect mapping and collaboration agenda implementation.

☑ Success stories shared collaborations promoted into national health plans.

Find out more about implementing strategic direction 8 in the country story in Annex 18 .

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operations/international-health-regulations-monitoring-evaluation-framework/joint-external-evaluations).
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infections-point-prevalence-survey-version6-1.pdf).
65. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units.
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sites/default/files/documents/HAI-Net-ICU-protocol-v2.2_0.pdf).
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hand-hygiene-day).
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Agriculture Organization, United Nations Environment Programme & World Organisation for Animal Health;
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76. Research gaps in patient and healthcare personnel safety. Priority research questions to drive improvements.
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associated-infections/media/pdfs/DHQPs-Research-Questions-508.pdf).
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improvements. Arlington, VA: Association for Professionals in Infection Control and Epidemiology (APIC);
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79. Self-assessment of organisational readiness tool (SORT). A guide to improving nursing research capacity
in health and care. Redditch: NHS England; 26 April 2024 (https://www.england.nhs.uk/long-read/self-
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82. Montorzi G, de Haan S, IJsselmuiden C. Priority setting for research for health. Geneva, Council on Health
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approach_August_2010.pdf).
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84. Okello D, Chongtrakul P, the COHRED Working Group on Priority Setting. A manual for research priority setting
using the ENHR approach. Geneva: Council on Health Research Development (COHRED); 2000 (http://www.
cohred.org/publications/library-and-archive/a_manual_for_researc_1_0/).
85. Ghaffar A, Collins T, Matlin SA, Olifson S. The 3D Combined Approach Matrix (CAM). An improved tool for
setting priorities in research for health. Geneva: Global Forum for Health Research; 2009 (https://www.files.
ethz.ch/isn/111447/2009_The-3D-Combined-Approach-Matrix.pdf).
86. WHO training package on environmental cleaning: evaluation methodology guide. Geneva: World Health
Organization; 2024 (https://iris.who.int/handle/10665/379551). License: CC BY-NC-SA 3.0 IGO.
87. Tackling antimicrobial resistance (AMR) together. Working paper 1.0: Multisectoral coordination. Geneva:
World Health Organization; 2018 (https://iris.who.int/handle/10665/336975). Licence: CC BY-NC-SA 3.0.

1
All references were accessed on 10 April 2025.

138
Annexes

Useful templates, reading

and country stories
Supplementary materials related to
Parts 1-3 to support the implementation
journey.
Development and implementation of national action plans for infection prevention and control: practical guide

Annex 1.
IPC core components and the eight strategic directions

IPC core components

1. IPC programmes
2. Evidence-based guidelines
3. Education and training
4. HAI surveillance
5. Multimodal strategies
6. Monitoring and audit of IPC practices and feedback
7. Workload, staffing and bed occupancy (for facility level)
8. Built environment, materials and equipment for IPC (for facility level)

IPC PROGRAMMES
and all relevant programme linkages

MONITORING,
GUIDELINES EDUCATION SURVEILLANCE AUDIT AND
AND TRAINING
FEEDBACK

ENABLING ENVIRONMENT
WORKLOAD, STAFFING, AND BED OCCUPANCY

BUILT ENVIRONMENT, MATERIALS AND EQUIPMENT

MUL IES
TIMODAL STRATEG

Source: WHO (1).

140
 Annexes

Summary of national-level IPC core components

1. IPC programmes: active, stand-alone, national IPC programmes with clearly defined objectives, functions
and activities should be established for the purpose of preventing HAI and combating AMR through IPC
good practices. National IPC programmes should be linked with other relevant national programmes and
professional organizations.
2. Evidence-based guidelines: these guidelines should be developed and implemented for the purpose of
reducing HAI and AMR. The education and training of relevant health and care workers on the guideline
recommendation and the monitoring of adherence with the recommendations should be undertaken to
achieve successful implementation.
3. Education and training: the national IPC programme should support the education and training of the
health workforce as one of its core functions.
4. HAI surveillance: national HAI surveillance programmes and networks that include mechanisms for timely
data feedback should be established to reduce HAI and AMR, with the potential to be used for benchmarking
purposes.
5. Multimodal strategies: national IPC programme should coordinate and facilitate the implementation of IPC
activities through multimodal strategies on a nationwide or sub-national level.
6. Monitoring and audit of IPC practices and feedback: a national IPC monitoring and evaluation programme
should be established to assess the extent to which standards are being met and activities are being
performed according to the programme’s goals and objectives. Hand hygiene monitoring with feedback
should be considered as a key performance indicator at the national level.
Abbreviations: IPC, infection prevention and control; HAI, health care-associated infection; AMR, antimicrobial resistance.

Eight strategic directions for country action to improve IPC

Strategic directions

Political commitment
SD1 and policies SD5 Data for action

Advocacy and
SD2 Active IPC programmes SD6 communications

Research and
SD3 Active IPC programmes SD7 development

IPC Knowledge Collaboration and

SD4 and career pathways SD8 stakeholders’ support

Abbreviations: IPC, infection prevention and control; SD, strategic direction.

Source: WHO (2).

141
Development and implementation of national action plans for infection prevention and control: practical guide

Mapping the strategic directions to each of the core components

There is a natural relationship and interconnectedness between each of the strategic directions and the core
components and minimum requirements. Table A1.1 maps the core component to the relevant strategic direction.
In some cases, multiple core components are relevant to and aligned with the strategic direction.

Table A1.1. Mapping core components to the strategic directions

Strategic direction Core component

SD1: political commitment and CC 1 IPC programmes

policies

SD2: active IPC programmes Relevant to all, with specific reference to:
CC 1 IPC programmes
CC 2 National and facility level IPC guidelines
CC 5 Multimodal strategies for implementing IPC activities

SD3: IPC integration and CC 1 IPC programmes

coordination

SD4: IPC knowledge among health CC 3 IPC education and training

and care workers and career
pathways for IPC professionals

SD5: data for action CC 4 HAI surveillance

CC 6 Monitoring/audit of IPC practices and feedback and control
activities

SD6: advocacy and communication CC 5 Multimodal strategies for implementing IPC activities

SD7: research and development CC 1 IPC programmes

SD8: collaboration and stakeholder CC 1 IPC programmes

support CC 5 Multimodal strategies for implementing IPC activities
CC 6 Monitoring/audit of IPC practices and feedback and control
activities

Abbreviations: SD, strategic direction; CC, core component; IPC, infection prevention and control; HAI, health care-associated infection.

Reference
1. Guidelines on core components of infection prevention and control programmes at the national and acute
health care facility level. Geneva: World Health Organization; 2016 (https://iris.who.int/handle/10665/251730).
Licence: CC BY-NC-SA 3.0 IGO
2. Global strategy on infection prevention and control. Geneva: World Health Organization; 2023.(https://iris.who.
int/handle/10665/376751). Licence: CC BY-NC-SA 3.0 IGO.

142
 Annexes

Annex 2.
Key WHO documents

Global
strategy
on infection
Global strategy on infection prevention and control: approved
prevention
and control by all Member States, the strategy vision that by 2030, everyone
accessing or providing health care is safe from associated
infections, serves as the backbone of the WHO GAPMF and was
adopted by all countries at the Seventy-seventh World Health
Assembly in May 2024 (1).

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Global action plan and monitoring framework: the eight

strategic directions indicated in the WHO global strategy are
critical to achieve improvement in IPC. The GAPMF describes
actions, indicators and targets to achieve the effective
implementation of these strategic directions and to track and
report progress over time through 2030 at the global, national,


sub-national and facility level (2).
62

1. IPC PROGRAMMES
Core components for IPC programmes: evidence- and expert
and all relevant programme linkages

consensus-based guidelines for developing effective IPC

2. GUIDELINES 3. EDUCATION
AND TRAINING
4. SURVEILLANCE
6. MONITORING,
AUDIT AND
FEEDBACK programmes, including six core components recommended
ENABLING ENVIRONMENT
at the national and facility levels and two additional core
7. WORKLOAD, STAFFING AND BED OCCUPANCY

8. BUILT ENVIRONMENT, MATERIALS AND EQUIPMENT

components specific to the facility level, including WASH (3).
5. M IES
U LT I
M O D AL S TR ATE G

Minimum requirements for IPC programmes: standards that

should be in place in all countries and all health care facilities,
based on the IPC core components (4).

143
Development and implementation of national action plans for infection prevention and control: practical guide

Part II: How to Successfully Implement Each Core Component of an IPC Programme

Implementation manual for the core components for

Interim Practical IPC programmes (national): practical manual to support
Manual supporting
national implementation implementation of the guidelines on core components for IPC
of the WHO Guidelines
on Core Components
of Infection Prevention
programmes at the national level (5).
and Control Programmes

Interim Practical Manual supporting national implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes 1

Implementation manual for the core components for IPC

programmes (facility level): practical manual to support
IMPROVING INFECTION implementation of the guidelines on core components for IPC
PREVENTION AND CONTROL
AT THE HEALTH FACILITY

Interim practical manual supporting implementation

programmes at the facility level (6).
of the WHO Guidelines on Core Components of Infection
Prevention and Control Programmes

GLOBAL PATIENT SAFETY ACTION PLAN 2021–2030

Global patient safety action plan 2021–2030: towards

Towards eliminating avoidable
harm in health care

eliminating avoidable harm in health care: provides strategic

direction for eliminating avoidable harm in health care and
improving patient safety through policy actions, as well as for
implementation of recommendations at the point of care (7).

Framework and toolkit for IPC in outbreak preparedness,

readiness and response: a practical framework of actions and a
toolkit to assist in the development of local contingency or action
plans for strengthening IPC outbreak preparation, readiness and
response at the national and facility level (8).

144
 Annexes

HAI surveillance practical handbook: comprehensive guidance

to design and implement effective surveillance systems to
measure the burden of HAI and take action for its prevention. It
also includes WHO HAI surveillance case definitions for use in
low-resource settings (9).

WHO implementation
handbook for national WHO implementation handbook for national action plans
action plans on
antimicrobial resistance
Guidance for the human health sector
on antimicrobial resistance: guidance for the human
health sector: provides a practical, stepwise approach to the
implementation of the national action plans on AMR and a
process and collation of existing WHO tools to prioritize, cost,
implement, monitor and evaluate NAP activities (10).

Water and Sanitation for Health Facility Improvement Tool

(WASH FIT): a risk-based, quality improvement tool for health
care facilities, covering standards and indicators of WASH and
health care waste management services, and selected aspects of
energy, building and facility management (11).

QUALITY HEALTH SERVICES

A PLANNING GUIDE

Quality health services: a planning guide: focuses on actions

required at the national, district and facility levels to enhance
quality of health services, providing guidance on implementing
key activities at each of these three levels (12).

145
Development and implementation of national action plans for infection prevention and control: practical guide

Implementation playbook,
pocket edition

Implementation playbook, pocket edition: a quick-reference

A quick-reference guide to delivering impact
for health, with tools and templates

guide to delivering impact for health, with tools and templates:

designed to support effective implementation to achieve
measurable progress toward health-related targets. Includes
multiple tools to support implementation (13).

Abbreviations: GAPMF, global action plan and monitoring framework; WASH, water, sanitation, waste management and hygiene; IPC, infection
prevention and control; HAI, health care-associated infection; AMR, antimicrobial resistance; NAP, national action plan.

References*
1. Global strategy on infection prevention and control. Geneva: World Health Organization; 2023 (https://iris.who.
int/handle/10665/376751). Licence: CC BY-NC-SA 3.0 IGO)
2. Global action plan and monitoring framework on infection prevention and control (IPC), 2024–2030. Geneva:
World Health Organization; 2024 (https://cdn.who.int/media/docs/default-source/integrated-health-services-
(ihs)/ipc/ipc-global-action-plan/who_gampf_w_annexes.pdf?sfvrsn=aef723f7_3).
3. Guidelines on core components of infection prevention and control programmes at the national and acute
health care facility level. Geneva: World Health Organization; 2016 (https://iris.who.int/handle/10665/251730).
Licence: CC BY-NC-SA 3.0 IGO.
4. Minimum requirements for infection prevention and control programmes. Geneva: World Health Organization;
2019 (https://iris.who.int/handle/10665/330080). Licence: CC BY-NC-SA 3.0 IGO.
5. Interim practical manual: supporting national implementation of the WHO guidelines on core components of
infection prevention and control programmes. Geneva: World Health Organization; 2017 (https://iris.who.int/
handle/10665/330073). Licence: CC BY-NC-SA 3.0 IGO.
6. Improving infection prevention and control at the health facility: interim practical manual supporting
implementation of the WHO guidelines on core components of infection prevention and control programmes.
Geneva: World Health Organization; 2018 (https://iris.who.int/handle/10665/279788). Licence: CC BY-NC-SA 3.0
IGO.
7. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Geneva: World
Health Organization; 2021 (https://iris.who.int/handle/10665/343477). Licence: CC BY-NC-SA 3.0 IGO.
8. Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and response
at the national level. Geneva: World Health Organization; 2021 (https://iris.who.int/handle/10665/345251).
9. Surveillance of health care-associated infections at national and facility levels: practical handbook. Geneva:
World Health Organization; 2024 (https://iris.who.int/handle/10665/379248). Licence: CC BY-NC-SA 3.0 IGO.
10. WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human
health sector. Geneva: World Health Organization; 2022 (https://iris.who.int/handle/10665/352204). Licence:
CC BY-NC-SA 3.0 IGO.

146
 Annexes

11. Water and sanitation for health facility improvement tool (WASH FIT). Second edition. Geneva: World Health
Organization & United Nations Children’s Fund (UNICEF); 2022 (https://iris.who.int/handle/10665/353411).
Licence: CC BY-NC-SA 3.0 IGO.
12. Quality health services: a planning guide. Geneva: World Health Organization; 2020 (https://iris.who.int/
handle/10665/336661. Licence: CC BY-NC-SA 3.0.
13. Implementation playbook, pocket edition: a quick-reference guide to delivering impact for health, with tools
and templates. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/376467). Licence:
CC BY-NC-SA 3.0 IGO.
* All references were accessed on 10 April 2025.

