Cabo Verde: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is evidence that Cabo Verde has a national AMR plan that covers surveillance, detection, and reporting of priority AMR pathogens.

The Cabo Verde National Action Plan for AMR (2018–2022) is publicly available on the Ministry of Health’s website. The plan prioritizes the creation of a national surveillance system under Objective 3 (p. 8). It includes clear objectives related to the establishment of a national surveillance system, strengthening laboratory capacity, promoting the rational use of antimicrobials, and developing infection prevention programs. These elements are outlined under Section 3.2 (Operational Strategies), specifically in Section 3.2.1, which is titled "Surveillance, Detection & Reporting of Priority Pathogens." ¹

It also details strategic and operational actions, timelines, and responsibilities across the human health, animal health, and environmental sectors, in line with a One Health approach. It includes the creation of an Infection Prevention and Control Committee, the establishment of a National Coordination Structure for AMR Monitoring, and the development of mechanisms to ensure that all health facilities have an Infection Prevention and Control Committee for Healthcare-Associated Infections (IPC-HCAI Committee). It also calls for monitoring the commercialization and consumption of antimicrobial medicines, and the implementation of a National Surveillance System for healthcare-associated infections (HAIs), antimicrobial resistance (AMR), animal diseases, and environmental factors. ²

As of June 2025, there is no publicly available updated version of the national AMR plan beyond 2018–2022.

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 0

There is insufficient evidence that Cabo Verde has a national laboratory system which tests for WHO's priority AMR pathogens.

Cabo Verde's National Action Plan for AMR (2018–2022) proposes specific provisions to develop a national laboratory network for AMR testing. It identifies the need to designate two national reference laboratories and one research laboratory (INSP) to confirm and characterize AMR pathogens It also proposes the implementation of a national laboratory surveillance model and outlines actions to improve infrastructure, diagnostics, and training (p. 24,25). ³

However, these laboratory improvements are planned but not yet fully implemented. As one of the activities 4.1.1.1, it involves the preparation and approval of terms of reference for national reference and research laboratories capable of implementing methods to confirm and characterize specific pathogens, as well as organizing quality assurance schemes (p. 24). In addition, other activities highlight the need for improving and adapting existing laboratory infrastructure to support the diagnosis and surveillance of IRCS, AMR, animal, and environmental diseases (activity 4.2.2.1); acquiring equipment and diagnostic tools for monitoring IRCS, AMR, animal diseases, and environmental conditions (activity 4.2.2.2); training human resources to work in the surveillance of IRCS, AMR, animal diseases, and the environment (activity 4.2.2.3); and strengthening the implementation of good practices in microbiology laboratories (activity 4.2.2.4). ⁴

The 2019 Joint External Evaluation (JEE) notes that Cabo Verde's National Laboratory Network (RNL) has developed lists of priority pathogens for both human and animal health, but these lists focus on broader infectious diseases rather than targeting AMR-specific organisms. Human health priorities include malaria, TB, HIV/AIDS, meningitis, and diarrheal diseases, while animal health priorities include brucellosis, African swine fever, and salmonella (p. 31). These diagnostic priorities indicate a broader surveillance scope but fall short of demonstrating targeted AMR pathogen testing aligned with WHO priorities. ⁵

Finally, the 2022 Tracking AMR Country Self-Assessment Survey (TrACSS) indicates that Cabo Verde "does not have a reference lab/s performing susceptibility testing for any of the bacteria" (p. 6). ⁶

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁷⁸

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is insufficient evidence that Cabo Verde conducts environmental detection or surveillance activities for antimicrobial residues or AMR organisms.

While Cabo Verde’s National Action Plan for AMR (2018–2022) outlines the intention to develop an integrated, One Health approach to antimicrobial resistance surveillance, there is no clear indication that environmental monitoring activities were already in place at the time of the plan’s publication. Strategic Intervention 4.2 proposes the implementation of a national laboratory network for AMR surveillance across human, animal, and environmental health sectors (p. 24,25). Specifically, Strategic Action 4.2.1 outlines plans to implement laboratory surveillance of resistant pathogens (IRCS) and AMR in human, animal, and environmental services. However, the outlined activities—such as conducting a situational assessment (4.2.1.1), redefining the surveillance model based on that assessment (4.2.1.2), and improving communication among microbiology laboratories (4.2.1.3)—are preparatory in nature. These show that implementation of environmental surveillance was still in the planning or diagnostic phase at the time, rather than already operational. ⁹

The 2019 Joint External Evaluation (JEE) does not report any active environmental surveillance for antimicrobial residues or AMR organisms in Cabo Verde. Although it notes the existence of the National Agency for Water and Sanitation (ANAS) within the structure of the Ministry of Agriculture and Environment, which is responsible for water safety and environmental contamination monitoring, it provides no indication that ANAS is involved in AMR-related environmental testing. ¹⁰ This is further supported by the Ministry of Agriculture and Environment website, which returns 0 results when searching for AMR. ¹¹

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Cabo Verde has a national legislation in place requiring prescriptions for antibiotic use for humans, but there is evidence of gaps in enforcement.

The National Action Plan for AMR (2018–2022), namely PAN-RAM, indicates that prescription of antibiotics in Cabo Verde is guided by pre-established clinical protocols, particularly in public health settings. It mentions that the availability of human-use antimicrobials is based on essentiality and is regulated through the national list of essential medicines. ¹² In addition, Cabo Verde’s Decree-Law No. 41 of 11 August 2014, which aims to promote the rational use of medicines, stipulates in Article 9 that the dispensing of antibiotics requires a special controlled medical prescription (p. 1638). ¹³

However, the PAN-RAM notes that supervision and laboratory support are limited, and it does not cite existing binding legislation mandating prescriptions, indicating gaps in enforcement (p. 18). ¹⁴

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ¹⁵¹⁶

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 0

There is insufficient evidence that Cabo Verde has a national legislation or regulation requiring prescriptions for antibiotic use for animals.

The Zoo Sanitary Law No. 30/VIII/2013 of 13 May 2013 governs animal health in Cabo Verde, by establishing standards for sanitary safety, animal health, environmental health, products of animal origin and veterinary public health. ¹⁷ However, as of the latest available WHO Joint External Evaluation (JEE), from 2019, this law remained in a regulatory development phase and did not contain a system for controlling antimicrobial use, nor did it require prescriptions for veterinary antibiotics. ¹⁸

The National Action Plan for AMR 2018–2022 further confirms the absence of regulamentation, stating that the country is still in the process of developing veterinary medicine regulations. Specifically, the Plan outlines the planned creation of a National Commission for Veterinary Medicines (9.1.2.1), a National List of Veterinary Medicines (9.1.2.2), and guidelines for the veterinary medicines supply chain (9.1.2.3). These are listed under strategic objective 9.1.2 and assigned to the Ministry of Agriculture and Environment (MAA) and the General Directorate for Agriculture, Silviculture and Livestock (DGASP). The Plan mentions that antibiotics are prescribed using "pre-defined protocols," but this is not grounded in enforceable legal requirements and lacks supervisory mechanisms and laboratory support (p.18) ¹⁹

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ²⁰²¹²²

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is evidence that Cabo Verde has national legislation, plans, and strategies for zoonotic disease prioritization, detection and reporting.

The Zoo Sanitary Law No. 30/VIII/2013 of 13 May 2013 serves as the main legal framework for animal health and zoonotic disease control. Chapter VII of the law specifically addresses contagious and zoonotic diseases, including provisions for monitoring animal health, reporting notifiable diseases, vaccination, sanitary inspections, and preventive measures (p. 652). Article 21 requires any animal owner or person responsible for the care of an animal to report suspected or confirmed cases of highly contagious diseases to the veterinary authority (p. 653). Article 22 outlines the measures the government may adopt to prevent the spread of notifiable diseases, including movement restrictions, mandatory prophylaxis, quarantine, slaughter of animals, and disinfection of affected areas (p. 653). These provisions form a legal basis for the detection and mandatory reporting of zoonotic diseases. ²³

Zoonotic disease prioritization is also supported by intersectoral planning. According to the 2019 Joint External Evaluation (JEE), Cabo Verde has defined national priorities for zoonoses in collaboration between the animal and human health sectors. These include diseases such as brucellosis, cysticercosis, tuberculosis, leishmaniasis, and avian influenza, which are on the country’s priority disease list for epidemiological surveillance, updated based on the prevailing epidemiological situation. Order No. 11/2002 created multidisciplinary rapid response teams at national (ETNIR) and local (ETLIR) levels, which may include veterinary and environmental sector members. These teams are tasked with detecting and responding to public health threats, including zoonoses. ²⁴

Cabo Verde’s National Action Plan for Health Security (NAPHS) and the National Action Plan for Antimicrobial Resistance (AMR) 2018–2022 adopt a One Health approach and explicitly identify zoonotic diseases as key threats to national health. The NAPHS highlights the growing interaction between human and animal populations as a driver of zoonotic risks, and both documents promote multi sectoral collaboration for prevention and control. ²⁵²⁶

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Cabo Verde's national legislation and planning documents contain specific measures for risk identification and reduction of zoonotic spillover from animals to humans.

There are measures designed to prevent the spread of zoonoses from animals to humans in Cabo Verde. Decree-Regulation No. 11/2020 defines a national list of highly contagious and serious animal diseases and specifies control and containment measures. ²⁷

Decree-Regulation No. 12/2020 regulates hygiene and sanitary controls in the animal production sector and throughout the animal-origin food chain. Article 5 requires producers to implement risk analysis systems, adopt sanitary prophylaxis and surveillance, and apply the HACCP system to reduce threats to animal, environmental, and human health. Articles 6–10 detail mandatory pre- and post-mortem inspections, procedures for humane and hygienic animal slaughter, and protocols for handling animals with contagious diseases. Articles 27–30 regulate the transport of live animals, including requirements for sanitary inspections, prevention of stress and injury, and isolation of suspected zoonotic disease cases. Article 47(1) prohibits the marketing of eggs from farms where zoonotic diseases are detected, requiring sanitary clearance before resumption of sales. These measures contribute to zoonotic spillover prevention. ²⁸

Cabo Verde’s National Action Plan for Health Security (PNASS) in Section 4.6.3 (p. 33) references Decree 12/2020 as part of the country’s regulatory framework for zoonotic risk control, alongside the Decree 11/2020. In Section 4.7 (p. 34), the plan outlines preparedness for Highly Pathogenic Avian Influenza, emphasizing monitoring of wild birds, border inspections, and multisector coordination as spillover prevention tools. The PNASS operates under a One Health approach, highlighting the integrated role of the Ministries of Health, Agriculture, and Environment in preventing zoonotic transmission. ²⁹

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 0

Cabo Verde has national plans that support the surveillance and control of specific zoonotic diseases, though not a comprehensive framework covering multiple zoonotic pathogens.

The 2019 Joint External Evaluation (JEE) notes that Cabo Verde has developed two disease-specific plans: the Plan for the Prevention and Control of Avian and Pandemic Influenza (2007) and the National Strategy for the Prevention, Control and Fight Against Endo and Ectoparasites (2019). ³⁰ However, these plans were not located in public sources and could not be independently verified.

The National Action Plan for Health Security (PNASS) 2022–2026, in Section 4.7 (p. 34), cites a dedicated national contingency plan for Highly Pathogenic Avian Influenza (HPAI). However, this HPAI plan is also not publicly available. The PNASS mentions it as being updated with support from FAO and WHO and implemented at national level. According to PNASS, the HPAI describes the national poultry and veterinary health context, identifies risk factors, outlines actions for both prevention and emergency response phases, and defines roles across central and decentralized levels. It also integrates public awareness efforts and training programs for professionals and civil society. Importantly, it adopts a multi sectoral and multidisciplinary approach under the One Health framework, coordinating the Ministries of Agriculture, Environment, and Health for early detection, border inspection, and surveillance of migratory birds. ³¹

No additional evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ³²³³

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

Cabo Verde has a multi sectoral coordination mechanism dedicated to zoonotic disease that functions across ministries.

The National Coordination Instance (INC), established in 2019, serves as Cabo Verde’s designated One Health coordination platform. According to the National Institute of Public Health (INSP), the INC is responsible for coordinating the sharing of data and information between sectors to ensure timely and effective responses to health risks. It also provides technical and scientific advice, develops cooperation with public and private entities (national and international), and may take on additional responsibilities as assigned by law or its supervising body. ³⁴

The INC includes representatives from key ministries and institutions, such as the Ministry of Health, the Ministry of Agriculture and Environment. Its mandate includes coordinating actions for zoonotic disease surveillance, control, and response, in line with national strategies such as the National Action Plan for Health Security (PNASS) and the National Action Plan on AMR (PAN-RAM). ³⁵³⁶

1.2.1e Presence of One Health strategic plan

Score: 0

Cabo Verde does not currently have a comprehensive national One Health strategic plan in place but Cabo Verde’s National Action Plan for Health Security (PNASS) operates under a One Health approach, highlighting the integrated role of the Ministries of Health, Agriculture, and Environment in preventing zoonotic transmission. ³⁷

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

Cabo Verde has an established national mechanism through which livestock owners contribute to disease surveillance, coordinated by the Ministry of Agriculture and Environment.

According to the National Action Plan for Health Security (PNASS) 2022-2026, the Directorate of the Livestock Service within the Ministry of Agriculture and Environment (MAA) operates a centralized epidemiological surveillance unit. Under section 4.6.2, titled "Operation of the MAA's Epidemiological Surveillance Network, the Plan mentions that this unit receives, processes and disseminates field information supplied by focal points working in the decentralized Delegations and Departments of the MAA. These focal points, located in Livestock Services and Border Inspection Services, collect data provided by farmers and by public and private partner institutions at the community level. Laboratory diagnosis is carried out by the national veterinary laboratory, which works in close coordination with both the central surveillance unit and the decentralized MAA services. After verification and analysis at the central level, the system promptly notifies the appropriate national, regional and international organizations. ³⁸

Moreover, the Family Livestock Modernization Program, approved by Resolution n.º 56/2024, is a national initiative that directly engages criadores familiares (family breeders/livestock owners). One of its objectives is to ensure the "sanitary safety of herds and animal products." Livestock owners contribute through their participation in core activities facilitated by this program, such as the implementation of the National Animal Identification and Registration System (SNIRA). The program also mandates the conduct of "serological and epidemiological surveys," in which animals belonging to family breeders are directly involved, providing data for disease surveillance. Additionally, it includes training for breeders and livestock operators, equipping them to better manage animal health and contribute to data collection. Responsibility for coordinating this mechanism is clearly assigned to the MAA. Specifically, the Directorate of Livestock and Animal Health Services, the Directorate General of Agriculture, Forestry and Livestock, and the decentralized Delegations of the MAA are tasked with overseeing and monitoring the program’s implementation. ³⁹

However, as of July 2025, the MAA webpage dedicated to the Directorate of the Livestock Service remains blank. ⁴⁰

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no evidence of legislation or regulation in Cabo Verde that explicitly safeguards the confidentiality of animal surveillance data.

A review of Cabo Verde's National Action Plan for AMR 2018–2022, National Action Plan for Health Security (PNASS) 2022-2026, and the 2019 WHO Joint External Evaluation (JEE) reveals no mention of legal provisions protecting the privacy or confidentiality of surveillance data provided by livestock owners. While these documents outline the collection of data by public authorities for epidemiological surveillance, they do not specify provisions for personally or commercially sensitive information confidentiality. The PNASS, while emphasizing data collection for monitoring and evaluation (p. 84) to strengthen health security, does not detail specific measures for data protection or owner privacy. Similarly, The JEE does not mention any kind of law or guideline that safeguards confidentiality for livestock owners in matters of data generated from surveillance. ⁴¹⁴²⁴³

The Zoo Sanitary Law No. 30/VIII/2013 of 13 May 2013 addresses various aspects of animal health in Cabo Verde but does not include provisions to protect the confidentiality of information generated through animal health surveillance for livestock owners. ⁴⁴ Likewise, Law No. 41 of 17 September 2013, which establishes the General Judicial Regime for the Protection of Personal Data of Individuals, does not contain any specific measures safeguarding the confidentiality of surveillance data related to animals or livestock owners. ⁴⁵

No additional evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁴⁶⁴⁷

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Cabo Verde conducts surveillance of zoonotic diseases in wildlife, poultry, and livestock, but is limited.