147
 Annex 3.
148

Development and implementation of national action plans for infection prevention and control: practical guide
Stakeholder mapping grid
Based on the WHO stakeholder mapping guide and tools (1).

Names of organizations/entities have been included for illustration – amend according to local situation.
Name of Name of contact Level of Type of influence Priority of Role and type of engagement Strategic
organization/entity person (title/level) influence engagement direction of
relevance
Ministry of health All

Non governmental All

organizations

Professional societies All

Government agencies All, 2

Political leaders, All

national

Political and All, 2, 5

government and
health care leaders
(sub-national)

Health care leaders All, 2

(national and facility)
 Name of Name of contact Level of Type of influence Priority of Role and type of engagement Strategic
organization/entity person (title/level) influence engagement direction of
relevance
IPC and other focal All
points/leaders in the
ministry of health

Focal points for All

IPC and/or other
responsible person(s)
in WHO regional and
country offices

National IPC All

committee

Focal points for All, 2, 3, 7

IPC of other health
programmes

Public health All, 2, 5

institute leaders

Accreditation and All

regulatory bodies

Educational/ All, 2, 4, 5
academic institutions
(public and private)

Professional All, 2, 5, 7
and scientific
organizations and
societies

Annexes
149
150

Development and implementation of national action plans for infection prevention and control: practical guide
Name of Name of contact Level of Type of influence Priority of Role and type of engagement Strategic
organization/entity person (title/level) influence engagement direction of
relevance
Unions All, 2

Research for health/ 7

research institutions

Ministry of finance All, 1

and finance leaders

Ministries of All, 1
education,
environment, labour,
water and population

Ministry of research 7
and universities

Senior managers All, 1

and administrators
responsible for
planning and budgets

National civil society All

organizations

Patient advocacy and All

community groups

National and All

international partner
organizations
 Name of Name of contact Level of Type of influence Priority of Role and type of engagement Strategic
organization/entity person (title/level) influence engagement direction of
relevance
Private sector All
organizations

International All
organizations
relevant for IPC

Donors All, 2, 7

Facility senior All, 2

managers including
director general,
medical and nursing
directors

Abbreviation: IPC, infection prevention and control.

Reference
1. WHO Toolkit: Stakeholder Mapping Guide. WHO Implementation guide for the medical eligibility criteria and selected practice recommendations for
contraceptive use guidelines.Geneva: World Health Organization; 2018 (https://www.who.int/publications/i/item/9789241513579). (Accessed 10 April 2025).

Annexes
151
Development and implementation of national action plans for infection prevention and control: practical guide

Annex 4.
SWOT analysis: example of a national SWOT analysis for
AMR surveillance
Helpful Harmful
Strengths Weaknesses
Awareness and political will Awareness and political will
• Renewed political commitment towards AMR • Limited visibility on the importance of AMU/
surveillance from the ministry of health. AMC surveillance at the subnational and
community level.
Coordination and stakeholder engagement
• Technical working group on AMR surveillance has Coordination and stakeholder engagement
been established with clear TORs and meets on a • No national coordinating mechanism(s) or
regular basis. TWG(s) for AMU/AMC in place.
Financial resources: Financial resources:
• Donor funding is available for selected facility-level • Lack of government funding for improvement in
Present factors

improvement of lab capacity. data collection systems for AMU/AMC.

Technical capacity: Technical capacity:
• Larger tertiary health care facilities have trained • No trained staff in health care facilities to undertake AMU/
clinical microbiologists. AMC surveillance at the facility.
Structures or enablers for implementation: Structures or enablers for implementation:
• Laboratory SOPs for antimicrobial resistance testing • No national standardized SOPs for analysing AMC
(AST) developed and well disseminated; EQA/IQA in data.
place in x facilities.
Implementation of NAP AMR activities:
Implementation of NAP AMR activities: • Limited training on point prevalence surveys in
• Training programmes for clinical diagnostics exist at health care facilities.
subnational level.
Monitoring and data:
Monitoring and data: • Segmented surveillance activities ongoing for
• National AMR data submitted via GLASS platform on an AMU.
annual basis.

Opportunities Threats
Awareness and political will Awareness and political will
• Generate awareness on AMC surveillance at the • Uncertainty in government about the devolution of
highest political level through presentations in power to the municipality level.
existing AMR governance mechanisms.
Coordination and stakeholder management
Governance and coordination: • Private sector not involved in AMR and AMC/AMU
• Link the TWG on AMR surveillance in human health to surveillance activities and reporting, although the
existing coordinating mechanisms in the animal health private sector covers 60% of health care facilities
sector for information sharing.
Financial resources:
Financial resources: • Some aspects of AMR surveillance programmes are funded
Future factors

• UHC donor support can be channelled to include AMR exclusively by donors, and funding will end in the near
surveillance activities. future.
• Identify internal national funding streams for AMR Technical capacity:
surveillance activities. • Health emergencies may keep technical staff from
Technical capacity: working on AMR surveillance if it is not incorporated into
• Larger tertiary health care facilities have trained the health security agenda.
clinical microbiologists. Implementation of AMR activities:
Implementation of AMR activities: • Competing interests from the private sector.
• New health insurance scheme can be used for Monitoring and data:
making an economic case for AMR surveillance • Limited surveillance data sharing within and between
activities. relevant sectors may lead to inconsistent messaging on
Monitoring and data: AMR.
• Opportunity to leverage existing AMR surveillance IT
systems to integrate AMU/AMC monitoring.
Abbreviations: AMC: antimicrobial consumption; AMR: antimicrobial resistance; AMU: antimicrobial use; EQA/IQA: external quality assurance/
internal quality assurance; GAP: Global Action Plan; GLASS: Global Antimicrobial Resistance Surveillance System; IT: information technology;
NAP AMR: national action plan on AMR; SOPs: standard operating procedures; SWOT: strengths, weaknesses, opportunities and threats; TORs:
terms of reference; TWG: technical working group; UHC: universal health coverage.
Source: WHO (1).

152
 Annexes

Reference
1. WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human
health sector. Geneva: World Health Organization; 2022 (https://iris.who.int/handle/10665/352204). Licence: CC
BY-NC-SA 3.0 IGO.

153
 Annex 5.
154

Development and implementation of national action plans for infection prevention and control: practical guide
Sample evaluation matrix for activity prioritization
Adapted from Table 1: Sample evaluation matrix for activity prioritization (1).
Strategic Activity or sub- Priority as Impact Imminent risk Early wins Feasibility Total
direction activity assigned within (1–5; 1 = low (1–5; 1 = low risk, (1–5; 1 = time- (1–5; 1 = low
stakeholder impact, 5 = high 5 = high risk) intensive; 5 = feasibility, 5 =
discussions impact) quick win) high feasibility)
(1–5; 1 = low
priority, 5 = high
priority)

Reference
1. WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human health sector. Geneva: World Health
Organization; 2022 (https://iris.who.int/handle/10665/352204). Licence: CC BY-NC-SA 3.0 IGO. (Accessed 10 April 2025).
 Annex 6.
Sample IPC national action plan template
Strategic direction (insert title of strategic direction)
Priority gaps Action required Lead and Start date End date Budget Monitoring
identified collaborators and evaluating
implementation
progress
(include review/
completion
dates)

List all gaps List the actions that are planned using List the lead person, State when the Estimate deadline For each action, Describe the
identified information gathered as you work through agency, partner or action will start to for action to estimate the budget progress that has
through baseline the 5 steps of the implementation cycle stakeholder driving be addressed (year be completed, required to address been made at
assessment the action or month) including periodic actions & state each review date
review dates if whether funding including decisions
applicable source is available and actions taken,
and the need for
further actions to be
taken to achieve
completion

Annexes
155
 Annex 7.
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Development and implementation of national action plans for infection prevention and control: practical guide
Template for detailed operational plan and budget
Strategic direction (insert title of strategic direction)
Activity:
Implementing Unit and Timeframe Monitoring indicator(s) Resources and Sources of funding
entity quantity including currency (human,
deadline infrastructure,
financial)
Sub-activity

Sub-activity

Sub-activity

Sub-activity

Sub-activity

Sub-activity
 Annexes

Annex 8.
Country story: Integrating policies and professionals
to build a robust IPC framework in China (strategic
direction 1, Political commitment and policies)

► What we achieved
Influenced by our continuous political leadership and commitment, we have established a comprehensive
legal framework for IPC in China, ensuring that IPC plans are implemented across all health care facilities.
To support the IPC NAP, we have developed a systematic quality control network that extends from the
national level down to provincial, municipal and county levels. By 31 May 2023, this network included 439
city-level quality control centres and 1554 county-level centres, each with dedicated budgets. Members of
the IPC quality control centre at each level have been elected and appointed by national and local health
commissions from the competent IPC experts voluntarily contributing their expertise and efforts to the
improvement of national and local IPC management. At every level, roles and responsibilities have been
clearly defined to ensure the effective implementation of both national and local IPC projects.

According to the latest data, there are 7247 health care facilities nationwide, including 2164 tertiary and
4938 secondary facilities. Approximately 56 000 IPC professionals are working in secondary and higher-level
health care facilities. The ratio of actual beds to a full-time IPC professional is 132:1 (doctors, 32.8%; nurses,
54.3%; and 11.6% other personnel, such as microbiologists and public health professionals). National
training programmes are conducted annually for IPC professionals at various levels of health care facilities.

► Who made this possible

At the forefront are the National People’s Congress and the State Council, which have provided the
necessary legislative and executive support. The National Health Commission has played a pivotal role in
overseeing and coordinating IPC activities across the country and has established the accountability of
local governments and health care facilities to mandate IPC implementation.

Health commissions at all levels, including national, sub-national, and municipal, have been instrumental
in ensuring that IPC policies are effectively implemented. The National Institute of Hospital Administration
and the National Administration of Traditional Chinese Medicine have also contributed to these efforts.

Key government departments have included the National Health Care Security Administration, the National
Administration of Disease Prevention and Control, the Ministry of Ecology and Environment, the Ministry
of Science and Technology, the Ministry of Finance, the Ministry of Education, the Ministry of Agriculture
and Rural Affairs, the Ministry of Industry and Information Technology, and the National Medical Products
Administration, among others.

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► How we achieved success

Establishment of a legal framework

In 2017, the Standing Committee of the National People’s Congress revised the “Law of the People’s
Republic of China on the Prevention and Control of Occupational Health,” focusing on occupational health
protection for medical personnel, including training and protective measures. This built upon: (1) original
work since 1986 on a three-level IPC management system at national, sub-national and facility levels; (2)
the Standing Committee of the National People’s Congress’s 1989 “Law of the People's Republic of China
on the Prevention and Treatment of Infectious Diseases,” establishing systems for infectious disease
monitoring, early warning and outbreak announcements; this law also strengthened control measures in
health care facilities and improved medical treatment systems; (3) the State Council’s 1994 “Regulation on
the administration of health care facilities,” requiring health care facilities to implement sterilization and
disinfection standards, establish isolation systems and adopt effective waste disposal measures to prevent
hospital-acquired infections; and finally (4) the National Health Commission’s “Regulation on Management
of Health care Associated Infection” in 2006, mandating that health care facilities implement IPC work
according to specified provisions and clarifying accountability.

Whole process management of IPC action implementation

Our approach includes the following elements.

• Developing: national IPC plans and monitoring and surveillance systems developed by the national
quality control centre. Key actions include “Clean Hands, Protect Health” and “National Action Plan to
Combat AMR”.
• Implementing: quality control centres guide and monitor IPC measures in health care facilities, using
quality control indicators and reporting data to the national centre.
• Auditing: rules and regulations clarify the obligations of health care facilities, including inspection and
accreditation standards, to ensure quality and safety.
• Surveillance: the “Health Care-Associated Infection Medical Quality Control Indicators (2024 Revision)”
guide data analysis and feedback.

Staffing and education of IPC professionals

In 2006, we mandated the establishment of independent IPC departments in health care facilities with 100+
beds. National guidelines and training programmes support the education of full-time IPC professionals.

► Outputs so far
• A comprehensive IPC legal framework
• Systematic quality control
• Approximately 56 000 IPC professionals working in secondary and higher-level health care facilities,
supported by annual national training programmes.

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 Annexes

► Critical success factors

• Continuous political leadership and commitment: a National Health Commission dedicated to
organize the development and implementation of IPC action plans.
• Four-level IPC quality control centres validated by national and local health commissions: with
clearly defined roles and responsibilities in IPC management for each of the health care facility levels.
• Dedicated, allocated budgets.
• National IPC quality control centre with serial education programmes: which are free training
opportunities for IPC professionals nationwide to boost their abilities and engagement in pursuing an
IPC career.
• The Chinese IPC Pavilion (see resources) illustrates the full-scale framework of IPC in China. China
has established the legal framework for IPC to mandate the implementation of IPC programmes
at all levels. In order to implement the national IPC programmes and put them into effect, China has
constructed a systematic IPC quality control network covering four levels, including national level, sub-
national (provincial) level, municipal level and county level, and all with dedicated. budget. Each level
has been designated clear roles and responsibilities in the process of implementing national and local
IPC programme.

► Overcoming barriers and challenges

• Broader engagement with other relevant sectors remains insufficient. Key institutions, such as the
National Health Care Security Administration, pharmaceutical, and laboratory departments within
health care facilities have the potential to play a more active role in supporting the implementation
of IPC improvement plans. Greater involvement from these sectors is critical for ensuring adequate
financial and professional support.
• The professional pathway of the IPC specialty has not been established at the national level,
despite efforts conducted in some sub-national regions. This problem could only be solved with the
wider political commitment and coordination of multiple government sectors, including the Ministry of
Education, Ministry of Human Resources, etc.

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Development and implementation of national action plans for infection prevention and control: practical guide

► Resources

Chinese IPC Pavilion

Legal
framework

Regulation on the Law of the People's Law of the People's Regulation on the
Management of Republic of China on Republic of China on administration of IPC requirements
Health Care the Prevention and the Prevention and health care facilities by laws and
Associated infection Treatment of Control of regulations
Infectious Diseases Occupational Health

Basic National action Basic Health

requirements plans standards for care-associated
on IPC in 1. “Clean Hands, on-site infection
Protect Health”
health care inspection of quality control
2. NAP to curb
facilities (2019) AMR health care indicators
3. Gudelines for facilities (2024 revision)
Practical Programmes,
improving the
guidelines on rate of Accreditation action plans,
IPC developed pathogenic standards for quality control
by a national bacteria testing grading of indicators, health
expert
for antibiotic
health care care facility
therapy in licensing and
committee hospitalized facilities
accreditation
patients
requirements on
4. National
action to IPC
strenghten
perioperative IPC
measures to
ensure surgical
quality and
safety, etc.

Develop Implement Audit Surveillance

Four-level IPC
Four-level Feedback quality control
IPC quality National Sub-national Municipal County centres and their
control centers Report roles in the
administration of
IPC across the
four levels of
Tertiary hospitals Secondary hospitals Primary hospitals Other types of health health care
care facilities facilities

160
 Annexes

Annex 9.
A new national IPC programme to enhance quality
of care in Nepal (strategic direction 2, Active IPC
programme)

► What we achieved
Over a three-year period, we built an active and sustainable national IPC programme in Nepal, which was
launched in 2023 within the Nursing and Social Security Division under the Department of Health Services
at the Ministry of Health and Population. In 2024, we developed a national IPC strategy, based on the WHO
global strategy, with a long-term vision and an action plan for strengthening the national IPC programme.

• Significant improvement of the national IPC capacity from 2021 to 2024 as shown with the increase of the
SPAR score from 27% to 53%.
• Improvement of IPC scores in 2024 from the IPCAF baseline assessment (2022, lower range (201-400) of
the basic level) in federal and provincial health care facilities to an average score of 300-400 in the upper
range of the basic level.
• Hand hygiene compliance ranging between 70-90% (varying among nurses and doctors) according to
monitoring undertaken daily, weekly and monthly in critical units of federal health care facilities.

► Who made this possible

The Ministry of Health and Population and the Department of Health Services initiated a collaborative effort
involving key divisions: Nursing and Social Security Division, Curative Services Division, Epidemiology
and Disease Control Division, Management Division, and National Health Training Centre, with technical
support from WHO. This initiative aimed to establish a national IPC programme and strengthen IPC
implementation and practice across federal-provincial-local governments, health facilities and health and
care workers.

► How we achieved success

• During a three-year period, the Ministry of Health and Population and the Nursing and Social Security
Division regularly worked with stakeholders including relevant professional societies, for example, the
Critical Care Society, Nepalese Association of Clinical Microbiologists, Infection Control Society of Nepal,
and the FHI 360, to clearly define objectives, workplans and identify the required budget for the new
national IPC programme.
• A functional steering committee and a technical working committee were established to support
the IPC programme. The multidisciplinary national technical working committee includes clinical
microbiologists, infectious disease expertise, IPC nurses and other relevant experts.
• At the same time, IPC was also embedded within the NAP Plan for AMR, where having IPC guidelines,
HAI surveillance, and appropriate hand hygiene practices in place were considered as fundamental

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actions to achieve AMR reduction.

• Different divisions and centres assumed different roles to ensure that objectives were met in relation
to HAI surveillance and workforce capacity building in IPC.
• Assessment of the gaps at health care facility level was conducted using the WHO IPCAF tool and this
enabled priorities for action to be identified and fed into the guideline content.
• Stakeholder engagement – a wide consultative process engaging relevant stakeholders was undertaken
and culminated in a national IPC symposium where the draft guideline was discussed with policy-
makers from the national and sub-national level who brought a view on the reality in the field and
helped make the draft document more implementable and acceptable in all levels of the health system.
Symposium participants also made recommendations that contributed to the outputs (see next section).
• Dissemination of the IPC guideline was through coordination by the federal and provincial levels, with
support by major local stakeholders and engaged all stakeholders to establish IPC as a programme at the
Ministry and health facility level as per the national IPC guideline.

► Outputs so far
• New active national IPC programme established within the Nursing and Social Security Division and
supported by a national IPC committee, functioning since 2023.
• Establishment of a national technical working group and steering committee on IPC with defined terms
of reference and a role in advising on IPC programme planning and implementation.
• The IPC guideline and an associated implementation manual launched in February 2023 by the Ministry
of Health and Population.
• An approved annual work plan and budget allocation for the national IPC programme.
• Update and expansion of the IPC training package, both basic and advanced formats, performed by the
Nursing and Social Security Division team in collaboration with the National Health Training Centre.
• IPC training in all provinces for medical doctors, nurses and paramedics using train-the-trainers and
master trainer approaches, including a clinical training skills development course.
• In 2023, Nepal successfully completed a WHO-led pilot point prevalence survey, testing simplified HAI
case definitions adapted for low-resource settings.
• Advanced IPC training on IPC monitoring and HAI surveillance to develop and measure impact of
local action plans. Participants are responsible for carrying out IPC assessment, monitoring and HAI
surveillance regularly at the health care facilities.
• Development of HAI surveillance standard operating procedures by a designated expert team, in
collaboration with the technical working group and through a consultative workshop with major
stakeholders. For the moment, the HAI surveillance programme is implemented in three federal
hospitals.
• Report of the IPC assessment (self and Joint External Evaluation) results.
• On-site coaching and mentoring programme conducted regularly and implemented in 12 federal
hospitals.

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► Critical success factors

• Contextual drivers: the COVID-19 pandemic was a driving force for the creation of the national IPC
programme.
• Strategic and legislative drivers:
□ the National Health Sector Strategy (2015-2020) highlighted improvement of IPC and health care
waste management practices as critical for high quality care at the point of delivery in output 2.3.
□ the Public Health Service Act (2018) stated that: “Each health institution must adopt necessary
precautionary measures to prevent and control transmission of any kind of disease".
□ these legal documents provided the mandate for the development of a national IPC guideline,
which was prioritized among the first actions in the context of the new IPC programme.
• Leadership and political support: active, tangible support from the Ministry of Health and Population
and key stakeholders.
• International Health Regulations: identification of IPC as a priority for action in the context of Joint
External Evaluations, according to the International Health Regulations.
• Professional health workforce: requests and lobbying by professionals from health care facilities for
the establishment of an operational IPC programme at the national and health care facility level.
• Global leadership: supportive and inspirational role of the WHO Secretariat at the regional and global
level and the availability of WHO tools for IPC.
• Financial and technical support: support from the WHO Country Office in Nepal.
• A pilot project for the advanced IPC training on IPC monitoring and HAI surveillance to develop and
measure impact of local action plans: this was conducted in two batches with around 40 IPC focal points
from the federal and provincial levels and academic hospitals.

► Overcoming barriers and challenges

• Gaps in availability and appropriate allocation of human resources: conducting the organization
and management survey and evaluating the results to implement actions to achieve a more rational
distribution of health and care workers according to local needs regarding health and care (worker/patient
ratio was one solution).
• Lack of a designated IPC focal person: establishment of a well-functioning IPC committee with defined
roles and responsibilities in all health care facilities supported a dedicated IPC role and time commitment.
• Culture and mindset leading to lack of accountability in applying and implementing standard IPC
practice: regular orientation about IPC dispensed to doctors, nurse, administrators, finance staff, cleaners
and pharmacists, as well as patients and visitors, to raise awareness that IPC is in everyone’s responsibility
and to emphasize our quality of care approach. Regular exchange of lessons learnt and practices among
the staff supported this.
• Lack of appropriate built infrastructure to support IPC implementation: for the existing infrastructure,
some engineering modifications were stimulated by the IPC manual. For the new health facilities or during
renovations, the design is encouraged to be IPC-friendly for the effective implementation of IPC practices.
The hospital management committee was sensitized on this topic during IPC assessments, on-site
coaching and the mentoring programme.

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Resources
• Infection Prevention and Control Guideline, 2079 and Infection Prevention and Control Manual, 2080:
https://publichealthupdate.com/infection-prevention-and-control-ipc-guideline-2079/
• First Joint External Evaluation (JEE) in Nepal https://www.who.int/nepal/news/detail/28-11-2022-first-
joint-external-evaluation-%28jee%29-in-nepal
• Nepal Health Sector Strategy https://nepal.unfpa.org/sites/default/files/pub-pdf/NHSS-English-Book-
final-4-21-2016.pdf

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Annex 10.
Insights and suggestions for integration and coordination
between IPC and other key programmes

Integration and coordination of AMR programmes with IPC

Introduction
Effective IPC measures can help prevent the emergence and reduce the spread of pathogens causing AMR while
reducing antimicrobial use. The strategic approach and response to the global threat posed by AMR include
prevention as the first pillar, with IPC, WASH and vaccinations considered as the most powerful interventions.
It has been estimated that around 75% of the burden of AMR (in terms of premature mortality and disability)
is associated with infections acquired in health care. Therefore, it is critical to have strong IPC strategies and
actions in place to support the AMR programme and action plan. Depending on the country situation and
approach, the IPC and AMR action plans could be integrated or separate plans. However, these must be aligned
and closely coordinated in their implementation. Investing in training and capacity building for health and
care workers to improve their knowledge and skills in both AMR and IPC, including integrated and coordinated
monitoring and surveillance actions, is crucial to achieve common goals.

► Strategies for effective integration and coordination

1. Strengthening IPC components in AMR NAPs and links to primary health care
Successful integration and coordination between AMR and IPC at country level builds on the close alignment
of IPC and other AMR-related interventions described in the global action plans on AMR and on IPC, taking
into consideration the WHO strategic and operational priorities included in the people-centred approach to
addressing AMR in human health (1). NAPs on AMR should include clear sets of activities/inputs, outputs and
strategic outcomes on IPC. Of note, IPC is already included as a specific section in the AMR global monitoring and
evaluation system (TrACSS).
There are critical interlinkages between IPC and other core AMR interventions that should be strengthened
at country level to support a more comprehensive approach to addressing AMR. These include AMR and
antimicrobial use surveillance data, antimicrobial stewardship, AMR laboratory/diagnostics, WASH, an
uninterrupted supply of essential health products, education and behavioural change initiatives for health
workers and the community, and effective governance and collaboration.
Some of the proposed actions to ensure strengthened IPC activities as part of the AMR NAP implementation
should include:
• ensuring the inclusion/active participation of IPC representatives in the AMR coordination committees,
including through the technical working group on prevention of infections;
• the presence of IPC indicators in the AMR NAP monitoring and evaluation frameworks, as well as
accountability for IPC representatives to collect, analyze and report on their indicators annually;
• taking into account IPC activities in the costing, budgeting and financing of AMR NAPs, or addressing
duplication of work and removing IPC line items from the AMR budget;
• highlighting the cost-effectiveness of IPC interventions to reduce infections and the potential impact on the
AMR burden;
• incorporating IPC elements in the awareness-raising, education and behavioural change programmes for
health and care workers and communities.

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Development and implementation of national action plans for infection prevention and control: practical guide

The WHO strategic and operational priorities for addressing drug-resistant bacterial infections highlights the
need to integrate the AMR response with broader health systems’ strengthening efforts, including primary
health care approaches to achieve Universal Health Coverage. In this regard, national IPC programmes should
be linked to key primary health care operational levers to ensure the sustainability and efficient use of limited
resources and the health workforce (2). These include improving the quality of care at all levels of the health
system, supporting models of care that promote high-quality and essential public health functions, ensuring
an adequate and competent workforce, physical infrastructure, and the supply and access to essential health
products.

2. Establishing a joint coordination structure that oversees both AMR and IPC programmes
To effectively address the interconnected public health challenges of AMR and IPC, countries should ensure
a joint leadership structure that oversees both programmes to achieve their successful integration and
coordination at the country level.
Beyond the key stakeholders identified in the global action plan on IPC, countries should also involve policy-
makers and stakeholders critical for AMR activities as mentioned above, including associations of clinicians and
microbiologists active in the AMR field, drug regulatory bodies, procurement agencies, and those responsible
for the distribution of antimicrobials.

3. Implementing a collaborative surveillance of HAIs, AMR and antimicrobial use

Countries should prioritize the development and implementation of a collaborative approach to HAI
surveillance, AMR and antimicrobial use.
Linking these surveillance systems may require an investment of additional human and financial resources to
build necessary microbiology diagnostic capacities, as well as epidemiology, informatics and data management
capacities at national and local levels. Existing costing and budgeting tools adapted to the context may help
with estimating the costs, such as the WHO AMR costing and budgeting tool.
Several other existing tools could be used both for the initial assessment of the baseline status of HAI, AMR and
antimicrobial use surveillance programmes and for their monitoring and implementation (such as IPCAT2,
IPCAT-MR, IPCAF, SPAR, TrACSS, GLASS questionnaires, and laboratory assessment tools for national reference
and local laboratories).
A national plan to integrate HAI and AMR and antimicrobial use surveillance with a focus on priority infections
based on the local context should be developed by a multidisciplinary technical group. A national/sub-
national HAI, AMR and antimicrobial use surveillance system should be established, including for early warning
purposes, to detect epidemic- and pandemic-prone pathogens causing HAIs or an unusual use of ‘Reserve’
antibiotics.
Key learning objectives and job competencies for HAI, AMR and antimicrobial use surveillance need to be
defined to inform educational curricula and ensure the availability of human resources educated and skilled in
HAI and AMR surveillance.
At the initial stages, the collation of HAI, AMR and antimicrobial use surveillance data may allow integrated
reporting and, eventually, integrated analysis to inform policies and coordinated activities. Alignment of
surveillance approaches and development of common surveillance standards, data repositories and platforms
will allow integrated data collection. A good start may be achieved with the inclusion of HAI definitions and IPC-
related variables in the protocols for national AMR and antimicrobial use surveys to measure prevalence and the
health and economic burden.
AMR surveillance data can be used in the field of IPC to inform national and local IPC policies by monitoring the
impact of interventions to prevent and control the spread of infection and evaluate IPC strategies, identifying
targets for the implementation of IPC measures, including patient populations at higher risk related to AMR,
informing the prevention and control of HAI outbreaks, including surgical prophylaxis in order to minimize the

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risk of surgical site infection caused by resistant pathogens. The use of antimicrobial use surveillance data can
inform adherence to best practices with regards to surgical antibiotic prophylaxis and thus help reduce HAIs.