Systematic surveillance in wildlife is insufficient, mainly tracking mosquito vectors without comprehensive disease sampling. ⁴⁸ The 2019 Joint External Evaluation (JEE) confirmed that "surveillance of animal health is very little developed" in the country (p. 34). ⁴⁹ The National Action Plan for Health Security (PNASS) for 2022–2026 includes future goals to "Extend coordinated laboratory-enhanced surveillance to all zoonotic diseases or pathogens" (p. 58), reflecting current gaps in integrated monitoring across these animal sectors (p. 21). The Ministry of Agriculture and Environment epidemiological surveillance network primarily relies on informal field information and farmer reporting, indicating a lack of structured data collection (p. 33). ⁵⁰

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ⁵¹⁵²⁵³

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH).

Cabo Verde operates a functional mechanism for routine reporting of animal disease events to the World Organisation for Animal Health (WOAH). Evidence from the WOAH World Animal Health Information System (WAHIS) platform shows recent public listings of animal disease events for Cabo Verde, with updates as recent as January 15, 2025, directly confirming ongoing surveillance and notification to the international body. This demonstrates that a system for reporting is actively in use and contributes to global animal health transparency. ⁵⁴

According to the 2019 Joint External Evaluation (JEE), Cabo Verde has designated a national focal point for the World Organisation for Animal Health (WOAH), previously OIE, for the notification of disease information (p. 38). Information is shared through these national focal points regarding the prevailing sanitary situation in the country (p. 38). However, while active reporting to WOAH is occurring, the JEE identified a need to establish standardized procedures and a technical mechanism to ensure routine multi sectoral information coordination and exchange, including regular forums between the International Health Regulations (IHR) and WOAH Focal Points (p. 38). The National Action Plan for Health Security (PNASS) for 2022–2026 further outlines the development of communication standards and protocols for Animal Health as a strategic activity (p. 65). ⁵⁵⁵⁶

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ⁵⁷⁵⁸⁵⁹

1.2.4a Number of veterinarians per 100,000 people

Score: 7.54

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 5.54

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 100

Cabo Verde’s national plan include mechanisms to engage the private sector in zoonotic disease control and response.

The National Action Plan for Health Security (PNASS) identifies the private sector as a stakeholder with "collective responsibility" in responding to public health threats (p. 41). It emphasizes fostering "strategic partnerships and technical cooperation with private organizations" to implement PNASS activities (p. 84). Specifically for surveillance, the plan aims to "Structure data analysis and alert mechanisms at Central and local levels for outbreak surveillance in the multi sectoral context including the private sector" by 2026 (p. 65). Furthermore, the PNASS indicates its intent to adapt the WHO AFRO Technical Guidelines for Integrated Disease Surveillance and Response (IDSR), 3rd edition, to the national context, specifying that this will incorporate "private actors" into community-based and event-based surveillance systems (p. 65). ⁶⁰

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Cabo Verde has a record, updated within the past five years, of the facilities in which especially dangerous pathogens and toxins are stored or processed, including details on inventories and inventory management systems of those facilities.

The 2019 Joint External Evaluation (JEE) identified the need to inventory microorganisms and their storage locations as a priority action, explicitly stating that an updated inventory of pathogenic agents and toxins was an area requiring strengthening (p. 5, 49).

Furthermore, the National Action Plan for Health Security (PNASS) 2022–2026 includes the activities to "Develop and maintain a national inventory of dangerous pathogens" and "Store dangerous pathogens and toxins in a minimum number of national laboratories" as future strategic activities (p. 60). This indicates that the establishment of such a comprehensive and updated record is a planned objective rather than an existing practice. ⁶¹

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁶²⁶³ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ⁶⁴ Cabo Verde has not submitted any Confidence Building Measures reports. ⁶⁵

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

Cabo Verde does not have in place legislation and/or regulations related to biosecurity that address requirements such as physical containment, operational practices, failure reporting systems, and/or cybersecurity of facilities where especially dangerous pathogens and toxins are stored or processed.

The 2019 Joint External Evaluation (JEE) states that Cabo Verde does not have any plans, legislation or regulations on biosecurity or biosafety (p. 26). ⁶⁶ While the National Action Plan for Health Security (PNASS) 2022–2026 includes a strategic activity to "Review and update national legislation and regulations on biosafety and biosecurity" (p. 60), this signifies a future objective and not a currently existing framework. ⁶⁷

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁶⁸⁶⁹ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ⁷⁰ Cabo Verde has not submitted any Confidence Building Measures reports. ⁷¹

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 100

Cabo Verde designates specific agencies responsible for enforcing biosecurity legislation and regulations within the framework of its National Action Plan for Health Security (PNASS) 2022-2026.

The PNASS identifies the National Institute of Public Health (INSP) and the Institute for Quality Management and Intellectual Property (IGQPI) as entities for implementing and enforcing biosecurity-related regulations (p. 60). ⁷² The INSP's mandate, as stated on its website, includes "public health surveillance" and "sanitary surveillance" which covers "food quality and safety" and "products subject to surveillance". The 2019 WHO Joint External Evaluation (JEE) further notes INSP's role in coordinating the One Health approach (p. 20) and its function as a national reference laboratory (p. 31). ⁷³

The IGQPI, created by Decree-Regulation nº 35/2014, according to its website, is responsible for "Quality management, standardization, metrology, accreditation, qualification, certification, and conformity assessment." These functions directly support the establishment and enforcement of standards critical for effective biosecurity. ⁷⁴ The PNASS indicates its plan for this agency to "Implement national biosafety and biosecurity regulations and guidelines with all relevant sectors" (p. 60), confirming a planned institutional responsibility for enforcement in this area. ⁷⁵

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly available evidence indicating that Cabo Verde has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

The 2019 Joint External Evaluation (JEE) highlighted this as a significant gap, recommending as a priority action to "Inventory the microorganisms that are manipulated and the location where they are being stored in the country" (p. 5, 49). The JEE further noted that an "updated inventory of pathogenic agents and toxins in entities that manipulate or store those microorganisms" was an area needing strengthening (p. 49). ⁷⁶

The National Action Plan for Health Security (PNASS) 2022–2026 lists "Develop and maintain a national inventory of dangerous pathogens" and "Store dangerous pathogens and toxins in a minimum number of national laboratories" as strategic activities (p. 60). These are forward-looking plans, confirming that the consolidation of inventories has not yet been publicly evidenced. ⁷⁷

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁷⁸⁷⁹ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ⁸⁰ Cabo Verde has not submitted any Confidence Building Measures reports. ⁸¹

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no publicly available evidence that Cabo Verde has in-country PCR-based diagnostic capacity for anthrax or ebola.

A review of Cabo Verde’s national plans—the National Action Plan for Health Security (PNASS) 2022–2026, the 2019 Joint External Evaluation, and Cabo Verde's National Action Plan for AMR 2018–2022—reveals no explicit mention of Polymerase Chain Reaction (PCR)-based diagnostics for anthrax (Bacillus anthracis) or Ebola virus. ⁸²⁸³⁸⁴ These pathogens require Biosafety Level 3 or 4 containment, and there is no indication that such facilities exist or are operational in-country. While the PNASS outlines general goals for strengthening laboratory systems and mentions training and capacity building for epidemic response (p. 64), it does not reference PCR as a specific diagnostic tool. In the absence of clear documentation, it cannot be concluded that Cabo Verde possesses the in-country capability to conduct PCR testing for these high-risk pathogens.

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ⁸⁵⁸⁶⁸⁷

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

Cabo Verde does not currently require standardized biosecurity training for personnel working with dangerous pathogens, toxins, or biological materials with pandemic potential.

The 2019 Joint External Evaluation (JEE) explicitly stated that Cabo Verde lacked plans or regulations addressing biosecurity and biosafety, noting only a general need for capacitation and training of personnel without specifying any existing requirement for biosafety training (p. 27). ⁸⁸

The National Action Plan for Health Security (PNASS) for 2022–2026 aims to address this gap by proposing strategic activities such as adapting education curricula and developing a national academic biosafety and biosecurity training program following international best practices (p. 60-61). These actions are identified as future implementations rather than current requirements. ⁸⁹

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁹⁰⁹¹ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ⁹² Cabo Verde has not submitted any Confidence Building Measures reports. ⁹³

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no evidence that Cabo Verde has regulations requiring security or health checks for personnel handling dangerous pathogens.

Neither the 2019 Joint External Evaluation nor the National Action Plan for Health Security (PNASS) 2022-2026 reference any legal or procedural requirements mandating drug testing, background checks, or psychological evaluations for personnel with access to dangerous biological materials. ⁹⁴⁹⁵ Although the PNASS highlights the importance of supervision, training, and biosafety measures in laboratories (p. 64), there are no licensing conditions or regulatory texts that outline personnel reliability checks. The national framework focuses on facility-level biosafety and biosecurity protocols, but does not extend to individual-level screening for mental or behavioral suitability.

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁹⁶⁹⁷ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ⁹⁸ Cabo Verde has not submitted any Confidence Building Measures reports. ⁹⁹

1.3.4a National transport regulations for Category A and B infectious substances

Score: 100

Cabo Verde has established and publicly documented standardized procedures for the transport of biological specimens, including explicit compliance with Category A and B infectious substance protocols.

The National Action Plan for Health Security (PNASS) 2022–2026 outlines actions to improve the national system for transporting infectious substances. It specifies the dissemination of a biological specimen transportation manual to all laboratories, the certification of focal points responsible for transport logistics, and training aligned with international standards. ¹⁰⁰

The Manual for Transport of Infectious Substances, published by the National Institute of Public Health (INSP), explicitly details classification, packaging, labeling, and documentation requirements for Category A (UN 2814/UN 2900) and Category B (UN 3373) infectious substances (p. 20). ¹⁰¹

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no legislation in Cabo Verde regulating cross-border transfer or end-user screening of dangerous pathogens.

While the National Action Plan for Health Security of Cabo Verde 2022 – 2026 (PNASS) identifies the Ministry of Foreign Affairs as responsible for "Brokering agreements to facilitate cross-border collaborations for health security" (p. 83), this refers to general cooperative agreements and not explicitly to legislation governing the transfer, import, or export of dangerous pathogens. The PNASS does not describe requirements for end-user screening to determine the purpose or recipients of transferred materials. ¹⁰²

Regarding the handling of biological materials, the 2019 Joint External Evaluation indicates that Cabo Verde has trained and certified technicians in accordance with international standards for the transport of infectious substances (p. 32, D.1.2). Certified packaging is available, and biological samples are regularly sent to international reference laboratories for analysis. Adequate refrigeration and preservation methods are also in place (p. 32, D.1.2). However, these capabilities pertain to the safe transport of specimens and do not constitute a regulatory framework for cross-border transfer or end-user screening of dangerous pathogens. The JEE identifies a need for strengthening the number of certified technicians in the transport of infectious substances and reinforcing procedures with national airlines for the efficient inter-island transport of biological samples (p. 32, D.1.2). ¹⁰³

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹⁰⁴¹⁰⁵ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹⁰⁶ Cabo Verde has not submitted any Confidence Building Measures reports. ¹⁰⁷

1.4.1a Biosafety laws/regulations

Score: 0

There is insufficient evidence that Cabo Verde has developed national biosafety and biosecurity regulations.

The National Action Plan for Health Security (PNASS) 2022–2026 outlines a national effort to strengthen biosafety legislation, including drafting a biosafety manual, developing containment and licensing standards, and enhancing laboratory safety practices. Under Section 4.3.1.6, the PNASS details plans for: "developing a national biosafety and biosecurity framework, including guidelines and record-keeping obligations for all laboratories working with hazardous agents (publication of the biosafety manual)" (p. 59), "developing pathogen control measures, including containment standards, operational handling, and failure reporting systems" (p. 59), "establishing a mechanism for licensing Animal Health Service Delivery Units" (p. 59), and "implementing biosafety and biosecurity best practices in all national, intermediate, and local laboratories" (p. 59). ¹⁰⁸

The 2019 Joint External Evaluation (JEE) reinforces this, stating that the country lacks comprehensive plans, legislation, or standard operational procedures on biosecurity and biosafety (p. 26). The JEE further notes that a priority action is to establish a National Commission for Biosecurity (p. 27). The national system currently relies on internal protocols within some laboratories and guidance from international frameworks, such as the World Health Organization's (WHO) biosafety manual (p. 26).

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹⁰⁹¹¹⁰ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹¹¹ Cabo Verde has not submitted any Confidence Building Measures reports. ¹¹²

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

Cabo Verde designates specific agencies responsible for enforcing biosecurity legislation and regulations within the framework of its National Action Plan for Health Security (PNASS) 2022-2026.However, it should be noted that while agencies are designated, there is insufficient evidence that Cabo Verde has developed comprehensive national biosafety and biosecurity regulations to enforce, as indicated in 1.4.1a. This creates a gap between institutional mandates and the actual regulatory framework currently in place.

The PNASS identifies the National Institute of Public Health (INSP) and the Institute for Quality Management and Intellectual Property (IGQPI) as entities for implementing and enforcing biosecurity-related regulations (p. 60). ¹¹³ The INSP's mandate, as stated on its website, includes "public health surveillance" and "sanitary surveillance" which covers "food quality and safety" and "products subject to surveillance". The 2019 WHO Joint External Evaluation (JEE) further notes INSP's role in coordinating the One Health approach (p. 20) and its function as a national reference laboratory (p. 31). ¹¹⁴

The IGQPI, created by Decree-Regulation nº 35/2014, according to its website, is responsible for "Quality management, standardization, metrology, accreditation, qualification, certification, and conformity assessment." These functions directly support the establishment and enforcement of standards critical for effective biosecurity. ¹¹⁵ The PNASS indicates its plan for this agency to "Implement national biosafety and biosecurity regulations and guidelines with all relevant sectors" (p. 60), confirming a planned institutional responsibility for enforcement in this area. ¹¹⁶

1.4.2a Biosafety training using a standardised, required approach

Score: 0

Cabo Verde does not currently require standardized biosafety training for personnel working with dangerous pathogens, toxins, or biological materials with pandemic potential.

The 2019 Joint External Evaluation (JEE) explicitly stated that Cabo Verde lacked plans or regulations addressing biosecurity and biosafety, noting only a general need for capacitation and training of personnel without specifying any existing requirement for biosafety training (p. 27). ¹¹⁷

The National Action Plan for Health Security (PNASS) for 2022–2026 aims to address this gap by proposing strategic activities such as adapting education curricula and developing a national academic biosafety and biosecurity training program following international best practices (p. 60-61). These actions are identified as future implementations rather than current requirements. ¹¹⁸

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹¹⁹¹²⁰ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹²¹ Cabo Verde has not submitted any Confidence Building Measures reports. ¹²²

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available, detailed evidence that Cabo Verde has specifically conducted a comprehensive assessment focused solely on ongoing research involving especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research.

The 2019 Joint External Evaluation (JEE) does not mention any assessment on ongoing research related to dangerous pathogens, toxins or any other dual-use research. ¹²³ No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹²⁴¹²⁵ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹²⁶ Cabo Verde has not submitted any Confidence Building Measures reports. ¹²⁷

The National Action Plan for Health Security of Cabo Verde (PNASS) 2022 – 2026 includes strategic objectives to enhance biosafety and biosecurity conditions. These plans aim to identify and document human and animal health facilities that store/keep dangerous pathogens and toxins, conduct assessments of current biosafety and biosecurity practices, and develop and maintain a national inventory of dangerous pathogens (p. 59, Section 4.3.1.6). These efforts reflect active steps to monitor and manage biosafety risks, contributing to Cabo Verde's broader "One Health" approach, but do not specifically constitute assessments of ongoing research involving these pathogens. ¹²⁸

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

Cabo Verde does not have legislation requiring oversight of dual-use or high-risk pathogen research.

The 2019 Joint External Evaluation makes no mention of such legislation or regulation (p. 21). ¹²⁹

The National Action Plan for Health Security (PNASS) 2022–2026 outlines plans to strengthen control over research with dangerous biological agents, aiming to "Identify and document human and animal health facilities that store/keep dangerous pathogens and toxins" (p. 59, Section 4.3.1.6) and including a strategic activity to "Develop a national biosafety and biosecurity framework, including guidelines and record-keeping obligations for all laboratories working with hazardous agents" (p. 59, Section 4.3.1.6). However, there is no mention of a law that governs the approval, monitoring, or ethical review of work with pathogens of pandemic potential or other dual-use concerns. ¹³⁰

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹³¹¹³² The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹³³ Cabo Verde has not submitted any Confidence Building Measures reports. ¹³⁴

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

Cabo Verde does not have a designated agency responsible for the formal oversight of research involving especially dangerous pathogens, toxins, or biological materials with pandemic potential.