4. Collaboration between IPC and antimicrobial stewardship programmes

Antimicrobial stewardship and IPC programmes share a common goal of preventing and controlling
infections to promote safety and quality in health care. At national level, there should be a regular interaction
and communication between relevant governance structures, such as committees or working groups for
antimicrobial stewardship and IPC. National guidelines for antimicrobial use and IPC should be well aligned,
with reference to appropriate antimicrobial use in IPC guidelines (for example, antimicrobial prescribing
support during outbreaks caused by multidrug-resistant organisms or guidelines for surgical prophylaxis) and
vice versa (for example, removing urinary catheters as part of the management for catheter-associated urinary
tract infections).
These programmes share common objectives, infrastructures, approaches and metrics, which makes their
integration not only logical, but also beneficial. For instance, antimicrobial stewardship committees often
include IPC professionals or well-established IPC committees expand their terms of reference to include
antimicrobial stewardship functions in some settings. Similarly, many of the same health professionals are
involved in routine activities of both antimicrobial stewardship and IPC programmes, including infectious
diseases physicians and microbiologists, thus highlighting the overlap in their goals and operations. At the
same time, minimizing HAI through good IPC practices reduces the incidence of infections and the need to use
antimicrobials in the first instance. By working together, these programmes can optimize antimicrobial use,
improve patient outcomes and prevent HAIs, thereby reducing the emergence and spread of AMR.
Education and training on the interconnectedness of antimicrobial stewardship and IPC can foster a culture
of safety and quality improvement among health care staff, enhancing workflow efficiency and patient care.
Multidisciplinary collaboration among health care professionals is crucial for the success of these programmes.
When engaging with and providing education to patients and caregivers, integrating concepts of appropriate
antimicrobial use and hygiene measures enables a more holistic approach to infection management.
Institutional leadership and support are also vital as both antimicrobial stewardship and IPC are cost-effective
for society, but may not be directly revenue-generating. Close collaboration is essential to overcome funding
challenges and achieve the shared goals of these programmes and should be advocated for by national policies.

► Resources*
• Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015 (https://iris.who.
int/handle/10665/253236).
• Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey. Geneva:
World Health Organization; 2023 (https://amrcountryprogress.org/#/map-view).
• Costing and budgeting tool for national action plans on antimicrobial resistance: user guide. Geneva: World
Health Organization; 2021 (https://iris.who.int/handle/10665/346344). Licence: CC BY-NC-SA 3.0 IGO.
• WHO national and facility level assessment tools of the IPC core components and minimum requirements.
Geneva: World Health Organization; 2025 (https://www.who.int/teams/integrated-health-services/infection-
prevention-control/core-components).

*All key resources and tools were accessed on 01 May 2025.

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Integration and coordination of IPC in health emergency preparedness, readiness and

response at country level
Introduction
Recent large-scale outbreaks of infectious diseases, such as Ebola virus, influenza, cholera, and the COVID-19
pandemic, have underscored the vital importance of IPC in health care facilities. These measures are crucial
for preventing outbreaks and containing the spread of infection, while ensuring the delivery of safe, effective
and high-quality care. In addition, any public health emergency places a significant strain on existing health
systems, increasing the risk of HAIs, including among health and care workers due to reduced staffing, damaged
infrastructure and limitations in procuring essential medical supplies. This is when reinforced IPC measures are
most needed to mitigate risks, especially in fragile, conflict-affected and vulnerable settings. For these reasons,
establishing dedicated and competent IPC roles within emergency preparedness and management structures
is critical for both the effectiveness of emergency operations and the quality and safety of essential health
services’ maintenance.

► Strategies for effective integration

1. Aligning IPC preparedness, readiness and response systems and mechanisms
IPC programmes are essential for ensuring safe patient care during all emergencies and an effective outbreak
response. In particular in settings with limited resources, evaluating existing IPC capacities and implementing
IPC core components and minimum requirements are crucial. Integrating IPC expertise into national public
health agencies’ emergency management programmes mitigates the spread of diseases during outbreaks
and reduces the risk of transmission extending beyond health care facilities into communities, thus providing
flexibility and contributing to long-term sustainability.

Key elements for integrating IPC with public health agencies/emergency management operations include:
• strategic plans: incorporate IPC actions and interventions into national strategic preparedness and
response emergency plans;
• guidelines: develop and/or adapt national IPC guidelines/guidance for disease-specific rapid response
during emergencies;
• surveillance systems: establish surveillance systems and monitor HAIs during preparedness stages, as
well as during public health emergencies, to detect and mitigate threats within health care and community
settings;
• training programmes: provide specialized training to health and care workers for the implementation of
IPC in high-threat scenarios;
• facility assessments: conduct rapid IPC assessments to identify and prioritize gaps for targeted
interventions and to identify required surge capacity for supportive supervision and mentorship;
• simulation exercises: use drills, intra- and/or after-action reviews to refine response capabilities and
enhance preparedness;
• multimodal implementation: tailor IPC measures and varied approaches to country-specific contexts to
ensure effectiveness.

These elements help create a robust framework for managing IPC within public health emergency operations,
ensuring both immediate and long-term benefits.

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2. Linking key players in national IPC and public health emergency response programmes
Strong national IPC programmes promote collaboration among policy-makers, agencies and frontline
workers. Establishing emergency coordination structures, like incident management teams and IPC taskforces
at the start of an outbreak, ensures a rapid and unified response. This approach helps streamline resource
mobilization and facilitates the dissemination of guidance, enhancing the overall emergency preparedness and
response.

3. Ensuring sustainable resources and financing

Sustained funding for IPC personnel, supplies and infrastructure is critical for resilience. National IPC
programmes facilitate budget planning, procurement and emergency stockpile management. During public
health emergencies, surge capacity is crucial, including human, logistic and infrastructure requirements. For
example, having a roster of IPC expertise available for temporary re-purposing to stopgap areas affected by
public health emergencies can significantly reduce the impact of an outbreak affecting a particular area.

4. Transitioning IPC from public health response to recovery

Public health emergencies test the resilience of health systems, revealing gaps that must be addressed for
continuous improvement once the emergency is declared over. Conducting intra- and after-action reviews post-
emergency ensures that lessons learned contribute to strengthening IPC programmes and future preparedness
efforts.

5. Conclusion
Effective integration of IPC within emergency preparedness, readiness and response mechanisms is essential
for mitigating and controlling public health emergencies and maintaining health system resilience. Investing in
sustainable IPC and WASH programmes ensures long-term preparedness, reducing outbreaks and the impact of
future public health emergencies.

► Resources*
• All resources and tools on IPC and WASH in health emergencies may be accessed at https://www.who.int/
teams/health-care-readiness/infection-prevention-and-control.
• Framework and toolkit for infection prevention and control in outbreak preparedness, readiness
and response at the national level. Geneva: World Health Organization; 2021 (https://iris.who.int/
handle/10665/345251) Licence: CC BY-NC-SA 3.0 IGO.
• Framework and toolkit for infection prevention and control in outbreak preparedness, readiness and
response at the health care facility level. Geneva: World Health Organization; 2022 (https://apps.who.int/
iris/handle/10665/361522). Licence: CC BY-NC-SA 3.0 IGO.

*All key resources and tools were accessed on 01 May 2025.

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Integration and coordination of IPC and occupational health and safety of health and care
workers
Introduction
The goal of occupational health and safety in the health sector is to protect health and care workers from
work-related harm. Occupational health and safety services and IPC programmes play an important role in
safeguarding the health, safety and well-being of health workers against avoidable harm caused by infections,
including those caused by antimicrobial-resistant pathogens acquired during the provision of health and care
services. While these programmes have distinct focuses, their integration and coordination are crucial for the
comprehensive protection of health workers, patients and the overall health system. Essential to this integration
are health workforce development programmes designed to ensure that health workers possess the necessary
knowledge through pre- and in-service education to remain in service and meet population health needs.

► Strategies for effective integration

Integrating occupational health and safety and IPC programmes in health care settings offers several advantages:
1. provides thorough identification and control of hazards, aiming to address gaps in health worker
protection;
2. optimizes resource utilization through collaboration and resource-sharing between programmes;
3. boosts efficiency of both programmes through streamlined processes, training, supply chain management
and communication;
4. ensures compliance with relevant regulations and standards for both occupational health and safety and
IPC.

The following actions could be beneficial to facilitate integration and collaboration at the national and sub-
national levels.
• Promote collaboration between occupational health and safety and IPC programmes by engaging a range
of government and non-government stakeholders. For example, ministries responsible for labour, worker
representatives, civil society organizations, professional associations, labour organizations, employers
(including those in the private health sector), and health workers themselves.
• Implement unified reporting and monitoring systems for HAIs. Ensure that these systems include indicators
for occupational infections among health workers, with disaggregated data on gender, age, occupation and
other relevant factors integrated into health information management systems.
• Expand IPC programmes to include workplaces across all sectors. This approach acknowledges the
interconnectedness of workplaces, care facilities, and communities in the spread and control of infectious
diseases, especially during public health emergencies.
• Incorporate occupational health and safety and IPC considerations into the inspection, auditing and
licensing processes for health care facilities. Utilize common standards to streamline the accreditation and
implementation of both programmes.

The following actions could be beneficial to facilitate integration and collaboration at the facility level.
• Ensure that individuals or teams responsible for both occupational health and safety and IPC in resource-
constrained settings receive sufficient training, support and resources. Advocate for increased staffing
levels to enable dedicated teams for each function.
• Develop collaborative risk assessments and control plans to address infectious hazards in health and care
settings.

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• Work with human resources and management to integrate occupational health and safety and IPC training
into pre- and in-service learning for all health and care workers
• Establish effective communication channels between occupational health and safety and IPC personnel,
where dedicated teams exist, to facilitate information sharing and collaboration.

Combining the strengths of both occupational health and safety and IPC programmes in an integrated approach
not only ensures compliance with legal standards, but also promotes a positive work atmosphere, resulting in
higher health worker retention, better patient outcomes, and a more resilient healthcare system.

► Resources*
• The goal of Occupational health and safety: https://www.who.int/health-topics/occupational-health
• Occupational safety and health in public health emergencies: a manual for protecting health workers and
responders. Geneva: World Health Organization and International Labour Organization 2018 (https://iris.
who.int/handle/10665/275385). Licence: CC BY-NC-SA 3.0 IGO.
• Occupational hazards in the health sector (e-tool). Geneva: World Health Organization; 2025 (http://www.
who.int/tools/occupational-hazards-in-health-sector).

*All key resources and tools were accessed on 01 May 2025.

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IPC integration and coordination with WASH for implementation of the global action plan
and monitoring framework
Introduction
WASH is critical to achieve IPC implementation and is included in core component 8 of effective IPC
programmes. It provides the necessary infrastructure, procedures and equipment enabling the implementation
of appropriate IPC practices and behavioural change among health workers and the community. The global
action plan and monitoring framework on IPC includes several actions, indicators and targets specifically
related to achieving WASH improvements. On the other hand, the global framework for action (2024–2030)
provides a mechanism to guide and track actions and includes IPC elements and indicators. At the national
level, there are opportunities to jointly address and fund WASH and IPC through AMR NAPs, emergency health
funding, and primary care and quality of care efforts.

► Strategies for effective integration

1. Key players
Engaging with those working on safe and sustainable WASH and waste services in health care facilities requires
using a multi-sectoral approach, usually within the ministry of health. Other key ministries include those related
to water, sanitation, infrastructure and local government.
WHO and UNICEF jointly lead and coordinate global activities related to WASH in health care facilities, including
a network of nearly 50 partners who are critical for successful implementation and sustainability, such as
non-governmental organizations (for example, WaterAid, World Vision), the World Bank, and donors and
partnerships, in particular for health care waste (for example, the Global Fund and GAVI).Furthermore, the
coordination and common objectives related to field operations are highly desirable to avoid duplication and
achieve efficient interventions that benefit both programmes.

2. Resources needed
The main financial resources required to make WASH improvements that can enable IPC practices are those
needed to make infrastructure improvements (for example, installing new water supplies or waste treatment
technologies), as well as costs for their regular operation and maintenance (for example, water treatment and
testing, repairing pipes and toilets). These costs will depend on the local situation and needs. On the human
resources side, all health facility staff should be familiar with WASH and waste management and operations.
Of note, some individuals (staff or private suppliers) should be specifically trained in cleaning and health care
waste management, with the ability to conduct regular water and sanitation monitoring within facilities and
make minor repairs.
Competing priorities in the health and WASH sector, difficulties in working and financing across sectors, and
lack of leadership and support to implement changes are critical barriers to achieving WASH and IPC integration
and goals. Lack of awareness about the situation and the cost of inaction also hamper engagement and
progress in both WASH and IPC.

3. Monitoring WASH in health care facilities

WASH assessments are widely published and, together with regular monitoring and reporting, can empower
leaders and facilitate the allocation of targeted resources – even limited, but regular budgets and funding can
help facilitate and sustain improvements, examples include:
• All IPC assessment tools for the national and facility levels include a section dedicated to WASH, waste
and electricity services (IPC core component 8), standards and related indicators.

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• The WHO/UNICEF Joint Monitoring Programme provides data on existing services (water, sanitation, hand
hygiene, cleaning and waste) at the national level.
• Data on national efforts regarding system change to support WASH (for example, costed national plans,
regular monitoring, updated standards).
• Both data sources are updated regularly, with the former linked to regular reporting on Sustainable
Development Goal 6 (safe WASH), and the latter associated with reporting on the United Nations General
Assembly Resolution on Sustainable, Safe and Universal WASH, Waste and Electricity Services in Health Care
Facilities.

► Resources*
• All resources and tools on WASH in health care facilities may be accessed at https://www.who.int/teams/
environment-climate-change-and-health/water-sanitation-and-health-(wash)/health-care-facilities/wash-
in-health-care-facilities.
• Guidelines on core components of infection prevention and control programmes at the national and
acute health care facility level. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/
handle/10665/251730). Licence: CC BY-NC-SA 3.0 IGO.
• Water and sanitation for health facility improvement tool (WASH FIT): a practical guide for improving
quality of care through water, sanitation and hygiene in health care facilities, 2nd ed. Geneva: World Health
Organization; 2022 (https://iris.who.int/handle/10665/353411). Licence: CC BY-NC-SA 3.0 IGO.
• Universal water, sanitation, hygiene, waste and electricity services in all health care facilities to achieve
quality health care services: global framework for action 2024–2030. Geneva: World Health Organization
and UNICEF; 2024 (https://iris.who.int/handle/10665/377776). Licence: CC BY-NC-SA 3.0 IGO.
• WHO/UNICEF Joint Monitoring Programme https://washdata.org/data/healthcare#!/.

*All key resources and tools were accessed on 01 May 2025.

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References*
1. People-centred approach to addressing antimicrobial resistance in human health: WHO core package of
interventions to support national action plans. Geneva: World Health Organization; 2023 (https://iris.who.
int/handle/10665/373458). Licence: CC BY-NC-SA 3.0 IGO.
2. Primary health care health systems levers for action. Geneva: World Health Organization; 2021 (https://
www.who.int/publications/m/item/primary-health-care-health-systems-levers-for-action).

* All references were accessed on 01 May 2025.

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Annex 11.
Country story: IPC and role model hospitals: a
demonstration of how coordination and integration
can become a reality to reduce AMR in Egypt (strategic
direction 3, IPC integration and coordination)

► What we achieved
Following the successful completion of a pilot phase in August 2023, we decided to expand the AMR
model hospitals in which cross-disciplinary integration and coordination are a fundamental part, starting
in September 2023. Our model is now operational in 60 public and private hospitals across all Egyptian
governorates.

All 60 participating hospitals showed significant improvements in infection IPC and AMS standards’
implementation, with leadership commitment achieving a 35% increase. Adherence to key IPC practices
improved by 25%, compliance with isolation practices for multidrug-resistant organisms rose by 51%, and
the implementation of device-related, HAI preventive ‘bundles’ increased by 38%. The AMS assessment
score improved by 31%, with notable improvements in compliance with antibiotic restrictions from the
Reserve group, which increased by 49%.

In May 2023, in collaboration with the WHO Country Office in Egypt, we developed and launched the
AMR Operational Plan for the Human Sector. This plan aligns with the AMR NAP endorsed in 2019 and
the WHO global action plan on AMR, focusing on enhancing IPC and antimicrobial stewardship practices,
capacitating microbiology laboratories, and ensuring leadership commitment.

► Who made this possible

This initiative has been possible thanks to the commitment, coordination and integrated efforts across
different national authorities including the IPC General Department, Central Public Health Laboratories,
the General Department of Pharmaceutical Affairs, the One Health General Department, and the Central
Administration for Private Sector and Licensing, all within the Ministry of Health and Population.
Additionally, our partnership with the WHO Country Office played a crucial role in ensuring the effective
implementation of our strategies through its technical and financial support.

► How we achieved success

Coordination at the heart of structures and systems

In April 2023, we launched the National One Health Strategy to coordinate efforts between the Ministries of
Health and Population, Agriculture and Environment, demonstrating our commitment to addressing AMR.

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Building on our robust IPC governance structure and the national IPC programme, which started in 2003,
was central to our achievements.

The IPC General Department at the Ministry of Health and Population was designated to lead, coordinate
and integrate efforts, as well as to supervise the implementation of national AMR initiatives, including
coordinating activities among Ministry of Health and Population departments, such as the Central Public
Health Laboratories and the General Department of Pharmaceutical Affairs. We also implemented a
comprehensive governance framework for AMR prevention and control at all levels (Ministry of Health
and Population, directorates, and hospitals), with clearly defined roles and responsibilities. This structure
includes representation from IPC, pharmacies, and microbiology laboratories, with IPC teams empowered
to lead and coordinate efforts.

We defined an integrated set of key performance indicators related to both process and outcome measures,
assessed at baseline and at follow-up field visits to track progress and facilitate continuous improvement.
These key performance indicators included leadership commitment, IPC (such as multidrug-resistant
organism incidence rates, adherence to key IPC practices, for example, hand hygiene, device-related
HAI preventive ‘bundles’, isolation precautions for multidrug-resistant organisms, and environmental
cleaning), antimicrobial stewardship (such as the hospital antibiotic consumption rate, and compliance
with WHO Access, Watch, Reserve [AWaRe]) antibiotic classification and surgical prophylaxis protocols), and
microbiology laboratory key performance indicators (such as the percentage of agreement between the
results of the hospital microbiology laboratory and central public health laboratories).

Integration of interventions

To execute the AMR operational plan and improve IPC practices at health care facilities, we implemented a
multifaceted strategy in phases starting in May 2023 and extending over a five-year period until all Ministry
of Health and Population hospitals are enrolled. This strategy encompassed the following key initiatives.

• From May to August 2023, we conducted a pilot phase involving 17 Ministry of Health and Population
hospitals across 13 of the 27 governorates in Egypt. These hospitals were selected as AMR model
hospitals based on predetermined requirements, including the presence of a functioning microbiology
laboratory and clinical pharmacists.
• We conducted baseline assessments for each enrolled hospital using standardized facility-level tools
to evaluate their status in core programme areas, including leadership, IPC, AMS and the microbiology
laboratory.
• We regularly disseminated integrated IPC/AMS/laboratory written feedback reports to hospital
leaderships, highlighting corrective measures, key intervention priorities, suggestions for improving
existing infrastructures, workforce capacities, and necessary equipment and supplies.
• We implemented a comprehensive 6-day training programme in each participating hospital to
capacitate 510 frontline staff, including IPC teams, clinical pharmacists, microbiology laboratory staff,
and clinical and surgical ward directors.
• We conducted continuous monitoring and follow-up visits by central and directorate teams, utilizing
the same standardized, baseline, facility-level tools to assess progress.

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Between August 2023 and May 2024, we developed and disseminated a total of 26 000 information,
education and communication materials to both enrolled and prospective hospitals. These materials
supported the integration of IPC and AMR and included promotional videos and posters focusing on hand
hygiene, isolation precautions, safe injection practices and judicious antibiotic use.

Model evaluation and decisions centred on a coordinated approach

Chaired by the Minister of Health and Population, high-level briefing sessions, were held with senior
management and stakeholders from the Ministry and partner organizations. These meetings served
to announce hospital progress rankings, recognize top performers or champions, and make high-level
decisions, such as linking hospital directors' performance evaluations and incentives to progress in all the
AMR model hospitals’ key performance indicators.

► Outputs so far
By August 2024, we had trained 1428 frontline staff and conducted 185 assessment visits across 60
hospitals, leading to a 35% improvement in leadership commitment to IPC and antimicrobial stewardship
activities. Compliance with isolation practices related to multidrug-resistant organisms increased from 28%
to 79%, and the implementation of device-related, HAI preventive bundles improved from 44% to 82%.

► Critical success factors

• Strong political commitment: the operational plan was endorsed by the Minister of Health and
Population. In May 2023, an official letter from the Assistant Minister was issued to all heads of health
organizations affiliated with the Ministry. This demonstrated visible commitment to a coordinated
approach and mandated the implementation of the AMR hospital model at the designated hospitals.
• Robust governance structures: we established strong IPC and AMR governance structures, facilitating
enhanced coordination across the Ministry of Health and Population and directorates.
• Enhanced coordination: this was achieved through coordinating activities among Ministry of Health and
Population departments including the IPC General Department, the Central Public Health Laboratories
and the General Department of Pharmaceutical Affairs, reviewing progress in AMR model hospitals
during regular AMR team meetings, consistent data sharing, and executing joint training sessions and
assessment field visits.
• Stakeholder engagement and partnerships: we engaged interested stakeholders in the spirit of
integration and formed strong partnerships with donors.
• Data-driven interventions: data on IPC and AMS were used to design targeted, focused and harmonized
interventions.
• Team motivation: recognized champions were identified and a ranking of hospitals' progress. Monthly
incentives for hospital directors were linked to the results of the AMR-key performance indicators.

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► Overcoming barriers and challenges

• Initial coordination issues: we faced poor initial coordination among relevant Ministry of Health and
Population departments due to unclear processes and roles. This was resolved by establishing a robust
and well-defined AMR governance framework with clear roles and responsibilities.
• Limited microbiology laboratory capacities: we addressed this challenge through a step-by-step
approach to equip facilities with essential supplies in collaboration with the WHO Country Office. This
approach involved assessing needs, developing a standardized inventory of microbiology supplies,
collaborating with partners and stakeholders for procurement, and providing WHONET training to
laboratory personnel.
• Clinician reluctance to change prescribing practices: we mitigated this issue through effective
communication addressing clinicians' concerns and providing consistent two-way feedback.

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Annex 12.
Assessment framework summary (national and facility level)
for education and training
IPC education and/ National level Yes/No
or career pathway (Y/N)
components
General IPCAT - 3.2.3: National curricula are informed by international curricula/ □ Yes
networks and adapted to national needs and local resources. □ No
IPCAT - 3.2.4: National curricula are adapted to national needs and local □ Yes
resources. □ No
IPCAT - 3.4.1: Standardized training tools in line with national guidelines and □ Yes
international standards to support implementation of curricula are available. □ No
IPCAT - 3.4.2: The national IPC training supports packages to promote the use of □ Yes
participatory and team- and task-based strategies. □ No
IPCAT - 3.4.3: The national IPC training supports packages to promote the use of □ Yes
simulation. □ No
IPCAT - 3.4.4: The national IPC training supports packages to promote the use of □ Yes
multimodal strategies. □ No
IPCAT - 3.4.5: The national IPC training supports packages to promote the □ Yes
integration and embedding of IPC training within clinical practice and the □ No
training of other disciplines.

Pre-graduate IPCAT - 3.2.1: National IPC curricula, developed (or under development) in □ Yes
collaboration with local academic institutions are available for pre-graduate □ No
courses.
IPCAT2 - 3.2.5: IPC training is integrated into continuing medical, nursing and □ Yes
allied health professional education and training. □ No
IPCAT2 – 3.3.1: a national system and schedule of monitoring and evaluation is □ Yes
in place to check on the effectiveness of training and education, for example, at □ No
least annually.

In-service IPCAT2 – 3.3.1: a national system and schedule of monitoring and evaluation is □ Yes
in place to check on the effectiveness of training and education, for example, at □ No
least annually.
IPCAT2 - 3.4.6: The national IPC training supports packages to promote the □ Yes
importance of involving patients or family members in facility-level training □ No
programmes

Postgraduate IPCAT2 – 3.2.2: national IPC curricula developed (or under development) in □ Yes
collaboration with local academic institutions for postgraduate courses. □ No
Core competencies for IPC professionals provide content for to guide curriculum □ Yes
development, as well as guidance related to IPC professional responsibilities □ No
IPC professional (career) IPCAT2 - 1.1.2: An appointed infection preventionist(s) in charge of the □ Yes
programme can be identified □ No
IPCAT2 - 1.1.4: The appointed infection preventionist(s) have undergone □ Yes
training in IPC in reducing the transmission and prevention of health HAI. □ No
IPCAT2 - 1.1.5: The appointed infection preventionist(s) have dedicated time □ Yes
for the tasks (at least one full-time person). □ No

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IPC education and/ Facility level Yes/No

or career pathway (Y/N)
components
IPCAT2 – 3.1.1: the national IPC programme provides guidance and □ Yes
recommendations for in-service training at the facility level (for example, □ No
frequency, expertise required, requirements for new employee orientation,
monitoring and evaluation approaches).
IPCAT2 – 3.1.2: the national IPC programme provides content and support for □ Yes
IPC training of all health and care workers at the facility level. □ No
IPCAT2 - 3.1.3: The national IPC programme provides content and support for □ Yes
other personnel that support health service delivery. □ No
Pre-graduate IPCAT2 –3.2.5: IPC training is integrated into continuing medical, nursing and □ Yes
allied health professional education and training. □ No
In-service Are there personnel with the IPC expertise (in IPC and/or infectious diseases) to □ Yes
lead IPC training? □ No
Do health and care workers receive annual training regarding IPC in your □ Yes
facility? □ No
Do cleaners and other personnel directly involved in patient care receive annual □ Yes
training regarding IPC in your facility? □ No
Do administrative and managerial staff receive general training regarding IPC in □ Yes
your facility? □ No
Are there additional non-IPC personnel with adequate skills to serve as trainers □ Yes
and mentors (for example, link nurses or doctors, champions)? □ No
Are there periodic evaluations of the effectiveness of training programmes (for □ Yes
example, hand hygiene audits, other checks on knowledge)? □ No
Is IPC training integrated in the clinical practice and training of other specialties □ Yes
(for example, training of surgeons involves aspects of IPC)? □ No
Is there specific IPC training for patients or family members to minimize the □ Yes
potential for HAIs (for example, immunosuppressed patients, those with □ No
invasive devices or multidrug-resistant infections)?
Postgraduate IPCAT2 - 3.1.4: the national IPC programme provides content and support for □ Yes
the training of IPC professionals to support competence development and □ No
development of an IPC career pathway
Is ongoing development/education offered for IPC staff (for example, by
regularly attending conferences, courses)?
IPC professional (career) IPCAT2 – 1.1.2 and IPCAT-MR – 1.2: an appointed infection preventionist(s) in □ Yes
charge of the programme can be identified. □ No
IPCAT2 – 1.1.5 and IPCAT-MR – 1.5: the appointed infection preventionist(s) has □ Yes
dedicated time for the tasks (at least one full-time person). □ No
IPCAF 8 – 1.3: at least one full-time (1:250 beds) IPC professional or equivalent □ Yes
available. □ No
Abbreviations: IPC, infection prevention and control; IPCAT2, infection prevention and control assessment tool; IPCAT-MR, infection prevention
and control assessment tool minimum requirements.