The National Action Plan for Health Security (PNASS) for 2022–2026 identifies the National Institute of Public Health (INSP) and the Institute for Quality Management and Intellectual Property (IGQPI) as entities involved in implementing and enforcing biosecurity-related regulations (p. 60). However, there is no specific national entity mandated to regulate or oversee dual-use biological research across all sectors. The PNASS indicates the establishment of a National Biosafety and Biosecurity Commission as a strategic activity (p. 60). ¹³⁵

The 2019 Joint External Evaluation (JEE) confirmed the absence of such an agency, noting that a priority action for Cabo Verde is the creation of a National Biosafety Commission to address this gap (p. 27). ¹³⁶

The Independent Health Regulatory Entity (ERIS) is responsible for the regulation and supervision of pharmaceutical products, food, medical devices, cosmetics, and health services. However, there is no specific mention or clear indication on the website that ERIS is mandated to oversee or regulate research, particularly dual-use biological research involving dangerous pathogens or toxins. ¹³⁷

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹³⁸¹³⁹ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹⁴⁰ Cabo Verde has not submitted any Confidence Building Measures reports. ¹⁴¹

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

Cabo Verde has no regulation requiring the screening of synthesized deoxyribonucleic acid (DNA) against lists of known pathogens and toxins before it is sold.

No evidence of any legal or regulatory requirement mandating that vendors or laboratories screen synthesized DNA sequences against lists of known dangerous pathogens or toxins was found. The 2019 Joint External Evaluation (JEE) does not mention any such legislation or regulation (p. 22). ¹⁴² The National Action Plan for Health Security (PNASS) for 2022–2026 and the National Action Plan to Combat Antimicrobial Resistance (PAN-RAM) for 2018–2022 do not refer to this safeguard. ¹⁴³¹⁴⁴

In the website of the Food and Agriculture Organization of the United Nations (FAO), the FAOLEX country profile for Cabo Verde primarily focuses on legislation related to food, agriculture, forestry, fisheries, water, and environmental management. While it lists various laws and regulations concerning these sectors, including some on phytosanitary and animal health, there is no specific mention of synthesized DNA, biosecurity protocols for synthetic biology, or requirements for screening synthesized DNA against pathogen and toxin lists before sale. ¹⁴⁵

No relevant evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ¹⁴⁶¹⁴⁷ The VERTIC (Verification Research, Training and Information Centre) database has no entries for Cabo Verde. ¹⁴⁸ Cabo Verde has not submitted any Confidence Building Measures reports. ¹⁴⁹

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 100

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

Foot-and-mouth disease (FMD) vaccination data for Cabo Verde are not publicly reported in the OIE database because the country is FMD-free.

According to the National Action Plan for Health Security (PNASS) 2022–2026 and veterinary sector plans, Cabo Verde has never reported a case of FMD and maintains an official FMD-free status. As a result, vaccination campaigns are not conducted, and no data is submitted to the World Organisation for Animal Health (WOAH, formerly OIE) under FMD vaccination reporting. ¹⁵⁰

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^151152153

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Cabo Verde has a national immunization plan, it covers equitable distribution and includes equity strategies.

According to the 2019 Joint External Evaluation, the country operates under a well-established national immunization strategy, the Programa Alargado de Vacinação (PAV), which has been in place since 1977 and receives consistent funding from the State Budget (p. 28). This strategy is further formalized within the recent National Action Plan for Health Security (PNASS) 2022–2026, which outlines strategic goals for increasing vaccination coverage and strengthening access and distribution (p. 61). ¹⁵⁴¹⁵⁵

The national immunization plan explicitly includes measures to ensure equitable distribution. Cabo Verde actively implements advanced and mobile strategies to reach populations in remote or difficult-to-access areas (p. 29). To overcome socio economic barriers, vaccination services are offered outside working hours in at-risk areas, providing flexibility for working individuals. Furthermore, the program ensures that migrant populations receive free access to vaccines under the same conditions as other residents, reflecting a commitment to universal coverage (p. 29). ¹⁵⁶

Beyond equitable distribution, the strategy incorporates specific measures to address various barriers. Geographic and socio economic challenges are tackled directly through mobile and flexible service delivery. To address potential cultural or linguistic differences and combat misinformation, Cabo Verde conducts activities during its annual "African Vaccination Week" and has developed a communication plan aimed at promoting vaccine efficacy and public health importance (p. 29). ¹⁵⁷ While gender-specific strategies are not explicitly detailed, the overarching focus on equitable access for all and the commitment to surveying vulnerable populations implies an inclusive approach to overcoming any potential gender-related barriers (p. 61). ¹⁵⁸

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Cabo Verde's national immunization strategy, outlined in the Complete Multi-Year Plan (PPAC) 2018-2022, explicitly includes measures to address vaccine hesitancy and build public trust.

A key objective of the PPAC is to ensure that by the end of 2022, 90% of individuals and communities comprehend the importance of vaccines and advocate for vaccination as a right and responsibility (p. 2, 51). To achieve this, the plan details several strategic activities under its communication component. It mandates the development and implementation of a national strategic communication plan for routine vaccination, campaigns, and the introduction of new vaccines (p. 45, 57). Furthermore, the strategy emphasizes broad community involvement, advocating for the engagement of women's associations, community leaders, religious figures, and NGOs in vaccination communication efforts (p. 57). The PPAC also plans for a Knowledge, Attitude, and Practice (CAP) study to identify and address specific factors contributing to hesitancy (p. 57). Finally, it prioritizes training health professionals in effective communication about the vaccination program, recognizing their crucial role in building public confidence (p. 57). ¹⁵⁹

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Cabo Verde has a national advisory group that provides technical guidance and advice on its immunization strategy and plan to the government.

The Expanded Vaccination Program (PAV), which outlines the country's immunization strategy, is supported by a Technical Support Nucleus (NAT) for the PAV. This body serves as a consultative organ for the PAV's coordination (p. 40). The NAT comprises key stakeholders such as the National Director of Health, the National Coordinator of the PAV, logistics personnel, the Director General of Pharmacy, the Coordinator of SVIRE, the Coordinator of the Laboratory Network, and focal points from WHO and UNICEF. It meets quarterly and as needed to support the vaccination program's coordination (p. 40). While the PPAC mentions a need to formalize the Interagency Coordination Committee for the PAV (CCIA), the NAT already functions as a dedicated advisory body for immunization (p. 40). The 2019 Joint External Evaluation (JEE) also notes that PAV data and program aspects are regularly discussed in NAT meetings and within the broader Ministry of Health Council meetings (p. 29). ¹⁶⁰¹⁶¹

1.6.1f Presence of an immunization programme for influenza

Score: 0

Cabo Verde does not have a long-standing, routine national immunization program for seasonal influenza akin to its Expanded Program on Immunization (PAV).

According to the 2019 Joint External Evaluation, the PAV primarily focuses on core childhood vaccines and diseases such as tuberculosis, hepatitis B, poliomyelitis, diphtheria, tetanus, measles, and rubella (p. 28). The country's Comprehensive Multi-Year Plan also outlines the later introduction of vaccines such as PCV13, rotavirus, and HPV (p. 2, 50) ¹⁶²¹⁶³.

More recent external sources report that Cabo Verde launched its first seasonal influenza vaccination campaign in November 2023, targeting the elderly and individuals at higher risk ¹⁶⁴. However, no additional information about follow-up campaigns was found in media outlets.

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^165166167

1.7.1a Strategy/plan for resilience of health system

Score: 100

Cabo Verde has a foundational strategy to address the health challenges posed by climate change, including the threat of infectious diseases, as evidenced by its "Operational framework for public health adaptation to climate change – Cabo Verde, 2012." This framework, detailed in the National Action Plan for Health Security (PNASS) 2022–2026, explicitly acknowledges climate change as a significant public health threat due to its broad impacts on environmental determinants of health, such as air and water quality and food resources (p. 37). Crucially, the strategy recognizes that climate shifts influence the "ecology and distribution of some diseases," specifically citing those transmitted by mosquitoes and those arising from contaminated food or water, as well as broader effects on agricultural and hydrological ecosystems (p. 37). The framework is designed with multiple components, including risk and capacity assessment, strengthening public health capacities, fostering integrated environmental and health surveillance, and outlining response and investigation mechanisms. ¹⁶⁸ However, it is worth mentioning that the online version of the framework is not available.

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 0

The national laboratory system in Cabo Verde does not demonstrate the confirmed capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests.

According to the 2019 Joint External Evaluation, Cabo Verde’s national laboratory network conducts diagnostic tests for several key public health conditions, including HIV, meningitis, Zika, hepatitis, dengue, yellow fever, acute flaccid paralysis, measles, chickenpox, and zoonotic diseases such as salmonella (p. 31). However, the specific types of tests used for these pathogens are not detailed in the available documentation. It is noted, though, that there is some laboratory capacity for performing antibiograms to support the diagnosis of antimicrobial resistance (AMR) in central hospitals (p. 18). ¹⁶⁹

No relevant evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^170171172

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

Cabo Verde has evidence of plans for conducting testing during public health emergencies, but there is insufficient evidence that these plans comprehensively include considerations for testing for novel pathogens, broad scaling capacity, and defined operational goals for all public health emergencies.

The country has developed contingency plans for specific outbreaks such as Ebola (2014) and Dengue (2023). ¹⁷³¹⁷⁴ However, these plans did not provide sufficient evidence of containing broader considerations for novel pathogens, scaling capacity, or testing goals. While the 2023 Dengue Contingency Plan demonstrates a national approach for a specific endemic threat, incorporating genomic sequencing to detect novel serotypes and outlining strategies for scaling and control during outbreaks (p. 11-12), the scope for truly novel or high-consequence pathogens remains a challenge. ¹⁷⁵ The 2014 Ebola National Contingency Plan explicitly states that national laboratories lack Biosafety Level 4 (BSL-4) conditions required for definitive diagnosis of filoviruses, necessitating samples to be sent to international reference laboratories (p. 21). ¹⁷⁶

Moreover, the National Contingency Plan for COVID-19 (published January 2020) was specific to that novel pathogen, focusing primarily on sample collection, storage, and transport, but lacked details on general testing processes, broader capabilities, or comprehensive testing goals for future novel pathogens or scalable responses. ¹⁷⁷

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^178179180

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

There is currently no accredited national reference laboratory in Cabo Verde under ISO 15189:2003, CLIA, or similar international standards.

Although the National Institute of Public Health (INSP) and national hospital laboratories function as central reference laboratories, the 2019 Joint External Evaluation (2019) and the National Action Plan for Health Security (PNASS) 2022–2026 do not indicate accreditation under ISO 15189:2003, CLIA, or equivalent schemes. Quality management systems are under development, and laboratory standardization is a stated goal, with strategic objectives in the PNASS aiming to improve quality assurance and establish a comprehensive quality management system (PNASS, p. 62-64; JEE, p. 33). ¹⁸¹¹⁸²

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^183184185

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 0

There is insufficient evidence that Cabo Verde has at least one national reference laboratory that participates in external quality assurance (EQA) programs.

The National Institute of Public Health (INSP) serves as Cabo Verde’s national reference laboratory. However, there is no publicly available evidence that the INSP is subject to external quality assurance (EQA) review. The 2019 Joint External Evaluation (JEE) conducted by WHO does not clarify whether the INSP participates in any international EQA schemes (p.31). ¹⁸⁶

The JEE highlights the need for Cabo Verde to develop a national laboratory quality policy and to implement standard operating procedures across the laboratory network (JEE, p. 33). The National Action Plan for Health Security (PNASS) 2022-2026 also outlines the expansion of EQA participation as a priority under laboratory system strengthening, including implementing inter-laboratory quality control (PNASS, p. 63). These initiatives reflect a recognition of current limitations and ongoing efforts to establish robust quality assurance, rather than existing comprehensive external review of the national reference laboratory. ¹⁸⁷¹⁸⁸

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^189190191

2.2.1a Nationwide specimen transport system

Score: 0

While components of a specimen transport system are in place and undergoing development, there is insufficient evidence of a fully established nationwide specimen transport system in Cabo Verde.

The 2019 Joint External Evaluation (JEE) indicated that some capabilities for specimen referral and transport existed, including trained and certified technicians, certified biological sample packaging, and refrigeration means (p. 31). However, the JEE also highlighted a lack of standardized protocols for the transportation of samples across the different islands (p. 26). ¹⁹²

The National Action Plan for Health Security (PNASS) 2022–2026 reinforces this ongoing development, recognizing the need to strengthen and standardize the national specimen referral and transport system (p. 63). PNASS outlines specific activities such as designating focal points, socializing biological specimen transportation manuals, certifying personnel, and establishing formal protocols with air and sea carriers (p. 63). ¹⁹³ These planned initiatives confirm that while significant efforts are underway, a fully functional and uniformly implemented nationwide specimen transport system across all regions and routine workflows is still a target rather than a current reality.

No additional evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^194195196

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

Cabo Verde does not have a publicly available plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

The National Action Plan for Health Security (PNASS) 2022–2026 outlines strategic activities for strengthening the national laboratory system, including standardizing procedures, implementing quality control, training technicians, and building infrastructure for the National Institute of Public Health (INSP) (p. 62, Section 4.3.2.1). However, these activities focus on enhancing the existing national laboratory network and its internal capabilities, rather than detailing a mechanism for rapidly authorizing or licensing external (e.g., private or non-public health) laboratories to supplement capacity during an emergency. ¹⁹⁷

The 2019 Joint External Evaluation (JEE), which informed the PNASS, also does not indicate the existence of such a mechanism. While it highlights the need to strengthen laboratory capacities and implement a strategic plan for the national network, it does not mention a plan for rapid external authorization or licensing to scale-up testing (p. 32, Section D.1.3). ¹⁹⁸

No relevant evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^199200201

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is evidence that Cabo Verde has initiated event-based surveillance (EBS) efforts. However, there is insufficient public information to confirm that surveillance data are analyzed on a daily basis.

The 2019 Joint External Evaluation (JEE) noted that Cabo Verde operates an indicator-based surveillance system for human health—known as the Disease Integrated Surveillance (VID-R)—but highlighted the need to establish a structured EBS system and improve the collection, centralization, and integration of data from various health units (p. 34). The National Action Plan for Health Security (PNASS) 2022–2026 addresses these gaps by outlining strategic actions to "implement an event-based surveillance system and functional communities" and "implement a functional multi sectoral electronic surveillance system" (p. 65). ²⁰²²⁰³

Cabo Verde launched new Technical Guidelines for Event-Based Surveillance (EBS) in September 2023. These guidelines, led by the National Institute of Public Health with World Health Organization (WHO) support, aim to strengthen the national system to detect, assess, and rapidly respond to public health events, integrating information from various sources and sectors under a "One Health" approach. ²⁰⁴

No relevant evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^205206207

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

Cabo Verde has an established mechanism for reporting public health events to the World Health Organization (WHO), centered on its IHR National Focal Point (NFP), as confirmed by the 2019 Joint External Evaluation (JEE). ²⁰⁸

The 2019 Joint External Evaluation (JEE) confirms the formal designation of an IHR NFP and highlights its role in communicating public health events to the WHO, emphasizing "timely information sharing through the National Focal Points regarding the current health situation in the country" (p. 15, 38). ²⁰⁹

Further evidence is found in the 2014 Ebola National Contingency Plan, which provides detailed protocols for immediate, case-by-case notification of suspected Ebola cases. It unequivocally states that "the occurrence of a single suspected case of Ebola Virus Disease is subject to the application of the International Health Regulations, IHR (2005), and must be notified to WHO within 24 hours" (p. 20). ²¹⁰

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 0

Cabo Verde does not currently operate a fully institutionalized electronic reporting surveillance system at both the national and sub-national levels.