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Annex 13.
Strategic direction 4: country story – Addressing the
educational needs of the new IPC professional in
Canada (strategic direction 4, IPC knowledge among
health and care workers and career pathways for IPC
professionals)

► What we achieved
Canada was one of the pioneer countries to establish an educational and career pathway for IPC
professionals, with the national professional society (Infection Prevention and Control Association Canada
[IPAC Canada] supporting these efforts for decades. The organization has supported the advancement
of the profession through several activities, including developing resources such as documents defining
the role of an IPC professional, a sample job description and the core competencies for IPC professionals.
IPAC Canada has developed a mentorship programme to support career advancement and organizes an
annual day targeted at advocacy efforts on a national level by bringing IPC professionals together annually
to meet with the federal government on important issues. In addition to these examples, IPAC Canada
has been a leader in supporting the advancement of knowledge and capacity building on the topic of IPC
through several education-related activities, ranging from the annual national conference to multiple
courses designed to educate frontline health and care workers, to more specific certificate courses for IPC
professionals.

Building upon this deeply rooted expertise, IPAC Canada recently responded to a specific demand for
training of newly-designated IPC link persons and focal points in long-term care by developing an online
course (‘Essentials of IPC’) designed to align with the core competencies for IPC professionals. In addition,
due to specific requests regarding the training of new IPC link persons and focal points from the Northwest
Territories and Province of Manitoba, IPAC Canada tailored the content of the ‘Essentials in IPC’ course to
ensure relevance for these provinces/territories, as well as for long-term care facilities. The ‘Essentials in
IPC’ is a six-module course that includes quizzes, examinations and a ‘reflection paper’ (taking the place
of a former on-site practicum). This was offered on three separate occasions, allowing to reach 100 IPC link
persons and focal points.

Due to ongoing demand, this course has now evolved into a new IPAC Canada resource primarily
designed for IPC professionals working in long-term care facilities. This new long-term care certificate
course is aligned with the core competencies for IPC professionals, as well as the domains included in the
Certification Board of Infection Control (CBIC) Long-Term Care Certification in Infection Prevention (LTC-
CIP®) examination. The inaugural course started in 2024 in the form of a one-month self-study programme,
followed by a two-day in-person workshop, and is currently in its third iteration.

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► Who made this possible

The need for basic training for health and care workers taking on IPC responsibilities (that is, newly-
designated IPC link persons and focal points) during the pandemic was evident in calls to IPAC Canada
for educational support. Noting specific needs in underresourced territories and smaller provinces, the
‘Essentials of IPC’ course was offered after negotiation with the provincial and territorial governments of
Manitoba and the Northwest Territories. A funding model was agreed upon and local health authorities
ensured the support of health and care workers by allowing work time to be used for attending the training
programme. Key players in the facilitation of the new long-term care hybrid course included the Ontario
Ministry of Health and Long-term Care, long-term care associations and specific local authorities. Course
coordinators and faculty are expert IPAC Canada members supported by IPAC Canada staff.

► How we achieved success

• The long-term care self-study programme was followed by a two-day in-person workshop to provide
practice in various scenarios. An additional benefit of this workshop is that it provides a starting point for
the development of a peer network.
• With the cooperation of the relevant local provincial/territorial health authorities, employers were
advised of the educational opportunity and permission was obtained for personal support workers
and IPC leads to devote time to self-study, followed by the intensive two- or three-day workshop. In
the Northwest Territories and Manitoba, the health authorities vetted students as to their interest and
responsibilities in IPC. The current series is open to anyone who has long-term care responsibilities.
• In the Northwest Territories and Manitoba, the course tuition fee was covered by the relevant health
authority. As part of ongoing education, this tuition would routinely be covered by students or their
employers.
• The 2024–2025 course was open to any person with the goal of obtaining education before sitting the
certification examination (LTC-CIP®) by April 2025. This requirement is a regulation of the Province of
Ontario.
• Social media was utilized to promote the course, in addition to communication with the Ontario
Ministry of Health and Long-term Care, regional IPAC Canada hubs, long-term care professional
associations and private long-term care residences.

► Outputs so far
• The ‘Essentials in IPC’ self-study programme, open to IPC professionals in any health care setting, is
offered twice per year. A regular 10-month programme takes place from September to June.
• A LTC Hybrid Essentials course was held in September 2024, February 2025 and March 2025, including a
month of self-study followed by a three-day in-person workshop in Toronto. This was in response to the
Province of Ontario Long-Term Care Act, which prescribes certification for IPAC Canada leads in long-
term care by April 2025.
• Evaluations of all the courses to date have indicated the excellent appreciation of the quality of the
curriculum and instructors by the students, also commenting that they respond to critical needs for

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basic knowledge in IPC. Furthermore, the high value of the strong peer network created through the
programmes has been recognized.

► Critical success factors

• Government support in the Northwest Territories and Manitoba was paramount in ensuring the success
of the programmes.
• Support of private and public long-term care residences is vital to the success of the long-term care
programme.
• A marketing campaign using written communications, website announcements and social media
ensured a robust attendance
• Conducting evaluations confirmed appreciation of the quality of the curriculum and instructors and
helped identify areas for improvement.
• Creation of a strong peer network that remains in place following completion of the programmes.

► Overcoming barriers and challenges

• All instructors are IPC professionals with experience in education who offer their expertise in the
development and facilitation of the courses. This resulted in a dedicated team who provided their time
and expertise. Resource constraints at the time limited their capacity to take on additional students.
The need for this type of course is huge and, specifically in Ontario, there is a time factor as provincial
regulations require certification of long-term care IPC focal points by 30 April 2025. IPAC Canada is
investigating the possibility of establishing several teams of instructors to accommodate the capacity.
In addition, IPAC Canada is working to develop self-study guidelines for those who are unable to take
advantage of the in-person portion of the curriculum.
• By creating regular, staggered intakes of both the ‘Essentials for IPC’ and/or long-term care course,
sustainability is built in to address ongoing requests for these courses coming from other regions of
Canada.

► Resources
• The original IPAC Canada Acute Care Distance Education Course (now archived) and the APIC Long-term
Care Learning Series https://apic.org/course/ltc-cip-certification-preparation-course/ were utilized as a
resource for instructors in the development of the curriculum for the Long-term Care Hybrid course.
• Role of an IPC professional https://ipac-canada.org/definition-of-an-icp-2
• Sample job description https://ipac-canada.org/photos/custom/pdf/8.73%20-%20Membership%20
-%20ICP%20Job%20Description%20May%202019.pdf
• The IPAC Canada Core Competencies for Infection Prevention and Control Professionals https://ipac-
canada.org/photos/custom/pdf/IPAC_CoreCompetencies_ICPs_2022_revised.pdf
• The IPAC Canada Core Competencies for Healthcare Workers https://ipac-canada.org/photos/custom/
pdf/IPAC_CoreCompetencies_2022_web.pdf

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Development and implementation of national action plans for infection prevention and control: practical guide

• IPAC Canada Essentials in Infection Prevention and Control Course https://ipac-canada.org/ipac-

canada-essentials-in-ipc-course
• About the Long-Term Care Certification in Infection Prevention (LTC-CIP®) https://www.cbic.org/CBIC/
Long-term-care-certification.htm
• IPAC Canada Essentials in Infection Prevention and Control Course https://ipac-canada.org/ipac-
canada-essentials-in-ipc-course

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 Annexes

Annex 14.
Country story: From research to action: strengthening
IPC in Sierra Leone using operational data (strategic
direction 5, Data for action)

► What we achieved
IPC assessments started in Sierra Leone as part of operational research; results were paramount to guide
improvement plans and interventions with remarkable impact. For this reason, the Ministry of Health and
stakeholders decided to institutionalize this approach, leading to the following key policy and practice
changes between 2021 and 2023.

• National IPC performance improvement: IPC performance at the national level improved from
intermediate (58%) to advanced (78%), with four of six core components reaching the advanced level
of IPC using the WHO IPCAT 2 tool. Among 12 district hospitals, median IPC scores increased from basic
(50%) to intermediate (59%), with improvements in six of eight IPC core components of the WHO IPCAF
tool. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been
addressed by 2023.
• Tertiary hospital IPC compliance: IPC in three major hospitals improved from basic to intermediate IPC
compliance, with score increases of 16.9%, 18.7%, and 26.9%, respectively.
• Guideline distribution and policy development: 1200 copies of updated national IPC guidelines were
distributed and terms of reference for full-time IPC focal points were introduced.
• Enhanced IPC supply chain: increased availability of essential IPC consumables, including soap and
alcohol-based hand rubs (local production).
• HAI surveillance and research: development of Sierra Leone’s first HAI surveillance strategy, protocol and
pilot case definitions within a point prevalence survey (under peer review).
• Surgical site infection reduction: surgical site infection incidence among Cesarean-section and hernia
patients dropped from 6.7% (2021) to 2.8% (2023) following improvements in medical records and
postoperative maternity ward facilities.
• National IPC framework development: drafting of Sierra Leone’s first IPC framework, toolkit, and
operational guide for priority disease outbreaks (2024).
• Hospital hand hygiene improvement: introduction of a hand hygiene quality improvement intervention
in hospitals.
• Border point IPC institutionalization: hand hygiene, sanitation, screening, and isolation were embedded
into routine protocols at Sierra Leone’s four main border entry points.

► Who made this possible

This was a truly multidisciplinary, collaborative effort. Leadership was demonstrated from the Ministry

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Development and implementation of national action plans for infection prevention and control: practical guide

of Health in Sierra Leone (including the national AMR programme, national IPC programme, disease
surveillance, and hospital IPC committee). The WHO Country Office and WHO headquarters also played
a role as well as the Special Programme for Research and Training in Tropical Diseases (TDR). In addition,
the Structured Operational Research and Training Initiative (SORT IT) global partnership supported the
achievements. The partnership was comprised of the International Union Against Tuberculosis and Lung
Diseases; Medicins Sans Frontières; ICMR–National Institute of Epidemiology, India; Sustainable Health
Systems, Sierra Leone; University of Guinea, Guinea; Institute of Tropical Medicine, Antwerp, Belgium;
University of Chester, United Kingdom of Great Britain and Northern Ireland; University of Liverpool, United
Kingdom of Great Britain and Northern Ireland; and the University of Washington, United States of America.

► How we achieved success

Over a four-year period, starting in 2019, a systematic approach was used to ensure success. Seven key
features on the pathway to success are listed below.

• Research prioritization and stakeholder engagement (2019): the IPC technical working group
identified key IPC research priorities, which were subsequently endorsed by the One Health AMR
Committee.
• Selection of trainees: candidates for training were nominated and their research topics were defined.
Selections were reviewed by a TDR-led committee based on specific SORT IT eligibility criteria, including
involvement in IPC and supervisor endorsement (https://tdr.who.int/activities/sort-it-operational-
research-and-training).
• Training and capacity building (2020): seven IPC personnel were trained by TDR and SORT IT partners
in research principles across four one-week modules, that is, research protocol writing, data analysis,
manuscript writing, and research communication.
• Evidence generation (2021-2022): trainees formulated priority IPC research questions using routine
programmatic data to address key challenges. Baseline data were available on surgical site infections,
IPC core component assessments and hand hygiene compliance. Research questions were used to
inform a series of publications (see “outputs so far”)
• Effective communication and advocacy: research findings were effectively communicated through
stakeholder mapping, technical presentations, evidence briefs and consultative meetings to inform
decision-making.
• Impact and follow-up (2023): based on recommendations, national and sub-national stakeholders took
actions to address IPC gaps. In 2023, a new cohort of IPC personnel and frontline workers was trained
to assess the impact of these decisions, identify any remaining gaps and assess the impact of previous
research (“is research evidence inducing change?”). Decisions were agreed upon and actions taken by
various responsible persons/institutions at national and sub-national levels to address the priority gaps
based on the recommendations provided.

► Outputs so far
• Publication and dissemination: findings were published in open-access peer-reviewed journals.

186
 Annexes

These studies highlighting strengths, gaps, and policy implications for IPC implementation at national
and facility levels spanned various IPC topics with policy and practice implications. For example,
implementations of the WHO IPC core components at national and health facilities, hand hygiene
compliance and framework assessments, surgical site infection, community IPC during the COVID-19
pandemic (point of entries).
• Reporting and publication on impact (2023): the new trainees published their findings and conducted
evidence dissemination, presenting to the national IPC programme, IPC advisory committee and senior
Ministry of Health stakeholders, including the Deputy Minister of Health. Their work culminated in a high-
level national dissemination event and a compiled research publication (see references Kamara et al,
2023, Table 2).
• The follow-up impact assessment documents changed from the previously identified priority gaps with
further improvement action using the same method of approach and tools.

► Critical success factors

• Capacity building opportunities provided by the SORT IT project on AMR.
• Financial support from TDR funding facilitated research implementation and evidence uptake.
• Dedicated IPC personnel and committees.
• Government leadership and commitment to support IPC initiatives.
• National AMR programme: institutional backing for AMR and IPC efforts.
• WHO Country Office human resources to support IPC and AMR initiatives
• Commitment of international organizations in combating AMR and interest in IPC.

► Overcoming barriers and challenges

Limited technical capability and knowledge of IPC personnel on implementation science still requires:

• strengthening of IPC monitoring, ensuring data quality through quarterly supervision and robust
operational research, all requiring trained personnel and adequate resources;
• supporting capacity-building initiatives and expert mentorship of IPC personnel on implementation
science;
• introducing self-paced and online learning resources for IPC personnel through free online learning
platforms like OpenWHO.

Finance, infrastructure and resource gaps

• Limited country budgets result in shortages of IPC infrastructure and resources – highlighting the need
for dedicated investments.

Sustainable financing and resource allocation

• Lack of government funding for IPC as an integrated health system priority necessitates strategic
budget allocation.