The 2019 Joint External Evaluation (JEE) explicitly recommended the "Institutionalization of the electronic surveillance tool DHIS2 at the central and peripheral levels" as a necessary step for the country (p. 36, Recommendations).While there have been efforts towards implementing an electronic system, the primary surveillance system (VID-R) in 2019 was still based on paper forms (p. 35, Section D.2.2). The DHIS2 platform was in an "experimentation phase" at the national health service level (p. 35, Section D.2.2). ²¹¹

The National Action Plan for Health Security (PNASS) 2022–2026, published after the JEE, lists "Institutionalize the DHIS2 platform as an electronic surveillance platform at the central and peripheral levels with One Health approach" as a strategic activity to be implemented during the 2022-2026 period (p. 65, Section 4.3.2.2). This indicates that, at the time of the PNASS's drafting, the system was not yet fully operational and institutionalized at both levels. ²¹²

More recently, Cabo Verde has launched technical guidelines for Event-Based Surveillance (EBS). This indicates progress in establishing a methodology for a type of surveillance. However, the existence of these guidelines for EBS does not automatically mean the entire reporting surveillance system is fully operational and institutionalized electronically across both national and sub-national levels for all reporting. ²¹³

No relevant evidence was found in the websites of the Ministry of Health, the Ministry of Agriculture and Environment, and the National Institute of Public Health. ^214215216

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 0

There is insufficient evidence that Cabo Verde's electronic reporting surveillance system collects ongoing or real-time laboratory data for comprehensive disaggregation and analysis by demographic variables such as age or ethnicity.

According to the 2019 Joint External Evaluation (JEE), while Cabo Verde is actively developing its electronic surveillance capabilities, as evidenced by the ongoing pilot phase for the DHIS2 platform at central and peripheral levels (p. 35), much of its current surveillance and notification processes still rely on paper-based forms (p. 34). ²¹⁷

The National Institute of Public Health (INSP), through its National Health Observatory (ONS) and the SIG-Saúde platform, serves as a key tool for data analysis and dissemination, with the strategic objective of enhancing public health surveillance. Data provided through the ONS includes health surveillance information that can be filtered by age and sex, indicating some level of demographic disaggregation capability. ²¹⁸ Furthermore, the INSP is engaged in strengthening human resources for epidemiology and data analysis, including training in QGIS for enhanced spatial data analysis, supporting efforts toward better data utilization and integration. ²¹⁹

However, there is no public evidence that this disaggregation capability directly applies to real-time laboratory data flowing from a fully integrated electronic system. The 2019 JEE noted persistent limitations in fully linking epidemiological and laboratory data, as well as in achieving comprehensive electronic integration across all sectors (p. 35). Additionally, there is no specific indication that the system is capable of disaggregating data by ethnicity. ²²⁰

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²²¹²²²

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 2 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²²³

According to the WHO's Public Health Situation Analysis on Cabo Verde, the country established environmental surveillance for poliovirus in 2023. However, there is no further evidence on whether this is currently ongoing.²²⁴

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records (EHRs) are not yet commonly used across the Cabo Verdean health system, but they exist.

Cabo Verde has had a national electronic health records system since 2005, though its use is not yet widespread across the health system. The 2015 WHO Atlas of eHealth country profiles shows that between 25–50% of primary care facilities, and 50–75% of both secondary and tertiary care facilities, use EHRs. ²²⁵ This confirms that EHRs exist and are somewhat used, even if they are not yet universal.

The 2019 Joint External Evaluation (JEE) does not extensively reference the widespread implementation of electronic health records in Cabo Verde. Instead, it indicates that much of the country's surveillance and notification processes still rely on paper-based forms (p. 34-35), implying that patient data is largely managed through traditional or fragmented digital systems at the facility level. ²²⁶

According to the The National Action Plan for Health Security (PNASS) 2022–2026, while a Health Information System (SIS) exists (p. 8), its primary function is for aggregated health service data collection and surveillance, rather than serving as a comprehensive clinical EHR for individual patient records. The PNASS outlines future plans to improve the digitization of health services. Specifically, it aims to "institutionalize the DHIS2 platform as an electronic surveillance platform at the central and peripheral levels" and integrate the "national vaccine registry with the national health information system" (p. 61, 64). These strategic objectives indicate a move towards greater digitization, particularly in disease surveillance and laboratory systems, but they simultaneously confirm that the implementation of comprehensive personal EHRs is not yet a nationwide standard across the health system. ²²⁷

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²²⁸²²⁹

2.4.1b Public health system access to individual electronic health records

Score: 0

The national public health system does not currently have full and routine access to individual electronic health records (EHRs) in Cabo Verde.

The 2019 Joint External Evaluation (JEE) and the National Action Plan for Health Security (PNASS) 2022-2026 imply the absence of a comprehensive national EHR infrastructure. Discussions around surveillance systems in the JEE highlight a reliance on paper-based forms and efforts to "institutionalize the DHIS2 platform as an electronic surveillance platform" (JEE, p. 34-35; PNASS, p. 64), rather than integrating with existing widespread individual EHRs. This suggests that public health authorities, such as the National Institute of Public Health (INSP), primarily receive aggregated surveillance data through structured reports from health facilities, rather than having direct access to patient-level electronic clinical records. ²³⁰²³¹

While the PNASS acknowledges the need to "strengthen information systems" and integrate the national vaccine registry with the health information system (p. 82, 61), these goals indicate a future direction towards better data platforms that could bridge public health and clinical data, especially for early outbreak detection and response. However, the current status confirms that public health action largely relies on facility-level reporting and manual aggregation, rather than routine, real-time access to individual EHRs. ²³²

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²³³²³⁴

2.4.1c Existence of data standards for health record data comparability

Score: 0

Cabo Verde currently lacks a fully standardized national framework for data protocols that ensures interoperability and international comparability across all health data systems, such as ISO standards.

The 2019 Joint External Evaluation (JEE) consistently highlights the absence of formalized standards and procedures across various health sectors. For instance, it notes the "necessity to create Standard Operational Procedures (SOPs) for communication between human, animal, and environmental health, including food safety" (p. 16). It also lists "Implementation of standard operational procedures (SOPs) and norms across different health sectors" as an area that needs reinforcement and is a challenge (p. 33). ²³⁵

The National Action Plan for Health Security (PNASS) 2022-2026 acknowledges these gaps by setting strategic objectives for standardization and improved data quality. For example, under the National Laboratory System, a goal is to "Standardize procedures and work instructions for the diagnosis of priority diseases in national laboratories" (p. 63). Similarly, for Surveillance, a key activity involves building capacity in surveillance data analysis and risk assessment in the multi sectoral context (p. 65), and for Notification, it mentions the development of communication standards and protocols for Human Health, Animal Health and Environmental Health (p. 66). These are forward-looking goals, confirming that these standards are currently under development or awaiting full implementation. ²³⁶

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²³⁷²³⁸

2.4.2a Data sharing mechanisms

Score: 0

There is insufficient evidence of established, routine mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to formally share data.

While Cabo Verde has established a National Coordination Instance (INC) operating under a "One Health" approach, integrating human, animal, and environmental health sectors, the 2019 Joint External Evaluation (JEE) explicitly states that "the Integration of surveillance information from the Human, Animal and Environmental Health sectors is not done, neither by the INC nor by any other service" (p. 34). The JEE highlights the "need" for such integration as a key area for reinforcement (p. 35). ²³⁹

The National Action Plan for Health Security (PNASS) 2022-2026 outlines strategic objectives aimed at fostering this integration and cooperation, such as institutionalizing the DHIS2 platform with a "One Health" approach and developing communication standards and protocols across human, animal, and environmental health sectors (p. 65, 66). This indicates that while the intent and planning for such mechanisms exist, they are still in the development and implementation phases rather than being fully established and routinely operational for comprehensive data sharing. ²⁴⁰

Efforts by the National Institute of Public Health (INSP), such as providing QGIS training for data analysis to its collaborators and strategic partners and maintaining the National Health Observatory (ONS) with its SIG-Saúde platform, demonstrate a commitment to enhancing data analysis capabilities within the public health sector. ²⁴¹²⁴² However, these initiatives do not, in themselves, constitute routine, established mechanisms for data sharing between ministries for cross-sectoral surveillance data on an ongoing basis.

No additional evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ²⁴³²⁴⁴

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

There is evidence of specific and current outbreak-related reporting.

The 2019 Joint External Evaluation (JEE) notes that "epidemiological bulletins are published weekly on priority diseases" (p. 34-35). However, the JEE also mentions that these bulletins are primarily circulated within the health system and are not regularly published online for public access. During major outbreaks like Zika (2016) and malaria (2017), specific bulletins and annual reports were posted on the Ministry of Health’s official website. While consistent public access to all these routine bulletins on government websites is not universally evident, the country does publish specific reports during outbreaks. ²⁴⁵

For example, the Ministry of Health website currently provides 2025 dengue reports. These specific, current outbreak reports demonstrate the country's capacity and practice of making relevant infectious disease data publicly accessible, particularly during active public health events. ²⁴⁶

The National Institute of Public Health (INSP) maintains an National Health Observatory (ONS), which, through its SIG-Saúde platform, presents some aggregated health surveillance data electronically. This platform can provide insights into incidence and prevalence for select diseases, and some datasets within it allow for disaggregation by age and sex. However, the data available on the ONS is not consistently updated in a real-time manner, often showing a significant lag. ²⁴⁷

The National Action Plan for Health Security (PNASS) 2022-2026 outlines strategic goals to strengthen information systems and data analysis capabilities (p. 65-66). These plans aim to enhance the flow and utilization of health data, supporting a more robust system for public dissemination. ²⁴⁸

While a comprehensive, high-frequency, and systematic public release of all de-identified infectious disease surveillance data may still be developing, Cabo Verde effectively makes specific, current outbreak-related surveillance data publicly available on its government websites.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Cabo Verde has legislation that safeguard the confidentiality of identifiable health information for individuals, including that generated through health surveillance activities.

The foundational legal framework is established by Law No. 133/V/2001, the General Legal Framework for the Protection of Personal Data of Natural Persons, which, along with its subsequent amendments, addresses the protection of personal data, including health information. ²⁴⁹ This law has been amended and reinforced by Law No. 41/VIII/2013 of 17 September 2013 and Law No. 121/IX/2021 of 17 March 2021, and complemented by Law No. 132/V/2001 of 22 January 2001. ²⁵⁰ Specifically, the General Judicial Regime for the Protection of Personal Data of Individuals (Law No. 41/VIII/2013 of 17 September 2013) mandates key protections: Article 8 addresses the treatment of sensitive information, explicitly including health information as a protected type of data; Article 12, Paragraph 5, unequivocally states that health and genetic data can only be accessed with the data owner's consent; and Article 16 further requires that health data be kept separate from other personal data. ²⁵¹

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is insufficient evidence that Cabo Verde has a law or regulation that protects the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, and includes mention of protections from cyber attacks.

The foundational legal framework is established by Law No. 133/V/2001, the General Legal Framework for the Protection of Personal Data of Natural Persons, which, along with its subsequent amendments, addresses the protection of personal data, including health information. However, it lacks specific provisions on cybersecurity threats. ²⁵²

While Decree-Law No. 9, passed on 29 January 2021, establishes a new judicial framework for cybersecurity and creates the National Center for Cybersecurity—aligning with ECOWAS cyber security directives—it does not specifically address the protection of health data or include detailed provisions related to cyber attacks such as ransomware. The decree became effective on 28 July 2021, but as of now, there is no public information regarding the operational status or oversight agency of the National Center for Cybersecurity. ²⁵³

There is also no reference to data protection or cyber threats in the 2019 Joint External Evaluation. ²⁵⁴ No relevant evidence was found on the websites of the Ministry of Health and the National Institute of Public Health. ²⁵⁵²⁵⁶

2.4.5a Cooperative commitments or agreements within regions

Score: 0

The government of Cabo Verde has made general commitments to share surveillance data during a public health emergency with other countries, but does not meet the criteria for this indicator.

Cabo Verde's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Cabo Verde is obligated to notify the World Health Organization (WHO) of public health events that may constitute a Public Health Emergency of International Concern (PHEIC) (PNASS, p. 3, 40-43; JEE, p. 37). This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. ²⁵⁷²⁵⁸

Cabo Verde's active participation in regional cooperative agreements demonstrates a commitment to data sharing. As a member of the Economic Community of West African States (ECOWAS) and its West African Health Organization (WAHO), Cabo Verde is involved in public health programs designed to strengthen surveillance, prevention, and response capacities across the region. These regional initiatives, such as the Regional Program Support to Pandemic Prevention in the ECOWAS Region (RPPP), inherently promote and facilitate the exchange of health data and information among member states. ²⁵⁹

While the 2019 Joint External Evaluation (JEE) identified a need for better integration of surveillance information between domestic sectors (p. 34), it simultaneously highlighted Cabo Verde's consistent reporting to the WHO and its participation in regional data exchange activities (p. 37). ²⁶⁰ The National Action Plan for Health Security (PNASS) 2022-2026 reinforces these international and regional collaborations as integral to national health security (p. 41, 44-46). ²⁶¹

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no publicly available evidence of a national system in place to provide support at the sub-national level for conducting contact tracing in the event of a public health emergency.

The 2019 Joint External Evaluation (JEE) report for Cabo Verde does not explicitly mention specific mechanisms or capacities for contact tracing. While the JEE and the National Action Plan for Health Security (PNASS) for 2022–2026 refer to structured mechanisms such as the Rapid Intervention Technical Teams (ETNIR) and local health delegations, their described roles are for broader "rapid intervention" and "response to public health events" (JEE, p. 15, 20-21; PNASS, p. 7, 15). However, the documentation does not detail explicit support for sub-national contact tracing efforts in terms of dedicated training, metrics standardization, or specific financial resources as established, ongoing mechanisms. The PNASS, while setting goals for regional capacity building, training, and logistics support, frames these as objectives or areas for future improvement, rather than fully established, continuous support mechanisms (p. 41, Section 2.3.2; p. 81, Section 7.2). The JEE further notes limitations in supervision and resource availability at sub-national levels (p. 20-22, Section 4.2), indicating that comprehensive preparedness outside active emergency periods remains incomplete. ²⁶²²⁶³

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²⁶⁴²⁶⁵

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no publicly available evidence that Cabo Verde provides comprehensive wraparound services, including economic support (such as paycheck or job security) or dedicated medical attention, to enable infected people and their contacts to self-isolate or quarantine as recommended.

The 2019 Joint External Evaluation (JEE) report outlines the country's capacities for emergency preparedness and response, including the mobilization of health personnel and case management procedures (p. 50, Section R.4.2; p. 50, Section R.4.3). However, the JEE does not document specific provisions or structured support mechanisms for individuals undergoing isolation or quarantine, beyond general public health monitoring. ²⁶⁶

Similarly, the National Action Plan for Health Security (PNASS) for 2022–2026, while aiming to "reduce morbidity, mortality and negative socio-economic consequences resulting from public health threats," (p. 41, Section 2.3.1), does not detail any plans or established services for financial, employment, or specialized medical support for individuals in isolation or quarantine. The PNASS focuses on strengthening broader health security capacities and coordination (p. 40-41, Section 2.3), without outlining explicit wraparound services to facilitate adherence to isolation measures. ²⁶⁷

Although the Ebola Contingency Plan references the management of contacts under quarantine, its focus is on medical observation and active case finding, rather than providing economic or livelihood support to those isolated (p. 5, 25). ²⁶⁸

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²⁶⁹²⁷⁰

2.5.2a Strategy for tracing and quarantining international travelers

Score: 50

Cabo Verde has protocols and multi sectoral collaboration in place to manage health threats at points of entry, but only in response to active public health emergencies.

The 2019 Joint External Evaluation (JEE) report indicates that public health authorities in Cabo Verde collaborate with customs, immigration, and transport authorities to conduct routine sanitary control of passengers, aircraft, and vessels at designated points of entry, particularly those from high-risk countries (p. 57, Section AT 17). This collaboration is further supported by the JEE's mention of linkages between public health and security authorities, including border control and customs, during suspected or confirmed biological events (p. 48, Section R.3.1). While operational collaboration exists on the ground, the JEE mentions that formalized protocols between public health, animal health, and security authorities are not yet fully established (p. 48, Section AT 14). ²⁷¹

The National Action Plan for Health Security (PNASS) for 2022–2026 aims to strengthen effective public health response capacities at points of entry (p. 73, Section 4.3.4.1). This includes developing and updating contingency plans for public health emergencies, training staff at all points of entry in the guidelines and Standard Operating Procedures (SOPs) for responding to public health events, and allocating necessary resources (p. 74, Section 4.3.4.1). Despite these collaborative efforts and planned improvements, the JEE explicitly points to the need for a better interlinking of sectoral emergency plans at designated points of entry (p. 58, Section AT 17), reinforcing that a fully institutionalized joint operational plan integrating border health with national outbreak response remains an area for further development. ²⁷²²⁷³

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ²⁷⁴²⁷⁵

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Cabo Verde meets the criterion for applied epidemiology training through both national and regional programs.

The country operates an in-country Field Epidemiology Training Program (FETP-Frontline), known as EpiCV, hosted by the National Institute of Public Health (INSP). The program was launched in 2020 and has trained multiple cohorts of health professionals across sectors, including surveillance officers, veterinarians, and military medical personnel ²⁷⁶. By April 2025, the seventh cohort had completed training, and the program is supported by the Cabo Verdean government in partnership with international funders such as the World Bank and the Africa CDC ²⁷⁷. In addition to this national training, Cabo Verde has also launched a master’s level advanced training program in applied epidemiology, coordinated by INSP and the University of Cabo Verde (UniCV), with support from the EDCTP and Africa CDC ²⁷⁸.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

Cabo Verde’s national Field Epidemiology Training Program (EpiCV) includes professionals from both the human and animal health sectors.

Cabo Verde’s national Field Epidemiology Training Program (EpiCV) is designed to be multi-professional, integrating participants from both human and animal health sectors to train health professionals at national and regional levels. ²⁷⁹ The sixth cohort, launched in October 2024, integrated participants from the animal health sector, explicitly described as “human and animal health professionals”. ²⁸⁰ While the 2019 Joint External Evaluation (JEE) recommended improved integration of veterinary expertise into applied epidemiology efforts, this recent program cohort demonstrates progress in multi sectoral workforce development. ²⁸¹

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

Cabo Verde has not published public evidence confirming at least one trained field epidemiologist per 200,000 population.

The National Institute of Public Health (INSP) has an active in-country Field Epidemiology Training Program (FETP), known as EpiCV, and regularly issues calls for applications for this training. ²⁸² This initiative aligns with the National Action Plan for Health Security (PNASS) for 2022–2026, which prioritizes the institutionalization and expansion of field epidemiology training programs at basic, intermediate, and advanced levels (p. 64, Section 4.3.2.2; p. 66, Section 4.3.2.4). ²⁸³

Further bolstering these efforts, the Field Epidemiology Training Programme in Cape Verde (FETP-CV) recently concluded its inaugural cycle with a significant closing seminar held in Mindelo, São Vicente, from July 9-14, 2025. This landmark event, themed ‘Scientific Production and Transition to New Challenges’, celebrated the transition of 15 Master’s students from trainees to public health professionals. These graduates, representing Cabo Verde, Guinea-Bissau, and São Tomé and Príncipe, were specifically trained through a Master’s degree program that emerged from a collaborative effort involving five African National Institutes of Public Health, five academic institutions (including the Institute of Hygiene and Tropical Medicine at NOVA University Lisbon), and five research centres. This Master’s-level training is part of a broader initiative by EDCTP and Africa CDC to support consortia providing advanced training in epidemiology and biostatistics. The seminar emphasized the graduates' crucial role as "guardians of knowledge and agents of transformation" in their respective countries, underscoring the program's impact on enhancing preparedness for emerging health challenges and strengthening public health responses. ²⁸⁴

Despite these investments and training efforts, public data confirming the specific number of trained field epidemiologists currently active in the country and how this translates to the recommended population ratio are not publicly available. The 2019 Joint External Evaluation (JEE) rated Cabo Verde’s human resources workforce capacity at a limited level (p. 40, Section D.4.1) and recommended further expansion of trained personnel across technical areas (p. 42, Section D.4.4). ²⁸⁵ The PNASS also includes targets to increase the number of epidemiologists (p. 67, Section 4.3.2.4), but without official statistics on the current headcount of trained individuals, it is not possible to verify that the benchmark is currently met. ²⁸⁶

No additional evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ²⁸⁷²⁸⁸

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 100

Cabo Verde has in place an overarching national public health emergency response plan, the National Action Plan for Health Security (PNASS) for 2022–2026, which addresses planning for multiple communicable diseases with epidemic or pandemic potential. This plan is publicly available and has identified initial funding.

The PNASS explicitly aims to serve as a comprehensive and cross-sectional framework for strengthening health security (p. 3, Preface; p. 14, Section 1). It presents strategic activities and actions across all 19 technical areas of the 2019 Joint External Evaluation (JEE), which include categories for preventing, detecting, and responding to epidemics, thus encompassing a broad range of communicable diseases and public health threats (p. 5, Executive Summary; p. 43, Section 3.3). The plan's general objective is to "Reduce morbidity, mortality and negative socio-economic consequences resulting from public health threats," acknowledging the diverse nature of these threats, including previous epidemics like Dengue, Zika, Malaria, and COVID-19 (p. 41, Section 2.3.1; p. 14, Section 1). ²⁸⁹²⁹⁰

The PNASS itself is a public document. Regarding funding, the plan estimated a total cost for its activities, and at the time of its publication, 17% of the planned activities had identified funding (p. 5, Executive Summary; p. 77, Section 5). This confirms that the plan is, at least partially, funded. ²⁹¹

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

Cabo Verde's overarching national public health emergency response plan, the National Action Plan for Health Security (PNASS) 2022–2026, was developed and published in 2022 (p. 3, Preface; p. 5, Executive Summary). As of July 2025, this publication date falls within the last three years. The PNASS serves as the current, comprehensive framework for addressing planning for multiple communicable diseases with epidemic or pandemic potential (p. 43, Section 3.3). ²⁹²

3.1.1c One health principles by covering multiple threat types

Score: 100

Cabo Verde has an overarching national public health emergency response plan in place that covers multiple threat types.

Cabo Verde has a strategic National Action Plan for Health Security (PNASS) 2022-2026 that addresses various health security threats, including antimicrobial resistance, zoonoses, biosafety/biosecurity (relevant to biological incidents), chemical events, and radiation emergencies. The plan was developed following the 2019 Joint External Evaluation (JEE) and integrates findings from several national assessments, including the Antimicrobial Resistance Plan (PAN-RAM), zoonotic disease risk reviews, and emergency simulations. The PNASS adopts a “One Health” approach, coordinating human, animal, and environmental health systems to address threats such as zoonoses and foodborne diseases (p. 14, 21). It also identifies gaps in biosafety and biosecurity measures, mechanisms for radiation and chemical emergency response, and public health coordination during emergencies—whether naturally occurring, accidental, or intentional (p. 21–22). ²⁹³

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Cabo Verde's overarching plan does not include any explicit consideration of the impact of health equity nor mechanisms for identifying and considering the needs of vulnerable populations.

The National Action Plan for Health Security (PNASS) 2022-2026 has a general objective to reduce morbidity, mortality, and negative socio economic consequences for the Cabo Verdean population and aligns with the 2030 Agenda for Sustainable Development Goals (ODS), including ODS 3 (Health and Well-being) (p. 5, 41, 83). However, "health equity" is not explicitly highlighted, and the focus on population-wide well-being and socio economic impact reduction is not further elaborated on. ²⁹⁴

The 2020 Stakeholder Engagement Plan (SEP), developed for the COVID-19 Preparedness and Response Project by the Government of Cabo Verde, (which contributes to broader health security capacity), explicitly identifies "Disadvantaged / vulnerable individuals or groups" (p. 6) such as the elderly, chronically ill, pregnant women, persons with disabilities, homeless, and illiterate people (p. 6). The SEP details proposed strategies for engaging these groups, including using direct contact methods like door-to-door visits and individual consultations, and adapting communication to be culturally appropriate and understandable (p. 6, 16). ²⁹⁵ However, this is not a part of the PNASS. The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), also highlights the importance of targeting vulnerable groups in risk awareness campaigns (p. 16). ²⁹⁶

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

A specific, overarching national mechanism for engaging with the private sector across all types of outbreak emergencies for preparedness and response is not explicitly described as fully implemented. There is evidence of private sector involvement in preparedness and response activities and a recognition of the value of these partnerships.

The National Action Plan for Health Security (PNASS) 2022-2026 highlights that "Strategic partnerships and technical cooperation with the private sector will be of great value in the implementation of PNASS activities" (p. 85). ²⁹⁷ The 2020 Stakeholder Engagement Plan (SEP), developed for the COVID-19 Preparedness and Response Project by the Government of Cabo Verde, identified private businesses as key stakeholders for consultation (p. 6). ²⁹⁸ The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), also points out a lack of formal emergency procurement procedures, and strengthening public-private partnerships is noted as a recommendation (p. 6). ²⁹⁹ While involvement exists, often driven by specific risks or project-based engagement, the documents do not detail a single, formal, nationwide mechanism designed specifically for systematic private sector assistance across the full spectrum of outbreak emergencies.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ³⁰⁰³⁰¹

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 50

Cabo Verde does not have publicly detailed policies, plans, or guidelines for non-pharmaceutical interventions (NPIs) that specifically address more than one communicable disease with epidemic or pandemic potential.

The National Contingency Plan for COVID-19 mentions NPIs in the form of quarantines and isolation of suspected cases. The COVID-19 plan includes preparedness for health facilities to reserve an area, equipment, and personnel for suspected cases to be maintained in isolation. It also sets procedures for different severity stages of the pandemic in the country, such that isolation procedures become more strict when the pandemic situation aggravates. It also sets priorities for isolation and specific instructions to each hospital, given their location and capacity. ³⁰²

The National Action Plan for Health Security (PNASS) 2022–2026 is an overarching strategic document that aims to strengthen overall health security and response capabilities for a range of public health threats, including past epidemics like rubella, pandemic influenza (H1N1), dengue, viral meningitis (ECHO-4), Zika virus, Coxsackievirus, malaria, and COVID-19 (p. 14, Section 1; p. 43, Section 3.3). Its general objective is to reduce morbidity and mortality from "public health threats" (p. 41, Section 2.3.1). However, the PNASS, being a strategic plan, does not itself detail specific NPI guidelines for each of these listed diseases. ³⁰³

The 2019 Joint External Evaluation for Cabo Verde does not mention any kind of plans to implement NPIs in cases of emergencies. ³⁰⁴ No other relevant evidence was found on the websites of the Ministry of Health and the National Institute of Public Health. ³⁰⁵³⁰⁶

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is insufficient evidence to confirm whether Cabo Verde has activated its national emergency response plan for an infectious disease outbreak or completed a national-level biological threat-focused exercise in the past year (June 2024 – June 2025).

The National Action Plan for Health Security (PNASS) 2022-2026, the 2020 Stakeholder Engagement Plan (SEP), developed for the COVID-19 Preparedness and Response Project by the Government of Cabo Verde, and the 2019 Joint External Evaluation (JEE) detail past outbreaks and exercises, such as responses to Zika, dengue, malaria, and COVID-19, and simulations related to Ebola and avian flu, but these occurred before June 2024, as the documents were produced before the specified timeframe. ^307308309

External searches for news or official reports regarding national-level infectious disease emergency plan activations or biological threat exercises in Cabo Verde during the period of June 2024 to June 2025 did not yield readily available information confirming these specific events. ³¹⁰³¹¹

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is insufficient evidence to confirm that, within the past year (June 2024 – June 2025), Cabo Verde identified a list of gaps and best practices in response (either through an infectious disease response, after action review, or a biological-threat focused exercise) and subsequently developed a plan to improve response capabilities specifically based on findings from that timeframe.

The 2019 Joint External Evaluation (JEE) confirms that Cabo Verde utilizes mechanisms like After Action Reviews (AARs) and simulation exercises to identify gaps and best practices (p. 22). ³¹² The National Action Plan for Health Security (PNASS) 2022-2026, developed in 2022 based on prior assessments, outlines activities for improving response capabilities and includes a monitoring framework planning for AARs, simulations, and a mid-term evaluation in 2024 (p. 69, 85-87). ³¹³ Furthermore, a Grant Agreement approved in July 2024 includes funding for activities such as rapid AARs (p. 1497), indicating ongoing efforts and resources dedicated to this process within the specified year. ³¹⁴

However, external searches for news or official reports concerning planned reviews, exercises, or specific infectious disease responses conducted between June 2024 and June 2025 did not yield readily available information confirming these specific events. ³¹⁵³¹⁶

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is insufficient evidence to confirm that, within the past year (June 2024 – June 2025), Cabo Verde has undergone a national-level biological threat-focused exercise that has included private sector representatives.

Cabo Verde recognizes the importance of involving the private sector and plans for multi sectoral exercises as part of its National Action Plan for Health Security (PNASS) 2022-2026 (p. 69, 85). ³¹⁷ While the capacity and intent to conduct such exercises are present in the strategic plans and supported by recent funding approvals (p. 1497), ³¹⁸ publicly available information confirming the execution of a national-level biological threat-focused exercise that explicitly included private sector representatives during the specific period of June 2024 to June 2025 is not readily available in the search results. ³¹⁹³²⁰

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Cabo Verde has formally established an Emergency Operations Center (EOC), but it is not yet fully operational.

The 2019 Joint External Evaluation (JEE) mentions the creation of the National Public Health Emergency Operations Center (CNOE) within the National Institute of Public Health (INSP), highlighting that its operationalization and defining procedures remains a challenge (p. 15, 46). ³²¹

The National Action Plan for Health Security (PNASS) 2022-2026 includes "Operationalize the EOC of Cabo Verde" as a strategic activity (p. 69). ³²² Most recently, a Decree from July 2024 approves funding for a program that lists "establishment and functioning of a public health emergency operations center (EOC)" as a component (p. 1497). ³²³

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is insufficient evidence that Cabo Verde has an operational Emergency Operations Center (EOC).

The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), explicitly stated "There are no Emergency Operation Centers (EOC) in place" (p. 47). It also detailed initiatives by the National Service for Civil Protection and Fire Brigades (SNPCB) to equip an identified space for an EOC, and noted that the National Institute for Public Health (INSP) was setting up an EOC expected to be operational by the end of 2019 (p. 47, 48). ³²⁴ The 2019 Joint External Evaluation (JEE) mentioned the creation of the National Public Health Emergency Operations Center (CNOE) within the INSP, highlighting that its operationalization and defining procedures remained a challenge (p. 15, 46). ³²⁵ The National Action Plan for Health Security (PNASS) 2022-2026 includes "Operationalize the EOC of Cabo Verde" as a strategic activity (p. 69). ³²⁶ Most recently, a Decree from July 2024 approves funding for a program that lists "establishment and functioning of a public health emergency operations center (EOC)" as a component (p. 1497). ³²⁷ Therefore, an EOC is not fully operational.

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is insufficient evidence to confirm that, within the past year (June 2024 – June 2025), the Emergency Operations Center (EOC) in Cabo Verde has conducted a coordinated emergency response or an emergency response exercise activated within 120 minutes of the identification of a public health emergency/scenario, with public evidence available for this specific activity.

A goal mentioned in the 2019 Joint External Evaluation (JEE) related to EOC capacity is for personnel to be capable of activating a coordinated response within 120 minutes (p. 46). ³²⁸ The National Action Plan for Health Security (PNASS) 2022-2026 includes the strategic activity to "Operationalize the COE of Cabo Verde" (p. 69). ³²⁹ Recent funding approved in July 2024 includes support for the "establishment and functioning of a public health emergency operations center (EOC)" (p. 1497). ³³⁰ The PNASS and JEE mention plans for multi sectoral simulation exercises (PNASS, p. 69; JEE, p. 45) and highlight the importance of conducting reviews after responses or exercises (PNASS, p. 86; JEE, p. 29, 30). ³³¹³³²

However, publicly available external searches for detailed reports of EOC activations or exercises within this specific recent period and including this level of detail (activation speed) also did not readily yield such evidence. ³³³³³⁴

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no evidence of Cabo Verde having carried out an exercise or possessing publicly available formalized agreements (Standard Operating Procedures, Guidelines, or Memoranda of Understanding) among public health, animal health, the private sector, and national security authorities specifically to respond to a potential deliberate biological event.

While the country shows engagement with the issue of deliberate biological threats, as evidenced by the National Institute of Public Health co-organizing a national workshop on the Biological Weapons Convention in September 2024, this workshop itself does not constitute a demonstrated exercise to respond to a deliberate event, nor does it equate to publicly available, formalized SOPs/MOUs involving all four specified sectors (public health, animal health, the private sector, and national security). ³³⁵

The 2019 Joint External Evaluation (JEE) report indicates that while some operational collaboration exists, formalized protocols between public health, animal health, and security authorities were lacking (p. 48, Section R.3.1; p. 49, Section R.3.1). The National Action Plan for Health Security (PNASS) 2022–2026, the country's overarching strategic plan, explicitly identifies the establishment of "permanent mechanisms for collaboration, formalized through protocols, Memorandum of Understanding or other instruments, between public health, animal health and security authorities" as a strategic activity (p. 70, Section 4.3.3.3). This signifies that such comprehensive agreements are a future goal rather than already publicly documented and implemented. ³³⁶³³⁷

Furthermore, there is no public evidence of past exercises specifically addressing "deliberate biological events" involving all four specified actors. No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ³³⁸³³⁹

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Cabo Verde does not yet have in place, within its national public health emergency response plan, a section detailing a risk communication plan applicable to all public health emergencies. However, during the COVID-19 pandemic, Cabo Verde developed a dedicated Risk Communication and Community Engagement Plan (March 2020), which covered prevention and response to the COVID-19 epidemic.