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Development and implementation of national action plans for infection prevention and control: practical guide

• The need to develop a shared work plan along with other related programmes such as WASH, AMR,
patient safety, and quality improvement programmes.
• Mapping of stakeholders (and donors) to identify the workstream for possible support based on
priorities in the IPC NAP.
• Enhanced donor planning and grant proposal involvement.
• Continue evidence-based advocacy and communication strategies involving using local data on IPC.
In low resources, always start with easily accessible and routinely collected data.

► Resources
• TDR and SORT IT research training resources: presentations, evidence communication tools. https://tdr.
who.int/activities/sort-it-operational-research-and-training

SORT IT programmatic approach.

Engagement of
stakeholdeers
Module 4:
Communication Define research Module 1:
priorities Protocol
advocacy and
development
uptake

Train
Conduct and publish
Enhance mechanism Embed operational research
for knowledge
sharing and uptake Retain Build sustainable
research capacity
Enable

Module 3: Module 2:
Manuscript writing Build structures and
processes for Data analysis
and publishing
evidence informed
decision making

188
 Annexes

• Fofanah BD, Abrahamyan A, Maruta A, Kallon C, Thekkur P, Kamara IF et al. Achieving Minimum Standards
for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the
COVID-19 Era! Int J Environ Res Public Health. 2022; 19(9); 5642. doi: 10.3390/ijerph19095642.
• Kamara IF, Tengbe SM, Fofanah BD, Bunn JE, Njuguna CK, Kallon, C et al. Infection Prevention and Control
in Three Tertiary Healthcare Facilities in Freetown, Sierra Leone during the COVID-19 Pandemic: More
Needs to Be Done! Int J Environ Res Public Health. 2022;19(9): 5275. doi: 10.3390/ijerph19095275.
• Squire JS, Conteh I, Abrahamya A, Maruta A, Grigoryan R, Tweya H et al. Gaps in Infection Prevention and
Control in Public Health Facilities of Sierra Leone after the 2014–2015 Ebola Outbreak. Trop Med Infect
Dis. 2021; 6(2): 89. doi: 10.3390/tropicalmed6020089.
• Kamara GN, Sevalie S, Molleh B, Koroma Z, Kallon C, Maruta A., et al. Hand Hygiene Compliance at Two
Tertiary Hospitals in Freetown, Sierra Leone, in 2021: A Cross-Sectional Study. Int J Environ Res Public
Health. 2022; 19(5): 2978. doi: 10.3390/ijerph19052978.
• Lakoh S, Maruta A, Kallon C, Deen GF, Russell JBW, Fofanah BD., et al. How Well Are Hand Hygiene
Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals. Int
J Environ Res Public Health. 2022; 19(7); 3787. doi: 10.3390/ijerph19073787.
• Carshon-Marsh, R., Squire, J. S., Kamara, K. N., Sargsyan, A., Delamou, A., Camara, B. S. et al. Incidence
of Surgical Site Infection and Use of Antibiotics among Patients Who Underwent Caesarean Section and
Herniorrhaphy at a Regional Referral Hospital, Sierra Leone. Int J Environ Res Public Health 2022; 19(7):
4048. doi: 10.3390/ijerph19074048.
• Kamara, K. N., Squire, J. S., Kanu, J. S., Carshon-Marsh, R., Koroma, Z., Koroma, A. T et al. Assessment of
Infection Prevention and Control Measures at Points of Entry in Sierra Leone in 2021: A Cross-Sectional
Study. Int J Environ Res Public Health. 2022;19(10): 5936. doi: 10.3390/ijerph19105936.
• Margao, S., Fofanah, B. D., Thekkur, P., Kallon, C., Ngauja, R. E., Kamara, I. F et al. (2023). Improvement in
Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before
(2021) and After (2023) Study. Trop Med Infect Dis. 2023; 8(7). doi: 10.3390/tropicalmed8070376.
• Kamara, R. Z., Kamara, I. F., Moses, F., Kanu, J. S., Kallon, C., Kabba, M. et al. (2023). Improvement in
Infection Prevention and Control Compliance at the Three Tertiary Hospitals of Sierra Leone following an
Operational Research Study. Trop Med Infect Dis. 2023; 8(7); 378. doi: 10.3390/tropicalmed8070378.
• Kamara, M. N., Lakoh, S., Kallon, C., Kanu, J. S., Kamara, R. Z., Kamara, I. F et al. Hand Hygiene Practices
and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in
2021. Trop Med Infect Dis. 2023; 8(11), 486. doi: 10.3390/tropicalmed8110486.
• Kpagoi, S. S. T. K., Kamara, K. N., Carshon-Marsh, R., Delamou, A., Manzi, M., Kamara, R et al. (2023).
Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and
Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021.
Trop Med Infect Dis. 2023; 8(8): 385. doi: 10.3390/tropicalmed8080385.
• Moiwo, M. M., Kamara, G. N., Kamara, D., Kamara, I. F., Sevalie, S., Koroma, Z et al. Have Hand Hygiene
Practices in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 following Operational
Research in 2021? Trop Med Infect Dis. 2023; 8(9). doi: 10.3390/tropicalmed8090431.
• Fofanah, B. D., Kamara, I. F., Kallon, C., Kamara, R., Nuwagira, I., Musoke, R et al. Evaluating the tolerability
and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among
health workers in Sierra Leone: A longitudinal hospital-based intervention study. BMC Health Serv Res.
2024; 24(1); 940. doi: 10.1186/s12913-024-11368-3.

189
 Annex 15.
190

Development and implementation of national action plans for infection prevention and control: practical guide
Communications and advocacy mapping template
Insert if the entities have strengths in/potential for collaboration (C), action (A), influence (I) under the topic headings.

Organization/ Identified from Website Summary of capacity, for example, Programmatic areas. Indicate collaboration (C),
focus number of people Insert IPC, AMR, WASH, action (A), influence (I)
patient safety, quality,
emergencies, occupational
health, other
 Annexes

Annex 16.
Country story: A decade of success: strengthening IPC
advocacy and communication during Qatar IPC Week
(strategic direction 6, Advocacy and communication)

► What we achieved
The national IPC) and AMR programme in the State of Qatar was established in 2015 within the Healthcare
Quality Department under The Ministry of Public Health. The programme adopted and shaped around the
six WHO IPC core components recommended at the national level.
The national IPC and AMR programme has successfully organized Qatar Infection Prevention and Control
Week (QIPCW) annually since 2015 as a sustainable, nationwide awareness campaign to highlight the
importance of IPC practices, to catalyse awareness and commitment, and shine a light on IPC.
This has resulted in increased visibility and empowerment of the IPC programme in Qatar across all levels,
engaging thousands of health care practitioners, and resulting in a number of specific achievements.
• Creation and strengthening of the Qatar IPC taskforce since 2015. This consists of a network of IPC
professionals across the country with representatives from government, private and semi-government
health care facilities among which are medical directors, IPC specialists, nurses and IPC link staff, a
microbiologist, infectious disease specialists and quality and patient safety staff.
• Promotion of leadership amongst IPC professionals to take active roles in driving IPC initiatives and
organizing activities within their facilities with Ministry of Public Health support.
• Establishment of the national IPC committee by Ministerial decree since 2019.

► Who made this possible

• The IPC and AMR programme within the Healthcare Quality Department at the Qatar Ministry of Public
Health.
• Key partners included: the WHO Eastern Mediterranean Regional Office, Hamad Medical Corporation,
Primary Health Care Corporation, Sidra Medicine, Qatar Red Crescent, other governmental entities,
including private and semi-government health care sectors across the State of Qatar.

► How we achieved success

• Effective organization and implementation of the QIPCW embedded within our IPC NAP that has been
based upon the targets of strategic direction 6 (WASH) and the IPC core components.
• Well-structured communication.
• Development of tailored messaging depending on the audience.
• Innovative marketing approaches, for example, by widely disseminating the news about the QIPCW

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Development and implementation of national action plans for infection prevention and control: practical guide

through social media platforms using a unified hashtag (#QIPCWeek), sending out periodic newsletters
from the Ministry of Public Health, organizing a range of public events in malls and libraries to engage the
community through games, dancing, and activities for children, along with conducting numerous media
interviews.
• Time investment: our success is the result of many years of effort by the national IPC programme, its
institutionalization within the Ministry of Public Health, and key buy-in by health care providers.
• Tangible activities, as part of QIPCW, to engage stakeholders: it has become an important milestone and
an opportunity.
• Consideration to sustainability: this is crucial for maintaining momentum, engaging our target
audience, and ensuring long-term impact in a strategic coherent and consistent manner.
• Building on an existing global initiative: since the launch of the IPC and AMR programme, the Ministry
of Public Health, in collaboration with the health care sector in the State of Qatar, began the celebration
of QIPCW during the third week of October, inspired by International Infection Prevention Week.
• Building in flexibility: this allowed QIPCW to evolve. It started as a symposium targeting IPC
representatives and has since evolved into a constant annual event celebrated across sectors after the
formulation of Qatar IPC taskforce in 2015 and strengthened after the establishment of the national IPC
committee in 2019.
• Having a clear aim and call to action: QIPCW aims to highlight the importance of IPC practices wherever
health care is delivered by adopting the slogan: “Qatar IPC Week: 365 Days of Commitment 01 Week of
Focus!”
• Adapting and tailoring the focus each year: every year, the QIPCW focus is chosen based upon our
local IPC risk assessment to cover a wide range of specific topics every year. Starting by “Break the
chain of infection” in 2015-2016, highlighting that “Infection Prevention is everyone’s responsibility” in
2017, stressing in 2022 that “The Future is Infection Prevention: Spread Prevention - Not Infection” and
“Celebrating the Fundamentals of Infection Prevention” in 2023.
• Encompassing a diverse array of advocacy efforts led by the Ministry of Public Health:
□ supportive site visits to health care facilities that emphasized leadership support to the local IPC
teams;
□ a 3-day scientific conference including a pre-conference outbreak management workshop, expert-led
presentations, panel discussions, and the official launch of Qatar’s AMR NAP 2024–2030;
□ launching a social media campaign in collaboration with multiple government providers with key
messages related to this year’s theme;
□ empowering IPC focal points across the health sector to actively engage health and care workers,
patients and the broader community through adopting various innovative approaches, such as poster
competitions, face-to-face quizzes, video contests, and educational sessions aimed to raise the IPC
awareness among all the people who have access to health care.

► Outputs so far
• For example, during the 2024 campaign, the following outputs were achieved:
□ over 1000+ participants attended a 3-day scientific conference (IPC staff, doctors, allied health and
care workers, nurses, quality staff, leaders and patient’s representatives).

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 Annexes

□ broad social media engagement with 39 posts across 3 platforms (X, Facebook, and Instagram)
achieving 63 000+ total impressions and 538 engagements;
□ publication of over 12 articles related to QIPCW activities in prominent local newspapers in both
Arabic and English;
□ live Qatar television interview highlighting the activities of the National IPC and AMR Section during
QIPCW;
□ award and recognition of IPC professionals from 13 healt hcare facilities for their outstanding
achievements throughout the year.

Furthermore, the strong visibility achieved through the QIPCW significantly helped the national IPC/AMR
team to convince the Ministry of Public Health leadership and stakeholders to support expansion of the
IPC programme with new activities such as the establishment of an e-Learning platform for continuous,
professional development. This is a national accredited training programme on IPC and AMR developed in
collaboration with the Department of Healthcare Professions at the Ministry of Public Health, with regular
monthly sessions delivered free of charge to all health care professionals in the State of Qatar.

► Critical success factors

• Continued political and leadership commitment.
• Strong national IPC programme and structure across the health system.
• Allocated budget for IPC and AMR activities at national and facility level.
• Establishment of an IPC taskforce to share best practices and engagement across sectors.
• Effective collaboration with public relations, communications and media teams in the Ministry of Public
Health.
• Empowerment and support for IPC professionals from the national IPC team during our site visits,
audits while engaging with facilities leaders, providing training and building capacity and encouraging
autonomy and delegating authority.

► Overcoming barriers and challenges

• Staffing shortages remain a challenge both at the national level and the facility level. To mitigate this
gap, the established Qatar IPC taskforce was employed to provide support across the sector to all the IPC
practitioners across the country where they can tap into each other’s expertise and learn from each
other.
• Greater community engagement. Looking to the future, the plan is to enhance advocacy and
communication for wider behavioural change in order to highlight that IPC is everyone’s responsibility!

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Development and implementation of national action plans for infection prevention and control: practical guide

► Resources
Media reports celebrating Qatar Infection Prevention and Control Week 2024

• https://www.gulf-times.com/article/693750/qatar/moph-meet-highlights-best-practices-in-infection-
prevention
• https://thepeninsulaqatar.com/article/03/11/2024/ministry-of-public-health-highlights-importance-of-
infection-prevention-control
• https://qna.org.qa/en/news/news-details?id=0030-moph-concludes-qatar-infection-prevention,-
control-week&date=2/11/2024
• https://www.qatar-tribune.com/article/147511/nation/moph-concludes-qatar-infection-prevention-
control-week-2024

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 Annexes

Annex 17.
Country story: Integrating research into the activities
of the national IPC unit in Norway (strategic direction 7,
Research and development)

► What we achieved
The milestone of this work has been the development of a research strategy based on the identification of
national and international research gaps in IPC, which is now available to inform and inspire IPC research
throughout the country.

The national IPC team has prioritized research among their activities, in particular:

• conducted systematic reviews and identified evidence gaps for the national IPC guidelines that have
been developed so far;
• developed analytical tools and models, as well as automated surveillance systems, to study the burden
of HAI and AMR and the effectiveness of other IPC interventions;
• regularly publishes scientific manuscripts and reports of research results, including conference
presentations, to document and interpret the results;
• regularly discusses emerging IPC research to stay updated and relevant.

The results of this research have been published mainly in peer-reviewed international journals for the
purpose of dissemination and demonstration of the importance of IPC evidence generation and its linkage
with public health programmes and interventions.

The national IPC unit has successfully contributed to a consortium application for the Horizon
Europe “Health” call for a European partnership for pandemic preparedness (HORIZON-HLTH-2024-
DISEASE-12-01). A key project in one of the work packages will be to “Establish and operate a research
network on effective IPC interventions” and will be led by the Norwegian Institute of Public Health.