This plan was comprehensive, including strategies for community engagement, mechanisms for monitoring and oversight, management of misinformation and rumors, and differentiated communication tactics for different phases of the epidemic (alert, imminent risk, and emergency). It also contained a detailed budget for its implementation. ³⁴⁰ While specific to COVID-19, this constitutes evidence that Cabo Verde has developed at least one formal, detailed risk communication plan for a public health emergency.

The National Action Plan for Health Security (PNASS) 2022-2026 includes Risk Communication as one of its technical areas (p. 52, 44). Reflecting the JEE recommendations, the PNASS lists "Develop a national multi-hazard and multi sectoral emergency risk communication plan, including risk communication norms, procedures, priority tasks, and responsibilities" as a strategic activity (p. 73). ³⁴¹ This indicates the intention to develop such a plan.

Most recently, a Decree published in the Boletim Oficial in July 2024 approves funding for a program that explicitly includes the "development and disclosure… of the national risk communication plan for public Health Emergencies" as a planned activity (p. 1490, 1497). ³⁴²

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ³⁴³³⁴⁴

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

Cabo Verde does not yet have a dedicated national, all-hazards risk communication plan for public health emergencies. It has, however, demonstrated capacity by developing a comprehensive plan specific to COVID-19 that outlines how messages will reach populations and sectors with different communications needs.

During the COVID-19 pandemic, Cabo Verde developed the Risk Communication and Community Engagement Plan (March 2020), which was comprehensive. It included measures to reach diverse and vulnerable populations, made informative materials available in multiple languages, and disseminated messages through television, radio, posters, and social media. It also engaged local influencers to promote accurate information, included mechanisms for managing misinformation and rumors, and provided differentiated tactics for the alert, imminent risk, and emergency phases. ³⁴⁵ This demonstrates that Cabo Verde has already produced at least one formal, detailed risk communication plan for a public health emergency.

The 2019 Joint External Evaluation (JEE) identified the lack of a dedicated national plan but noted communication elements in other emergency plans, recommending its development (p. 55). ³⁴⁶ The National Action Plan for Health Security (PNASS) 2022-2026, reflecting this, lists developing a multi-hazard, multi sectoral risk communication plan as a strategic activity, showing the intent to create a detailed guide (p. 73). ³⁴⁷ These guiding documents and past responses indicate approaches to reach diverse populations. The 2020 Stakeholder Engagement Plan (SEP), developed for the COVID-19 Preparedness and Response Project by the Government of Cabo Verde, explicitly highlights the importance of adapting communication for vulnerable and hard-to-reach groups, suggesting methods like direct contact and door-to-door visits and outlining plans for feedback collection mechanisms to understand community perceptions and preferred channels (p. 4, 6). ³⁴⁸ Recent funding approved in July 2024 supports the development and disclosure of the comprehensive national plan, which is expected to consolidate these approaches (p. 1490, 1497). ³⁴⁹ However, as this recent public evidence from July 2024 confirms, the plan is still in development phase.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ³⁵⁰³⁵¹

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 100

A specific national risk communication plan for public health emergencies is still under development.

The 2019 Joint External Evaluation (JEE) states that the Ministry of Health is responsible for public communication during health emergencies through a spokesperson (p. 53). It also specifies that other entities, such as the National Directorate of Health and the Directorate General of Agriculture, Silviculture and Livestock, have spokespersons who address the public on matters related to their specific domains, including health emergencies. Similarly, the National Service of Civil Protection is noted as having a spokesperson for emergencies related to natural disasters. These roles for spokespersons tied to specific ministries or types of emergencies are described. However, it does not contain an explicit designation of one singular position within the overall government structure to serve as the primary spokesperson for all public health emergencies nationwide. ³⁵²

The National Action Plan for Health Security (PNASS) 2022-2026 includes the future development of a risk communication plan that will outline roles and responsibilities, indicating that a more formalized structure for this function is planned, but not yet designated. ³⁵³

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ³⁵⁴³⁵⁵

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 0

Based on external searches covering the past two years, there is no publicly available evidence indicating that the public health system has actively shared messages via online media platforms (e.g. social media, website) to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation. No evidence was found on local and international media, such as DW, A Semana, or Expresso das Ilhas, nor in the websites of the Ministry of Health and the National Institute of Public Health. ^{356357358359360}

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

Based on external searches covering the past two years, there is no publicly available evidence indicating that senior leaders in Cabo Verde, such as the President or Ministers, have shared misinformation or disinformation regarding infectious diseases. No evidence was found on local and international media, such as DW, A Semana, or Expresso das Ilhas. ^361362363

3.6.1a Percentage of households with Internet

Score: 75.4

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 61.13

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 66.67

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 58.33

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence indicating that Cabo Verde has implemented restrictions on the export or import of medical goods (such as medicines, oxygen, medical supplies, or PPE) due to an infectious disease outbreak.

Reviews of public health announcements and national news outlets within the last year do not show a change in this stance or the implementation of new trade restrictions on medical goods. ^{364365366367368}

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available evidence indicating that Cabo Verde has implemented restrictions on the export or import of non-medical goods (e.g., food, textiles) due to an infectious disease outbreak.

Subsequent checks of public announcements and national news within the last year do not show indication of such restrictions being implemented. ^{369370371372373}

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no publicly available evidence indicating that Cabo Verde has implemented widespread inbound or outbound travel restrictions due to an infectious disease outbreak within the past year.

Recent official communications from the Ministry of Health and national news outlets do not show international travel bans linked to infectious diseases. ^{374375376377378}

3.7.2b Risk-based approach to international travel-related measures

Score: 0

Cabo Verde does not apply a risk-based approach to international travel-related health measures.

The 2019 Joint External Evaluation (JEE) points that the country implements sanitary controls for passengers arriving from countries identified as being at risk (p. 57). The nation's points of entry, including international airports and ports, are strategically positioned for timely detection and effective response to public health risks (p. 56). However, a fully comprehensive and consistently applied risk-based framework for all international travel-related measures is still in development. The JEE indicated a need to consolidate a national emergency response plan that fully encompasses ports and airports (p. 58). The National Action Plan for Health Security (PNASS) for 2022–2026 includes strategic activities to "Develop/update Contingency Plans for Public Health Emergencies… at the Points of entry" and to train staff (p. 73), signifying ongoing efforts to strengthen and formalize these capabilities. ³⁷⁹³⁸⁰

No additional relevant evidence was found on the websites of the Ministry of Health and the National Institute of Public Health. ³⁸¹³⁸²

4.1.1a Doctors per 100,000 people

Score: 10.55

4.1.1b Nurses and midwives per 100,000 people

Score: 20.67

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Cabo Verde does have a health workforce strategy in place that identifies fields with insufficient workforce and outlines strategies to address these shortcomings, and it has been updated within the past five years.

The Country Cooperation Strategy 2024-2028 explicitly states that "The Ministry of Health's project for the Strategic Plan for Health Human Resources Development 2022-2026 identified the following specific medium-term challenges" (p. 12). These challenges include "training and recruitment of a sufficient number of replacement health professionals", "retention of health professionals, and "few specialists or limited access to specialized care" (p. 12). ³⁸³

This indicates that a strategic plan for health human resources, covering the period from 2022 to 2026, has identified existing workforce shortcomings and is designed to address them. The Country Cooperation Strategy also states that the World Health Organization will "focus on strengthening capacities in certain areas, on developing an information system to manage human resources (HR) throughout the archipelago, and on continuing the process of National Health Workforce Accounts" as part of Priority 1: Improving specific dimensions of the health system (p. 24). This confirms the existence and ongoing implementation of a strategy to manage and improve the health workforce. ³⁸⁴

4.1.1d Health system capacity for essential health services

Score: 0

While Cabo Verde's health system has made significant progress, it does not currently have sufficient capacity to consistently deliver essential health services.

The WHO Joint external evaluation of the International Health Regulations (4-8 November 2019) scores the country the lowest possible score on this measure and says that the country must establish a national plan for the mobilization of human resources for public health events, namely for biological, chemical and radiological disasters; formulate clearly defined incentives for the deployment of personnel; and establish emergency medical intervention teams (EMT).³⁸⁵

Moreover, the system faces persistent disparities in regional and population access and quality, as noted in the National Health Promotion Plan 2023-2027 (Section 3.2, p. 28). Access to complementary exams and necessary medicines is also identified as a major problem (Section 6.1, p. 103). ³⁸⁶ The 2023 Diagnostic Study on the Exercise of Citizenship in Health in Cabo Verde highlights ongoing challenges with insufficient infrastructure, resources, and services, leading to differentiated access in various regions, precarious care, service costs, delays, and a lack of essential medicines, multidisciplinary teams, and equipment (p. 13-14). ³⁸⁷ The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), also indicates that the healthcare system operates at a basic level, challenged by a lack of resources, equipment, and qualified personnel (Component 4, p. 58). ³⁸⁸

No additional relevant evidence was found on the websites of the Ministry of Health and the National Institute of Public Health. ³⁸⁹³⁹⁰

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

While there are plans for responding to public health emergencies, they do not explicitly detail a comprehensive plan specifically aimed at ensuring the continuity of essential routine health services during such events.

The National Health Promotion Plan 2023-2027 mentions incentivizing public and private entities to establish contingency plans, which could potentially include continuity measures (Section 6.2, p. 49). ³⁹¹ The 2023 Diagnostic Study on the Exercise of Citizenship in Health in Cabo Verde notes the negative impact of the COVID-19 pandemic on routine care, including reduced frequency of visits to health structures and increased risks for chronic patients due to diminished assistance (Section 9, p. 197, Chart 88, p. 234). ³⁹² Furthermore, the 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), found "no finding" for the criterion "Disease Prevention and Core Services" within the emergency preparedness framework (Component 4, Criterion 4.1, p. 59-60), indicating a lack of established capacity or specific planning in this area at that time. ³⁹³

No additional relevant evidence was found on the websites of the Ministry of Health and the National Institute of Public Health. ³⁹⁴³⁹⁵

4.1.2a Hospital beds per 100,000 people

Score: 50.37

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

There is no evidence to suggest that Cabo Verde possesses or is actively developing dedicated biocontainment patient care units or highly specialized isolation rooms designed for diseases requiring stringent containment measures.

The 2019 Joint External Evaluation (JEE), a thorough assessment of the country's health capacities, does not mention any biocontainment patient unit in the document. It consistently points to broader gaps in health security infrastructure. ³⁹⁶

While the National Action Plan for Health Security (PNASS) outlines ambitious goals for strengthening overall health system resilience and laboratory capabilities, such as building the INSP laboratory for epidemic response (p. 63), these forward-looking plans do not encompass the establishment of specialized patient containment units. ³⁹⁷

Furthermore, contingency plans for highly communicable diseases, like Ebola, describe "isolation" protocols primarily adapted to general hospital settings. The Ebola plan details strict isolation measures, including dedicated rooms and limited access (p. 23), but these refer to standard medical isolation practices. ³⁹⁸

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ³⁹⁹⁴⁰⁰

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

Explicit evidence demonstrating the capacity to expand isolation capacity in response to an infectious disease outbreak, or a plan specifically developed, updated, or tested for this purpose within the past two years, is not clearly detailed.

The National Health Promotion Plan 2023-2027 mentions incentivizing entities to establish contingency plans (Section 6.2, p. 49). ⁴⁰¹ The National Action Plan for Health Security (PNASS) 2022-2026 outlines the development/updating of Multi-hazard Plans for Operations in Public Health Emergencies and Contingency Plans for major events as strategic activities (Section II, 4.3.3.2, p. 69-70), highlighting the need for preparedness following the COVID-19 pandemic (Intro, p. 13). ⁴⁰²

However, external searches for news and official reports regarding demonstrated capacity to expand isolation facilities—or evidence that the country has developed, updated, or tested a plan to do so in response to an infectious disease outbreak within the past two years—did not yield readily available information. ⁴⁰³⁴⁰⁴

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 0

Cabo Verde has protocols for procurement, but they do not cover all government entities and all purchases.

The protocols are publicly available on the public purchases website hosted by the Ministry of Finance and administered through the eCompras platform. ⁴⁰⁵ The website provides manuals and best practices guides for suppliers and service providers. ⁴⁰⁶ It also publishes the annual procurement plans of government entities, which are submitted to the Ministry of Finance. Annual purchase plans are now available for 2019–2025. The Ministry of Health has not provided any annual purchase plan, while the Ministry of Agriculture and Environment provided the plan for 2025. ⁴⁰⁷

The National Action Plan for Health Security (PNASS) 2022-2026 and the 2019 Joint External Evaluation (JEE) both point to a lack of an efficient multissetorial system for the acquisition of consumables and reagents (PNASS Section II, 4.3.2.1, p. 63-64; JEE Section II, D.1.4, p. 33), recommending the implementation or strengthening of such a system (PNASS Section II, 4.3.2.1, p. 64; JEE Section II, D.1.4, p. 33). ⁴⁰⁸⁴⁰⁹ The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), highlights a lack of emergency procurement procedures and a centralized procurement system overall, with procurement for EP&R often decentralized to the municipal level (Section 1, Indicator 1.2.2, p. 29; Section 3, Criterion 3.3, p. 55). ⁴¹⁰ While supplies are clearly acquired, the existence of a standardized, inter-ministerial protocol for routine needs is a recognized gap.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴¹¹⁴¹²

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

Cabo Verde does not have stockpile of medical supplies (e.g. MCMs, medicines, vaccines, medical equipment, PPE) for national use during a public health emergency defined by the overarching national public health emergency response plan.

The National Action Plan for Health Security (PNASS) for 2022–2026 includes strategic activities under the "National Laboratory System" to "Ensure minimum stock of material reagents and consumables for the detection of 10 priority diseases" and to "Develop procedures for the annual forecasting process of reagents, materials and consumables" (p. 62). These are outlined as ongoing objectives and strategic activities, , indicating that this overarching planning and definition of the emergency stockpile is a future objective. The PNASS focuses on developing a national plan for medical countermeasures, but does not detail how equitable distribution will be ensured within this developing framework. ⁴¹³

The 2019 Joint External Evaluation (JEE) noted that while Cabo Verde maintains a stockpile of supplies, including medical supplies, these are generally sufficient only for routine, non-emergency needs (p. 45, 51). The JEE also highlighted the existence of a Widened Programme for Vaccination (PAV) which has stockpiled various vaccines since 1977 (p.28). However, there is no indication that the review of the stockpile is conducted annually by a government entity. ⁴¹⁴

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴¹⁵

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is insufficient evidence that Cabo Verde has a dedicated national stockpile of laboratory supplies (such as reagents and media) specifically for use during a public health emergency.

The 2019 Joint External Evaluation (JEE) states that while Cabo Verde possesses a general stockpile of supplies, it is "only sufficient for its current needs" and not specifically for emergency situations (p. 45). The JEE further notes a clear need for the country to "organize a basic stockpile of medication, supplies, and equipment for public health emergencies" (p. 51). ⁴¹⁶

The National Action Plan for Health Security (PNASS) for 2022–2026 includes strategic activities under the "National Laboratory System" to "Ensure minimum stock of material reagents and consumables for the detection of 10 priority diseases" and to "Develop procedures for the annual forecasting process of reagents, materials and consumables" (p. 62). These are outlined as ongoing objectives and strategic activities, indicating that a comprehensive emergency stockpile is a goal rather than an existing reality. ⁴¹⁷

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴¹⁸⁴¹⁹

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is insufficient evidence that Cabo Verde conducts or requires an annual review of its national stockpile to ensure sufficiency for a public health emergency.

The 2019 Joint External Evaluation (JEE) noted that while Cabo Verde maintains a stockpile of supplies, including medical supplies, these are generally sufficient only for routine, non-emergency needs (p. 45, 51). The JEE also highlighted the existence of a Widened Programme for Vaccination (PAV) which has stockpiled various vaccines since 1977 (p.28). However, there is no indication that the review of the stockpile is conducted annually by a government entity. ⁴²⁰

The National Action Plan for Health Security (PNASS) for 2022–2026 focuses on financing, strategic activities for prevention, detection, and response, and resource mobilization (p. 45-77). However, it does not specifically detail a requirement for an annual review of national stockpiles to assess their sufficiency for public health emergencies. ⁴²¹

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴²²⁴²³

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

Specific plans or mechanisms covering the full scope of these criteria regarding medical supplies during a public health emergency are not explicitly detailed as fully established or tested.

Regarding leveraging domestic manufacturing capacity, the 2019 Joint External Evaluation (JEE) and the National Action Plan for Health Security of Cabo Verde (PNASS) 2022-2026 do not contain evidence of a plan or agreement to utilize public and/or private sector domestic (including regional) manufacturing to produce medical supplies during emergencies. ⁴²⁴⁴²⁵

For the procurement of medical supplies during a public health emergency, the JEE and the PNASS indicate that measures for the acquisition of medical countermeasures, including medicines and equipment, are taken as necessary in case of an emergency (JEE R.4.1, p. 50; PNASS Section II, 4.3.3.4, p. 71). While this confirms procurement happens, a specific, expedited mechanism for emergencies is not clearly detailed as fully established or tested. The PNASS outlines the development of a functional system for activating and coordinating medical countermeasures (Section II, 4.3.3.4, p. 71). ⁴²⁶⁴²⁷

Concerning expediting medical supplies through points of entry during a public health emergency, the documents describe routine sanitary controls at points of entry and the need for updating contingency plans for emergencies at these locations (PNASS Section II, 4.3.4.1, p. 75; JEE PoE.1 & PoE.2, p. 56-57). They also mention the capacity for disinfection/decontamination (PNASS Section II, 4.3.4.1, p. 75; JEE PoE.1 & PoE.2, p. 57). However, there is no explicit evidence detailing a specific plan or mechanism designed to expedite the passage of medical supplies through points of entry specifically during an emergency, although strengthening points of entry response capacity is planned (PNASS Section II, 4.3.4.1, p. 74). ⁴²⁸⁴²⁹

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴³⁰⁴³¹

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no evidence that Cabo Verde has a plan or agreement to leverage domestic manufacturing capacity to produce laboratory supplies for national use during a public health emergency. There is also no evidence that Cabo Verde has a plan or mechanism to procure laboratory supplies for national use during a public health emergency. The 2019 Joint External Evaluation (JEE) identified the implementation of an efficient multi sectoral system for the acquisition of laboratory consumables and reagents as an area needing improvement (p. 61). The National Action Plan for Health Security (PNASS) 2022–2026 proposes strategic activities to "Develop procedures for the annual forecasting process of reagents, materials and consumables" (p. 63), indicating these mechanisms are in development rather than fully established. ⁴³²⁴³³

Regarding the expedited transport of laboratory supplies through points of entry during emergencies, publicly available evidence remains limited. The PNASS plans to "Sign protocol with air and sea carriers, AAC and other relevant stakeholders" for biological sample transport (p. 64), which are future steps toward enhancing this capability. Overall, comprehensive and operational emergency procurement and expedited delivery mechanisms for laboratory supplies are not fully demonstrated. ⁴³⁴

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴³⁵⁴³⁶

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

While Cabo Verde has identified the importance of logistics and supply chain management in health emergencies and has plans to develop or strengthen capabilities in this area, there is no clear evidence of a comprehensive, fully operational system that meets all the criteria.

In the 2019 Joint External Evaluation (JEE) and the National Action Plan for Health Security (PNASS) 2022-2026, specific considerations like cold chain management for vaccines are addressed and are areas targeted for strengthening and monitoring (JEE Section II, P.7.2, p. 30; PNASS Section II, 4.3.1.7, p. 61-62). ⁴³⁷⁴³⁸ The PNASS outlines activities related to developing intersectoral logistical plans and systems for infrastructure and equipment maintenance (Section II, 4.3.3.2, p. 71; Section II, 4.3.2.1, p. 65). ⁴³⁹⁴⁴⁰

However, the 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), points to a lack of functional logistics systems for receiving and distributing international support and notes that Government entities lack dedicated warehouse facilities, relying partly on improvised solutions or partners like the Red Cross (Section 3, Criterion 3.3, p. 55-56; Section 5, Criterion 5.4, p. 76). The need to strengthen the warehousing system is highlighted (Section 5, Criterion 5.4, p. 76). ⁴⁴¹ While in the PNASS plans exist for reviewing and testing response mechanisms through exercises (Section II, 9, p. 85-87), the documentation does not explicitly confirm that a unified, comprehensive emergency logistics and supply chain management system covering both public and private sectors is currently fully established, exercised, reviewed, and updated on a regular basis. ^442443444

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁴⁵⁴⁴⁶

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

Cabo Verde does not have a comprehensive plan, program, or specific guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency.

The National Action Plan for Health Security (PNASS) for 2022–2026 acknowledges this gap by identifying "Develop a national plan of medical countermeasures for public health emergencies" as a strategic activity to achieve its goal of developing a functional system for activating and coordinating MCMs (p. 71). This indicates that such a specific dispensing plan is a future objective, not currently established. The 2019 Joint External Evaluation (JEE) previously highlighted this, stating there was "no system in place for activating and coordinating medical countermeasures" during public health emergencies (p. 50) and recommended its elaboration (p. 51). While the National Action Plan on Antimicrobial Resistance (AMR) for 2018–2022 focuses on ensuring continuous access, strengthening the supply chain, and promoting rational use of antimicrobials, it does not detail guidelines or programs for dispensing medical countermeasures (MCM). ^447448449

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁵⁰⁴⁵¹

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

While there are plans and efforts to strengthen human resources within the health sector and improve coordination during emergencies, a specific public plan designed to facilitate workforce surge in an emergency is not explicitly detailed as being in place.

The 2019 Joint External Evaluation (JEE) indicated a lack of capacity in activating and coordinating health personnel during a public health emergency at the time of that assessment (Section II, R.4.2, p. 51). ⁴⁵² The National Action Plan for Health Security (PNASS) 2022-2026 includes objectives and activities aimed at developing and implementing a workforce strategy and strengthening the public health workforce available to respond to risks (Section II, 4.3.2.4, p. 67). ⁴⁵³ It also plans for a national mechanism for mobilizing human resources for public health events (Section II, 4.3.3.4, p. 72). However, these documents outline the planning and development of such capacities rather than confirming the existence of a current, publicly available plan specifically focused on workforce surge during an emergency.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁵⁴⁴⁵⁵

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

Cabo Verde currently lacks a public plan or specific guidelines for receiving health personnel from other countries in response to a public health emergency.

The 2019 Joint External Evaluation (JEE) identified this as a gap, noting that there is no adequate legal basis or formal regulation in place to initiate the action, activate, and coordinate technical teams from abroad (p. 50). The country's current approach relies on ad-hoc governmental decisions regarding the sending or receiving of professionals when deemed necessary, as was the case in 2019 when personnel were sent to Mozambique (p. 50). ⁴⁵⁶

While the National Action Plan for Health Security (PNASS) for 2022–2026 outlines strategic activities to "Develop a national mechanism for mobilizing human resources for response to public health events," these efforts are focused on internal capacity building and mobilization of national personnel, not on the formalized reception of foreign health workers (p. 71). ⁴⁵⁷

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁵⁸⁴⁵⁹

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is evidence that Cabo Verde has a plan to develop a mechanism for mobilizing existing health personnel within the country for emergency response. However, a fully implemented and publicly available plan to facilitate immediate workforce surge/redeployment in an emergency was not assessed as being definitively in place.

The National Action Plan for Health Security (PNASS) 2022-2026 outlines a strategic activity to develop a national mechanism for mobilizing human resources to respond to public health events (Section II, 4.3.3.4, p. 72). This plan aims to strengthen the public health workforce available to respond to risks and includes objectives related to human resource strategy and development (Section II, 4.3.2.4, p. 67). ⁴⁶⁰

Earlier assessments, such as the 2019 Joint External Evaluation (JEE), had scored the capacity to activate and coordinate health personnel during a public health emergency as lacking (Section II, R.4.2, p. 51). ⁴⁶¹ The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), also noted the absence of a clear mechanism for the flexibility and scalability of the response structure regarding personnel (Component 5, Criterion 5.1, p. 69). ⁴⁶²

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁶³⁴⁶⁴

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 75

The Constitution of the Republic of Cabo Verde explicitly guarantees the right to health, which is realized through access to medical care.

According to the Diagnostic Study on the Exercise of Citizenship in Health in Cabo Verde, Article 71º of the CRCV establishes the right to health (Section 5.3, p. 65). Furthermore, this article mandates the State to create conditions for the universal access of citizens to health care (Section 5.3, p. 67-68). The text of Article 71º specifies that the right to health is realized through an adequate network of health services and includes ensuring the existence and functioning of a national health system, promoting public health services, and incentivizing private initiative in providing preventive, curative, and rehabilitative health care, as well as medical and pharmaceutical care (Section 5.3, p. 67-68). Therefore, the Constitution guarantees the right to health and details that this right is operationalized through universal access to various forms of health care, including explicitly mentioning medical care. ⁴⁶⁵

4.4.1b Access to skilled birth attendants (% of population)

Score: 95.59

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 75.92

4.4.1d Coverage of essential health services through universal health coverage

Score: 91.67

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 91.19

4.4.1f Rate of mortality amenable to health care

Score: 31.05

4.4.2a Guaranteed paid sick leave

Score: 100

In Cabo Verde, workers are guaranteed paid sick leave for both mental and physical health problems.

Employees are entitled to a maximum of 30 days of paid sick leave annually, contingent on completing three months of service and providing a valid medical certificate. This leave is available for both physical and mental health conditions as long as the employee provides a medical certificate documenting their inability to work due to the illness. ⁴⁶⁶

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

Cabo Verde has not issued legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency.

The 2019 Joint External Evaluation (JEE) recommended the implementation of a prophylactic policy focusing on preventative care for health professionals based on their risk exposures (p. 27). This addresses prevention rather than prioritized treatment should they become ill. While the National Action Plan for Health Security (PNASS) for 2022–2026 outlines strategic activities to develop a national mechanism for mobilizing human resources for public health events (p. 71), it does not include provisions for prioritized medical treatment for sick healthcare workers. Even in the context of the COVID-19 pandemic, while healthcare professionals were prioritized for vaccination due to the National Plan for Introduction and Vaccination against COVID-19, this plan is limited to prophylactic measures and does not indicate a broader commitment to prioritized treatment for illnesses incurred during emergency response. ^467468469

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁷⁰⁴⁷¹

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is insufficient evidence that there is a system in place for public health officials and healthcare workers to communicate during a public health emergency.

The 2019 Joint External Evaluation states that there is internal coordination within the government entities and partners (which, from context, include healthcare workers) for communication during emergencies (p.52). There is a platform and mechanisms that support internal and partner communication. Several emergency response plans developed by the country—for Ebola, Zika, Dengue, and others—include communication components. However, there is no dedicated national risk communication plan (p. 52). ⁴⁷²

The National Action Plan for Health Security (PNASS) for 2022–2026 outlines strategic activities focused on enhancing multi-sectoral and multi-disciplinary coordination and communication mechanisms, as well as strengthening overall risk communication (p. 72). While these efforts aim to improve communication among stakeholders, they do not explicitly detail a dedicated two-way emergency communication channel for real-time operational interaction between public health officials and all healthcare workers during a public health emergency. ⁴⁷³

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁷⁴⁴⁷⁵

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

While the importance of multi-sectoral coordination and communication during emergencies is recognized, there is no explicit evidence detailing a fully established system specifically designed for public health officials and healthcare workers in both the public and private sectors to communicate during an emergency.

The National Action Plan for Health Security (PNASS) 2022-2026 highlights the principle of a "One Health" approach and multi-sectoral collaboration, outlining strategic activities to strengthen coordination and communication mechanisms (PNASS Section II, 2.4 & 3.5, p. 41, 45; PNASS Section II, 4.3.1.2, p. 54). ⁴⁷⁶ This suggests an intent to involve various actors beyond just the public health sector.

However, the 2019 Joint External Evaluation (JEE) noted a lack of a mechanism for coordination internal to the country or between relevant ministries, although communication existed between the national IHR focal point and sectorial commissions (Section II, P.2.1, p. 16). It also mentioned that information sharing and discussion between the human and animal health sectors was not coordinated through regular or standardized forums (Section II, D.3.1, p. 38). ⁴⁷⁷

The 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), pointed to limitations in communication and coordination mechanisms during emergencies, noting that inter-agency communication often relies on informal methods (Component 4, Criterion 4.2, p. 61-62). ⁴⁷⁸

While the ongoing plans aim to develop and strengthen integrated communication capacities, the specific integration of private sector healthcare workers into a unified official communication system for use during an emergency is not clearly described as a current, fully operational system.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁷⁹⁴⁸⁰

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no explicit evidence that the national public health system in Cabo Verde is actively monitoring for and tracking the number of healthcare-associated infections (HCAI) that occur in healthcare facilities.

While the 2019 Joint External Evaluation (JEE) and National Action Plan for Health Security (PNASS) 2022-2026 discuss infection prevention and control (IPC) and the need for a national IPC program (JEE Section II, AT 3, p. 18; PNASS Section II, 4.3.1.3, p. 57), and mention the existence of some good IPC practices in central hospitals with trained professionals (JEE Section II, AT 3, p. 18), they do not detail a surveillance system specifically for HCAI. The focus is more on general infectious diseases and antimicrobial resistance surveillance. ⁴⁸¹⁴⁸²

The PNASS outlines strengthening surveillance systems as a whole (Section II, 4.3.2.2, p. 65) but does not specifically mention HCAI surveillance. ⁴⁸³ The JEE, in its assessment of the national laboratory system and surveillance, also doesn't specifically refer to HCAI tracking as part of the existing or planned surveillance activities (Section II, AT 8 & AT 9, p. 31-36). ⁴⁸⁴

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁸⁵⁴⁸⁶

4.6.1b Infection prevention and control programme

Score: 0

While there are mentions of infection prevention and control practices and some good practices in central hospitals with trained professionals, there is no national action plan for Infection Prevention and Control (IPC) in place nationally.

The 2019 Joint External Evaluation (JEE), in the section on Antimicrobial Resistance, rates the indicator "Infection prevention and control" with a score of 1, meaning "without capacity". It notes that at the level of Infection Prevention and Control (IPC), there are some good practices installed in central hospitals and trained professionals, but there is no national action plan (Section II, AT 3, p. 18). ⁴⁸⁷

Similarly, the National Action Plan for Health Security (PNASS) 2022-2026 lists the creation of a national multissetorial program for prevention and control of infections as a priority action under the Antimicrobial Resistance area, following the recommendation from the JEE (Section II, 4.3.1.3, p. 57). ⁴⁸⁸

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁸⁹⁴⁹⁰

4.6.1c National plan to ensure a safe environment in health facilities

Score: 0

Cabo Verde does not have a plan to ensure a safe environment in health facilities nationally.

The 2019 Joint External Evaluation (JEE) previously identified the absence of a national action plan for infection prevention and control, noting that while some good practices existed in central hospitals, a comprehensive national plan was lacking (p. 18). The National Action Plan for Health Security (PNASS) for 2022–2026 includes the strategic objective to "Develop a functional infection prevention and control system in health care facilities and on farms" (p. 55) and to "Create a national program to prevent and control the occurrence of HCAI [Healthcare-Associated Infections]" (p. 60). Current documentation indicates it is under development and in various stages of establishment and implementation, the plan to ensure a safe environment in health facilities is not fully ready. ⁴⁹¹⁴⁹²

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁴⁹³⁴⁹⁴

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

Cabo Verde has a national requirement for ethical review before beginning a clinical trial.

Specifically, Decree-Law No. 26 of 30 June 2007 established a National Committee of Ethics (CNEPS). This committee is an autonomous, independent, multi-sectoral, and multidisciplinary entity responsible for overseeing all studies and data related to human research. Its mandate is to safeguard the dignity, rights, and safety of all potential participants in health research (p. 517). The decree explicitly mandates that approval from CNEPS must be secured prior to commencing clinical trials. ⁴⁹⁵

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no explicit evidence detailing an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or a mechanism for the mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics.