► Who made this possible

• An expert and stakeholders’ network was created to identify and prioritize IPC-research aligned with
global challenges and strategic needs. This network includes key players from IPC departments in the
Norwegian Institute of Public Health, IPC specialists working in health institutions, university employees
and students, patient organizations, and the national Directorate of Health.

► How we achieved success

Conducting and prioritizing research has been at the core of the work of the national IPC unit in Norway,

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Development and implementation of national action plans for infection prevention and control: practical guide

aligned with strategic direction 7 of the WHO global action plan and monitoring framework on IPC.

Since 2000, having a national IPC network composed of key IPC specialists from health care institutions
across Norway has allowed discussions on IPC issues, including the identification of research gaps and
opportunities. The inclusion of expertise on research in the national multidisciplinary IPC team including
statisticians and epidemiologists (2018-ongoing) has also contributed to this. The national IPC team also
engages with various universities to motivate students to undertake a master/doctoral thesis on AMR/IPC
topics.

Additionally, there has been:

• cooperation on developing and publishing several systematic reviews to facilitate the harmonization of
IPC guidelines and advice at both the national and Nordic level (2023-ongoing);
• recognition of the need for IPC research (2019-ongoing) through contributions to the development of
systematic reviews and gap reports internationally and nationally;
• capacity building through developing data structures and research methods (2020-ongoing);
• development of strategies to secure research funding (2024- ongoing);
• active participation in the Horizon Europe Coordination and Support Actions Be Ready and Be Ready
Plus, improving research preparedness by developing a European Strategic Research and Innovation
Agenda and a European Partnership for Pandemic Preparedness, both of which advocated for inclusion
of IPC (2024- ongoing).

► Outputs so far
• A research strategy and reviews to identify research gaps.
• Digital tools to advance research methodologies as well as progress reports.
• An application to lead on work as part of the Horizon Europe call for a European partnership for
pandemic preparedness.

► Critical success factors

• Having a political and leadership focus for building up AMR and IPC research capacity at the Norwegian
Institute of Public Health (for example, by having national AMR strategies and IPC action plans that
includes research needs).
• Participating in various networks, both nationally and internationally, advocating for IPC research and
close cooperation with several universities (for example, IPC education at the University of Gothenburg).
• Close contact through regular meetings with IPC professionals at the health facility level to develop a
similar understanding of IPC challenges, as well as sharing information about methods, success factors
and barriers.
• Ownership of and extensive experience with health register data, including the possibility to link
different registers and data sources by personal identification number and thus enable merged datasets
and automated surveillance systems.

196
 Annexes

• Multidisciplinarity focus on integrating the whole research process from ideas and clinical insights to
data processing, analysis and dissemination.

► Overcoming barriers and challenges

• Limited funding opportunities for IPC research, both nationally and internationally: addressed by
developing strategies and networking, cooperation and awareness raising.
• Lack of human resources for daily operations and research the field of IPC: addressed by building-up
a multidisciplinary team and liaising with universities and other institutions. Major discrepancies
between needs and expectations, and capacity have also been acknowledged.
• Challenges to conducting randomized control trials in health care settings: addressed by
collaborating with the Centre for Epidemic Interventions Research (CEIR), which aims at identifying and
overcoming barriers to carrying out studies as one of its tasks.

► Resources
• Further information about CEIR is available here: https://www.fhi.no/en/kn/ceir/.
• Lacotte Y, Årdal C, Ploy MC; European Union Joint Action on Antimicrobial Resistance and Healthcare-
Associated Infections (EU-JAMRAI). Infection prevention and control research priorities: what do we
need to combat healthcare-associated infections and antimicrobial resistance? Results of a narrative
literature review and survey analysis. Antimicrob Resist Infect Control. 2020;9(1):142. doi: 10.1186/
s13756-020-00801-x.
• Gap report of AMR-research need (in Norwegian). https://www.fhi.no/globalassets/dokumenterfiler/
rapporter/2020/amr-kunnskapshull-rapport.pdf.
• Lindstad CB, Myrbakk T, Fagernes M, Eriksen-Volle HM, Aasheim ET. Sustainable infection control -
gloves off. Tidsskr Nor Laegeforen. 2024;144(10). doi: 10.4045/tidsskr.24.0343. (English, Norwegian).
• Solberg RB, Fretheim A, Elgersma IH, Fagernes M, Iversen BG, Hemkens LG et al. Personal protective
effect of wearing surgical face masks in public spaces on self-reported respiratory symptoms in adults:
pragmatic randomised superiority trial. BMJ. 2024;386:e078918. doi: 10.1136/bmj-2023-078918.
• Skjeldestad FE, Bjørnholt JV, Gran JM, Eriksen HM. The effect of antibiotic prophylaxis guidelines on
surgical-site infections associated with cesarean delivery. Int J Gynaecol Obstet. 2015;128(2):126-30.
doi: 10.1016/j.ijgo.2014.08.018.
• Di Ruscio F, Guzzetta G, Bjørnholt JV, Leegaard TM, Moen AEF, Merler S et al. Quantifying the
transmission dynamics of MRSA in the community and healthcare settings in a low-prevalence country.
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Annex 18.
Country story: Promoting partnership and teamwork
to strengthen IPC across Nigeria (strategic direction 8,
Collaboration and stakeholder support)

► What we achieved
In 2019, Nigeria established its national IPC programme, ‘Turn Nigeria Orange’, under the leadership of
the Nigeria Centre for Disease Control and Prevention (CDC). The strategy entails working with healthcare
facilities through a collaborative network model known as the Orange Network, where participating
facilities, under the Nigeria CDC’s leadership, support one another as peers and mentor other healthcare
facilities. The programme’s approach is anchored in the WHO’s core components of IPC and is guided by
the philosophy of “One Nation, One Plan”—ensuring coordinated action with linkage to other national
programs like AMR and WASH and a unified vision among all stakeholders involved in IPC implementation
across all levels of the health system.

Since its inception, the programme was able to engage with national institutions and to gain support from
multiple international partners. The approach in establishing agreements and collaborations with these
stakeholders and partners has been to request a strong focus on IPC needs emerging from the national
and facility assessments conducted by the national programmes and the priorities established through
the national strategy and action plan. Similarly, allocation of funds was aligned with the national strategy
and action plan, allowing to secure dedicated resources and budgets for IPC at both national and facility
levels.

Most recently, in 2024, the National Council on Health approved the revised 2024 national IPC policy,
which is critical for IPC strengthening and resource mobilization at all levels. The national IPC programme
also has functional, multi-sectoral and diverse technical working groups with all the key players from
the Nigerian government, disease programmes, national and international partner organizations and
academic institutions being part of the national IPC technical working group. This serves as a platform for
strengthening IPC coordination and resource mobilization among stakeholders.

Another main objective of the Turn Nigeria Orange, has been to establish IPC expertise and programmes
at the state and facility levels through collaborative approaches. The Participatory Approach to Learning
in Systems was implemented for health care facilities by training state-level IPC Professionals (trainers)
and Healthcare Facility IPC teams (change agents) in social and organizational skills to strengthen and
sustain interprofessional and inter-cadre collaboration and foster closer communication and engagement
between IPC teams and hospital management. This system was also a result of the partnership between
the Nigeria CDC and the Robert Koch Institute (Berlin, Germany).

In 2020, the Orange Network was launched, a coalition of public tertiary health facilities striving to become
centres of excellence in IPC. Initially, 25 facilities joined the network. By 2022, an additional 16 facilities
were onboarded, thus achieving the goal of having one network facility per state. By the third quarter

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of 2024, the Orange Network expanded to include 41 tertiary health care facilities, 111 secondary care
facilities, and 256 primary health care centres, all actively participating in IPC communities of practice.

► Who made this possible

The journey in strengthening IPC in Nigeria has been made possible through the collaborative efforts of
various key players. Notably, the Federal Ministry of Health and Social Welfare and the Senate, together with
the Nigeria CDC, provided leadership and coordination. Collaboration with national institutions accelerated
rapid progress. For example, the National Primary Health Care Development Agency and the College of
Medicine at the University of Lagos were instrumental in training and capacity building. The Nigeria Society
for Infection Control and the Dr. Ameyo Stella Adadevoh Health Trust played crucial roles in advocacy and
community engagement.

The national IPC technical working group, a multi-agency and multi-professional group, guided efforts and
engaged with key partners such as WHO, the United States Centers for Disease Control and Prevention, the
Infection Control Africa Network, the United States Agency for International Development, the Africa Field
Epidemiology Network, Aids Prevention Initiative Nigeria Public Health Initiatives, and the Robert Koch
Institute. International collaborations provided essential support and enriched our training programmes.
In the health care facilities that are part of the Orange Network, chief medical directors are supporting IPC
programmes by allocating necessary resources.

► How we achieved success

In 2018, we established the first national IPC focal point within the Nigeria CDC to coordinate IPC
activities nationwide. On 5 May 2019, we launched the ‘Turn Nigeria Orange’ programme, followed by the
nomination of IPC focal persons from tertiary health care facilities in all the states.

A thorough stakeholder mapping exercise led to strong relationships with key partners aligned with our
national IPC programme priorities and the implementation of the Participatory Approach to Learning in
Systems for health care facilities.

In 2020, the Orange Network was launched and further expanded in 2024 to create the Aids Prevention
Initiative Nigeria Orange Network for secondary health facilities and primary health care centres, with support
from the United States Centers for Disease Control and Prevention, Nigeria CDC, the Africa Field Epidemiology
Network, the National Primary Health Care Development Agency, and Resolve To Save Lives. In 2021, we
published the first national IPC guidelines, which were developed with support from the Robert Koch Institute.

Our success in implementing IPC measures has been a result of strategic planning and strong collaborative
efforts to further highlight the following focus elements.

• Training, professional development and international collaboration: we collaboratively developed the

national IPC training programme with the University of Lagos, the Infection Control Africa Network, and
the United States Centers for Disease Control and Prevention. IPC focal points participated in workshops

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focusing on WHO core components, hand hygiene improvement and HAI surveillance. We were involved
in global partnerships for HAI surveillance, hand hygiene audits, and validation of WHO case definitions
for HAIs. IPC expertise was gradually built up, in part by growing numbers participating in the national IPC
training programme, which equips health workers with the knowledge and skills to establish and maintain
IPC programmes in their facilities. Graduates become part of a network of health champions and remain
engaged in ongoing communities of practice.
• Advocacy and communication: the Dr. Ameyo Stella Adadevoh Health Trust played a significant
role in advocating for IPC activities and communicating their importance. We routinely engaged with
chief medical directors to advocate for support of IPC within their institutions and for the allocation of
necessary resources.
• Peer-to-peer learning and support: Orange Network participants engaged in peer-to-peer learning
through an active WhatsApp group, webinars, peer site visits and supportive supervision.
• Leveraging existing resources: an emphasis was placed on leveraging existing resources and finding
mutual areas of interest with other programmes to facilitate collaboration.

► Outputs so far
We published our first national IPC manual for health facility implementation in 2021 and updated our
national IPC policy in 2022. By the third quarter of 2024, our Orange Networks expanded to include 41
tertiary health care facilities, 111 secondary care facilities, and 256 primary health care centres. We also
published four Participatory Approach to Learning in Systems training manuals for various categories of
stakeholders, from health workers in the facility, to state trainers and hospital managers.

Improvements in the WHO IPCAF scores: 83% of facilities reached intermediate or advanced IPC levels after
one year (2022), up from the 41% baseline in 2021.

► Critical success factors

• Continuous advocacy: continuous promotion of buy-in from leaders at all levels, ranging from the
ministry of health to the health care facility level.
• Strong partnerships and collaboration: creation of partnerships with multiple national and
international institutions to foster a sense of belonging and ownership. Collaboration with local and
regional institutions to strengthen IPC capacity.
• Realistic, achievable goals: setting of reasonable and attainable initial goals for IPC programmes,
starting small and scaling-up, based on lessons learned.
• Sustainable IPC workforce: investment in training and mentorship opportunities for IPC professionals,
building a passionate and committed team of health care workers.
• Resource utilization: leveraged existing resources within and outside the health system to address IPC
priorities and mobilized donor funding according to country needs and plans.
• Participatory approach: encouraged the use of communications and networking to address priority IPC
problems, including communication through an active WhatsApp group, site visits by peers and mentors,
and advice from experienced members through communities of practice.

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► Overcoming barriers and challenges

• Varying and competing interests among stakeholders: we conducted a stakeholders´ analysis to
understand their interests and then accommodated multiple stakeholders with varying and sometimes
competing interests within the national IPC technical working group to provide powerful coordination
mechanisms. The strong political commitment and leadership of the coordinating Minister of Health and
Social Welfare ensured that all stakeholders came and worked together towards a unifying ‘One nation,
One plan’ strategy under the stewardship of the national IPC programme coordinator.
• Lack of funding: establishment of the programme was supported by non-state actors, with limited
funding. To maintain and advance the programme, funding from all three tiers of the Nigerian
government will be needed.
• Structural and legal deficiencies: including the lack of an IPC legal framework, mandatory standards,
limited human resources, infrastructure issues, weak monitoring and evaluation, underreporting of
health care workers’ exposure events, and lack of a career path for IPC professionals: to address these
challenges, the programme is currently establishing an IPC legal framework that will set out regulations
for IPC standards, as well as collecting HAI surveillance and IPC practice data to improve safety.

► Resources
• Nigeria CDC. Presentation of the Turn Nigeria Orange programme. 2025 (https://youtube.com/
watch?v=HoFW4C0vAE4&feature=shared).
• Nigeria Capacity Development (NICADE) – IPC. Participatory approach to learning in systems –
Participatory Approach to Learning in Systems. 2025 (https://nicadeipcpals.ncdc.gov.ng/).
• Nigeria CDC. Highlights from the First Participatory Approach to Learning in Systems Conference
(https://nicadeipcpals.ncdc.gov.ng/gallery/).

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