The National Action Plan for Health Security (PNASS) 2022-2026 includes "Medical countermeasures and personnel mobilization" as a key area. A strategic activity is to elaborate a national plan for medical countermeasures for public health emergencies (Section II, 4.3.3.4, p. 72). ⁴⁹⁶ This suggests the development of a structured approach for MCMs during emergencies is planned, but it does not confirm the existence of an expedited approval process for trials or recognition of external data for unregistered MCMs within that plan.

The 2019 Joint External Evaluation (JEE) rated the capacity for activating and coordinating medical countermeasures low (1/5) and highlighted the need for a national plan (Section II, AT 15, p. 50-51). This assessment did not specifically detail or evaluate processes for clinical trial approval or mutual recognition in this context. ⁴⁹⁷

Cabo Verde has a regulatory body for health/pharmaceuticals, the Independent Health Regulatory Entity (ERIS) (PNASS Section II, 4.3.1.3, p. 57; JEE Section II, AT 1, p. 13). According to the Diagnostic Study on the Exercise of Citizenship in Health in Cabo Verde, there is also a National Committee on Research Ethics for Health (CNEPS) (p. 261). ^498499500 This indicates that processes for approving health research, including clinical trials in general, exist under the purview of these bodies. However, the documents do not specify if these general processes are expedited during emergencies or if there is a mechanism for mutual recognition of clinical trial results from other countries for unregistered MCMs during pandemics/epidemics.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵⁰¹⁵⁰²

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is a government agency responsible for regulating health activities and products, including medical countermeasures, for human use.

This agency is the Independent Health Regulatory Entity (ERIS). According to the Diagnostic Study on the Exercise of Citizenship in Health in Cabo Verde and its annexed legal framework, ERIS was created by Decree-Law No. 3/2019 and is described as an independent administrative authority with regulatory functions, including regulation, supervision, and sanctioning of infractions (Section 5.6, p. 72; p. 253 and 255). ⁵⁰³

According to Decree-Law No. 3/2019, ERIS is endowed with regulatory functions, including regulating, supervising, and sanctioning violations of the activities of healthcare establishments, and the pharmaceutical and food sectors (p.2). ⁵⁰⁴

While the Diagnostic Study does not explicitly use the term "approving new medical countermeasures," ERIS's mandate to regulate and supervise the health sector and pharmaceutical products implies its responsibility for the authorization and control of medical products for human use in Cabo Verde. ⁵⁰⁵

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no explicit evidence detailing a currently established expedited process for approving medical countermeasures (MCM) for human use or a mechanism for the recognition of approval decisions taking place elsewhere specifically during public health emergencies.

According to the Diagnostic Study on the Exercise of Citizenship in Health in Cabo Verde and its annexed legal framework, the Independent Regulatory Entity for Health (ERIS) is the designated authority overseeing the regulation of health products, including MCMs, through standard approval pathways (Section 5.6, p. 72). Legislation enacted following the COVID-19 pandemic includes measures for acquiring and introducing COVID-19 vaccines (p. 265), indicating that an ad hoc expedited process may have been used. However, this response was context-specific and does not constitute a general or permanent regulatory mechanism for future emergencies. ⁵⁰⁶

While the National Action Plan for Health Security (PNASS) 2022–2026 highlights the importance of medical countermeasures and aims to develop a national plan for their deployment during emergencies (Section II, 4.3.3.4, p. 72), it does not provide specifics on an expedited regulatory process. ⁵⁰⁷ Similarly, the 2019 Joint External Evaluation (JEE) rated national capacity for medical countermeasure coordination as low (1/5), underlining the absence of a comprehensive plan and formalized approval pathways (Section II, AT 15, p. 50–51). ⁵⁰⁸ There is no evidence of a formal framework for expedited approval or international regulatory recognition applicable to all MCMs in emergency contexts.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵⁰⁹⁵¹⁰

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Cabo Verde has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁵¹¹

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

Cabo Verde integrates epidemics and pandemics into its national risk reduction framework primarily through the National Action Plan for Health Security (PNASS) 2022-2026, which serves as a dedicated and comprehensive strategy for public health threats. ⁵¹²

This plan explicitly aims to strengthen and maintain the country's capacity to prevent and detect public health threats in a timely manner and to respond quickly to public health threats, including epidemic outbreaks and natural disasters (Section II, p. 41). It also emphasizes the "One Health" approach, recognizing that most emerging infections are zoonoses, requiring multidisciplinary collaboration across human, animal, and environmental health sectors (Section 2.4, p. 41). ⁵¹³

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

Cabo Verde possesses established mechanisms for cross-border cooperation and communication regarding public health emergencies, with gaps in implementation.

According to the National Health Promotion Plan 2023-2027, the country actively participates in international and regional health frameworks, including regular interactions with organizations like the World Health Organization (WHO), Economic Community of West African States (ECOWAS), and Community of Portuguese Language Countries (CPLP) (Section 2.2, p. 19). ⁵¹⁴

The 2019 Joint External Evaluation (JEE) highlighted existing points of contact for notification to international bodies like FAO, WOAH, and WHO, and noted timely information sharing in response to public health events such as Zika, malaria, measles, and dengue outbreaks. The evaluation also identified the need to strengthen formalized intersectoral coordination mechanisms for routine information exchange at the multi-sectoral level, including improved notification protocols with neighboring countries and regional partners (Section D.3.1, p. 38). ⁵¹⁵

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵¹⁶⁵¹⁷

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Cabo Verde, as a member state of the African Union (AU) and the Economic Community of West African States (ECOWAS), participates in regional frameworks that include cross-border agreements and protocols concerning animal health emergencies, particularly Transboundary Animal Diseases (TADs).

The Comprehensive Africa Agriculture Development Programme (CAADP) report emphasizes that "Regional harmonization, coordination, information sharing and cross border prevention and control of transboundary animal diseases (TADs) was enhanced through the convening of eleven continental and regional coordination mechanisms: Meetings of the Regional Steering Committee (RSC) of Global Framework for Transboundary Animal Diseases (GF-TADs) Africa; the Continental Animal Health Platform Africa (CAHP-Africa) Guiding Group; and Meetings of the ECOWAS and the Eastern Africa Regional Animal Health Networks (RAHNs) that promote coordination, harmonization and information sharing to reduce threats from transboundary animal diseases (TADs) on food security, livelihoods and trade" (p. 161, Section 8G). This indicates an established regional system for managing animal health emergencies that member states like Cabo Verde are part of. ⁵¹⁸

While the 2019 Joint External Evaluation (JEE) highlighted the need for improved integration and formalization of animal health efforts and emphasized reinforcing communication and notification requirements with neighboring countries and international partners (p. 38, Section D.3.1), this refers to national-level implementation and engagement within the existing regional frameworks. The presence of these regional mechanisms, which Cabo Verde is a part of, indicates a form of cross-border agreement for animal health emergencies. ⁵¹⁹

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵²⁰⁵²¹

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Cabo Verde is fully a State Party to the Biological Weapons Convention (BWC) with the same legal effect as ratification. ⁵²²

Signing the BWC was only possible before its entry into force on March 26, 1975. Cabo Verde did not sign before that date (it was established as independent only in 1975). It therefore acceded (which has the same legal effect as ratification for states that didn't originally sign the treaty) on October 20, 1977. ⁵²³

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

Cabo Verde has made no CBM submissions. ⁵²⁴

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Cabo Verde submitted a national report to the 1540 Committee in 2015. ⁵²⁵

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Cabo Verde is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), the Australia Group (AG), nor the Proliferation Security Initiative (PSI). ^526527528

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

Cabo Verde conducted a Joint External Evaluation (JEE) in 2019 and released a comprehensive report. No subsequent evaluations have been published since then. ⁵²⁹

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Cabo Verde has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years. ⁵³⁰

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Cabo Verde has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. ⁵³¹

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

Cabo Verde has not provided clear public evidence of allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

While Cabo Verde has outlined a National Action Plan for Health Security (PNASS) for 2022–2026, which details strategic activities and associated costs for strengthening public health capacities, the plan explicitly stated at the time of its elaboration that only 17% of its estimated costs had identified funding (p. 77, Section 5). The PNASS emphasizes the need to mobilize both internal and external resources to finance its implementation, including securing domestic funding for International Health Regulations (IHR) capacities (p. 53, Section 4.3.1.1). ⁵³²

Most recently, a Decree from July 2024 was approved, which lists the "establishment and functioning of a public health emergency operations center (EOC)" as well as funding for activities such as rapid After Action Reviews (AARs). However, this funding is derived from the International Bank for Reconstruction and Development (IBRD). While national decrees are necessary to approve and enable the utilization of such external funds, the funds themselves are not allocated from the country's national budget. ⁵³³

In the State Budget documents of 2022, 2023 and 2024, there are no mentions of epidemics, pandemics or
other relevant terms. ^534535536 No evidence was found in the websites of the Ministry of Health and the Ministry of Agriculture and Environment. ⁵³⁷⁵³⁸

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 100

The National Action Plan for Health Security (PNASS) 2022-2026 does describe and allocate specific funding in terms of estimated costs to address identified gaps over its five-year period.

The total estimated cost for the PNASS activities is 2,783,928,058 ECV (approximately 26,263,472 USD), with over half of this budget (52.9%) calendarized for the first two years (2022-2023) (p. 5, 46). The plan provides a detailed breakdown of these estimated costs across four thematic groups (Prevention, Detection, Response, and Other areas of the Joint External Evaluation) and further by 19 technical areas, including specific annual projections from 2022 to 2026 (p. 46, 49). However, it is crucial to note that while these costs are described, the PNASS explicitly states that only 17% of the planned activities have identified funding (p. 5, 78). The Ministry of Health intends to use the PNASS as a tool for advocacy to mobilize resources, both internal (from the national budget) and external (from development partners and donors) (Section 5, p. 78). ⁵³⁹

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

Cabo Verde has not completed and published a Performance of Veterinary Services (PVS) assessment or gap analysis in the last five years. ⁵⁴⁰

5.5.3a Emergency public financing during a public health emergency

Score: 100

Cabo Verde has publicly identified special emergency public financing mechanisms and funds to address public health emergencies and other disaster situations.

According to the 2019 WHO Joint External Evaluation (JEE) and the 2020 R2R Diagnostic Cabo Verde report, produced by the World Bank and the Global Facility for Disaster Reduction and Recovery (GFDRR), the country established the National Emergency Fund (FNE), through Law No. 61/IX/2019, as a national reserve fund intended to provide immediate financing for natural disasters, including health-related incidents as defined by the International Health Regulations (JEE, Section P.1.3, p. 14; R2R Diagnostic, Section 1.2.1, p. 28). The R2R Diagnostic report mentions that access to the FNE is granted upon the declaration of a state of calamity or a state of alert (Section 1.2.1, p. 29). ^541542543

In addition to this national fund, Cabo Verde has an established agreement with the World Bank for emergency financing through a Catastrophe Deferred Drawdown Option (Cat DDO). This mechanism provides a contingent line of credit, accessible after a State of Calamity declaration, to support post-emergency recovery and reconstruction efforts (JEE, Section P.1.3, p. 14; R2R Diagnostic, p. 11). ⁵⁴⁴⁵⁴⁵

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 0

No evidence has been found that senior leaders of the government have made public commitments to either support other countries to improve capacity to address epidemic threats by providing financing or support, or improve the country’s domestic capacity to address epidemic threats by expanding financing or requesting support to improve capacity.

No evidence was found in the website of the Ministry of Health. ⁵⁴⁶ At the time of research, the website of the Ministry of Foreign Relations was not accessible. ⁵⁴⁷ No evidence was found in media outlets.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Cabo Verde invested finances from donors to improve its own domestic capacity to address epidemic threats in the past three years, but there is no evidence that it has provided other countries with the same support.

Most recently, Cabo Verde was awarded a US$4.49 million grant from the Pandemic Fund to implement the "Strengthening National Health Security Through the One Health Approach" project. This grant is part of a larger financial strategy, supplemented by an additional US$2.4 million in co-financing and US$13.4 million in co-investment from partners. The project is a collaboration between the Cabo Verdean government (Ministries of Health, Finance, and Agriculture and Environment), national universities, and four Implementing Entities: the Food and Agriculture Organization (FAO), UNICEF, the World Health Organization (WHO), and the World Bank. ⁵⁴⁸

This recent funding complements previously tracked financial support. According to the Global Health Security Tracking Dashboard, Cabo Verde received US$75 million in aid between 2014 and 2022. The largest recipients of the funds were the national laboratory system, real-time surveillance, and workforce development. The three largest donors were the African Development Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank. ⁵⁴⁹

There is no evidence that Cabo Verde has supported other countries to improve capacity to address epidemic threats by providing financing or support in the past three years. There is no data of Cabo Verde being a funder in the Global Health Security Tracking Dashboard. ⁵⁵⁰ No evidence was found on the website of the Ministry of Health. ⁵⁵¹ At the time of research, the website of the Ministry of Foreign Relations was not accessible. ⁵⁵²

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

There is clear evidence that Cabo Verde has fulfilled its full assessed contribution to the WHO for the 2024 calendar year by utilizing previously credited payments.

The 2024 assessed obligation of USD 5,740 was fully covered. The payment was made in advance, not in the year of assessment itself. ⁵⁵³

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

While Cabo Verde actively collaborates with international partners on public health matters and exchanges epidemiological data, a comprehensive, publicly available national plan or policy specifically for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with associated epidemiological data with international organizations and/or other countries that goes beyond influenza is not readily identifiable.

Cabo Verde actively collaborates with international partners and routinely shares epidemiological data, particularly during outbreaks such as Zika, dengue, and COVID-19, as part of International Health Regulations (IHR) reporting. Samples are regularly sent to international reference laboratories for confirmation and advanced analysis, suggesting functional mechanisms for sharing biological materials for diagnostic purposes (JEE, Section D.1.1, p. 31; PNASS, Section 4.3.2.1, p. 63). ⁵⁵⁴⁵⁵⁵ The country’s strategic plans, including the National Action Plan for Health Security (PNASS) 2022–2026 and the National Health Promotion Plan 2023–2027, promote a "One Health" approach, encouraging cross-sector collaboration and data sharing across human, animal, and environmental health domains. ⁵⁵⁶⁵⁵⁷

However, a centralized, publicly accessible document outlining a broad national policy for the sharing of genetic data and biological materials beyond immediate diagnostic needs or beyond specific pathogens like influenza, with explicit guidelines on data ownership, intellectual property, benefit-sharing, and ethical considerations, is not available.

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵⁵⁸⁵⁵⁹

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

Publicly available evidence indicating that Cabo Verde has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) Framework in the past two years is not readily available.

A review of general public health reports from Cabo Verde and WHO communications does not reveal any explicit public statements or reports of non-compliance by Cabo Verde regarding sample sharing under the PIP Framework in the specified timeframe. ⁵⁶⁰

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵⁶¹⁵⁶²§

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

Publicly available evidence indicating that Cabo Verde has not shared pandemic pathogen samples during an outbreak in the past two years is not apparent through general public health reporting.

There is no public information or reports suggesting that Cabo Verde has failed to share pandemic pathogen samples during an outbreak within the last two years. ⁵⁶³

No other relevant evidence was found in the websites of the Ministry of Health and the National Institute of Public Health. ⁵⁶⁴⁵⁶⁵

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 50

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 50

6.1.1e Corruption

Score: 62

6.1.1f Accountability of public officials

Score: 50

6.1.1g Human rights risk

Score: 75

6.1.2a Orderly transfers of power

Score: 75

6.1.3a Risk of social unrest

Score: 50

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5a Presence or risk of armed conflict

Score: 100

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 100

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 93.82

6.2.2a UNDP Gender Inequality Index score

Score: 86.33

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 89.65

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 100

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6a Gini coefficient

Score: 57.6

6.3.1a Adequacy of road network

Score: 50

6.3.2a Adequacy of airports

Score: 100

6.3.3a Adequacy of power network

Score: 50

6.4.1a Urban population (% of total population)

Score: 30.07

6.4.2a Change in forest area (percentage points)

Score: 85.13

6.4.3a Natural disaster risk

Score: 25

6.5.1a Total life expectancy (years)

Score: 97.96

6.5.1b NCD mortality rate

Score: 85.05

6.5.1c Population aged 65+

Score: 57.58

6.5.1d Tobacco use (% of adults)

Score: 59.13

6.5.1e Level of adult obesity (%)

Score: 47.66

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 71.11

6.5.2a Access to potable water

Score: 91.99

6.5.2b Access to at least basic sanitation facilities

Score: 82.98

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 36.79

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50